Workload Success Stories

Workload Success Stories
INTRODUCTION
Although awareness of the benefits of using a workload approach to caseload
management is high among school-based SLPs, the level of implementation reported in
ASHA Schools Surveys remains relatively low. This session aims to reverse that trend
by providing real success stories about creative ways to use a workload approach to
solve problems and increase the quality of SLP services in schools.
LEARNING OUTCOMES
You will be able to:
analyze and revise weekly schedule to allow for more service delivery options
and a better balance across workload clusters
complete a gap analysis between the ideal condition and current status related to
workload issues of most concern to the SLP
develop an action plan to close the gap between better/best workload
implementation and current status
EVIDENCE-BASED PRACTICE
It is the position of the American Speech-Language-Hearing Association that
audiologists and speech-language pathologists incorporate the principles of
evidence-based practice in clinical decision making to provide high quality
clinical care. The term evidence-based practice refers to an approach in
which current, high-quality research evidence is integrated with practitioner
expertise and client preferences and values into the process of making
clinical decisions.
Participants are encouraged to actively seek and critically evaluate the
evidence basis for clinical procedures presented in this and
other educational programs.
Adopted by the Scientific and Professional Education Board, April 2006
ASHA Webinar 14104 / 14204
PROGRAM HISTORY
Live webinar:
Wednesday, September 17, 2014
2:004:00 p.m. Eastern time
2:00 p.m. ET
1:00 p.m. CT
12:00 p.m. (noon) MT
11:00 a.m. PT
On-demand webinar:
September 19, 2014September 17, 2015
This course is offered for 0.2 ASHA CEUs (Intermediate level, Professional area).
FACULTY
Judy Rudebusch, EdD, CCC-SLP, is the assistant superintendent for student services
& federal programs, in Irving (Texas) Independent School District. She has more than 30
years of experience in public education as an SLP, autism assessment specialist,
program specialist, special education director, and state and federal programs director.
She is on the executive board of the Texas Speech-Language-Hearing Association and
is completing a term on the ASHA SIG 16 Coordinating Committee. She participates in
national and state initiatives to improve services in schools and is a frequent presenter at
workshops and conferences on issues related to workload, response to intervention,
systems change utilizing a workload approach, literacy, school-based speech-language
services, and aligning SLP services to the Common Core State Standards.
FINANCIAL DISCLOSURES
Judy Rudebusch co-authored Language LAB (Super Duper, Inc.) and received financial compensation from
ASHA for this webinar.
NONFINANCIAL DISCLOSURES
Judy Rudebusch is ASHAs VP of Finance.
JoAnn Wiechmann, EdD, CCC-SLP, served for 17 years as a campus SLP in several
school districts in Texas and one district in Oklahoma. She is currently the special
education coordinator for compliance in the Irving (Texas) Independent School District.
Prior to her time in Irving, she served as the supervisor of speech-language pathology
services in Pasadena Independent School District, managing more than 50 speechlanguage pathology positions. She has served as vice president for professional
services for the Texas Speech-Language-Hearing Association and is on the ASHA Ad
Hoc Committee for School Issues. Wiechmann is a writer, speaker, and mentor with an
interest in improving quality of service delivery in school settings.
FINANCIAL DISCLOSURES
JoAnn Wiechmann co-authored Language LAB (Super Duper, Inc.) and received financial compensation
from ASHA for this webinar.
NONFINANCIAL DISCLOSURES
JoAnn Wiechmann is an ASHA Schools Committee member, is on the ASHA SIG 16 Coordinating
Committee, and is the SIG 16 Professional Development Manager.
MANAGER
MODERATOR
Aruna Hari-Prasad, MA, CCC-SLP
Associate Director, School Services
ASHA
Laura Staley
Instructional Designer
ASHA Professional Development
WORKLOAD
SUCCESS
STORIES
Judy Rudebusch, EdD, MA, CCC-SLP
JoAnn Wiechmann, EdD, MA, CCC-SLP
Disclosure Statements
Financial Disclosures
Judy and JoAnn co-authored Language LAB (Super Duper, Inc.),
referenced in the workshop
Judy and JoAnn received an honorarium from ASHA for developing and
presenting this webinar
Nonfinancial Disclosures
Judy is the ASHA VP for Finance, 2015-2017
JoAnn is an ASHA Schools Committee Member, 2014-2017
JoAnn is on the ASHA SIG 16 Coordinating Committee and is the SIG
16 Professional Development Manager, 2014-2017
Presentation Outline
Introduction & Overview of Using a Workload Approach
Highlighted Strategy 1: Service Delivery Variations With a Workload
Approach
Success Story
Questions
Highlighted Strategy 2: Scheduling With Flexibility to Meet Individual Needs
Success Story
Questions
Highlighted Strategy 3: Educational Relevance and Standards-Based SLP
Services
Success Story
Questions
Summary & Closing
Increased Demands on SLPs

CCSS & Standards-Based IEP Goals
The SLP Staffing Spiral

Health care
competes with
schools for SLPs
Not enough new SLPs

graduating with MS
degrees
High rates of
identification:
autism, LD, etc.
More demands:
CCSS, paperwork,
RTI
SLPs retiring,
going on leave,
quitting
Job openings go
unfilled
Burnout & low job

satisfaction
Kids need services for

longer periods to make
progress
More attrition
Higher caseloads & heavier workloads
Its Still a Caseload-Driven

World: Why?
ASHA: American Speech-Language
Hearing Association
Schools Survey Report
1995-2012
Caseload Approach
Workload Approach
Why Using a Workload

Approach Makes Sense
Creates capacity for educational
relevance in service delivery
Allows for full range of roles &
responsibilities
Allows for continuous
improvement
Uses systems thinking
Better outcomes for students
Workload Approach
Workload
Taking all activities of the school-based SLP into account
when determining how many students can be well-served
Workload clusters
Direct services
Indirect services to implement IEP
Indirect activities to support students in the curriculum &
LRE
Compliance and other activities
Results from school survey show high awareness and low

implementation
Reasons Workload May Be

Difficult to Implement
Need a workload attitude
Comfort zonedoing the same thing & expecting
different results
Requires much more coordination and communication
than working your caseload
Wants to be embedded in a systems approach
Implementation is dynamic, not static
Business office/HR/Special ed still use numbers for
staffing personnel units
Doesnt work well if you dont frontload planning
Deep Change
is not adding more to an already
full load
means reconfiguring what we do
and how we do it
and then evaluating how well we
are doing it in terms of outcomes
What Does It Take to Change?

