If you work as a school based SLP, getting speech therapy referrals for the R sound is pretty common. The /r/ distortions are pretty noticeable by teachers, parents and staff. Have you ever gotten that referral from a preschooler or kindergarten teacher and think, “I should probably get that teacher a developmental norms chart ASAP.”
A couple of years ago, our SLP Professional Learning Community discussed how to handle speech therapy referrals for /r/. Guess what happened…..there were a lot of varying answers and viewpoints. It stirred up a hot debate (all friendly discussion). And we left the PLC without a clear direction with how to handle /r/ speech therapy referrals.
What I learned after the Professional Learning Community Discussion
The perspectives of the /r/ referral varied from SLP to SLP. Some felt that you should take them younger (6-7 years of age) if they are stimuable. Other SLPs felt that the student wouldn’t meet eligibility for an articulation disorder based on educational code, but the student would receive support via Response To Intervention (RTI) with speech improvement. There were some SLPs that didn’t feel comfortable with providing RTI because of potential legal ramifications for seeing gen ed students without an IEP.
I decided to send out a survey on Speech Therapy Referrals
The discussion with other SLPs in the room was helpful in learning about different perspectives regarding an /r/ referral. However, I didn’t leave the discussion with a clearer understanding of what our district was supporting SLPs to do. Everyone had valid points and reasons for how they handled /r/ referrals, but we lacked a cohesive game plan for /r/.
My biggest question to the SLPs in the group was “when do you consider an /r/ error outside normal development?” I also wanted to know when SLPs took students with /r/ distortions on their IEP caseload or if they treated it through RTI.
Again, answers varied from SLPs. This prompted me to wonder what other SLPs thought across the United States. I figured I could get a bigger perspective by surveying a larger group.
Here is the situation I shared with SLPs
You have a 7 year old in second grade with a distorted /r/ in all positions. The teacher shares that at times it is difficult to understand the student. The parent also has concerns about his articulation. The parent signed a screening form for you to do a quick observation of his speech. You noticed that the /r/ is pretty distorted and he is not stimuable for /r/ when given prompts.
These were the results from the survey on how SLPs would handle /r/ referral:
Speech Therapy Referrals – Considerations about /r/
Many SLP’s commented that they would do an RTI model for this student; however, their district does not allow them to see students without an IEP.
Some SLP’s shared that they would not get an assessment plan signed until after age 8 because their district eligibility guidelines would not allow them to take a student for /r/ at age 7. Interestingly, some SLP’s shared that their district would not deem a single sound error of /r/ to meet eligibility for speech services. (There is an argument that /r/ is not a single sound error among some SLPs).
Many SLP’s also shared that because the teacher and SLP are observing reduced intelligibility, this may warrant a full assessment of articulation.
What I learned from being in the school setting & doing this survey
In certain districts where I have worked, I would not be able to get a signed assessment plan until the student turned 8. I was also told that I could not serve students in an RTI model because this would impact legalities with my job.
When looking at an /r/ referral, I have to determine if the articulation disorder is adversely impacting the student’s academic progress. This is where we ask ourselves if the student’s /r/ distortion is adversely impacting the student’s ability to meet the speaking and listening standards. We would also want to determine if the student’s intelligibility is below 80% intelligible. If it isn’t affecting academics or intelligibility, it is highly likely that the student will not meet eligibility for an IEP under an articulation disorder. That being said, if you feel that the /r/ distortion is adversely impacting those two areas, it is very important to make distinct mention of that in your report findings.
A few SLP’s shared that the classroom teacher must do 6-8 weeks of general education intervention before moving towards an assessment.
Many SLP’s shared that when the student’s /r/ is addressed earlier than 7.5-8 years in a “speech improvement model”, the /r/ improves. Furthermore, many have found when they monitor the student’s growth just by checking in with the gen ed teacher, that most develop the /r/ in third grade without intervention.
We must also consider our professional judgment with dealing with these referrals. We use the developmental norms as a guideline and really need to look at educational impact when looking at a student with articulation errors.
How I handled /r/ referrals in my previous job
Based on some reading that I did on ASHA’s website, federal law may impact an SLP’s ability to take students with /r/ on an IEP. Serving students in an RTI model may also lead use to legal implications. ASHA recommends SLPs not label intervention as RTI, but rather call it a “speech club.” I call my intervention “speech improvement class.”
