Out There

SLP Caseloads

Posted in SLP, teaching, Uncategorized by Pete on March 14, 2016

I’m copying and pasting something from an SLP forum that I lurk on.  This is about caseloads and thought it was a good perspective and I wanted to be able to access it later so I’m pasting it in here.

I have posted this more than once. My rule of thumb is my caseload cannot exceed the number of hours I work over a week. So…if I work 38 hours, I can’t have more than 38 students. In that 38 hours, you are ALL entitled to 30 minutes of duty free lunch daily, and whatever planning time is given to the professional staff in your school. If you are working through lunch and planning time, you are NOT doing anyone any favors…and that includes the district and your students. You are allowing yourself to be taken advantage of.

So back to my rule of thumb. Where I worked, I had 30 minutes of lunch and 30 minutes of planning (planning was averaged out over the week…so really 2 1/2 hours per week) per day. So that left 28 hours in which to do everything else…therapy, testing IEP meetings, consults, classroom observations, report writing, meetings…you get the picture. Even with 28 hours to do all of that per week, I sometimes found myself stretched. When I read about caseloads that are double or triple what I had, I wonder just how FAPE is being met. And I wonder about the real quality of services…and I wonder just how quickly some of you will burn out.

It took me a while to get to the point I was at…that caseload of 30 or so students. Back in 1973 when I started, I had 13 schools and well over 100 students. It was a job that could NOT be done….period. I was at each school once every two weeks. The kids didn’t even know my name.

I immediately became a strong advocate for decent services for my students. NOTE…not for me…for my students. BUT in advocating for my students, I also advocated for myself, and our profession.

Our administration understood that the apraxic, low cognitive student with multiple issues…and multiple weekly consults…took much more of my time than even a multi sound artic case. And I needed to have the time for these things.

I understand that some folks don’t want to make waves because of job security and the like.

But read what you are saying….your admins expect you to make up time with students when you are absent for a day…but they also think it’s good quality services for you to be seeing 60 plus kids per week? I guess I think those are contradictory statements.

If they are REALLY worried about FAPE, they should get more staff…so ongoing services can be better.

Where I am, districts with these larger caseloads also have HUGE turnover in SLP staff…because folks simply move on to districts where the working conditions are better. And yes…that sometimes means a huge cut in pay. But I know a few people who went from having over 75 on their caseloads to under 40 and also lost over $6000 a year in salary. They say…it was well worth the reduction in salary to be able to provide a quality service to their students.

As a profession, we need to stand up and be counted. Do the special ed teachers in your district see 60 or 75 kids per week? How about OT and PT? If you are in a primary school….what classroom has 60-100 kids?

Please…advocate for quality services for your students. And for heaven’s sake…stop short changing yourselves by working through lunch and planning times…and taking hours of work home nightly.

OK…off my soapbox.

-S

And someone replied with:

I think everyone can reply to this question but not much can be concluded.  Numbers do not reflect workload.  I think that is where administrators loose perspective on appropriate staffing.  So much goes into determining workload for any specialists.  Everything from severity of students to universal supports provided in a school system.  I personally could service 30 articulation kids over a couple of days with my eyes closed but give me 30 more involved students and the game changes.

We all need to advocate for reasonable workloads and numbers.  The amount of work, paperwork and meeting time that is required for each student also need to be taken into consideration.  I also find that administrators have little to no understanding of the process of language development nor how decreased language abilities impact academics.

This past year I published a book,  The School Speech Language Pathologist,  An Administrator’s Guide to understanding the role of the SLP in schools along with strategies to aid staffing, workload management and student success.  It’s just a start in educating administration.  Available on Amazon and through my publisher Booklocker.

I think it would also be interesting to know how much turnover occures because of workloads/caseloads that are too high an unmanageable.  My 30 years of experience can also state that staffing levels have not grown over the years but numbers have.  Think about that.

I didn’t write either of these but they are good food for thought, for me at least.  I’ve wrestled since before I became an SLP with the service delivery model used in the Alaska bush (at least in my home district of LKSD) and this applies to that issue.

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seguransa madness!