Things that stall the change process
Lack of clarity about the change and what it looks
like when we have it in place
Lack of leadership that pushes and supports the
change
Weak belief that the change will improve services to
students
Instituting changes seems harder than keeping
things the way they are
Staying in the box (with lid shut)
Systems Approach: Workload

Educational Relevance
Flexible Schedules
Eligibility
Inputs
EBP
Dismissal
Advocacy
Workload Clusters
Service Delivery
Outputs
Outcome:
Student
Performance
WORKLOAD
STRATEGY 1
Service Delivery
Rethinking Service Delivery

Look at the whole child
Does every week need to
look the same?
Individual & group
options
Academic, nonacademic,
and extracurricular times
Traditional vs. new
Other telepractice
Variations in Speech-Language
Service Delivery Models
Service
Delivery
Model
Description
Direct
Services
Provision of services directly with the student

or a group of students on a set schedule
Indirect
Services
Instruction and modeling provided to persons

within the students environment (e.g., teachers,
paraprofessionals, parents)
Flexible
Services
Provision of services based upon the needs of

the student
National Research Study on

Service Delivery
74% of speech therapy services are served as
pull out therapy
12 % of speech therapy services served as coteaching or inclusion in the classroom
21 % of speech therapy services provided in selfcontained setting
(Brandel & Loeb, 2011)
Direct Service Delivery Models

Direct services defined:
Direct services for speech therapy refers to the
direct provision of services between the SLP
and the student
Direct services are billable for
SHARS/Medicaid reimbursement
Examples: Pull-out, classroom-based (team
teaching, supportive teaching, etc.), drill bursts
Direct Service Delivery Models

Pull-out: SLP removes students from the
classroom and takes them to another location
Drill bursts: typically for intensive
articulation drill in frequent, short sessions
could be a pull-aside in the classroom, drill at
the class door, or pull-out service delivery
Direct Service Delivery

Classroom-based (inclusion)
Team teaching (teacher & SLP teaching the same lesson

to the class)
Parallel teaching (teacher & SLP teaching the same lesson

to different groups in the class)
Pull aside (SLP pulls selected students to small group

within the classroom)
Station teaching (SLP instructs specific skills at a station,

students rotate through)
Supportive teaching (teacher instructs class, SLP

supports specific students on skills)
Indirect Service Delivery Models

Speech therapy services that involve the SLP
supporting the students goals/objectives by
working with other providers
Indirect services are not billable for
SHARS/Medicaid reimbursement
**Caution against monitor only: Monitoring
student progress in and of itself does not
constitute a special education service
Indirect Services Examples

Examples of indirect speech therapy services
Attending grade-level professional learning

communities
Programming assistive technology devices to
allow access to general ed curriculum
Classroom engineering to enhance
language/communication
Student-specific teacher consultation
Identifying language/literacy in the curriculum
Combination of Service Delivery

Many students may need a combination of direct and
indirect services
Example
30 minutes weekly of direct speech therapy in the
self-contained sped classroom (billable time) &
30 minutes monthly of indirect speech
consultation to train teachers and staff on
assistive technology device and programming
(not billable time)
SERVICE
DELIVERY
SUCCESS STORY
Intensive Language Therapy: A Dosage/Treatment Intensity Study
It is clear that
School-age children with spoken and written language
disorders need
Frequent
Intense
Explicit
Systematic intervention
And require a different approach from the traditional pullout model.
(Nippold, 2012)
Workload Strategy 1: Intensive

Language Therapy Study
Pilot study completed 2013-2014 school year in suburban school district
in Texas
Experimental group: Speech language impaired, some of the students
were also LD
Treatment: 90-120 minutes of language therapy per week for 10 weeks
Method: Used Language LAB oral narrative program
Implemented by: District SLP
Control group: Speech language impaired, some of the students were also
LD
Treatment: 30-60 minute of language therapy weekly per IEP for school year
Method: Used Language LAB oral narrative programfocusing on students
goals
Implemented by: Campus SLPs
Intensive Language Therapy Study

Data collected on all students
Language lab pre- and post-screener
Test of narrative retell pre- and post District listening/reading comprehension testing
(beginning of year, end of year)
Teacher rating scale (beginning, middle, and end of year)
Intensive Language Therapy

Study: Results
Number of students was small (experimental n=36, control
n=19)
All students made progress
Experimental group made more progress than control group
No regression of skills after intensive language therapy was
stopped
Teachers reported all but one student made progress
Story retell
Sequencing events
performance in ELAR
Making predictions
confidence in ELAR
Making inferences
General
Student
It Works
I dont know what the statistical analysis is going
to show, but I can tell you by working with the
students and talking to the teachers, Language LAB
works.
~Leah Bowen, MS, CCC-SLP

Action Researcher, Irving ISD
SERVICE
DELIVERY
SUCCESS STORY
Systematically Increased Classroom-Based SLP Services
Questions and Answers
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Press *1 on your telephone keypad to signal that you wish to ask a

question.
WORKLOAD
STRATEGY 2
Flexible Schedules
Types of Schedules
Traditional weekly schedule
Receding schedule (student)

Pulse schedule (student)
Cyclical schedule (caseload)
Block schedule (caseload)

Flexible schedule
Types of Schedules
Traditional weekly schedule
Same schedule for students every week for entire semester
or school year
Same schedule for SLP every week
Every student on caseload seen for direct services every
week
Often use small group pull-out for majority of students
on caseload
The norm and assumed type of schedule
Types of Schedules (student

schedules)
Receding intensity
Intense direct contact followed by monitoring transfer of
skill to home or school environment
Pulse scheduling
Intensive contact followed by a period of no contact
Growth and skill transfer monitored during period of no
contact
Intensive contact repeated, followed by a period of no

contact
Encourage growth at beginning of each pulse cycle
Cyclical Scheduling
Example:
6-weeks schedule: Students divided into three groups
2 weeks intense, 1 week off