Here is a link to RTI information on ASHA. This could be a great discussion piece to have with your districts and speech departments. I also found the Speech Sound Disorders page on the ASHA website helpful.
At the time of this survey, my speech department was having a lot of discussions about implementing a “speech improvement program” or seeing students on an IEP for /r/. There was not a final discussion. So, I did see a couple of students in speech improvement class that have noticeable /r/ distortions. The students were in second grade and between 7 or 7 1/2 years of age. Parent permission was obtained and the speech improvement class was for 6-8 weeks.
What are your thoughts about the /r/ referral or single sound error referrals?
How does your SLP department and district handle speech therapy referrals for /r/? What are your thoughts on taking an /r/ student in the school setting? I would love to hear your expertise. Feel free to email me at email@example.com or share in the comments below.
Do you have students that are at the generalization level with their articulation? I have some articulation carryover therapy resources that will help you plan therapy that also go well with mixed groups!
Need some free visuals to support self awareness and functional practice of your student’s articulation sounds? This blog post has FREE printables and ideas for how to organize your articulation therapy.
Managing your caseload IS overwhelming. Especially, if your caseload is over 65. SLP caseload organization is seriously a process–lol! Some of you SLPs have caseloads that I am sure 4 speech pathologists could be managing. That is crazy to me.
The Struggles I Faced With SLP Caseload Organization
About 6-7 years ago, I was managing two schools, with a very transient population. Kids were coming and going every month. I had, on average, 75-83 students on my caseload at any given time. In addition to this, I served two Mod-Severe Special Day Classrooms with students on the Autism spectrum. I also served a mild-mod Special Day Classroom for grades 3-5. It was too much for me to healthily manage. But at the time, I was stuck managing this caseload until something or someone stepped in to lighten my workload. During those few years, I learned ways to manage my caseload as best I could. It wasn’t always pretty and it definitely wasn’t perfect. You will probably hate me for writing this, but I am going to put it out there.
What I Learned From Managing A High Caseload
I struggled, and continue to struggle, with keeping my schedule organized, staying up to date with medicaid billing, managing incoming referrals, communicating with staff and parents, lesson planning and making sure to log my therapy notes. It is something that I do well with during certain times of the year and something that is a struggle when I have 10 or more IEPs in a month.
Once I had a more manageable caseload of 48-57, I realized how many organizational strategies I had learned and implemented with my large caseload. With my large caseload, I had developed systems to help me do things quicker and more efficiently. I talked with my SLP colleagues to see how they were doing things. I figured out what was going to give me the most organization for the least amount of upkeep.
SLP Caseload Organization Does Get Easier
Organizing my smaller caseload was much less overwhelming because by that time, I had 7 years in the field under my belt. And, I knew what systems worked for me. Let me just say, having a smaller caseload, doesn’t always make the caseload management piece less overwhelming. I was still overwhelmed those first few months back! Especially, whenever I transitioned to a new school assignment. I felt brand new all over again. Within a few months, my brain was no longer on fire from trying to remember everything. You know what I mean…..remembering staff member names, student names, passwords, copier codes, students goals, your schedule, lesson plans, etc.
So if you are new to the schools or just have a rough transition to the start of the year, I wanted to share some systems and forms that may help you with your SLP caseload organization.
What should I expect to do that first week back?
Show up – lol! You will probably go to professional development on the first and second days back at work. The professional development will be a lot of information. If you find your brain wandering, start writing down a list of things you want to go back to when you get time.
Get all the things – check out your computer, get your keys, check out an Ipad, copier codes, etc. If you are new to a site, I introduce myself to staff. I make a point to meet new teachers that I will be working with for the year.
Make sure everything works – check your passwords and print out something you need, like your caseload. If technology isn’t working, this is when you can submit IT ticket support. It is a pain, but better to get it fixed now.
Meet With Your SPED Staff
Start scheduling for the year – Those that are new to a site, find out from your IEP team how you need to schedule IEPs. I recommend getting staff together and scheduling IEPs for the year. Things will change during the year, but it is nice knowing a rough outline. If your team doesn’t schedule out the whole year, I would recommend scheduling all your IEPs that you are the case manager. Typically, I do at least 3 months out, so I can plan “To Do” tasks accordingly each week.
