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Early Intervention Speech Therapy

The Paperwork Issue Continues

Published April 26, 2010 12:48 PM by Stephanie Bruno-Dowling
Last week I discussed the issue of paperwork at my new Early Intervention Preschool position. Several of you wrote in with various comments, some of which reflected my own thoughts and reasoning for decisions made both in the past and now.

When I first graduated over a decade ago, I went right to the schools. It was where I felt most comfortable and had truly enjoyed my internships as a student. After working in several districts, struggling with caseloads of 75+ children and hours and hours of paperwork, I made the decision four years ago to try EI homecare.

I loved homecare and remained in the job for 3 and 1/2 years, but the position was full-time and ran 52 weeks a year. With recently having a baby, I made the decision in January 2010 to take a position with a shorter workday and 14 weeks off a year (what they call a "stretch" preschool schedule) to spend as much time as possible home with my baby.

Now that I'm a mom, the demands at home are as constant as when I am at school. Budgeting time is easier said than done when you are busy all day long at work and have the demands of home and family waiting for you at the end of your work day. I am constantly multitasking and yet there is always another "to do" list item waiting to be checked.

The reason for writing last week's post was not to complain about my job, but instead to shed some light on a problem that exists both in the school systems (as many of you mentioned) and also at the EI preschool level, where I am currently working. Before having a baby, I would bring paperwork home—no problem! I didn't love it, but I was willing to do it. I would plop myself on the couch at night and tackle billing, reports and IEPs for hours.

As one therapist commented, "Spending more and more time doing paperwork and meetings and less time providing direct service to kids is exactly why I left public schools for EI. I was tired of having to constantly prove that I was doing my job..." She went on to share that since working in EI, "I've rediscovered the joy I use to feel doing speech therapy and I will never return to schools".

I share this perspective not as a complaint, but to raise an issue that exists within our field. Are we losing good therapists in the schools because of the paperwork demands and high case loads? And if so, as therapists, is there anything we can and should do about it?


Join me next week as we talk about some possible solutions....!


Hey Everyone,

I was perusing the net and caught the comments on Stephanie's blog. Here are your answers:

For 5 years, I worked with multi-needs exclusively in a K-5 building as a contract therapist. My caseload NUMBER varied. The most I had was 22 and I had to see ALL of those kids in 2 days. (Some of the kids had 90 mins. Try fitting THAT into your schedule of  2 days.) Did I complain? No. I jumped in and provided service. I had other responsibilities that related to classroom mgt and team mgt. Did I say no? Nope, I jumped in and did it. How did I plan for these students? Hmm, I planned during the school day, during lunch, while I was in the shower and while I shaved. I was a multi-tasker. Did I participate in extracurricular activities that went after school? Yes, I was on the eco-friendly team that taught the K-5 kids how to be eco-friendly. This was year round. In addition, I wrote a grant that serviced after school kids. Did I complain? No, I jumped in and did it. Hmmm, did I ever take work home? Not usually. The only time I worked weekends was when I had to write my I.e.p's and that was only 1x a  year when it was time for Annual Reviews.

In answer to Annie, Yes, I am familiar with the time study and I carried it out every time it was given to me.

Let's see what other things did I do? I made phone calls (REPEATEDLY) to ALL the  pvt therapist's that worked with the kids on my caseload. In addition, I talked with parents and brought them up to speed on the progress of their kids. The reason? Well, I did NOT want to overwhelm them at Annual Review when we only allotted 60 mins for a mtg.

My secret? Time mgt and great multi-tasking skills. Did I ever want more $$ for stuff that I did before or after school? No, I am dedicated to my field and I love what I do. I could never have asked my principal or my team for planning time when I knew what working in a school was all about. Call me crazy but I was glad to have a job.

Bob Roza, Speech - President, Integrative Speech, Inc. May 6, 2011 6:50 PM
Westchester IL

I've worked mostly in public schools since 1983 and Bob, times have drastically changed in that setting from when you may have worked there. If you haven't carried a school caseload in the past 5 years, then you would be shocked at the demands placed on SLPs by government regulations and administrators. My favorite piece of torture is the dreaded time study where we have to track and code every minute of our day for two weeks in 15 minute increments. Hmm...let's see, I spent 30 minutes seeing a group so that's 2 periods of H1, then I ran to the bathroom for 5 minutes-is that a G3 or I2? Meetings set up without consulting you, so you scramble to update your goals, write a summary, and make graphs--in between seeing kids--knowing that the groups you are having to cancel will have to be squeezed in somewhere for a make up time--and yes, at least one teacher will complain to administration. Asking for paperwork time? Your union will complain when they find out, so your administrator won't let you have it when teachers aren't given similar time. It's a recipe for failure.