A= Low incidence
B= Speech manner
C= Language processing
1. AB
2. CA
3. BC
4. AB
5. CA
6. BC
Block Schedule
Instructional time is blocked into longer segments
with fewer periods per day
Common block schedule: AB

Each class/course scheduled every other day
SLP application
Adjust schedule if campus is using block schedule
Consider ways you can block time to give students with
intense needs a longer block of time
Flexible Scheduling to Meet

the Needs of Each Child
Altering the frequency of services provided each
week and/or month
Providing opportunities for individual therapy
Combining service delivery models
Providing opportunities for indirect services

Scheduling in compliance activities
Scheduling RTI/prevention sessions during

backpack times of day
Remember:
Schedule activities,
not
students
Monday
Tuesday
Wednesday Thursday
Friday
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assess
Monday
7:45-8:15
RTI Tier II
8:30 9:00
IEP Services
Tuesday
Wednesday
Thursday
RTI Tier II
IEP Services
IEP Services
9:00 9:30
Classroom
Classroom
9:30 10:00
Collaborate
IEP Groups
10:00 10:30
10:30 11:00
Friday
Prep
IEP Groups
Assessment
Collaborate
Indirect RTI
Gen Ed
Gen Ed
Assessment
Drill Bursts
Drill Bursts
IEP Meetings
11:00 11:15
Drill Bursts
11:15 11:45
Lunch
Articulation
11:45 12:00
Assessment
Compliance
Travel to High School
Individual IEP
Travel to High School
12:00 12:30
Observations
Paperwork
IEP Services
Compliance
IEP Services
12:30 1:00
IEP Services
Language
Sped Class
Paperwork
Sped Class
1:00 1:30
Co-Teach
1:30 2:15
2:15 2:45
2:45 3:30
RTI Tier II
Indirect
IEP Services
IEP Services
Observations
IEP Services
RTI Tier II
Compliance/IEP
Meetings
RTI Tier II
Compliance/IEP
Meetings
Conference
Flexible Schedule: Morning

Monday
RTI Artic Lab
Tuesday
RTI Artic Lab
Wednesday
RTI Artic Lab
Thursday
RTI Artic Lab
8:30-9:00
IEP Language
Group (K)
IEP PPCD Class
IEP Language
Group (K)
IEP Fluency Group IEP Fluency Group

(3rd-4th)
(3rd-4th)
9:00-9:30
IEP Phono
IEP PPCD Class
Processing
Group
IEP Language
Collaboration Gen
Group (2nd-3rd) Ed
IEP Resource
Class
IEP Phono
Processing Group
Assessment/IEP
Meetings
IEP Language
Group (2nd-3rd)
Collaboration Gen
Ed
Indirect RTI Activities
10:00-10:30
Fluency/Artic
Group
IEP Language
Group (1st-2nd)
Fluency/Artic
Group
IEP Language
Group (1st-2nd)
Assessment/IEP
Meetings
10:30-11:00
IEP Language/
Artic Group
IEP Language
Group
IEP Language/
Artic Group
IEP Language
Group
Assessment/IEP
Meetings
11:00-11:15
Apraxia/Artic
Drill Bursts
Apraxia/Artic
Drill Bursts
Apraxia/Artic
Drill Bursts
Apraxia/Artic Drill
Bursts
Assessment/IEP
Meetings
11:15-11:45
Lunch
Lunch
Lunch
Lunch
Lunch
7:45-8:15
9:30-10:00
Friday
Prep
Flexible Schedule: Afternoon

11:45-12:00
Fluency Group IEP PPCD Class Secondary

Campus
12:00-12:30
IEP PPCD Class
Fluency Group
Secondary Campus
Sped Class
IEP PPCD Class
Sped Class
12:30-1:00
Artic Group (K) Language CoTeach
Sped Class
Artic Group (K)
Sped Class
1:00-1:30
Language Group Language Co(4th)

Teach
Language Group
Classroom
Observation
Language Group
1:30-2:15
Classroom
Observation
Language Group
(4th)
Language Group
Language Group
(4th)
Language Group
2:15-2:45
RTI Language
Lab
RTI
Language Lab
Assessment/IEP
Meetings
RTI Language Lab
Assessment/IEP
Meetings
2:45-3:30
Conference
Conference
Conference
Conference
Conference
FLEXIBLE
SCHEDULE
SUCCESS STORY
Flexible Scheduling: Meeting Needs of Students With Autism
Example IEP minutes for BJ

Mainstreamed 2nd Grader; HFA
Receives Speech, Resource, Content Mastery Support
Speech services will be provided for a minimum of 270
minutes/6-week period (150 minutes direct within classroom, 60
minutes direct pull-out, 60 minutes observation/staff consult).
Sample Breakdown:
(direct w/in classroom) = 5x 30-minute classroom
lessons or supports OR
2x 45-minute classroom lessons + 2x 30-minute supports
(direct pull-out) = 2x 30-minute OR 4x 15-minute pullouts for introducing new skills or priming for class lessons
Observation/staff consult time as needed (includes Core
Team meetings, related service consults, etc.)
Next Slide: Example for one 6-week grading period
Example Therapy Table #1 (BJ)

Week
Monday
15 P
30 CL
15 P
30 CL
15 P
30 CL
15 P
30 CL
Tuesday
Wednesd
ay
30 CS
*Winter Party
Thursday Friday
Holiday
Break
6
P = Priming
Green= Pull-out
CL = Classroom Lesson
Purple = Push-in
CS= Classroom-Supported Activity
This example represents a combination of four 15-minute pull-out sessions (used for priming for classroom lessons),
four 30-minute classroom lessons, and one classroom-supported activity (in this case, CN supported student during
participation in social activities during his classrooms Winter Party.) By using flexible scheduling, the CN was able to
look ahead at the 6 weeks, choose the service option that best fit the constraints of the holiday break, and take advantage
of the opportunity that the classroom party gave for supported social interaction as a classroom-supported activity. An
alternate therapy schedule might better fit the next grading period. Indirect minutes (observation/staff consult) can be
scheduled as needed.
Example Therapy Table #2 (BJ)

