This document was approved as a CSHA position paper Oct 7, 1995
 
In California there is a growing concern among speech-language pathologists (SLPs) employed in the public schools about the number of students assigned to them for services. This concern is magnified by the increasingly complex communication disorders presented by many of the students assigned. Caseload data are beginning to reflect a trend toward fewer children being identified as having a speech-language disability (ASHA, 1992). This is not surprising when we consider advanced medical technology which impacts survival rates among pre-mature infants who are at risk for normal communication development, as well as the detrimental effects of substance abuse. There are the additional challenges of cultural and linguistically diverse student populations; single parents, working with little time for family responsibilities; changes in service delivery models; revisions of eligibility criteria for services; expansion of age groups, including pre-school and even infants and toddlers; multi-disciplinary conferences; paperwork which may now include tracking Medicaid and health insurance reimbursement; and meeting the many responsibilities involved in comprehensive service delivery. Add to this economic constraints, budget cuts, personnel shortages, and overall downsizing of government programs. There is no doubt that professionals in California, particularly those working in the public schools where caseloads are the highest (1992 Omnibus Survey, ASHA, August 1992, p. 61), are dealing with increasingly complex service delivery issues.
 
In the 1960s, speech-language pathologists reported seeing an average of 111 students per week. By 1981, six years after the passage of PL 94-142 (Education of the Handicapped Act [EVA]), caseloads had decreased significantly with national caseloads averaging 43 students. Slowly this number began to rise nationally. In 1992, the ASHA Omnibus Survey indicated that the average monthly caseload for speech-language pathologists working full-time in the schools was 52. This means that some professionals had caseloads considerably higher and others much lower than average reported.
 
In 1987 CSHA conducted a statewide survey using data reported as of December 1 of that year. In this survey, individual caseloads were reported as high as 123, and 30% of individual specialists reported caseloads exceeding 55 students. Forty-six out of 126 districts/county offices surveyed indicated caseloads exceeding the legal maximum average of 55 (Plummer, 1988). Current data (May 1995), gathered from three districts and two county offices in northern California, with 79 specialists responding to a survey, plus reported data from one district in Southern California indicate school caseload averages to be between 61 and 69. Anecdotal reports suggest that some speech-language pathologists have caseloads of 80,90 and even 100. How does this impact the quality, legality and appropriateness of service provided? Are there matters of professional ethics to be considered? What happens to a professional’s obligations to the client when outside pressures bear upon the relationship with the client? Obviously the answers to these questions are not simple. This document examines, some of the resources available to SLPs* in the search for appropriate solutions to these dilemmas.
 
*NOTE: While ASHA and CSHA guidelines for publication style designate the use of the term "Speech-Language Pathologist", the California Education Code refers to the job title of "Language, Speech and Hearing Specialist" as the official title for the professional responsible for providing speech and language services within the public schools. Therefore, these terms may be interchanged throughout this document.
 
National Policy/Guidelines

I. Legal Considerations
 
Federal Law - The following information focuses on two major federal laws protecting the rights of children with disabilities. The establishment and implementation of these laws have a profound effect on the way all children are educated in this country. The Individuals with Disabilities Education Act or IDEA (originally entitled the Education of All Handicapped children’s Act, PL 94-142), guarantees the right of a free and appropriate public education to every child identified with a disability. Section 504 of the Rehabilitation Act discusses the provision of appropriate education.
 
IDEA - Individual with Disabilities Education Act (originally PL 94-142) requires the provision of a free, appropriate public education (FACE) which includes individually designed instruction to meet that child’s unique needs. Appropriate education services do not have to be "the best" services. Appropriate means a program designed to provide "educational benefit" to the child. A full, comprehensive evaluation is required assessing all areas related to the suspected disability. Note that the Local Education Agency (LEA) and its local plan is a contract with the state to provide special education under IDEA, and the California Department of Education (CEDE) and its Special Education Division’s (SEED) approved State Plan is a contract with the federal government. Both of these contracts have provisions for a complaint system as well as a compliance system. It must be noted that the SLIP or other special educator performing the assessment and making recommendation, is NOT the responsible entity for the final IMP team decision nor the school administration’s placement of the child.
 