Posted in commercial by Pete on October 13, 2009

Insurance companies.  Necessary evil or just evil?  I’m an anal, detail-oriented person whose favorite job was doing accounting, but I despise dealing with our insurance company.  We pay people money so that we don’t have to pay a lot later, and their job is to deny/minimize those future claims whenever possible, and our job is to monitor, harass, beg, cajole, and threaten them into paying what they’re supposed to.  Who thought this up?  The kingdom won’t be like this.  Heck, CANADA isn’t like this.

So, the reason for this post is my total confusion regarding my current insurer’s policy regarding double coverage.  This will be a long, boring post with lots of photos of boring stuff.  The only ones who could care about this are those who work in the field or who find themselves in the belly of the beast as I am now and turn to google in desperation.  Here are some photos of “explanation of benefit” (EOB) statements from a doctor visit in April.  At that visit, we paid $30.30 up front since our plan usually requires us to pay 90%.

P1010055 edited

So for those of you scoring at home, the total due is $303, $51.87 of which Premier (our insurance company, aka PCA) says “exceeds usual & customary.”  Of the remaining $251.13, they apply a $10 deductible, then pay the rest at 90%.  My wife is the one who went to the Dr, and this is applied to her insurance.  Then check out the EOB below, which is applied to my insurance (same insurance company, same employer, same benefits, etc).

P1010051 edited

So if you can’t read that, the total due is $303, $51.60 of which “exceeds usual & customary.”  No idea why the amount that exceeded usual and customary changed slightly.  Of the other $251.40, they apply the annual $150 deductible, and then pay $85.98, which they claim is 90% of the remainder (even though it’s not – it’s just the amount needed to get to $303 in total).

So taken together, they applied $160 to deductibles AND paid the full $303 despite the fact that $51 and change exceeded usual and customary.  Is that normal?  Plus we paid $30.30, and haven’t seen any refund.

Fast forward a few months to a dental visit.  This one also has charges that exceed usual and customary, but they’re not picking them up this time.

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Tammy is again the patient in this example, and the above is her EOB statement.  Below is the same thing, but applied to my insurance.

P1010058 edited

So why did they pay the charges that exceed usual & customary in the first case, but not this one?  Our dentist sent us a bill for the $65.69 for each of the 3 of us, and I’m unsure whether I should pay the dentist or try to get the insurance company to pay it.  Some of our other medical providers will write off the amount not covered by insurance that is labelled as exceeding “usual & customary,” but not apparently in the case of Dr Nick Feldman!  Who, I must say, although it was only one visit, appears to be a superb dentist.  In addition to the usual stuff, the guy takes digital pics of each of your teeth from 3 different angles, and you watch it all on a color monitor – even with Claire they let her hit the button to take each picture – she left the dentist at 38 months thinking that going to the dentist is fun fun fun.

About now you are thinking “What a huge waste of time.  Did you consider CALLING the insurance company??”  Yes, I did and spoke with a woman there for literally like over an hour trying to make sense of the 4/30/09 EOB statements.  We got nowhere.  She was very nice and professional and patient, but we just repeatedly missed each other and both left the conversation very frustrated.  She even called me back at home (unexpectedly) a few minutes after we hung up and we went around again for like 20-30 more minutes, me asking earnest questions 10 different ways and her endlessly explaining but to me she was not understanding my questions and answering questions I hadn’t asked and repeating the same information every time.  The conversation ended with her basically saying she has lots of work to do and can’t spend all day repeating the same information to me that I can’t absorb.

Much of the confusion is because for the last 5 years Tammy had the only job and all our insurance was through her.  But for the 14 months since that time we are both working for the school district and have dual coverage.  And a big part of the problem I think is that our medical plan book that has all the details doesn’t have a section on dual coverage that spells out how it will work.  Another factor is that we have significant history with this company with lots of mistakes in their payouts, like an average of a couple errors per year probably, to the point that I keep all the charges from all the EOBs in 3 big excel spreadsheets.  Tammy adds that another reason not to trust them is that our insurance company changes its name every 6 months and is based in Reno, NV.  : – )

I have to admit that this probably WAS a total waste of time, but for whatever reason I was compelled to do it.  Now I can just send an email to Premier with a link to this blog post and not have to explain it all in the email.  ; – )  So for all of you insurance experts – do you have any insight for me?  Am I screwed up or is it them?  Should I pay the dentist?