Week
Monday
Tuesday
Wednesda Thursday
y
30 P
45 CL
30 CS
Achievement Testing
45 CL
30 CS
P = Priming
Green= Pull-out
Friday
CL = Classroom Lesson
Purple = Push-in
30 P
CS= Classroom-Supported Activity
This example represents a combination of two 30-minute pull-out sessions, two 45-minute classroom lessons, and two
classroom-supported activities. As SLPs are often required to take part in administration of statewide achievement tests
on their campuses, or may not have access to many of the children on their caseloads, they may be unable to provide
regular services to their students on those particular days, making this combination of services ideal for this particular
grading period.
Documentation for Therapy Table #2 (BJ)

= Completed
Week
Monday
Tuesday
Wednesday
Thursday Friday
30 P
Tchr consult: checkin email
(5 min.)
(5 min.)
45 CL
30 CS
(CN absent)

(5 min.)
Achievement Testing
30 P
45 CL
30 CS
30 CS
Designed new
support with teacher
(15 min.)
Created Support
(15 min.)
Teacher training (10
min.)
Observation
(10 min.)
CORE meeting
Observation
(10 min.)
Table used as a graphical representation of total time spent. Reflects one makeup session from a clinician absence. Easy
way to keep records. Keep a copy in students file and send home a copy with report card each 6 weeks.
FLEXIBLE
SCHEDULE
SUCCESS STORY
Flexible Scheduling: Receding Schedule for Students
Preschool Fluency Intervention Groups

Centralized preschool program for young stutterers
Small group therapy: two 30-min sessions per week (or more if
needed)
Parent training concurrent with therapy
As fluent speech stabilizedreturn to IEP and reduce therapy time

and parent training time (i.e., one 30-min/week, one 30min/month, consultation)
Dismiss from therapy when stuttering has been resolved.
~Frisco ISD, Frisco TX
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Access:
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question.
WORKLOAD
STRATEGY 3
At the Intersection
Of Quality Services and StandardsBased
SLP Services
The New World of the Common

Core State Standards
Communication Competence
School success depends on a students
communication competence
Reading, the focus of the past decade, is part of an
integrated model that intertwines:
Writing
Speaking
Listening
Language
Common Core State Standards

Reading standards
For literature
For informational text
Foundational skills
Writing standards
Speaking & listening

standards
Language standards
CCSS Expectations
Reading, Writing, Speaking, Listening, Language

(Flynn & Power-deFur, 2012)
Comprehend and evaluate texts

Construct arguments and convey intricate information
Demonstrate strong content knowledge

Adapt communication to varying demands of
audience, task, purpose, discipline
Use technology strategically & capably

Understand other perspectives and cultures
Key Points: Speaking & Listening

Students gain, evaluate, and present increasingly complex

information, ideas, and evidence through listening,
speaking, and examining the media
Focus is on academic discussion in 1:1, small-group, and

whole-class settings
Formal presentations
Informal discussion
Key Points: Language

Grow vocabulary through conversations, direct

instruction, and readings
Students determine word meanings, appreciate

nuances, and expand repertoire
Use formal English in writing and speaking
Choose many ways to express self
Academic Language Is
Specialized language used to talk about disciplinary
content within school settings
Lexically, syntactically, pragmatically specialized
E.g., academic language tends to contain relatively high
volume of morphologically complex words drawn from
Latin and Greek
Postsecondary education is a key path to upward
mobility in the United States
Morphologically complex words
Refined lexical relations among words
Infuse Standards Into IEP

Language
Standards-Based
Goals/Obj
Three Steps
1. Statement of student expectations
2. Statement of present levels relative to
expectations
3. Statement of measurable and achievable
instructional targets (IEP goals/objectives)
The Ideal IEP Process for

Incorporating Standards
Review all the assessment information
available on the student, both criterion
referenced and normative
Collaborate in advance, including parents
Evaluate student strengths and areas of

need related to the standards
Design a comprehensive PLAAFP
statement
Start With Targeted PLAAFP

Statements
At this point in the school year, most xx
grade students have mastered xxx [are able to
xxx]
(Students) skills in this area are on grade level (or
commensurate with his peers), or
(Student) understands xxx; however s/he is unable
to xxx, or
(Student) struggles to xxx; s/he has difficulty xxx
Instructional priorities recommended for the

new IEP
Case Study: 4th Grade Student

Developing a Standards-Based IEP Goal
ELAR Standards
Vocabulary development
Listening & speaking

Oral & written
conventions
Reading comprehension
PLAAFP
At this point in the school year, most
4th graders are able to choose words
& ideas to convey ideas precisely,
produce complete sentences, and
recognize/correct fragments and runons.
Andrew is able to understand
simple synonyms, antonyms, and
homonyms but struggles with precise
use of grade-level vocabulary. He is
inconsistent in being able to retell a
story and struggles to speak in complete
sentences during academic tasks, which
affects his ability to write using
complete compound and complex
sentences.
What to Include in StandardsBased IEP Goals & Objectives

Timeline
Conditions of performance
Observable behavior
Level of performance
Wording Incorporated Into

CCSS-Aligned Goal
By the end of the 3rd grading period following the annual
review, Andrew will demonstrate use of grade
level vocabulary by defining and using new words in

compound and complex sentences, using core curriculum
vocabulary, story grammar vocabulary, and word lists,
for 15 out of 20 target vocabulary words.
Wording Incorporated Into

Standards-Based Goal
By (timeline)
Student will demonstrate use of

grade level XXX (conditions of
performance)
by (observable behavior)
for (level of performance)
Workload Strategy 3
Much of graduate program training focuses on a
clinical model of speech therapy services
School-based SLPs must infuse themselves in the

Curriculum conversations with teachers
Student data analysis process
School-based SLPs must write educationally relevant

goals/objectives
Result: Student gains in communication skills and
academic skills, and teachers recognize the importance
of the SLPs role
EDUCATIONAL
RELEVANCE
SUCCESS STORY
Student Data Profile
Tap into the SLPs expertise

in language
School administrators need to tap into the expertise that SLPs
bring to the area of language. Language is critical for the
development of reading and writing. We should maximize use of
the SLPs skills to provide student supports in these areas. We are
excited to measure how our students benefit from the SLPs
providing RTI language interventions during arrival and dismissal
times rather than having SLPs work a campus duty.
Dr. Adam Grinage
Associate Superintendent of Academic Services
Irving ISD, Irving TX
SLP expertise benefits the

whole school
Speech-language pathologists are vital members of the
education team. The SLP lens provides expertise in researchbased practices related to language development and language
instruction. Utilizing the SLPs expertise to better design:
classroom ELAR instruction

small group targeted language intervention
language interventions for struggling learners
individual student intervention
is a benefit to the whole school community.