Annie, SLP May 8, 2010 8:17 AM

Bob - tell us your secret! What was your caseload like that you were able to see all your kids, go to all the meetings and get all paperwork done in your work day? Did you say "no" to other responsibilities? It's always great to hear how other therapists are making it work ....

Thank you to everyone who is writing in - this issue NEEDS to be discussed!

stephanie bruno dowling, blog author May 1, 2010 1:00 PM

I resigned from my position because the paperwork was becoming more important to the administrators than working with the children They also told you how to conduct therapy, how to write your IEP's  what to say at meetings, etc.  They did not respect your professional judgement, training or advanced degrees.   They expected you to make communication books,  PECS books or program AAC devices , meet with teachers, document progress and attendance all during our 30 minutes PREP time before or after the start or end of the school day, and make up therapy time if there were absences, field trips, etc.for yourself or another therapist.  Teachers were also so bogged down with paperwork for ABA, program training books and graphing progress, that they were behind their computers all day most of the time through lunch, and had to leave the teaching to their TA' s..  The TA's discuss with each other how to document a response or lack of an appropriate response, turn their backs to the children, the children "stim" in the corner, have outbursts, and are not learning or generalizing what they learn because they are not engaged in a learning process in a natural, functional environment.   I left for EI and love, love, love it!!!  

J, Autism - SLP, Special Services School April 30, 2010 4:02 PM
Paramus NJ

I've even had trouble completing all of my paperwork at my job at a hospital working with outpatients, due to our high productivity requirement.  Our outpatient documentation system is totally geared to PT & OT, so adapting it for use by the speech dept. has been a mess too.   I stopped using some of the forms and went back to our old ones... and it's only getting worse due to strenuous insurance company requirements for coverage!

Julia , Speech-Language Pathologist April 28, 2010 11:05 PM

I share that frustration, and have seriously thought about changing to a contract position, even I've worked in the public schools for close to 15 years.  It gets worse and worse all the time.  My schedule is jam packed, I have one day for paperwork, meetings, assessments and make up therapy.  Unfortunately, many of my IEP meetings have been scheduled for days other than my allocated day, and I miss therapy that I have to make up.  Plus, if I take a day off (whether I'm sick, have to stay home with my sick child, or go to the dr. myself) I'm expected to make that therapy up, too!  I try to do only minimal paperwork at home, but I'm way behind,  and my apologies to Mr. Roza, but not taking paperwork home is not an option in the public schools.  

Tammy April 28, 2010 6:02 PM

Somehow, because I'm a pretty fast typer, I seem to be able to get it done. I have organized my schedule so that one day is mostly for paperwork and testing although I do paperwork on other days too.

Yes, I do believe people are leaving due to the increased paperwork demands and caseloads, and I think it's better NOT to take it home. If you can't get that paperwork done in the hours you have at work, the adminstration tends to step in to help (they want those kids countable!)

Ally, SLP April 28, 2010 3:08 PM
Seattle WA

I would offer this question for those of you that are taking home paperwork> "Why do I feel compelled to do this and what steps do I need to take to have better time management?

If therapists are taking things home - STOP. If you feel guilty about not being able to spend  quality time with your families - STOP. If you can NOT say NO when you have reached your creative limits - STOP!

STOP your madness, change the channel. Look at those around you that can mentor you. Ask them, "How do you do this?" Then take baby steps to change your behaviors. Basically, this involves a BEHAVIOR CHANGE!

(This from someone who NEVER took home weekly paperwork and was able to keep abreast of it all!)

Bob Roza, Speech - President, Integrative Speech, Inc. April 28, 2010 11:28 AM
Westchester IL

I resigned my school position last week for the same reason.  I am heading back to being a contracting EI where the paperwork is minimal and I can set my own hours.  I don't have the stomach anymore for the meetings and mounds of paperwork which mostly do not do anything to directly help the child.  Since having a baby, I don't want to bring work home with me and really, that is the only way I've found it possible to provide adequate services to the schools.  The job satisfaction is no longer there for me and I won't be returning unless major changes occur.

Denise April 28, 2010 10:39 AM

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About this Blog

    Stephanie Bruno Dowling, M.S. CCC-SLP
    Occupation: Speech-Language Pathologist
    Setting: Early Intervention in Delaware County, PA
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