Section 504 of the Rehabilitation Act of 1973. While IDEA is a federal mandate and has due process requirements for parents (i.e. fair hearings, appeal processes, etc.), it is basically a funding statute. If violated, federal funds can be withheld. Section 504, however, is a broad civil rights act prohibiting discrimination by schools and those entities receiving financial assistance from the federal government based upon handicaps, similar to prohibitions based upon race. The term "appropriate", for Section 504 purposes, means an education comparable to that provided to non-disabled students. Reasonable accommodations must be made for students with disabilities in order that they are afforded "an opportunity to participate or benefit from the aid, benefit, or service" that is provided other students.
 
The above IDEA and Section 504 laws and rights of the student with disabilities are vital. Some people argue that the state’s complaint and compliance systems under IDEA are weak. Therefore, Section 504 protecting an individual’s civil rights may be more powerful. While excessive caseloads are often thought of in terms of abuse or violation of the SLP’s employment contract, working conditions, or class size or caseload law, the more powerful legal argument is the inability to provide "appropriate" services as outlined in the child’s IMP and to all children carried on an individual SLP’s caseload.
 
II. Ethical Considerations.
 
American Speech-Language Hearing Association (ASHA) -

1. ASHA Code of Ethics (Revised January 1, 1994)
    
   This is the document which provides the most support for professionals who are concerned about the quality and appropriateness of service they are providing. As Levy and Mishkin (1990) state: 

• The framework for solving ethical conflicts faced by professionals rests upon one indisputable precept: Ethics is an individual responsibility.
   
  There are times when budget constraints, personnel shortages and other outside pressures restrict the speech-language pathologist from exercising his/her professional responsibility to develop and/or implement appropriate clinical services. It is incumbent upon the speech-language pathologist to determine when to accept limitations on professional responsibility and in so doing the individual should consider the following:
  
• Principle of Ethics I: Individuals shall honor their responsibility to hold paramount the welfare of persons they serve professionally.
  This is a fundamental precept of the Code. It is intentionally represented as the first principle because it is viewed as a beacon around which other principles of ethics revolve.
  
• Principle of Ethics I, Rule B. Individuals shall use every resource, including referral when appropriate, to ensure that high quality service is provided.
  Individuals should promote the most comprehensive intervention programs possible within the resources available to the client.
  
• Principle of Ethics IV, Rule E. Individuals shall not provide professional services without exercising independent professional judgment, regardless of referral source or prescription.
  Individuals are expected to exercise independent clinical judgments and not accept prescriptive directives from non-ASHA certified persons.
  
  All professional activity must be consistent with the Code of Ethics. Particularly relevant to clinical practice are those provisions for holding paramount the welfare of persons served. As an employee, the recommendations of the SLIP may be overruled by higher administrative authority. If so, and such ruling in any way compromises the service provided to students on the SLP’s caseload, the SLIP should use appropriate channels to seek a resolution to the problem (See Exhibit "B").
   

2. Preferred Practice Patterns - ASHA 1993 (ASHA, 35, No. 3, Supp. 11)
    
   ASHA established these practice patterns to enhance the quality of professional services. These statements serve as a guide to professionals and they apply across all settings in which speech and language services are rendered. They are sufficiently flexible to permit both innovation and acceptable practice variation, yet sufficiently definitive to guide practitioners in decision making for appropriate clinical outcomes. The guiding principles (See Exhibit A attached hereto) formed the basis of the Preferred Practice Patterns.
   
3. The official statement of ASHA concerning caseloads and service delivery in the public schools.
    
   Responding to concerns of its membership working in the public schools, ASHA initiated an ad hoc committee to examine service delivery in the schools. This committee examined various service delivery models including consultation, collaboration-consultation, classroom based, self-contained as well as the traditional pull-out model. The committee also examined the issue of support personnel within these various service delivery models. Lastly, the committee examined the controversial issue of caseload size. In 1992, the committee developed "Guidelines for Caseload Size and Speech-Language Service Delivery in the Schools." These guidelines are the official statement of ASHA and they were published in ASHA (1993) 35 (Supplement 10), pp. 33-39. These guidelines recommend a maximum of 25 when the caseload consists entirely of preschool students, and a maximum of 40 for school age children. These guidelines also provide suggestions for caseload management. For example, they suggest that in addition to eligibility criteria, "weighted systems, formulas, and severity scales may be of assistance in determining the degree of severity of the disorder and in equalizing or comparing individual caseloads." Weighted criteria to determine/justify amount of service can also assist in determining equitable speech-language pathologist staffing assignments.
   