Laurie Gagne, MEd, Director of Special Education
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question.
ASHA Says
Speech-language pathologists should
provide services that are connected
with functional and meaningful
outcomes. Therefore, they should
provide pull-out services only when
repeated opportunities do not
occur in natural learning
environments or to work on
functional skills in more-focused
environments.
(ASHA, 2006)
Systems Approach: Workload

Flexible Schedules
Eligibility
Inputs
EBP
Dismissal
Advocacy
Workload Clusters
Service Delivery
Outputs
Outcome:
Student
Performance
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76
Feature | August 2013
Time Block After Time Block

To offer a full range of RTI and IEP
services, school-based SLPs can
schedule activity blocks rather than go
student by studenthere's how.
Judy Rudebusch, EdD, CCC-SLP; JoAnn Wiechmann, EdD, CCC-SLP
The ASHA Leader, August 2013, Vol. 18, 40-45. doi:10.1044/leader.FTR2.18082013.40
Elizabeth, the speech-language pathologist at Shady Grove Elementary, must schedule treatment
for 51 students with individualized education programs. The classroom teachers all plead that their
students can't miss instructional timeand, oh yes, they all have a few more new students to refer
for evaluation. To make sure the referrals will be appropriate, Elizabeth suggests scheduling
speech and language response-to-intervention sessions to gather data about the new students.
Together, they schedule a four-times-weekly RTI articulation group for the first 30 minutes of the
school day, and a three-times-weekly RTI language group the last 30 minutes of the school day.
The teachers agree this schedule is least intrusive on instructional time and understand that the
RTI groups will run for a specified number of weeks.
Scheduling: It's the bane of just about every school-based speech-language pathologist's
existence. We are responsible for assessing students, providing intervention, writing goals for
individualized education programs, participating in IEP meetings and conferences with teachers,
working with general education students who are not performing at grade level, and completing
mountains of paperwork.
Prevention, assessment, intervention, dismissalmeeting all of these responsibilities often seems
like trying to assemble an intricate, complex puzzle. And just when we think all the pieces are
interlocking perfectly, we realize there are a dozen pieces we've forgotten to put in.
The demands on school-based SLPs' time and expertisethe pieces of the puzzleare not
limited to the needs of students with individualized education programs that include speechlanguage intervention. Current educational models call for robust response-to-intervention
programs in which teachers and other school personnel help struggling students meet grade-level
expectations and avoid unnecessary special education placement.
Some SLPs may not understand that under federal lawthe Individuals With Disabilities Education
Actspeech-language pathology services encompass the expectation that SLPs provide
prevention (RTI) services (see "Where's the Money?"). If that provision is new to a school or
district, the SLP's first step may be to meet with the special education director or administrator to
gain administrative support. Using federally funded SLPs to provide RTI that is part of general
education services, then, is allowed under IDEA.
So how do you fit those servicesas well as assessments and dismissals, paperwork,
conferences with parents and teachers, and prep timeinto a manageable schedule?
We believe the key to caseload management is a workload approach (see "School Matters"). A
successful workload approach can:
Provide the capacity and flexibility to meet students' needs.
Broker both general and special education systems.
Offer a full continuum of RTI and IEP services.
A workload approach starts with the total work activities of the school-based SLP, rather than the
total number of students who need services. As we described in our Aug. 30, 2011, Leader article
("How to Fit Response to Intervention Into a Heavy Workload"), the workload approach allows the
SLP to make student-centered decisions about who to serve, how to serve, how long to serve,
where to serve and what context to use for services. It includes direct and indirect response-tointervention and educationally relevant IEP services and activities. It differs from traditional
scheduling, which usually prioritizes direct IEP services first and uses any remaining time for
indirect services and activities and for paperwork and compliance obligations.
Flexible scheduling
This approach incorporates the features of more traditional scheduling to use time and meet
students' needs most effectively.
To understand the theory behind flexible scheduling, it helps to look at the features of some
traditional approaches:
In a traditional weekly schedulethe norm in most schools-the SLP schedules students for services on the
same time/day(s) every week. You can, however, vary the amount of time, location and service delivery
approach: for example, provide one session of individual pull-out treatment per week and alternate smallgroup pull-out sessions with classroom-based service delivery every other week. Combining service delivery
models allows you to focus on educational relevance and treatment effectiveness.
In a receding schedule, the SLP provides direct services in an intense schedule of increased frequency for a
period of time, and then reduces direct services while increasing indirect services. For example, in the first
semester you work with a student 90 minutes per week on IEP articulation goals; in the second semester, you
reduce the amount of individual direct services to 15 and provide 30 minutes of indirect services per week
(independent practice of target sound production and monitoring generalization).
In a cyclical schedule, the SLP provides direct services to students for a period of time followed by no
services or only indirect services for a period of time. You foster growth and learning of new skills in the first
phase and monitor stabilization of skills in the second phase. The 3:1 model is an example of a cyclical
scheduledirect services for three weeks in a row are followed by indirect services and activities in the fourth
week. Another type of cyclical schedule can be described as pulse scheduling with, for example, direct
intensive services for weeks followed by one week of no direct service and indirect service provided. The
pulse on-off direct services allow students to stabilize skills learned during the "on" cycle.
In a block schedule, sessions are longer but less frequent, and often reflect the school's master block
schedule (fewer, longer classes every day or every semester). SLPs should clearly define direct and indirect
services on the IEP schedule of services so the student and parents understand which types of services will
be delivered at what times.
A flexible schedule uses features of these schedules to maximize services and best meet students'
needs.
Get started with activity blocks