Get comfortable with processes at your site – If you are brand new to your site, I recommend learning about the Student Study Team (SST) or general ed Response To Intervention (RTI) process at your site. This is the time to make yourself a GUIDE for how staff will refer students to you all year. Check out my speech referral process HERE (it has links & tips for making an organizational binder).
Here is a checklist of what SLPs should do the first week back
Having a checklist of responsibilities helps reduce anxiety when trying to manage your caseload. There are a lot of things that need to be set up before you see kids. Make a list or ask an SLP for their list to help you feel less overwhelmed. Here are some things on my checklist:
Organize the therapy/data binder. Review goals and services for your students. I put all of this information on my therapy log forms using SLPtoolkit. You can read my blog post on this caseload management system HERE.
Once school starts, review your caseload on SEIS and verify students attending your schools. Put in requests to remove students from your caseload that are not attending your school. Put in requests to add students that transferred in that are not on your caseload.
For any new students who do not have a working file, contact the SLP from his or her previous school or put in a records request to obtain information.
Review IEPs of students. Document accommodations/modifications, services and goals. Communicate services and accommodations with the classroom teachers.
Make your speech schedule. This may take A LOT of drafts, but it will get made, I promise!
Verify your student’s attendance and make note of his classroom teacher.
Collect all schedules you may need: PE schedule, RSP schedule, OT schedule, Bell Schedule (need lunch and recess times), ELD schedule, Music schedule and Intervention Schedule
Create a draft speech schedule and send out to teachers. Make changes as you get feedback from staff.
More “To Do” Tasks for The Start of the Year
Print and put contact logs for each student in your therapy binder or in their folders. During the year, you will have easy access to the log when contacting parents. I use contact logs from The Speech Bubble SLP.
Organize your IEP calendar by figuring out your annuals and tri’s for the year. You can print your caseload from your IEP database and put them in your calendar or on an IEP monthly tracking form. HERE is a google sheet I created to keep track. You can keep digitally or fill out for your caseload, and print. Then, you can manually check off what you need to do if you are more a paper/pencil SLP. Schedule out IEPs at least 3 months out or for the whole year.
Set up your behavior management system. Prep any forms, sticker charts, rules, etc. for your speech room.
Contact students’ parents. Check in with them and introduce yourself. A letter of introduction is recommended. Review it with your Principal prior to sending home. There is a link to a FREE letter below.
Set up your medicaid billing system with your students, so you can easily bill during the year.
Print parent rights copies for IEP meetings and store in a file folder.
Put any monthly staff meetings or Professional Learning Community meetings on your calendar.
Inventory materials and assessment tools (if you have time).
HERE is a checklist of all these things you need to do those first weeks back.
Facebook LIVE Tips for SLP Caseload Management Those First Weeks Back
Watch my Facebook LIVE replay to see what I do my first weeks back if you are more of an auditory/visual learner.
Helpful SLP Caseload Organization Forms
Need lesson plan templates for sensory bins, push-in language lessons, themed lessons, social skills or weekly lessons? Click the button below to get your FREE lesson plan guides.
There you have it! That is what you need to do to be successful with organizing your caseload. If you take the list of “to dos” and take on one task at a time, you will get through. How do you make setting up your caseload at the beginning of the year work? Your tips may help an SLP feel less frazzled at the start of the year. Share your expertise in the comments!
The speech referral process influences our caseload size and impacts how teachers and parents view the role of SLPs. Working in the school setting, you will get speech referrals from teachers, parents and the RTI general education process. Today, I want to share why I have a speech referral process.
Why I have A Speech Referral Process
Having a speech referral process helps you make better clinical decisions when deciding if you should test a student. Many SLPs work with a large number of students who speak English as a second language. So, although, the student may not be meeting common core standards in the classroom, it may not be related to a language disorder. A student could be struggling because he or she is learning a second language. Furthermore, environmental factors may impact a student’s communication development. For example, a student starting Kindergarten without attending preschool may not be exhibiting language skills equivalent to his or her peers. The student’s language abilities may be due to lack of exposure to the school environment. RTI can help the SST team determine if it is a language disorder or lack of exposure to school.