4. ASHA guidelines on admission and discharge criteria.
    
   In 1994, an ad hoc committee of ASHA developed Admission/Discharge Criteria in Speech-Language Pathology. This document was developed in order to promote the use of objective criteria to ensure cost-effective provision of quality services. Such guidelines can be useful in the management of caseloads. These guidelines should be published sometime in 1995.

State Policy/Guidelines

I. Legal Considerations
 
Maximum caseload size - Provisions for caseload size are delineated in the California Education code which specifies:
 
Education Code Section 56441.7 establishes a maximum per therapist caseload of 40 for SLPs providing services exclusively to preschool children (0-5 years) with exceptional needs. (If an SLIP is serving pre-schoolers on a part-time basis or carries a mixed preschool and non-preschool caseload, the caseload numbers must be pro-rated. Caseload size can be waived, if justified, by the State Superintendent of Public Instruction.)
 
Education Code Section 56363.3 establishes a maximum average of 55 per district, county offices or special education local plan area (SELPA), unless the local comprehensive plan specifies a higher average caseload and the reasons for the
greater average caseload.
 
Note 1. the state Special Education Division at one time declared that the caseload average is to be determined by the location of employment (i.e., if the SLIP is employed by the district, then the maximum average caseload is to be determined by numbers across the district). Currently the wording in the code section "or SELPA" has prevailed to compute averages.
 
Note 2. The Local Special Education Plan including caseload waiver provisions should be approved by parents and the local union.
 
School Based Coordination Programs (SBCP) - When the SLIP works in an approved School Based Coordinated site under a School Site Plan accepted by the local bargaining unit, the maximum caseload requirements may exceed 55 with a waiver application under the guidelines of Education Code 52860. However, SLIP services to non-identified students on a regular basis must be counted as part of caseload limits, and SLIP services to non-special education students are not to preclude satisfying services for identified IMP students (CEDE Program Advisory, SBCP 1987).
 
Fiscal Guidelines - The California Department of Education (CEDE) adopted fiscal guidelines for reimbursement to schools serving individuals with exceptional needs, including one full time equivalent (FTE) SLIP position for each 24 unduplicated students. Thus, if a student is served within a special day class or a resource program, and receives other Designated Instructional Services (DIS), such as speech and language, the school district or SELPA does not receive additional income for these necessary and duplicated related services. Essentially, public schools are financially penalized for providing any duplicated special education services. When these fiscal guidelines were adopted years ago, part of the unit funding was to be for duplicated DIS services (about 30% above base total). The inadequacy of these fiscal guidelines is part of the reason for current proposals to block grant funds with local control of spending. It is highly doubtful, however, that block grants will ease the problems of under funding for duplicated services.
 
The law has established maximum caseload requirements of 55 per SELPA average. Because of the AVERAGE caseload wording, it is not unusual for SELPAs to report individual caseloads ranges from as low as 30 to as high as 90+ per full time SLIP. This happens because as long as the SELPA average does not exceed 55, students receiving speech and language services are considered to be appropriately served. In addition, the 55 average may be increased under the provisions of the SELPA local plan. As noted above, in the discussion of the Code of Ethics, each SLIP must decide whether under these circumstances appropriate service is indeed being provided.
 
II. California Speech-Language Hearing Association (CSHA).
 
Protections offered by the State association:

1. Lobbying: It should be noted that every year for the last ten years, SELPA directors have advocated the elimination of school SLIP caseload requirements citing the need for greater flexibility due to mainstreaming and shortages. CSHA has successfully opposed these elimination efforts so caseload maximums would not increase. Currently, a growing call for block grant funding and local control poses an even greater threat to the continuation of state caseload mandates. CSHA continues to fight for appropriate caseload maximums. Discussions as to lowering the SLIP caseload maximums or even changing the wording to "maximum per therapist" would require over a million dollar augmentation-an impossible position for the current legislature.
   
2. Changes in CEDE policies: CSHA has been successful in having the Coordinated Compliance Review (CCR) manual require questions as to caseloads/class size. The CCR team should attempt to verify a district’s statement that they are within state caseload maximums when conducting district compliance reviews. If caseloads exceed the legal average, the CCR team should verify that waivers have been appropriately obtained. If waivers are being utilized, the question should be raised "are IEPs being fully and appropriately implemented for the children on each SLP’s caseload?"
   
3. Complaints: CSHA can file a complaint with CEDE/SEED. To assist in such a complaint, school or SELPA SLPs should gather caseload data for their district and/or SELPA and forward to the CSHA Office.
   
