Pediatric Therapeutic Services

Straight Talk on Therapy Caseload Management

“We need another therapist!” 

School-based occupational therapist supervises seven boys and girls on her caseload as they practice their handwriting.As a special education administrator today, you’re likely familiar with this sentiment.

It seems your students’ needs for therapy services constantly outpace your staffing level. Your therapists and teachers are stretched to the limit, a situation which can compromise compliance and quality of care.

To compound the problem, your hands are tied. Do you add more staff? Where’s the money going to come from? And tax increase referendums and myriad legal mandates make your job even harder.

Your only viable option is serving the students you have with the staff you have. To do that, you’ll have to make your therapists’ caseload management as efficient as possible.

As managers of Pediatric Therapeutic Services (PTS), we’ve learned a few “tricks of the trade” for discerning what a reasonable workload is for a therapy professional. Taking these few simple steps can help you untangle this common problem and improve caseload efficiency once and for all.

Start by Taking Stock of Your Therapists’ Scheduling

The first step in the process is to ask ALL your therapists for their schedules.

You’ll need to request the schedules in a specific format. If you don’t, you’ll get a weekly chart listing what building or program therapists serve in each day.

Smiling female special education administrator stands in high school classroom, students and teacher in background.You need to see:

  • The student names and treatment times

  • Whether the student must be seen individually or may be seen in a small group

  • Whether the student is in a low-incidence class (such as Autistic Support or Multi-Disabilities Support)

When you evaluate a therapist’s schedule, see if it’s set up efficiently.

For example, if the therapist holds most meetings before school or early in the day, be on the lookout for large blocks of time set aside midday when meetings are unlikely to occur. Is the therapist seeing all her students individually, even though their education plans indicate they can be seen in a small group?  

Looking at your therapists’ schedules with fresh eyes can reveal many such opportunities for working smarter, not harder.

Assess the Time Therapists Reserve for Testing and Paperwork

Next, you’ll need to evaluate therapists’ schedules each week for diagnostics, planning, and paperwork. Is the weekly time allotted reasonable?

Therapists in elementary buildings, where referrals for therapy services are more numerous, must set more time aside each week for diagnostics. In middle and high school, where most diagnostics are related to re-evaluations, blocks of time for testing should correlate with the number of students on caseload.

For example, if a therapist sees 55 students in a middle or high school, she’d have about 1.5 re-evaluations or reviews per week. A therapist in an elementary building would have the same number of re-evaluations, but may have an additional new referral and several screenings per week.

Take your policy on therapists’ attendance at IEP meetings into account as well. If therapists are required to attend all meetings, they’ll need to build that time into their schedules, as well as leave room for make-ups for students whose sessions were missed.

Consider Caseload Intensity, Not Just Number of Students

Male school-based occupational therapist kneels next to desk where middle school female student sits and practices handwriting.Recognizing all therapy caseloads aren’t created equal is critical for managing therapy caseloads effectively.

Low-incidence students require higher consultation and collaboration than students who get therapy once a week or every other week. For more involved students to make adequate progress, therapists must spend more time in the classroom addressing equipment issues, alternative communication strategies carryover, paraprofessional staff training, and so on.

Therapists caring for these students won’t be able to handle the same number of students on their caseload as therapists who aren’t. In addition, many of these students’ more involved physical or behavioral needs mean they can’t be seen in small groups, so most will need individual sessions.  

Collect and Examine Data for the Big Picture on Workload Distribution

It’s important to look at equitable workload distribution across your team. How much direct service and consultation is each therapist expected to deliver per week?

PTS uses our patent-pending BudgetWatch™ technology to get information at the click of a button about the total number of students on caseload and the total amount of direct and consultative service that must be delivered each week. You may need to mine your online IEP system for this data, or have your therapists write it up in a list.

You’ll also need to take into account some of the factors we discussed above, looking out for wide ranges of workload across individual therapists. Occasionally, more senior staff members will overload newer team members.

Load distribution also changes over time. Within a few months of the start of the school year, most therapists’ caseloads have shifted. Some will have discharged students from their list. Others will be buried under an avalanche of new referrals.

By briefly checking each therapist’s load, you’ll often identify opportunities for keeping caseload distribution equitable. For instance, middle school therapists often discharge students by late fall after observing they no longer need support. These secondary therapists can jump over to another building to help with diagnostics or consultations when an elementary therapist is underwater.  

Let Therapists Compare Caseloads 

 Female school-based psychologist sits next to elementary-age boy who sits cross-legged in his chair, listening to him talk.We’ve found being open with your entire team about how caseloads are distributed takes a lot of the conflict out of these discussions.

Many therapists, for instance, resist traveling to multiple buildings during the week or seeing a type of student outside their clinical comfort zone. But it’s good for therapists to see what they’re covering compared to their colleagues. 

Also, if a therapist says a large caseload is stretching her too thin but her numbers are comparable to her peers’, you can suggest she do more group therapy (as opposed to individual) or whole-class push-in services (instead of pulling students out of class).

When you need to add additional therapy services at a building, it’s generally best for the assisting therapist to have a narrow focus, such as covering new evaluations or limiting services to a specific grade level. This approach helps minimize confusion around communication for building staff.

PTS Gives You the Data You Need to Improve Caseload Management

We know the strategies for therapy caseload management we’ve outlined here work. We’ve been implementing them in related services programs across the greater Delaware Valley for two decades!

They’ll not only eliminate a lot of your therapists’ angst but also help your budget by maximizing the efficiency of every person on your team.

If you’d like to discover even more ways to increase your program’s efficiency, why not request a free related services audit from PTS? With just some basic information about your program and a copy of your service provider’s latest monthly bill, we’ll show you immediate opportunities for serving more students with the same amount of resources you have now. 

You really can balance your program’s quality and productivity. You just need a little reliable information in your hands! 

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