By: Kendall Cain, MS, CCC-SLP, Public School Committee Chair, and Cherry Wright, MS, CCC-SLP, TSHA/TCASE Public School Advisory Joint Committee

The Public School Committee worked in collaboration with the Public School Advisory Joint Committee of the Texas Speech-Language-Hearing Association (TSHA) and the Texas Council of Administrators of Special Education (TCASE) to complete a survey of the 2,000 public school TSHA members that attended the Public School Forum at the TSHA Convention and through an online survey in April 2022. Approximately 500 responses were received, which reflected a response rate of 25%.

Concerns
The survey asked participants to rate the following concerns on a scale of 1 to 6 (with 1 being the most severe).

                                              Most severe (1-2)                 Least severe (5-6)

Large caseloads                    65%                                        21%

Shortage of personnel           56%                                        23%

Impact of pandemic               37%                                        27%

New School Health and Related Services (SHARS)
rules and procedures            34%                                        27%

Student assessments           34%                                        22%

Encroachment issues           27%                                        38%

Staffing
Of the respondents, 81% indicated a shortage of licensed speech-language pathologists (SLPs) in their districts, and 91% reported needing additional positions.

Also, 79% indicated that speech-language pathologist assistants (SLP Assistants) are employed in their districts, and 72% reported contracting for services. In addition, 57% reported a re-alignment of roles and responsibilities to address the need.

Following is a summary of activities that were reported as worrisome strategies being used by the districts to address staffing shortages:

• Districts are hiring more SLP Assistants, some without adequate SLPs for supervision.
• SLPs are delegating more to SLP Assistants.
• SLPs are supervising, completing evaluations, and conducting Assessment, Review, Dismissal (ARD) meetings rather than providing services.
• SLPs are serving multiple campuses.
• SLPs are assuming large caseloads.
• SLPs are attempting to clarify Multi-Tiered Systems of Supports (MTSS) to help with referrals. This also is referred to as Response to Intervention (RTI) in some districts.
• Districts are contracting with companies to provide teletherapy.
• Districts are contracting for bilingual evaluations .
• Districts are hiring clerks to assist with paperwork.
• Diagnosticians are handling all ARDs.
• Districts are assigning case management for all primary speech-impaired (SI) students to special education teachers. Diagnosticians are conducting ARD meetings and writing non-speech sections of the full and individual evaluation (FIE).
• Districts are developing assessment and ARD teams among SLPs.
• Districts are paying extra duty pay for testing and writing reports .
• Districts are hiring retired diagnosticians to help with paperwork.
• Lead SLPs are assuming assessment responsibilities.
• Districts are focusing on compliance with timelines, rather than therapy services.
• Districts are trying to ensure SLPs are only held accountable for roles that align with their job responsibilities, removing expectations of campus duties, campus committees, and campus state testing assignments.
• Districts are focusing on hiring more teachers, not SLPs.
• Districts are growing, which is resulting in more referrals, but not additional SLPs.
• Pay is insufficient.

New SHARS Rules and Procedures
Of the respondents, 56% indicated that SLPs in their districts had applied for a National Provider Identifier (NPI) number. Only 44% reported that SLPs had enrolled in Medicaid.

In addition, 41% indicated that their districts had a SHARS referral process for evaluations in place, and 81% reported that the SLPs were familiar with documentation requirements. Also, 54% have a process in place to address the seven-day reporting timeline.

Student Assessments
Of the respondents, 95% reported they had seen an increase in requests for assessments since the pandemic, and 90% indicated an increase in parent requests. Also, 82% reported that most students being referred qualified for services. When asked the reason for referrals, 50% reported a lack of instruction during the pandemic, and 64% indicated student population growth in their districts. In addition, 83% indicated that the TSHA Disability Determination Guidelines are being used in their districts.

Large Caseloads
Of the respondents, 96% indicated that their districts had seen an increase in caseloads, and 50% felt it was due to the shortage of SLPs. In addition, 89% reported it was because of an increase in students qualifying for services.

Impact of the Pandemic on Student Services and Progress
Of respondents, 86% reported that their districts had provided online services during the pandemic, but only 38% felt that online services were the cause of failure to demonstrate desired progress. In addition, 72% indicated that their districts are providing supplementary services to catch up due to the loss of instruction during the pandemic.

Respondents indicated that districts are providing needed services through compensatory services including before and after school, on Saturdays, and during intercessions, through extended year services, and by providing additional direct/indirect therapy. Some reported that services have been necessary more for academic reasons rather than for speech and language. 

Legislation and Advocacy
Most respondents reported that they were unsure if their districts felt that vouchers were a major challenge. Of respondents, 70% supported TSHA spending significant time in the regulatory process to attempt to raise Medicaid funding in SHARS, and 52% reported that they had experienced encroachment issues from dyslexia, applied behavior analysis (ABA), etc., in their districts.

Attendees at the Public School Forum raised concerns about pay in the schools. As a result, a question was included in the online survey, and 55% indicated that they had received a pay raise the last time the legislature approved a raise for teachers, librarians, and nurses.

Of the respondents, 64% said they would volunteer to contact their legislators to advocate for SLPs in the schools, and 62% indicated they would assist in collecting data to support TSHA’s legislative agenda.

Greatest Needs in Districts
Greater than 90% of responses revolved around the following needs:

• Need for increased compensation: SLPs feel more is expected of them as a result of increased referrals, increased caseloads, additional duties, the seven-day rule for Medicaid billing, etc. Pay is not increasing proportionally to the increase in workload/caseload. Concerns were expressed that the current statewide focus is on the shortage of classroom teachers although there is a shortage of SLPs as well. The need for retention incentives also was mentioned.
• Excessive paperwork: With the addition of new house bills such as HB 4545, changes in Medicaid documentation, increase in the volume of RTI (MTSS), ARDs, and FIEs, additional paperwork is required. Paperwork often has to be completed after hours and on weekends.
• Increase in referral volume: Fast-growing districts are not hiring sufficient SLPs to manage the increase in students who qualify for services. Referrals, including parent referrals, have increased post-pandemic.
• Lack of staffing: The critical shortage of SLPs across all settings is pervasive. The school setting is competing with other settings such as medical, home health, private, and telepractice. Attrition of SLPs in the schools is increasing.
• Caseload Size: It was consistently reported that large caseloads and the accompanying workload negatively impact the quality of services provided. It is becoming increasingly more difficult for SLPs to provide therapy due to required attendance in meetings. There was mention of the need for statewide caseload caps. 
• Lack of support/understanding/empathy/respect from district leadership: This was a common and pervasive theme throughout survey responses. Many feel that campus-level leaders do not understand the role and responsibilities of SLPs and have concerns that their clinical judgment and expertise are not respected. Others pointed to the lack of advocacy for the SLP position at the district level.

In summary, TSHA appreciates the response of its members in the public school setting. The results of this survey will provide TSHA’s public school committees with an understanding of the current status of SLP services in the schools, including the greatest needs, and will assist in targeting efforts to provide guidance and support. SLPs are encouraged to share the information with administrators in their respective districts to advocate for the professions and their critical role as an SLP in public schools.