4. CSHA Task Force on Caseloads: In 1992 CSHA established a task force to examine caseload management issues in the schools. The committee worked diligently to receive input from the general membership, and as result they identified issues and made recommendations for dealing with the various problems identified (See Exhibit B attached hereto). At the 1994 CSHA Annual Conference, the committee presented a draft of the issues with preliminary recommendations. Following the input received the draft was revised and the final document is attached as "Exhibit B." The Task Force also developed suggested strategies for caseload management and this is attached as "Exhibit C" to this document.
    
   Also, on recommendation of this committee, the CSHA Board voted to adopt the ASHA (1993) Guidelines for Caseload Size and Speech Language Service Delivery in the Schools (January 1993 CSHA Board Meeting).

What is Happening in Other States

SLIP caseload guidelines and recommendations have been written into special education state plans in most states. State guidelines vary from 24 to no limit. Caseloads in excess of state guidelines are reported by SLPs each year, leading to serious questions concerning quality and appropriateness of service for students with communicative disorders. SLPs in California and other states have voiced their concerns about the quality and appropriateness of these services. At the federal level, the Office of Civil Rights (OCR) has investigated a number of complaints under the appropriate education and discrimination provisions (Section 504, Rehabilitation Act). In one recent complaint, the State of Alabama was cited for violation of Section 504. Alabama was directed to provide services to speech and language impaired students based on the individual needs of the student rather than on the availability of time SLPs have to provide services.

Conclusion

In spite of SLIP concerns, school boards continue to pressure administrators to address and increase local control and allow more flexibility in various reform efforts such as year round schools, full inclusion, and alternative service delivery options. For many SLPs this means that constraints are imposed by influences outside the professional relationship, and each SLIP must decide when such influences begin to impact the quality and appropriateness of services provided.
 
In summary, this article represents the significant work accomplished by the CSHA Task Force on Caseloads. It has attempted to urge professionals working in the public schools to be aware of the resources available to them as they manage ever increasing caseloads and strive to provide quality services. While ethics is an individual responsibility, legal considerations must guide the provision of all services. This document outlines both legal and ethical resources available to SLPs and hopefully this document will assist in resolving potential legal and ethical conflicts.

References

American Speech-Language-Hearing Association (1992). 1992 Omnibus Survey. ASHA. August, 1992, p. 61. ASHA: Rockville, MD.
 
American Speech-Language Hearing Association (1993) Preferred practice patterns for the professions of speech-language pathology and audiology. ASHA, 35, No. 3 (Supp. 11). ASHA: Rockville, MD.
 
American Speech-Language-Hearing Association (1993). Guidelines for caseload size and speech language service delivery in the schools. ASHA, 35, (Suppl 10), pp. 33-39. ASHA: Rockville, MD. (Note- this document is available from ASHA by Fax on Demand at 202-274-4520.)
 
American Speech-Language-Hearing Association (1994). Admission and discharge criteria in speech-language pathology. Unpublished.
 
Blake, Andrea (1992) Speech language pathologists in the schools. In ASHA, June/July,p. 82. ASHA: Rockville, MD
 
California State Department of Education (1989). Program guidelines for language speech and hearing specialists providing designated instruction and services, CEDE: Sacramento, CA.
 
California Speech Language Hearing Association (1963) Caseload study. A Monograph Supplement of CSHA, May, 1963. CSHA: Sacramento, CA
 
Diedrich, William M. and Bangert, Jeff (1980). Articulation learning. Houston, Texas.
Johnson, Cassandra Peters (1992). Professional practices perspective on caseloads in schools. ASHA, p. 12. ASHA: Rockville, MD.
 
Plummer, Bonnie (1988) New SLH caseload data. CSHA Newsletter, June. CSHA: Sacramento, CA
 
Secord, Wayne A. (1990) Best practices in school speech-language pathology. Educom, Colombus, Ohio.
 
Shewan, Cynthia M. and Slater, Sarah C. (1993). Caseloads of speech-language pathologists, ASHA, January, 1993. ASHA: Rockville, MD.

Exhibit"A" - Guiding Principles

Reprinted from Preferred Practice Patterns for the Professions of Speech-Language-Pathology and Audiology. ASHA (1993), 35, No. 3 Supplement 11. II. Guiding Principles
 
The following guiding principles formed the basis of the Preferred Practice Patterns. The practice patterns:

1. Keep paramount the welfare of patients clients served in all practice decisions and actions.
   
2. Identify the professionals within the discipline of human communication sciences and disorders who may perform any given procedure.
   
