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Have you ever wondered where you were ever going to find the time in the school day to contact a parent, write a request for equipment for one of your students, answer an email invite to a meeting, or pee!? Sound familiar to you? For sure, that was me!
As PTs, SLPs, and OTs entered school-based practice in the 70s and 80s, we brought along the medical model of practice, which included a caseload model of service. How things have changed since the olden days! Now we understand and embrace an educational model of practice, and work with students and teachers in classrooms, in cafeterias, and on the playground.
And we are busier than ever:
- We collaborate with the IEP team to write current levels of performance, measurable goals, and intervention plans. We document progress.
- We collaborate with teachers to create educational activities and embed therapy into a kindergarten learning center time
- We craft visual schedules, create accessible curriculum materials, and order adaptive equipment
- We work with community partners to design learning activities for students in transition
All of these activities support our students in meeting their educational outcomes. The list goes on, and on, and on, and on. And we LOVE this list. It defines our roles and fills our souls as related service providers.
Re-read that list. No, you don’t need to! You know these pieces of your job. These include the important indirect activities that are provided by related service personnel on behalf of our students and equally important administrative pieces of our job.
The AOTA, APTA & ASHA Supports You and the Workload Approach
Along with our direct service with students, this is our workload. In a joint statement (AOTA, APTA, ASHA, 2014), the American Occupational Therapy Association, the American Physical Therapy Association, and the American Speech-Language-Hearing Association recommend a workload approach as a more effective and beneficial way to improve student outcomes.
This critical document grew out of shared concerns regarding a caseload approach as related to retention of personnel, implementation of best practices, and increased accountability in schools practice.
A caseload model of service only counts the number of students with IEPs, without regard for intensity of need or intensity of services, and is considered an antiquated method for assigning staff and meeting service delivery needs.
Williams & Cecere (2013) discussed their process for tracking service stats over one school year in two county school districts in Maryland. Given their time study, they developed a formula for a workload approach that took into account many job factors, including direct services to students, travel, documentation, indirect services, meeting time, collaboration time, and professional development time.
A workload approach is a management strategy (Jackson, 2013) that ensures all personnel and equipment resources are utilized most effectively. This is a pretty important point: a workload approach can help ensure that services provided to students are indeed the services that are needed, rather than those typically offered for administrative or practitioner convenience (ASHA, 2002).
Rather than grouping students with disparate needs for convenient scheduling, a workload approach can be used to define productivity, support ethical practice, provide objective data for staffing needs, and improve quality of service and individualized student outcomes (Williams & Cecere, 2013).
4 Steps towards a Workload Approach
STEP 1: Conduct a Time Study
Most authors recommend starting with a time study of some sort. AOTA, APTA, and ASHA recommend thinking state or district-wide as well as at the individual practitioner level. Let’s start with the individual level data collection; that seems more in our control and something we can do this coming week.
Keep a log of EVERYTHING you do over a workday throughout a week or two. I actually recommended logging in 15-minute increments, so you don’t lose the opportunity to collect important data.
So in my log, I have direct time spent with students in intervention activities wherever, time on the phone and email, documentation, meetings, travel, prep and set-up, collaboration with teachers, and the multiple times I am stopped in the hallway to answer a question. Your time study will be a little more detailed (student names associated with time slots, etc.).
Workload Resource: Here is one template for conducting a time study. This is the first place to start. And really, you can start this Monday. Print this template (or find another or create your own blank template), keep it with that daily schedule you cannot live without (I have driven back to a school 20 minutes out of my way to retrieve my forgotten schedule book; I know, I know!), and jot down what you do when you do it and who you do it with. Don’t miss anything.
STEP 2: Categorize Activities
After you’ve collected your time study data, our professional organizations recommend that we then group all those activities into categories (AOTA, 2014); broad categories such as:
- direct service to students
- activities that support student programming (meetings, collaboration)
- activities that support state and federal regulations (documentation, progress monitoring and data collection)
- and others (i.e. RtI involvement).
STEP 3: Crunch the Numbers
Do you have enough time in the day to do your job? Ha, we all know that answer! But realistically, would you be interested in carving out time at work, during the workday, to write your notes, or email team members, or create intervention supports? A workload approach may be one way to head there.
STEP 4: Champion a Workload Approach
Now what do you want to do? Do you want to stew over the fact that you have just proven to yourself what you already know? That you have no time, no time to pick up another student, even though there is no other therapist who can pick up this student and their accompanying services? Or are you interested in heading to your administrator?
If you want to head to administration, perhaps have another colleague fill out a time study too, and invite your administrator to meet with you and your work-buddy. There is power in numbers and power in colleague support. Before your meeting, brush up on Universal Design for Learning and recommend a specific change to the playground or cafeteria to make it more accessible for all.
Have some examples at-the-ready to demonstrate what heights you will accomplish within a workload model! While you have that administrator’s ear, discuss that perhaps not every student needs to be directly seen 1×30 or 2×30 each week; that is a historical habit pattern and not necessarily an evidence-based service delivery decision.
This would be a great place to conversationally drop the 3-1 model. Add that, for some students, maybe load up service at the beginning of a school year, rather than spread throughout the academic year. Oh boy, this is one of those discussions that is future-changing!
Change Takes Time, but Worth It!
I am not saying that this change will be easy; change is usually not so. However, advocacy for a workload approach, in the service of best practices for ourselves and our students, may be one way to attain the accountability that is so necessary in modern schools practice.
Stay with me here, please. With data, with numbers, we may be able to achieve a more manageable workload. Here are some possibilities if we transition to a workload approach:
- We place value on indirect services on behalf of our students.
- We may be able to collaborate while seated rather than rushing past each other in the hall.
- If we create this time to productively collaborate, we might be able to do a PubMed search to find research, perhaps even a systematic review on, say, the benefit of contextual services.
- Armed with this evidence, we may step into the natural environment of the classroom and collaborate with the teacher to design in-class activities to support the general education math or science or handwriting curricula. WOW!
- This is an exciting domino-effect! This is 21st –century schools practice!
Here’s one more resource: a free webinar recording of workload models in schools practice. It’s an hour long, so grab a cup of coffee!
And one last suggestion: I am going to head back to one more of my favorites phrases ‘words matter’. Drop the word ‘caseload’ from your vocabulary. Say ‘workload’ instead; someone may actually ask you what that means! There’s our opening.
*Of special note: if you are at all intrigued by a systems approach to handwriting intervention in schools, which, by the way, fits well within a workload model, I am giving a workshop in January 12, 2018 in New Orleans, LA. Check out the All Write Already! Top-down Systems Approach to Evaluation and Interventions in Handwriting on the ApplyEBP website for more information.
American Occupational Therapy Association. (2014). Transforming caseload to workload in school-based occupational therapy services. Available from www.aota.org
American Speech-Language-Hearing Association. (2002). A workload analysis approach for establishing speech-language caseload standards in the schools: guidelines [Guidelines]. Available from www.asha.org/policy
Jackson, L. (2013). Best practices in determining school workloads, in Frolek Clark & Chandler, Best Practices for Occupational Therapy in Schools. Bethesda, MD: AOTA Press.
Williams, J. & Cecere, S. (2013, April). School-based workload: What’s the magic formula? Short course presentation at The American Occupational Therapy Association 93rd Annual Conference, San Diego, CA.