Understanding and Managing the Growing SLP Shortage

A Forum for School Leaders
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UNDERSTANDING AND MANAGING THE GROWING
SLP SHORTAGE
By Karen Roth, M.S. CCC-SLP, Clinical Professor, Arizona State University
For many of you it may seem like qualified SLP’s are disappearing, and no wonder, because
the SLP shortage is affecting every school and every school administrator to some degree
or another. Luann Purcell, executive director of CASE, (Council of Administrators of Special
Education) offered her perspective on the shortage at the 2012 CASE national conference.
“The shortage of speech and language pathologists is very real and persistent,” she said.
“There are some systemic issues that prevent us from having adequate supply of SLPs.”
As Luann says, we know that the SLP shortage is an ongoing and growing problem. And,
there is data to suggest it’s not going away. Forecasts from the U.S. Department of Labor as
well as numbers included in a recent U.S. News and World Report article about the hottest
jobs of the future show continued growth in demand for SLPs, well above that of the nation-
al average for other professions. So, we can expect to have significant growth in job open-
ings for SLPs. This is not a short-term problem; this is very much a long-term problem that
is going to require some long-term solutions.
SLPs face many challenges. All SLPs have significant education requirements due to scope
of practice, clinical training needs, and the limited capacity of graduate programs. School-
based speech language pathologists have special challenges that include high caseloads,
shifting expectations and increased complexity in student needs.
The first major challenge for speech language pathologists is training. I get questions from
friends, colleagues and people in the community about why SLPs go to school for so long
and why we have to jump through so many hoops in order to become Certified. I don’t think
the community at large, or even professionals with whom SLPs work understand why the
job requires so much training.
One reason for such extensive training is the scope of practice. SLPs must demonstrate
competency in providing services for all communication disorders in populations from birth
to death. They not only have to be able to serve those in need across the entire lifespan,
but also across all communication disorders. What I mean is swallowing disorders, feeding
disorders, voice and other complex disorders that require a lot of education and training. In
addition to the lifespan and the broad scope of practice, to be licensed and certified, there
are multiple environments in which speech language pathologists have to be trained in or-
der to effectively deliver services.
THE SIZE AND SHAPE OF THE SLP SHORTAGE

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SLP training requires classroom-based academic training as well as 400 clinical clock
hours. Clinical hours are much more difficult to come by and are more intense than class-
room-based education. The training has to be supervised by speech language pathologists
who have what we call their “C’s” -- their Certificate of Clinical Competency--- which fully
certifies them to bill for Medicaid services and allows them to work without supervision. The
CCC credential is reached after nine to twelve months of full-time supervised employment
after the master’s degree is earned. Beyond the two-year masters degree, a year of clinical
fellowship is required before a speech language pathologist has her “Cs”. The intensity of
that clinical training requires one-on-one mentoring across a variety of settings. If you add
it all up -- the clock hours, supervision by someone with their C’s, the intensity of the train-
ing in hospitals, school settings and outpatient clinics -- you can see how difficult it is to
train enough SLPs to meet the growing demand.
The capacity of graduate training programs is a significant factor as well. Most programs
accept only 15 to 20 graduate students a year, and the number of applicants far exceeds
the available space. Online courses are expanding, but the necessary clinical training clock
hours and competencies can’t be done via online courses. What may worsen the training
picture is what many see in the future. We anticipate that a clinical doctorate may eventual-
ly become the entry-level credential for speech language pathologists. Now, it’s a master’s
degree, which used to be commensurate with our colleagues in physical therapy and occu-
pational therapy. PT and OT have gone almost exclusively to a clinical doctorate. If we are
looking at the SLP profession also moving in that direction, it means more extensive training
which will do nothing to address the shortage of SLP’s.
According to ASHA statistics, since 2009, the average number of applicants to SLP gradu-
ate programs was 142.5, and the number of admissions was less than half that. Enrollment
is far smaller than admission, partly because only a percentage of those who are accepted
actually enroll. Some applicants are admitted in several places and obviously accept admis-
sion to only one program. So enrollment is significantly below admission and the number
of degrees awarded is even lower than that. So out of over 142 applicants, only 24 speech
language pathologists graduate and go out into the world. You can see that that is a signifi-
cant aspect to this problem.
With regard to the school speech language pathologist perspective of the challenges that
contribute to the shortage, what we see in the ASHA (American Speech and Hearing Asso-
ciation) school survey is that workloads and caseloads continue to increase. Most speech
language pathologists say there isn’t a shift from the caseload approach to a workload ap-
proach in order to better manage more complex students. In other words, speech language
pathologists typically manage a certain number of students on their caseload regardless of
the complexity and severity of the disorders. Many school districts are working hard to make
sure that there is balance. But, most speech language pathologists who work in schools
across this country say that the workload isn’t a factor in mitigating the size of their case-
load. Currently the mean number of students on a caseload is in excess of 40 students for a
speech language pathologist.

