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What's the Magic Formula? An Update on Caseload to Workload Conversion




Workload has been a “hot” topic for school-based practitioners for the last 20 years. The reauthorization of IDEA in 2004 and its focus on inclusion and accountability facilitated the need for states and districts to look beyond the tradition service delivery models of “direct” and “indirect” and recognize the expanding roles for related providers based on the legislative changes. No longer were SLPS, OTs and PTs just providing support for students who were eligible for special education and related services; there was now a requirement to support educational initiatives such as Universal Design for Learning (UDL), Response to Intervention (RtI), Multi-tiered Systems of Support (MTSS) and Positive Behavior Intervention Supports (PBIS). Coupled with increasing rigor in academic programs and ever-evolving accountability systems, the caseload approach – providers assigned by the number of students receiving IDEA services regardless of the intensity of need and associated work tasks including licensure documentation requirements– no longer kept providers “afloat.”  Professional organizations heard the frustrations of their members; in 2014, AOTA, ASHA, and APTA authored a joint white paper, “Workload Approach:  A Paradigm Shift for Positive Impact on Student Outcomes” to draw attention to the challenges faced by providers. Over time, some states added caseload caps and authored guides to practice that mention the need for a workload approach, but few states have actual methodologies for workload calculation – a “magic” formula.


In 2023, the Oregon legislature tasked the Oregon State Department of Education (ODE) with conducting a study to determine an appropriate workload methodology for public school SLPS, OTs, and PTs. In January 2024, the ODE submitted the report “House Bill 2618:  School-Based Occupational Therapy, Physical Therapy and Speech-Language Pathology Workload Methodology” to the Oregon legislature.


This comprehensive report clarifies the terminology: “caseload” and “workload” and articulates in detail the roles and responsibilities of each discipline. A mixed-method study process used to develop the report included group engagements, provider interviews, and a review of available literature and workload methodologies. The report reflects provider concerns including but not limited to: (1) inability to work to full potential, (2) feelings of being overburdened by paperwork and legal requirements, (3) students not receiving the services they need (4) staff recruitment and retention and (5) provider shortages. Based on social media content related to caseload and workload, the feelings of surveyed Oregon providers align with national sentiment.


The ODE recommended a workload methodology and metric starting point: The North Carolina Department of Public Instruction (NCPI) workload methodology. ODE recognizes further analysis of this methodology for alignment with the Oregon education system is needed to develop a workload metric that would reflect the unique needs of Oregon and its communities. These recommendations include the inclusion of early intervention and early childhood providers, School Medicaid billing as a workload consideration, provider shortages and state-level infrastructure, training, and support for school districts during implementation.


I encourage all stakeholders to engage in caseload-to-workload discussions to advocate for needed changes to address the diversity of student learning needs and implement best practices. SLPs, OTs, and PTs should engage in advocacy efforts at the state and local level to provide quality services for students and provide what federal legislation requires of us to support all students in “further education, employment and independent living”.

 

References and resources on caseload to workload:

American Speech-Language Hearing Association (ASHA). ASHA Workload Calculator.

American Speech-Language Association, American Physical Therapy Association, American Occupational Therapy Association, (2014). Workload Approach:  A Paradigm Shift for Positive Impact on Student Outcomes

Burton, S., Buckley, S., Cecere, S., Cobb, S., Figueiredo, D., George, E., Kierstead, K., Lesch, D., Mastrilli, J., Vandervalk, K., Williams, J. (2008, 2015). Occupational and Physical Therapy Early Intervention and School-Based Services in Maryland.

Carlin, C., Watt., L. Fallow, W., Carlin, E., Shernavaz, V. (2103) Caseload Ratio Study:  Final Report to the Ohio Department of Education

North Carolina Department of Public Instruction. Workload Calculator Guidance.

Seruya and Garfinkel Workload Resources

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