3. Address the clinical indications for performing any given procedure.
   
4. Define appropriate environmental factors related to procedures (e.g., seKlng, equipment, and materials).
   
5. Address demographic factors (e.g., age; development; education; occupation; and cultural, ethnic, linguistic, and social factors).
   
6. Consider risk as it relates to the health, safety, and welfare of patients/clients and practitioners; severity of illness or disability, severity of communication, swallowing, or other related disorder(s); premorbid health and cognitive status; related conditions and complications; effects of medications, surgery, and other interventions; special needs (e.g., glasses, hearing aid, wheelchair); social needs/support system; and other services needed.
   
7. Consider outcomes including prevention of communication, swallowing, and other related disorders; improvement and/or maintenance of functional communication; and enhancement of the quality of life.
   
8. Consider intradisciplinary (speech-language pathology and audiology) and Interdisciplinary approaches to service delivery.
   
9. Recognize the dignity of individuals and consider patient/client rights, expectations, needs, and preferences.
   
10. Recognize the importance of documentation.
    
11. Recognize a variety of appropriate service delivery models and procedures (e.g., collaborative consultation, use of support personnel, and new and advanced technologies).
    
12. Adhere to the specifications and intent of the current Code of Ethics.

Exhibit"B" - Issues and Recommendations CSHA Task Force on Caseloads, 1994

Issue 1. Monitoring and Reporting Caseloads.

• The existing maximum average caseload requirements are often ignored or infrequently monitored within the public schools.
  
• Current data collection procedures for Federal and State reports (December 1 and April 1 counts) do not include specific data on duplicated caseloads. The April 1 student count lists unduplicated and duplicated students, but does not differentiate types of services or disability. This current method of data collection does not report average duplicated caseloads, rather, only unduplicated are reported.

Recommendation

1. In order to ensure compliance of State mandates relative to caseload maximums required in the California Education Code, Section 56363.3, it is recommended that SELPAs report both duplicated and unduplicated caseloads on the December 1 and April 1 child count. This pupil count shall report number of children served by each Language, Speech and Hearing Specialist.
   
2. During Coordinated Compliance Reviews, be sure the CCR team has verified the district’s statement that they are within the caseload maximums. If not, they should check to see if a waiver has been obtained.
   Issue 2. Maximum Caseloads Per Language, Speech and Hearing Specialist (LSH).
   LSHs in California have consistently reported excessively large caseload averages. Within the last decade, services in the schools have been compromised in order to accommodate the ever increasing population demands, personnel shortages, and service delivery changes.

Recommendation

Consider the legal and ethical issues discussed in detail in this document. Remember, ethics is an individual responsibility, but there are also legal protections at both the State and Federal levels. If the caseload size is excessive and, in the opinion of the LSH the individual needs of the identified student(s) cannot be met, caseload reduction alternatives need to be explored. Seek assistance from district/county administrators or SELPA directors in investigating appropriate solutions (e.g. alternative services delivery models, reduction of paperwork, supportive personnel). If such administrators are not supportive, report your concerns to CSHA. Only when CSHA hears from sufficient numbers of LSHs can change begin.
Issue 3. Serving Non-Identified Individuals with Exceptional Needs (IWENS).

An increasing number of students who do not meet eligibility criteria (CA Education Code, Section 56333) may require special accommodations and services under the requirements of Section 504 of the Rehabilitation Act, or under the provisions of the School Based Coordination Act. At the present time, these two provisions are probably not included when determining average caseloads at the local or SELPA level. In many instances, only those students identified with IEPs are included in calculating caseload. While students who do not meet eligibility requirements may not be counted, they do require a significant amount of time both in assessment and consultative services. These students need to be recognized on the caseload in some fair and efficient manner.

Recommendation

The existing caseload requirements apply only to those individuals with exceptional needs (IWENS). If services are requested for individuals who are not identified as IWENS, then it is recommended that LSHs serve such individuals PROVIDING that those students on the existing caseload can be appropriately served in a manner consistent with state and federal laws and guidelines. Issue 4. Serving Students in Year Round Schools. LSHs are compromised by increasing mandates to provide services in all settings, including year round schools. Often students continue to receive DIS services while not enrolled in a cycle, thus impacting LSH caseloads.

Recommendation

1. Students are eligible to receive DIS services during their 180 day school schedule. Services during off-track times are above and beyond what is required by law. If "off cycle" students with active IEPs are served, they should be placed on the December l and April 1 count. In other words, if a student is receiving direct services during an off cycle, that student should be included in the caseload count. Possibly, IEPs should contain number of weeks of service, or the track on which the child is served, in addition to number of times per week.
   