****UPDATE as of 10/22/09****

I called the dentist to schedule a visit for a new crown I need.  I asked what my balance was, and they told me zero.  Apparently PCA paid my entire bill, including the $65.69 that exceeded usual and customary rates (UCR – I’m learning the lingo here).  So I took the plunge and called PCA.  They sent me to the same poor woman I spoke with at such length before.  I’m sure she remembered me, or certainly did after a few minutes.  She explained that they paid the eligible expense on mine at 70% (because I’m in my 1st full calendar year with LKSD, it goes up year by year by 10%), then they coordinated it with Tammy’s coverage, which paid 100% of what was left, including the amount that exceeded UCR.

So my question for her was how come they didn’t coordinate Tammy and Claire’s visits with my coverage so that mine would pay 70% of the amounts that exceeded UCR from their appointments?  She couldn’t get it, but was convinced that I wasn’t understanding her repeated explanations.  She was unfailingly polite and patient, and it really pains me to email or call PCA and ask for anyone but her in order to get this resolved.  I think she is assigned to our company, so we’re sort of stuck with it.  It may well be that they have a solid rationale or explanation, but I didn’t hear it.

So now it’s some time later and I called them and asked for anyone but the first person and was directed to Suzi.  She listened well and after 10 minutes of explaining and some confusion she spoke with her supervisor with me on hold for 5-10 minutes and then came back on and said I was absolutely right, it was inconsistent and the amounts in excess of UCR should always be paid by the other spouse’s coverage at whatever their coverage is (in my case 70%).  So instead of owing $65.69 on each of Tammy and Claire’s accounts with Dr Feldman, we’ll only owe 30% of that (about $20) after PCA coughs up their 70%.  In a diplomatic way she closed by saying that things aren’t always as consistent at PCA as they’d like and they’re working on it.  I’m thrilled, not for the $90 or whatever they will pay, but that there is an end to this long story.  Speaking with that first employee was like being on the eternal treadmill elliptical of insurance futility.  And the worst part is she was as nice as your grandma so I can’t hate her.

polystyrene (styrofoam) trays

Posted in teaching by Pete on August 18, 2008

So here is a random topic I’ve chewed on for a few years (no pun intended) and was just reminded of by a colleague. Our school district, like New York City public schools, uses styrofoam (well technically it’s called polystyrene) trays to serve breakfast and lunch to all students everyday. Keep in mind that our village dump is actually just a spot on the tundra half a mile from the village on the edge of a lake and everything is burned from time to time. So we’re paying for these trays, which appear to cost between $35 and $70 per case of 500.

Now keep in mind the shipping will greatly increase that cost. The district might be paying as little as $55 per case if they’re getting a good deal. Then there is the cost of driving over to the post office and picking them up (1.5 miles each way by boat or snowmachine, and school employees do this on the clock), and then 3 full trash bags that they fill (per meal), and then the cost of hauling those full trash bags by the handcart load out of the school, down the boardwalk to the school dock to the school boat and to the dump (.5 miles each way and again on the clock). This doesn’t take into account the environmental cost, nor the supreme irony of everyone in the lower 48 getting bent out of shape over global warming that is mostly only affecting people in the remote north, while we in the remote north burn our styrofoam to save a little $. Penny wise, pound foolish, I suspect. But this is what I wanted to examine, to find out.