If you decide to try a flexible approach, you will need to look at your time in a different way. Resist
the urge to schedule intervention for your IEP students first, and then squeeze everything else
around them. Instead, a good first step when using a workload approach to scheduling is to
designate blocks of time for key activities. Schedule blocks of time for:
Direct IEP-mandated interventions that use a variety of service delivery models, including individual or group
pull-out sessions and classroom-based sessions.
Direct prevention services, such as Tier II or Tier III intervention through response to intervention.
Indirect services to support implementation of students' IEPs.
Indirect services and activities related to RTI.
Indirect activities to support students in the least restrictive environment and help them progress in the
curriculum.
Evaluation activities, including direct testing, classroom observation at different times of day and on different
days, and conversations with teachers and parents.
Remember, in this workload approach, the schedule for each week may not be the same.
This 1 chart illustrates a sample week in which activitiesnot studentsare scheduled.
Find time for RTI

Prevention services in a response-to-intervention model often work well in several discrete time
slots:
"Backpack" times of the day. It's important to minimize interruption to the core instructional times of the
day, and the first and last 30 minutes of the school day"backpack" timesare typically not intensive
instructional times. Students are either emptying or loading their backpacks to prepare for class or to go
home.
Before or after school. Many school-based SLPs are included in faculty duty assignment rotations (for
example, breakfast duty or dismissal duty). The SLP's time is better spent offering Tier II or Tier III
intervention with a group of students during duty times. When extended day programs are available at the
school through grant funding, the SLP may provide Tier II or Tier III intervention as part of the grant-funded
program.
A hybrid of backpack and before- and after-school slots, if state rules and regulations allow for work
outside of the school day hours. A student could, for example, come to RTI for 15 minutes before dismissal
during "backpack" time and stay after school for 15 minutes to participate in a 30-minute intervention session.
Because RTI is a general education initiative, there may be flexibility to keep students after school with parent
permission.
During the school day, if the school has intervention times built into the master school schedule. For
example, a campus might designate 22:30 p.m. on Tuesday, Wednesday and Thursday as school-wide
intervention times for identified students. A student might participate in a Tier II reading intervention in that
slot on Tuesday and Thursday and a language intervention session on Wednesday.
A sample schedule provides a more detailed description of how the SLP schedules the various
workload activities: It includes hybrid scheduling for RTI articulation lab at 7:458:15 four
days/week; backpack scheduling for RTI language lab at 2:152:45 three days/week; and indirect
RTI activities at 9:3010 one day/week. Although IEP speech-language services may vary from
week to week with an established rotation pattern, RTI sessions should be scheduled on the same
day and time each week in a similar manner to the scheduling of Tier II and Tier III reading
interventions at the school. For example, an SLP may establish three different schedules and
rotate through the three schedules throughout the school year.
Prevention, assessment, treatment and dismissal are the cornerstones of SLPs' responsibilities in
schools. With a limited number of hours in a week and increasing numbers of students with a wide
range of needs, SLPs may find that stepping outside of the traditional IEP-centered schedule gives
them the flexibility to combine service delivery models and times to meet student needs across the
continuum.
Where's the Money?

Worried about funding for the workload approach? Under federal law [CFR 300.34(c)(15)], speechlanguage pathology services include:
(i) Identification of children with speech or language impairments;
(ii) Diagnosis and appraisal of specific speech or language impairments;
(iii) Referral for medical or other professional attention necessary for the habilitation of speech or
language impairments;
(iv) Provision of speech and language services for the habilitation or prevention of communicative
impairments; and
(v) Counseling and guidance of parents, children, and teachers regarding speech and language
impairments.
Where to Start?
ASHA offers school-based SLPs some step-by-step information about incorporating the workload
approach to scheduling:
Practice Portal-Caseload and Workload, and examples and worksheets for the workload analysis
approach are located on the ASHA's schools webpage.
References
American Speech-Language-Hearing Association (2010). Roles and Responsibilities of Speech-Language Pathologists
in Schools. [Professional Issues Statement]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association (2002). A Workload Analysis Approach for Establishing SpeechLanguage Standards in the School: Position Statement. [Position Statement]. Available from www.asha.org/policy.
National Association of State Directors of Special Education (2005). Response to Intervention: Policy Considerations
and Implementation. Alexandria, VA: Author.
Rudebusch, J., & Wiechmann, J. (2011, August 30). How to Fit Response to Intervention Into a Heavy Workload. The
ASHA Leader.
Judy Rudebusch, EdD, CCC-SLP is assistant superintendent for student services and federal
programs in the Irving (Texas) Independent School District. She has more than 30 years' experience
in public education as a speech-language pathologist, autism assessment specialist, program
specialist, special education director, and state and federal programs director. She is a member of
the Coordinating Committee of ASHA Special Interest Group 16, School-Based Issues.
JoAnn Wiechmann, EdD, CCC-SLP is a speech-language pathologist and special education

compliance coordinator for the Irving (Texas) Independent School District. She also served for eight
years as the supervisor of speech-language pathology services in large school districts and is an
affiliate of SIG 16.
August 30, 2011 Features
How to Fit Response to Intervention Into a Heavy

Workload
by Judy Rudebusch & JoAnn Wiechmann
Response to intervention (RTI) is the practice of ensuring there are systems in place in general education to help
every student meet grade-level expectations in academics and behavior. The essential components of an RTI
system include (NASDSE, 2005):
High-quality instruction and learning opportunities matched to student need.

Identification of students struggling to meet grade-level expectations.
Attention to students' learning rate and level of performance.
Increasing intensity of instruction/intervention based on student needs.
Data-informed educational decisions using a team problem-solving method.
Speech-language pathologists have important roles and responsibilities in RTI frameworks. Speech-language
pathology practice in schools has evolved to emphasize service delivery that is grounded in grade-level curriculum
and the Common Core State Standards (2010). This focus on literacy and providing just-in-time assistance for
students is emphasized in the ASHA document Roles and Responsibilities of Speech-Language Pathologists in
Schools (2010) and is a natural fit for the specialized knowledge and skills of the school-based SLP (see Figure
1 [PDF]).
Perhaps the most significant challenge for the SLP involved in RTI activities is incorporating general education roles
and responsibilities into an already full caseload. Using a workload approach (ASHA, 2002) provides the impetus for
RTI activities to become integral to the array of services provided rather than an "add-on" or optional set of activities.
The workload approach starts with an analysis of all responsibilities and activities necessary to provide appropriate
services, and then assigns staff based on that analysis. Using a workload approach allows the SLP to make
consistent, systematic, and student-centered decisions about whom, how, how long, and where to serve, and what
context to use for services.
The roles of the SLP in RTI are to provide direct and indirect intervention services designed to prevent placement in
special education when interventions through general education are sufficient to assist the student, and to provide
early identification of communication disorders that warrant specially designed instruction through an Individualized
Education Program (IEP). Thus, the SLP's involvement in prevention activities and early identification practices is
required, not optional (see Figure 2 [PDF]).
Embedding RTI in a workload approach brings together two powerful concepts that can improve quality of service
for students who struggle to meet grade-level or course expectations. Key leverage points for embedding RTI in a
workload approach include considerations of educationally relevant services, a continuum of service delivery
models, flexible scheduling, data-driven decisions, and advocacy and leadership roles for communicating a change
in SLPs' roles and responsibilities.
Educationally Relevant Services