More Considerations For Why Having A Speech Referral Process Is Important
In a school setting, it is important confirm that general education interventions were performed for any students with language and social pragmatic concerns. This should be done before moving toward a speech assessment. This is in alignment with IDEA whereby we ensure that we are providing a free and appropriate education in the least restrictive environment. When the least restrictive environment isn’t being successful with general education interventions, that is when a discussion about a special education assessment is warranted.
One reason to conduct general education interventions is that we do not want to inaccurately identify a child with a speech and/or language disorder. Additionally, if general education interventions are working for the student, completing an assessment may not be recommended at that time.
It is highly recommended that you discuss your referral guidelines with your administration and speech department. Every state has different education codes for special education and being well-versed on your state’s education laws is paramount.
Here Is What The Speech Referral Process Looks Like In My World
All articulation, speech fluency and voice concerns come directly to me via a google form I created. You can read more about how to electronically gather speech referrals with google forms/docs HERE.
I follow up with the teacher to review concerns and determine if errors are developmental or a dialectal difference. This is when you can ask the teacher questions about speech intelligibility, and frequency/duration of dysfluencies. Then, follow up with how the speech concern is adversely impacting the student (this is key).
Then, you can conduct a classroom observation. If you need parent permission to informally talk to a student, then this would be the time to get a parent permission slip signed. If you notice red flags that this student may possibly need a speech assessment, you can do RTI for 6-8 weeks or initiate an initial assessment. SLPs needing an articulation & language screener for elementary, can use this one that I created HERE.
What To Do If The Student Is Stimuable For Their Sound Or Strategy
If the student is stimuable for the speech sound in some contexts and intelligibility is not significantly impacted, you may address the need through RTI speech improvement class. You typically would need to get parent permission. Discuss with your speech department how RTI speech improvement will look for SLPs. , I do RTI speech improvement for 6-8 weeks for my students that have only 1-2 sounds in error, or not demonstrating a year delay with sounds. If I observe multiple sound errors, decreased speech intelligibility and it is adversely impacting them in the classroom, I typically initiate a speech assessment. Sometimes, I will do RTI intervention and then make a decision to test after that 6-8 week intervention.
This is the process that was approved in my current district. I have worked in other districts that did not want me working with students that did not have an IEP.
How I Handle Language & Social Pragmatic Concerns
Any language and/or social pragmatic concerns I refer the teacher back to the Student Study Team (SST) general education process (your district may call it something else). In my district we have a pre-referral Student Assistant Program (SAP) in which a school team documents and discusses tier I and tier II interventions. I have let my schools and teachers know that if there are concerns with language and/or social pragmatics to include me in those meetings. Looking for information from ASHA regarding RTI? Check out their RTI page and ASHA’s position about Early Intervention.
Why Attending RTI or SST Meetings Is Worth Your Time
I go to any SST meetings that have language and/or social skill concerns for the following reasons:
Staff and parents can see my professional expertise in the areas of speech and language when I am present at the meeting.
SLPs can ask questions to the parents and collect background information on the spot. The background information is documented if a speech and language assessment is recommended or a full team assessment. Then, you don’t have to call the parent again for background information. You can also have parents fill out forms before or after the SST meeting.
This prevents professionals writing in recommendations for speech and language assessments to be completed without getting your professional insights. I know you may be think, “But, I don’t have time for more meetings.” I hear you. None of us have time for more meetings. But, when you think about how much time a full assessment can take to complete, you may re-consider. Testing the child, writing the report, IEP and holding the IEP meeting can take 8-15 hours of work. Attend 1 hour meeting or do a 15 hour assessment? If your team is signing you up for assessments that you know will not meet special education eligibility, you are opening yourself to work that could be spent more effectively. For example, if you aren’t doing that 15 hour assessment, you could be providing RTI intervention. Or you could be providing visual supports for teachers with that time.
Being at the meeting allows me to identify any red flags for a possible speech/language disorder
When a teacher has language and social pragmatic concerns, I may consult with them for strategies to implement in the classroom during the meeting or right after the meeting.