So I thinking we’re paying at least 11 cents per tray just to get them to the post office. Then the gas (at $6 or more per gallon) to haul them everywhere and the salary of those doing the hauling, plus using up the big trash bags when they’re done. I think I can quite safely say 13 cents per tray. So we have about 65 kids and some staff and community members who eat at school every meal, so lets say 80 trays per meal. 80 trays * $.13 = $10.40. Meanwhile, we live in an area (see Wade-Hampton Census area and Bethel Census area) with outrageous unemployment over 25%, where you have no difficulty finding someone who would be willing to wash 80 reusable trays in an hour for around $8 in pay.  And if our district is paying a higher price than they should for the trays, and if I’m underestimating the other incidental costs, maybe it’s as much as 18 cents a tray, which would come to $14.40 per meal, about enough to pay for TWO hours of dish duty.  So…wouldn’t it be cheaper to go with the environmentally friendly, reusable lunch tray? I know this is a simplistic analysis, but surely I’m in the ballpark.  Correct me where I’m wrong.

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warm bodies

Posted in teaching by Pete on April 20, 2008

I get copies of messages posted on the Alaska Teacher Placement forum.  It is THE site for those interested in teaching here, and you can visit them here.  The forum is where people ask questions in pursuit of better understanding of what they’d be getting themselves into.  Anyway, today I got a copy of a post with the subject “Getting to Kwethluk.”  Here is the message:  ***UPDATE – This thread has been generating a lot of traffic and I don’t want this new hire feeling singled out or ashamed.  I’ve changed the places they’re coming from and going to, and I removed the exact age of their child.***

is there any way to drive from the lower 48 (Phoenix) up the can-am (or whatever it is called) highway to Bethel-then put my vehicle on a boat to the village (Kwethluk) so we’d have a vehicle?(4wheel dr)?? Considering I’m coming with a middle schooler, 2 dogs, a cat, LOTS of books (heavy to ship $$$) #’s of boxes I thought it might be less hassle and possibly cheaper.

My intention here is not at all to mock or demean this person.  I just feel for them.  Not knowing if you can drive to Bethel or not?  It sounds like she already has a job and has signed a contract but doesn’t know the most basic information about this part of the world.  As a single teacher your first year in the village is stressful and very hard work in the midst of major culture shock and transition.  Having 1 pet is hard, because you don’t have the time to give them what they need.  Having 3 is going to be tough.  Can you imagine the three animals rattling around inside a little apartment for 6 months of winter?  Now the son/daughter might help give the animals attention, but giving them the time they need will be tough too, and he/she will probably need more than ever due to the culture shock.

Its just hard that we’re so desperate for teachers that we bring in lots of well-meaning, nice people and throw them in completely over their heads and then we bemoan our teacher turnover rate.  I’m not trying to single out any particular school district or that person or anything, this is par for the course.  I believe the average stay for teachers in LKSD, my district, is right around 2 years.  Someone correct me if I’m wrong. 

I think this might be the most devastating hardship that our village schools deal with.  New teachers usually arrive in the village less than a week before class starts.  They’re trying to unpack and find which box has the spaghetti so they can eat, and set up their room, and how do I get to the post office so I can find my boxes, and they’re often just learning what classes they’re going to be teaching in 3 days!  They’re tripping over the cultural differences all around them and making all kinds of questionable assumptions about their neighbors based on misunderstandings.  They’re intimidated about teaching (which is totally normal), sleep-deprived, and stressed out.  And often they have to figure out a curriculum that might be totally unique and nothing like they prepared for in school, like LKSD’s phase system.  If you ask many veteran teachers, they’ll tell you that the first year they did a pretty lame job teaching a lot of the material.  Not because they were lazy or at fault in any way, they were just new and totally overwhelmed and learning as they went.  Someone told us that your first year teaching in the bush is like getting run over by a train.  And the next year you see the train coming but can’t get out of the way in time, and the third year you MIGHT get out of the way barely, and then each year keeps improving.  This is only our 5th year, but its totally true in our experience.  When we have a first year teacher who leaves after 1 year, the next year we’ll often discover they spent the first semester treading water for the most part and the kids are way behind or there is little documentation of progress as there should be.