Educationally relevant speech-language services are grounded in grade-level standards reflected in the general
education curriculum, and in working with students on speech, language, and communication skills needed for high
levels of performance in academics and behavior. The Common Core State Standards (2010)the result of an
initiative led by the Council of Chief State School Officers and the National Governors Associationare a synthesis
of the standards-related work to date and provide a common set of standards that are rigorous, research- and
evidence-based, aligned with college- and career-readiness standards, and internationally benchmarked. Viewed
through this lens, the SLP's role in RTI also revolves around supporting students in mastering the common core
standards in areas that overlap with speech and language skills. Thorough knowledge of the common core
standards is a critical component of current speech-language service delivery.
Continuum of Service Delivery Models

Service-delivery models in school contexts include direct and indirect speech-language services and activities that
can be provided as pull-out, classroom-based, community-based, or self-contained classroom services (Cirrin et al.,
2010). The most commonly used service-delivery models in RTI provide direct and indirect classroom-based
services for Tier 1 supports, and pull-out for Tier 2 or Tier 3 focused intervention.
Given that the intent of Tier 1 instruction is to provide all students with a scientifically based curriculum that follows
state or core standards, the primary role of the SLP at Tier 1 is to provide indirect services that support students in
the curriculum. An SLP providing Tier 1 services, for example, could:
Provide information for parents and teachers regarding speech and language development.
Plan and develop lessons on effective language and communication skills within the context of the
classroom curriculum.
Provide professional development on language-to-literacy connections (e.g., phonological awareness,
vocabulary, language structures, verbal reasoning).
Collect data during classroom observations on students' speech and language skills or language demands
during instruction/delivery of the curriculum.
Design and facilitate homework programs to target speech-language skills.
Highlight language development connections in the curriculum.
Direct services at Tier 1 can include conducting expanded speech and language screenings to identify students for
Tier 2 or Tier 3 speech or language interventions, modeling lessons for teachers that target effective language and
communication skills within the context of the classroom curriculum, or providing lessons that bridge speaking,
listening, reading, and writing through the use of narratives.
Tier 2 is designed for students who are performing below grade-level standards. Tier 2 interventions often are
provided in the form of targeted small-group instruction using evidence-based practices to address specific student
weaknesses. Tier 2 interventions are provided in addition to the services and instruction provided at Tier 1. The
targeted small-group instruction is provided by skilled teachers and/or specialized professionals. Speech-language
interventions at Tier 2 may include both indirect and direct services.
An SLP providing indirect services may:
Assist in selection of evidence-based practices for literacy interventions.

Identify, use, and disseminate evidence-based practices for math, reading, listening, speaking, and writing.
Serve on the campus intervention team.
Observe Tier 2 students to identify when their struggles are linked to speaking, listening, reading, or writing
and to assist in collecting additional data to drive decision-making.
Communicate Tier 2 progress to teacher/parent.
An SLP providing direct services may:
Provide small-group articulation intervention.

Provide small-group language intervention.
Monitor student progress on target skills.
Students who continue to struggle at Tier 2 may need intensive, individualized intervention at Tier 3. Tier 3 services
are provided in addition to services and instruction provided in Tier 1. Tier 3 interventions by an SLP include indirect
supports and direct intervention. Interventions are similar to Tier 2 but are more frequent, more intense, and longer.
Considering both RTI and IEP services, the SLP can develop a service delivery continuum of indirect and direct
services that includes speech-language interventions through RTI and speech-language services as outlined in
each student's IEP. Using a workload approach, the SLP avoids the pitfall of one-size-fits-all services that place all
students on the same intervention schedule of one to two times per week for 30-minute pull-out services in a small
group.
Flexible Scheduling
Flexible scheduling is pivotal to a workload approach and allows time for RTI activities in an already full schedule. A
workload approach takes into account the total work activities provided on behalf of or to students. In this approach,
flexible scheduling helps maximize use of time to meet the needs of each student. Flexible scheduling includes
possible changes in the frequency of service, a combination of service- delivery models, and scheduled indirect
services (including compliance activities). Flexible scheduling is also important for monitoring and adjusting service
delivery to meet the changing needs of the student for both IEP and RTI services.
There are five commonly used schedules:
Traditional weekly schedule. Students are generally scheduled for services every week on the same day(s) of the
week, at the same time of day. Weekly schedules are the most common and have become the norm in terms of
expected service delivery.
Receding schedule. Students are seen for direct services on an intense schedule with increased frequency for a
period of time (e.g., one semester); direct services are then greatly reduced with an increase in indirect services
(e.g., the following semester).
Cyclical schedule. Students are seen for direct services for a period of time followed by no services or indirect
service for a period of time. The intent is to foster growth and learning of new skills during the direct services phase
and monitor stabilization of skills during the no-services or indirect-services phase of the cycle. The cycle repeats
throughout the term of service delivery.
Block schedule. Students are seen for longer session duration but with reduced frequency. The SLP often follows
the block schedule reflected in the master school schedule. (For example, in an A/B block schedule, students attend
four of their eight classes on A-day and the other four classes on B-day; in an accelerated block schedule, students
take fewer classes and have longer class periods, but complete courses in a shorter amount of time.)
Flexible schedule. The SLP integrates two or more types of schedules to maximize services and best meet
students' needs (see Figure 3 [PDF]). For example, a weekly schedule can be combined with a cyclical schedule so
the student attends Tier 2 small-group intervention once per week for 30 minutes and participates in Tier 1 support
services with the SLP providing classroom-based co-teaching lessons once every three weeks.
Data-Driven Decisions
SLPs have an important role in data-driven decisions for RTI. At Tier 1, data are collected to determine how
students are doing compared to one another and to grade-level expectations in academics and behavior. Data are
used to determine whether the curriculum scope and sequence need adjustment or whether instructional delivery is
meeting the needs of most of the students. Data from universal screening and periodic progress monitoring of all
students are used to determine which students are struggling to meet grade-level expectations and may need Tier 2
or Tier 3 intervention.
For students in focused Tier 2 or Tier 3 intervention, data are collected in frequent progress monitoring of the target
skill(s) to determine whether the student is learning the expected amount of material at the expected rate. Generally,
if a student is responding, the intervention is continued. If the student is not responding to the intervention, either the
strategy is changed or the student receives more intensive services. Data collection and analysis are critical indirect
services in an RTI framework.
Advocacy and Leadership for Change