What To Do If You Can’t Attend The SST Meeting
If I can’t attend the meeting, I pre-staff the meeting with the psychologist or head person running the SST. I give examples of red flags that may warrant a language assessment or provide questions to ask the parent and team. Furthermore, if the team is feeling that language is a big concern, I ask them to document “consult with the speech pathologist” under actions. This allows me to see the SST notes, and consult teacher/parent before giving recommendations. If I see that RTI interventions haven’t been done or the student is an ELL learner, I want to make sure those things have been put in place before moving forward.
How To Stay Organized With Your Referral Process
If you are more of a visual learner, you can check out my Facebook LIVE video about how to streamline your speech referral process HERE.
One way that I stay organized with incoming referrals is by making a binder. That way, when you have educators handing you forms, you can shove it all into one place! You can support teachers by having an electronic version of your speech referral process. Send this process through email when a teacher has a question. You can get my referral process HERE and add/change what you need.
Helpful Forms and Resources For Your Speech Referral Binder
You can include helpful developmental milestones, and parent permission slips. Put your screener forms, or cheat sheet guides in your binder too. Here are some links to organizational forms that you can include in your speech binder:
Data Binder Forms that include parent permission slips for RTI intervention from The Speech Bubble SLP (My district has their own template, so if you don’t have a template, I recommend using these).
What forms or important information do you include in your speech referral binder?
Share Your Experience With The Speech Referral Process
All in all, a speech referral process is a guide. The speech referral process is there to help SLPs make more informed clinical decisions. Do you have a speech referral process? Why or why not? What roadblocks have you faced with trying to implement your speech referral process? Did you find any solutions that you can share with other SLPs? I would love to know your thoughts around this topic in the comments!
This year, I am trying to streamline some caseload management processes into a digital format. What I love about using Google Docs for speech referrals is that you can view and share information digitally. This means fewer piles of paper to organize, and that I can store the info digitally and then can print out the referral information if needed.
Why I love using google docs for speech referrals
There are some tasks for which I prefer to use pen and paper, but sing Google Docs for speech referrals is one tool I am very glad to have in my belt. Here are a few reasons why I love using Google Docs:
Once you’ve created your Google Doc with your speech referral process, you can email it to your entire staff with one quick click!
Sometimes my staff need a reminder about my process. Instead of writing out new emails with the same answers, I have been able to automate this process. I can just re-send the referral process to teachers.
I have fewer piles of paper. I can store information digitally and print referrals only when I need to (or not at all)!
I can access the information at no matter where I am. If I need to access the information to help me plan for the week, I always can.
Teachers can send me their referrals for students using Google Forms. They can easily check off sound errors and answer questions about their student’s communication.
I have a paper trail for when someone sent me a referral. I don’t have to worry about losing the referral form because it is all digitally stored.
How to access and use my Google Docs for speech referrals
One of the great features of google docs and forms is that you can share them with people! So, you can access the google docs and forms that I have already created.
This will show in view only, so you’ll need to save it to your drive first. To do this, go to File –> Make a Copy –> then save it to your drive! This will allow you to edit the file as you need for your own caseload.
If you hit request access, it will send me an email and I will not be able to respond to requests. If you follow the method above, you will get access and be able to edit for your own use.
Have you made any speech therapy Google Doc forms? I would love to add some digital forms and docs to my stash. It’s saved me so much time and helps me communicate effectively while completing all my necessary tasks.
I don’t think I have met an SLP or any educator for that matter that has said, “Stress. That never happens to me.” Working as a school SLP is very stressful. Raise your hand if you feel like a “stressed out SLP”!? Today, I wanted to talk about chronic stress on the SLP and how it can effect our well being and job performance. Some of the biggest “stresses” with the job of an SLP is the paperwork, managing IEP’s, planning and conducting therapy and progress monitoring all of your students on your caseload. There have been days when I have wanted to cry, hide and go get my job back at Starbuck’s.
Acute stress vs. chronic stress
Stress is how our body and brain reacts to any demand that is placed on us. SLPs have lots of demands placed on them, hence, why we are stressed lol. Acute stress is caused by those unpredictable events or situations that happen outside of our control. When we experience acute stress, our bodies release hormones to help our bodies/brains deal with the situation. For example, we may have acute stress from running an intense IEP meeting or having to write three speech reports in a week.
