Cost-Cutting Treatment and Caseload Management

By Pam Marshalla

Daily PlannerQ: I am faced with cutting my caseload down considerably due to budget cuts. We will see the more severe kids a max of one time per week, and that’s fine. However, we are being asked to cut the mild kids more, and even eliminate them from our caseloads. Do you have any ideas?

Many therapists are facing this today.  Here is a brainstorm I had that may get you thinking outside the box.

The idea is to use four levels of interaction.  Consider it a type of RTI model.

Level 1

Venue: School Assembly (Whole school? K-3?)

Topic: “Good Speech”

Goal: Get everyone thinking about speech.

Content: Teach all the kids about good speech.  Good speech is made by sitting or standing up straight, by speaking up, speaking out, speaking like you mean it, by using appropriate question and statement inflection.  Don’t speak with a harsh voice or use glottal fry. Inside/outside voice. Expressing emotion—happy, sad, angry, inviting, rejecting, whispering secrets, cheering at a game, singing, etc.  This is good, old-fashioned elocution.

Level 2

Venue: Classroom (Whole class)

Topic: “Making Sounds”

Goal: Address all the kids who only need a little bit of instruction.

Content: Design a series of classroom activities to teach basic auditory discrimination and production of a wide variety of sounds.

    • Do a basic listening activity.  Topic: Am I saying these words correctly or incorrectly?  Use word pairs like “Alligator” vs. “Aggilator”.
    • How do we make B? D? M? S? R? L? F? Z? Sh? CH? Etc.
    • Teach that ALL sounds are made with the tongue inside the mouth except one.  Design a game/contest to see who can figure out what sound is made with the tongue sticking out (Th).
    • Teach that R can be made in two ways— with the back of the tongue pushing up high or the tip curling back.  Have the kids use mirrors to discover how they personally make the R sound.

Level 3

Venue: Small group.

Topic: “Learning Better Sound Production”

Goal: Fix the easy kids who need some direct instruction.

Content: Enroll the kids who do not succeed with levels 1 and 2 in typical small group therapy.  Put 4-5 kids in a group for 4-8 weeks? to focus on their specific errors.

Level 4

Venue: Individual therapy.

Topic: “Remediating Errors”

Goal: Remediate the difficult kids who failed at all three levels above.

Content: Enroll the kids in regular weekly 1:1 therapy.  Perhaps do this the second year.

7 thoughts on “Cost-Cutting Treatment and Caseload Management”

  1. An interesting response. Basically, just accept that state and city governments are cutting the budgets on the backs of children, adolescents, and adults with special needs? We should accommodate the government by simply agreeing with their decisions leaving our families with little avenues for enabling change in their child’s lives? There are other budget lines that can be reduced in every government and there is more that each Speech-Language Pathologist can do to advocate against changes that impact his/her profession but more importantly impact the future of the children we serve.

    1. Leslie- This is getting into the politics of healthcare and education and I do not feel qualified to respond. I was simply trying to make the point that I think we underserve our mild cases.

  2. @Leslie I highly doubt Pam means that :-/ She has strong complaints about government interference in what should be a speech-pathologist’s domain, and especially about the challenges presented to SLP’s within the bureaucracy of schools. But these are very real circumstances that SLP’s are facing — it doesn’t help in the meantime to ignore the need for solutions here and now — and I think that’s clearly what Pam is addressing here.

  3. Seeing the most severe kids once a week?. What are they thinking they’ll get done????? So many kids have a variety of issues at once- speech and language issues at the same time. Then there’s the phonological awareness issues that most of the phonological delay kids have, which negatively affect their reading and spelling for years to come if not intensively remediated. Speak up people! Don’t let this happen. Educate the parents of these students and get them to fight also!

  4. I hope the parents in your district with special needs students get a good attorney and go after the district. Meanwhile, may I suggest that for your mildest artic kids–those with 1 or 2 speech sound errors–that you instead see them 1:1 for a 5-minute intensive drill session done outside of their classroom 1-2X/wk? That along with a home program has been proven effective for most if these mild artic kids. The key is that parents must do the home program. I got good results with this. I escaped from public schools and have been doing EI for 5 years-and love it! I left when faced with the situation you are in. Good luck to you!

  5. The window of opportunity for speech-language development is birth to about age seven; if a child is not meeting milestones, SLP’s could at least offer consultation through those years. Why wait until the window is nearly closed?

  6. Before I became a speech pathologist, I was a classroom teacher. For those children who were low in reading and math – I met with them DAILY for direct instruction. I am now seeing my speech children in a 1:1 intensive daily drill session type therapy, which makes peace with the teacher inside of me AND I am seeing a significant reduction in my caseload as a result. I use both Pam’s R Therapy book and her Frontal/lateral Lisp books for those troubling sounds. I incorporate auditory discrimination and generalization as Pam directs into my sessions as well. I don’t use this type of therapy for all my children, but it works very well for many of them.

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