Advocacy and leadership, along with strategic communication about the SLP's roles and responsibilities, are
important for implementing RTI. Strategic communication with professionals, parents, and students from the
beginning is the key to full participation in the school's RTI system. If embedding RTI in a workload approach
represents a significant change, it is unlikely to occur if only the SLP knows about it. District and campus
administrators, educators, and parents need information about how the SLP's role in RTI will affect them, and most
importantly, the anticipated benefit for students.
Communication With Teachers and Principals
Focused conversations about standards, developmental expectations, and the connections between
language and learning.
Discussions about potential barriers to mastering standards for students with impoverished languagelearning systems.
"Data-talks" about student learning, teacher support, fidelity of interventions, and students' responses to the
interventions.
Conversations about using a workload approach to maximize students' rate of learning.
Communication With Parents
Conversations about how to be involved in helping children with schoolwork.

Providing information about the school's range of services and supports through RTI, and specifically, how
SLP services fit into the school's RTI framework.
Providing information about the student's learning challenges and how Tier 2 or Tier 3 interventions are
designed to accelerate learning of target skills during intervention.
Conversations about the schedule of RTI services and the rationale for the proposed services.
Conversations about the developmental aspects of communication and literacy.
Suggestions of specific activities that parents can use to improve the student's language and literacy skills.
Communication With Students
Providing information about skills to be mastered, the plan and schedule for working on those skills, the
target level of performance, and the plan for exiting intervention.
Since the reauthorization of the Individuals With Disabilities Education Act in 2004, the concept and practice of RTI
have brought the SLP's role in prevention into focus. Rather than viewing RTI as an added responsibility, the SLP
becomes an agent of change with a unique opportunity to help others meet the needs of every student in the school
by embedding RTI in a workload approach. When fully integrated in both general education and special education
initiatives, SLPs using educationally relevant services and a continuum of services bring great value to the school
community.
Judy Rudebusch, EdD, CCC-SLP, is assistant superintendent of student services and federal programs at the Irving
(Texas) Independent School District. She is a member of Special Interest Group 16, School-Based Issues. Contact
her at jrudebusch@irvingisd.net.
JoAnn Wiechmann, MA, CCC-SLP, is the coordinator of evaluation at the Pasadena (Texas) Independent School
District. She is a member of Special Interest Group 16, School-Based Issues. Contact her at
jawiechmann@yahoo.com.
cite as: Rudebusch, J. & Wiechmann, J. (2011, August 30). How to Fit Response to Intervention Into a Heavy Workload. The ASHA
Leader.
References
American Speech-Language-Hearing Association (2010). Roles and Responsibilities of Speech-Language
Pathologists in Schools. [Professional Issues Statement]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association (2002). A Workload Analysis Approach for Establishing
Speech-Language Caseload Standards in the School: Position Statement. [Position Statement]. Available
from www.asha.org/policy.
Cirrin, F. M., Schooling, T. L., Nelson, N. W., Diehl, S. F., Flynn, P. F., Staskowski, M., Torrey, T. Z., &
Adamczyk, D. F. (2010). Evidence-Based Systematic Review, Effects of Different Service Delivery Models on
Communication Outcomes for Elementary School-Age Children.Language, Speech, and Hearing Services in
Schools, 41, 233264.
Code of Federal Regulations Title 34 Department of Education. 300.34(c)(15).
Common Core State Standards Initiative (2010). Common Core State Standards. Available
fromwww.corestandards.org/the-standards.
National Association of State Directors of Special Education (2005). Response to Intervention: Policy
Considerations and Implementation. Alexandria, VA: Author.
RESOURCES
American Speech-Language-Hearing Association. (2002). A workload analysis approach for
establishing speech-language standards in the school: Position statement [Position statement].
Retrieved from www.asha.org/policy
American Speech-Language-Hearing Association. (2006). Roles and responsibilities of speechlanguage pathologists in diagnosis, assessment, and treatment of autism spectrum disorders
across the life span [Position statement]. Retrieved from www.asha.org/policy
American Speech-Language-Hearing Association. (2010). Roles and responsibilities of speechlanguage pathologists in schools [Professional issues statement]. Retrieved from
www.asha.org/policy
Brandel, J., & Loeb, D. (2011). Program intensity and service delivery models in the schools:
SLP survey results. Language, Speech, and Hearing Services in Schools, 42, 461490.
Flynn, P., & Power-deFur, L. (2012, July). Integrating common core standards into school-based
treatment. Paper presented at ASHA Schools 2012 conference, Milwaukee, WI.
National Association of State Directors of Special Education. (2005). Response to intervention:
Policy considerations and implementation. Alexandria, VA: Author.
Nippold, M. (2012). Different service delivery models for different communication disorders.
Language, Speech, and Hearing Services in Schools, 43, 117120.
Rudebusch, J., & Wiechmann, J. (2011, August 30). How to fit response to intervention into a
heavy workload. The ASHA Leader, 16, 10. (Included in the webinar handout)
Rudebusch, J., & Wiechmann, J. (2013, August 1). Time block after time block. The ASHA
Leader, 18, 4045. (Included in the webinar handout)
Wiechmann, J., Rudebusch, J., & Kuhles, N. (2011). Language LAB: A response to intervention
program for teaching grammar, vocabulary, and storytelling. Greenville, SC: Super Duper, Inc.

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