Chronic stress is caused from situations and events that are repeatedly happening to us, resulting in the release of the stress hormones. Many scientists feel that the human body was not designed to endure constant stress. When our bodies over produce the stress hormone, it can have negative affects on our bodies. Examples of chronic stress could be going through a divorce, while having to manage a caseload of 70 with many IEP meetings, not having supportive co-workers and trying to raise two children on your own.
When To Know You Have Chronic Stress
Stress is a funny term because as an SLP community, I think we often associate stress as a negative impact on our lives. Research shows that stress can be good if it helps us to be more productive. It is when we have hit our level of “overwhelm” that stress begins to negatively impact us. There is a fine balance of allowing stress in our jobs and personal lives. When we do not manage our stress, it can impact our lives significantly. Furthermore, stress is very personal to the individual. That being said, stress varies from person to person and that feeling of “overwhelm” may look different from one SLP to another.
Below is a list of different symptoms that people with chronic stress may be exhibiting. This may help you gauge if you are managing your stress well. Exhibiting many of these symptoms may mean that you are dealing with chronic stress in your life.
Why is chronic Stress Harmful
Chronic stress impacts our mind and body. It can begin to rob us of the physical and emotional things we want to enjoy in life.
How Chronic Stress Impacted Me
I took some time this year to reflect on the BIG stresses in my life and made an action plan for how I was going to manage the stress until the end of the school year. I know that MUCH of my stress were external factors that were out of my control and I needed to find a better way to survive. When I looked at the list of symptoms, I as exhibiting some insomnia, memory issues, mild depression and physical body aches and pains. I loved reading this post about the 5 Year Burn Out from the Queen’s Speech. It really gave me some good perspective about my job as an SLP and as a person.
Solutions To Help Reduce Chronic Stress
Advocate for your needs. Let your employer know that you are overwhelmed and need assistance.
Acting as if you can complete all the job tasks in a reasonable work day only makes administration think YOU can do the job successfully.
Exercise at least 3 times a week. This has helped me release my stress and manage my weight and eating better. I have more energy for my job and my focus has improved.
Limited coffee or energy drinks. I will admit that I have not given up coffee, but I reduced my intake of caffeine. When the effects of caffeine wear off, you can feel sleepy and sluggish.
Boost your mood. I have a music ready to play at the end of the day or when I have to cook dinner. Find something that helps boost your mood.
Work on getting a good night’s rest. I try to turn off the electronics an hour before bed and read a book and/or the bible. Sleep makes all the difference and stimulating your brain with TV or computer doesn’t help your body get ready for sleep.
Get organized. Invest time to set up systems and ways for your to stay on top of everything in your job and life. When you plan ahead, you reduce a lot of stress.
SLPs need to remember to take care of themselves
Most SLPs got into this field because they wanted to help people. We are naturally giving spirits and often put others first before ourselves. I think it is a very admirable quality, but when we don’t remember ourselves, we chip away at that giving, loving spirit. You don’t know how hard it has been for me to put these next steps of advice into place, but I have and continue to work on these things.
Let your YES be YES and your NO be NO. Don’t commit to something that internally you don’t have the time to complete. People pleasing will get you in a negative mindset and causes you to busy up your life. You can read about my 10 Phrases Every SLP should say at work to help with setting boundaries at work.
Seek counseling or some sort of support group. I attended some counseling sessions to help with the stress in my life and also went to a bible study that was geared towards drawing me back to relying on God for support in times of trials and STRESS.
Do something YOU enjoy every day……I take a hot shower to help ease my mind, hang with my kids, chill with my hubby, and listen to music when I need to revive my spirit.
Laugh….I am trying to find the joy of laughter in my students, my kids, on youtube, talking with friends, reading funny books and watching movies that will give me a laugh. Laughter relieves stress, so put more in your life!!
When your current STRESS isn’t going away any time soon
Accept what you can or cannot do, cry, whine, and moan for a few minutes with a friend. Then, make a plan for how you are going to get through the stress. Don’t let your workload stay the same for next year!! Make the necessary changes now even if that means looking for new employment. With the help from your admin, you may be able to or reduce or change your assignment. This are all easier said that done, so make sure you have great friends that are there for you along the way!
How do you manage stress? What advice could you give to an incoming CFY for how to start their career off right?