We sell the experience to college seniors as “adventure,” which it certainly is, and they want to believe “high pay,” which it mostly isn’t when you consider the cost of living & travel.  But don’t we owe our kids better than an “adventure” when it comes to knowing what kind of education they’ll get?  I think the thing we need to stress to prospective teachers is how very different the local culture is here.  This is less true in hub villages like Bethel, Nome, Barrow, etc.  But new teachers think the weather will be hard.  Or not being able to ever have a drink, or go shopping or to a movie, that will be tough.  Those things are pretty trivial compared to the culture shock most teachers find themselves in.   “Why won’t anyone answer me when I ask a question?  What did I do to them??  Even the native staff won’t look at me or answer my questions!  Or I don’t hear them and say “What?” and they don’t answer!”  Or “Why don’t people get plumbing in their homes?  What is wrong with them?  How can they be so lazy/nasty?”  “My only toilet is an incinerator toilet!?!” “My student has a BOIL on his arm – don’t these people take showers?!?”  “Why are these kids always harassing me wanting to VISIT at 11 pm??”

I know I move onto controversial ground, thin ice, when talking about culture.  Every culture has its strengths and weaknesses.  Alaska is made up of many different cultures and I’m not going to be so foolish as to try and list my take on all of them here.  But teachers should expect something similar to moving to the third world to teach.  They might not have running water, they might not understand their neighbors (language or behavior!), they might be forced to live in what they consider lousy housing and possibly with a roommate(s).  They might believe they’re being judged by people and they don’t even know why or what they did to offend anyone.  The huge cultural transition is a complex thing, not to be taken lightly.  But how do you educate someone about this at a job fair in a fancy hotel?  I think for the most part its not talked about that much.  If they had these expectations, the only surprise they might get is a pleasant one.

I realize that I’m throwing lots of stones so far and not providing any answers.  I don’t know.  There is no easy answer or don’t you think we’d have implemented it long ago?

I think its great if people can visit prospective villages before signing contracts.  Yes, expensive.  Maybe the district could agree to reimburse them for half of the cost only 3 months after they start teaching, so if they visit then say no thanks they get no reimbursement.  They could sleep on the floor of the school–the point is not a half-price vacation for 22 year olds.  Of course this would still be a cost for the districts, but I believe it would cut back on 1 year teachers (and especially the rare teacher who shows up, sees the village, and immediately leaves, which does happen occasionally).  Maybe they could get half of it reimbursed after their first year teaching, and the other half after their 3rd year or something.

In addition, I think teachers should be encouraged to live in the village in the SUMMER with reduced rent during those months.  Something really small just to cover utilities like $300/month.  My district is  penny-wise and pound-foolish in this regard, charging full rent for June & July if you stay (and even a “storage fee” for your stuff if you leave it).  We spent our first 3 summers here, and it would be every summer except I’ve been required to do summer internships in Anchorage for my master’s degree.  We think its the best time to be here.  Totally relaxing, beautiful, warm.  You sleep in and read and get your classroom and planning ready at a nice pace, while your neighbors work feverishly all summer fishing & hunting & berry picking, stocking up for the year.  We go with them sometimes and have a blast.  Anyway, by charging full rent, teachers are out of here to see friends and family.  Maybe if they could stay for cheap, some would leave to see friends and family but then return for the bulk of the summer.  They could form relationships with the village outside of their role as a school authority figure, play with the kids, go to feasts, go berry-picking and fishing with people, etc.  Totally different from the school year, and an experience that would help them understand the village better, and help the village understand THEM better, and ultimately that can only lead to more positive results.  Hardly any teachers stay at this point, so I don’t think this would reduce district revenue much, if at all.  Relationships are key to people being happy and staying, but new teachers have no energy or time to form those relationships during their first year or two.  So let’s be creative and make it easier to be there in summer!

My only other ideas are problematic.  A big bonus after every 5 years with the district?  I don’t like that it would be an incentive for bad teachers to stay (which reminds me of another soapbox of mine, I wish it were easier to get rid of the really bad teachers/principals, who are rare but they do exist and most people onsite know who they are).  Or some kind of merit pay or reward system?  I know the Chugach School District does this, or at least they used to.  Its based on a combination of factors like academic performance of students, parent/student questionnaires, etc.  The union would blow its stack at these ideas, but its a way to pay the best teachers a bonus and hopefully help them to stay.  Like I said, these ideas are problematic.  If you have an idea to add, put it in the comments!

 

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