\What is the impact of a large caseload?
When caseloads are high, and you're seeing a tremendous number of students, what's the impact? First, the outcomes are not as good. Students on smaller caseloads are more likely to make measurable progress on functional communication measures than those who are on large caseloads because we may need to serve students in a group, whereas individually may result in better or faster improvements.
Also, student outcomes depend on the SLP's ability to provide services that integrate the educational curriculum. It takes time and collaboration to know what the student's working on and what they are struggling with. It takes time to work with the teacher to figure out how to help support them exactly.
Large caseloads also tend to drive the service delivery amounts that we recommend on the IEP. In other words, "How can I fit this student on my schedule" instead of "What service time does this student need to provide effective services and efficient remediation of a disability?" Not to mention, the more students we have, the more Medicaid billing and paperwork we have to complete, which also takes a lot of time.
If we could go into classrooms and co-teach, that would benefit all students, not just those we serve in the classroom with an IEP. But we can't do that if we have a large caseload or a large workload.
It's also worth mentioning that large caseloads are associated with difficulties in recruiting and retaining qualified SLPs. That's a big piece of it. Additionally, large caseloads limit the time that we have to train and supervise student clinicians, clinical fellows, and other support personnel like SLP assistants and paraprofessionals who may be implementing some of the recommendations of our IEPs.
This Ask the Expert is an excerpt from the course, School-based SLPs: Are Our Caseloads Really That High, presented by Angie Neal, MS, CCC-SLP.