2. Also, as stated above, if service to these off cycle students compromises the services received by "on cycle" students with active IEPs, then alternative solutions must be explored. Seek assistance from administrators.
   Issue 5. Providing Appropriate Services.
   When caseloads seem excessive, LSHs may not be familiar with state and federal protections (as outlined in this document) or with local procedural steps to resolve caseload abuses.

Recommendation

1. Be familiar with this document, Language Speech. Hearing Service Delivery in the Public Schools: Legal and Ethical Considerations. This article highlights the protections available to LSHs.
   
2. Refer to Exhibit "C" of this document, where caseload management strategies are discussed.
   
3. When caseload abuse issues cannot be resolved at the local level, seek assistance from CSHA. It is important to be a member of your State Association. The Articles of Incorporation of CSHA, Section 3(1) and Section 3 (2i) state that CSHA will provide informational support and advocacy for its members and for children with communication handicaps.

General Recommendation

1. It is best that caseload issues be resolved at the local level. Start with the site administrator, or DIS supervisor. Make them aware of "Best Practices in School Speech-Language Pathology" (Secord, 1990). It might be wise to provide a copy for each site administrator. Often these individuals have a limited perspective of our ever-changing profession and current trends.
   
2. Determine the local District and/or SELPA averages for unduplicated and duplicated caseload counts.
   If the count exceeds the 55 average, review the local plan to determine if there are provisions for exceeding the 55 limit. The "Local Plan" is located at the SELPA office. If the SELPA average exceeds 55 and the local plan does not allow for exceptions, your SELPA is in non-compliance with the California Education Code. This is a compliance issue. Options are to consider hiring additional staff or non-public agencies, interagency agreements, additional duty stipends, etc.
   
3. Consider working through your local bargaining unit. The caseload maximums might be negotiable at the local level. Caseload averages for the district or even caseload size per therapist could be spelled out in the local contract. Actually, a contract could be more enforceable than the enforcement procedures presently in place. At the minimum, the local employment contract could make reference to caseload law or even contain a simple clause "that provision of services will be in compliance with all laws."
   
4. Explore Caseload Management Strategies (Exhibit C, attached) After deciding which of these might be implemented, discuss the choices with immediate supervisors and propose a trial period followed by evaluation of the effectiveness in resolving caseload concerns. If the above attempts have not been successful in reducing caseload concerns, contact the State Department of Education in Sacramento and request assistance from a local consultant. It is possible that the consultant can meet with you and your site administrator to review the concerns and explore possible alternatives.

Exhibit"C" - Suggested Ideas to Make Your Caseloads More Manageable

Adopted from Best Practices in School Speech Pathology (Secord, 1990) and the Program Guidelines for Language, Speech and Hearing Specialists Providing Designated Instruction and Services (1989)
 
Review caseloads periodically to determine if any students have been served for the same disorder for more than 3 years, or have shown no growth within a 3 year period. (This is an ethical issue)
 
Determine if some students have the same goals and objectives for more than two years. If so, consider therapy rest, a review of the intervention procedures, or referral to another clinician (This is an ethical issue).
 
Determine if some students ready for carryover could receive services on a once a month basis to monitor maintenance and generalization.
 
Determine if any other professional or an assistant could facilitate the goals and objectives written for a particular student, or help in the monthly monitoring process.
 
Consider intensive block scheduling or broader multi-disability groups. Rearrange students for greater results in a shorter period of time.
 
Place students on a mutually agreed upon contract to complete their therapy in 16 weeks, 10 or more sessions, etc. This will help to increase student accountability.
 
Examine parental involvement. Get parents involved by participating in home assignments. This is an effective procedure for monitoring articulation and language learning. Can also be effective in helping to establish voice and fluency changes.
 
Examine service delivery and caseload management models in surrounding districts or SELPAs.
 
Consider using weighted formulas in determining caseload eligibility. Severity rating scales and number of sites can be useful in determining LSH assignments within a district.
 
Read and implement best practice articles in professional journals and periodicals.

The following CSHA members contributed to the development of this document:

James F. Blinn
Wendy Bergman
Jomar Lococo
Judy Montgomery
Lisa C. O’Connor
Diane Bangar
Arlene Kasprisin
Catherine McCormack
Gina Nimmo
Charlene Rau