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In that same ASHA school survey, speech language pathologists cited some of their oth-
er challenges. One of those is the high amount of paper work. We all know this is a federal
requirement that we can’t do that much about. SLPs who responded to the survey indicated
that large caseload is a big factor in why they leave the school setting. SLPs are also chal-
lenged by the limited understanding of their role by families, teachers and administrators
and also by students who are receiving services.
Another frustration is the lack of time for appropriate service delivery. SLPs are expected to
provide services that are effective, but they don’t have enough time to manage their case-
load in a way that allows them to provide services in the most efficacious way. Lack of time
for planning, for meeting and collaborating with fellow staff is also a frustration I hear from
teachers and speech language pathologists. In a school setting, we need time for planning,
meeting and collaborating, and there just isn’t time to do it in the way that caseloads and
services are currently managed.
These are some of the challenges SLPs are citing as reasons why they quit their jobs. But,
like most educators, SLPs are dealing with changing and expanding roles and expectations.
Speech language pathologists report feeling a lack of specificity for their role as the nation-
wide school service delivery model changes. Response to Intervention is one area of con-
cern. Over a quarter of speech language pathologists indicate they have no role in Response
to Intervention -- that they don’t participate in RTI on any level, which sounds shocking to
me.
In addition, many school districts are looking at the role of every school professional in edu-
cating the child and the outcomes of the child’s education. They are using some new tools,
including Value Added Assessments. When ASHA reviewed the value added assessment
tools, they found that they really didn’t apply to speech language pathologists and take into
account their unique role in a school district. ASHA has developed a way of assessing the
SLPs contribution to the outcomes of student education through something called PACE
(performance Assessment of Contributions and Effectiveness of Speech-Language Patholo-
gists). You can learn more about this on the ASHA website.
We know that Common Core Standards are coming into play nationwide as well. Common
Core is shifting how speech language pathologists are writing short-term goals, how we
are writing IEPs, how we are targeting the relevant skills in regards to communication and
cognitive linguistic skills and evaluating these important components as they relate to these
Common Core Standards.
What’s more, SLPs are required as practicing professionals to use evidence-based practice,
much the same way as physicians are required to use evidence-based medicine. In fact, our
model for using evidence-based practices comes straight from the medical model and it is
to be equally applied in school districts. Yet, I hear from so many speech language pathol-
ogists that they simply don’t have the time to do literature reviews and study the research
and apply it clinically to their own practice in a school-based setting.

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Finally, it seems that the challenge in schools also has to do with the complexity of students
we are serving. This has increased very significantly. The students that SLPs and teachers
are serving in their classroom are far more medically fragile than we’ve seen in the past. We
have premature infants surviving at 26 weeks of gestation because of medical technolo-
gy. The aftermath of that increased survival rate is that many of these children arrive in our
school districts with huge needs. Their communication needs can be impacted by the fact
that they have a tracheostomy. They may have a ventilator that helps them breathe, they
may have had a feeding tube placed permanently. All these things impact their participation
as a student in the classroom, and it impacts the type of services they can receive.
The survival rate of premature infants is just one reason why the scope of practice for the
SLP has increased and why there is much more demand for expertise in a school district.
There is also greater need than ever before for augmentative communication, autism spe-
cialties, feeding specialties, and reading specialties, because reading is language. All of
these things fall within our scope of practice. The students on our caseloads have very com-
plex situations. Some of them are in and out of the hospital, and there are very few people
in the school districts that are better trained than a speech language pathologist to under-
stand the needs of the complex and medically fragile students who are arriving.
With all these factors contributing to the SLP shortage, what are universities doing to in-
crease the flow of qualified SLPs? There are a lot of programs being put into place. At
Arizona State University, for example, we have a part-time employment program for speech
language technicians working in the school districts. If they meet the admission require-
ments for our Masters program, we give them an opportunity to do the two years of work
across three years while they continue to work in their employing school district. Classes
are scheduled in late afternoon and evening to accommodate their schedule. There are pro-
grams like this across the nation, as well as some online programs that either require once a
year onsite participation or is all online and students have to find some clinical placements
within their community. In addition, ASU, many community colleges and four-year universi-
ties have started providing training for SLP-As, Speech Language Pathology Assistants.
We’ve seen that there are a number of challenges SLPs face, starting with getting into grad-
uate school, and then on the job as well. But as CASE director Luann Purcell mentioned,
the reason for the SLP shortage is systemic. Finding a solution is not just about addressing
retention. Our recruiting practices are also fueling the SLP shortage. I asked a recent SLP
graduate to offer her perspective about the recruiting process from a recent personal expe-
rience, and to offer some ideas you can use to improve your odds of finding the SLPs you
need to work in your schools.
STRATEGIES FOR RECRUITING SLPS TO WORK IN SCHOOLS

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First, realize that SLPs want to work in schools. And by and large, they do. This is something
that we have been aware of at ASU. SLPs who come through our program want to get a
job in a school district. They are interested in serving that population. It’s an opportunity
to work in an environment where they don’t have to bill insurance and where they get to
serve students who have special needs. SLPs get to see students in their environment in the
culture of their school that uses the language of the curriculum. To have the opportunity to
provide services in schools is really ideal for a SLP. So, we know that almost half of all SLPs
work in schools and the rest of SLPs are distributed through other settings in smaller per-
centages. At some point in their career, the majority of SLPs work for a school district. In
terms of the ASHA school survey, we made note of the increased caseloads and workloads
that have a negative impact on the SLP shortage. Decreased appropriate service delivery
and quality of services were the perceptions of SLPs, and ultimately those things add up to
a decreased job satisfaction. The numbers speak loudly that SLPs want to work in schools,
but we know some of the struggles for SLPs in that setting.
I’d like to share the viewpoint of Jennifer, a recent SLP graduate from the ASU master’s
degree program and now works for a school district. I had the opportunity to have a con-
versation with her and she gave me some insight about things that attracted her to school
district where she works now and things that were impacting her decision.
Jennifer was hired in August by a school district and placed in two environments. She works
in a preschool, where it is an inclusion preschool, and on top of that she has some resource
students she works with in the resource room. She works in the preschool two days a week
and in an elementary school another two days a week. Jennifer is responsible for 44 IEPs:
just over 30 elementary students and in the preschool, 11 in inclusion and three resource
kids. She doesn’t have any help.
Jennifer only interviewed for SLP positions with school districts. She was a teacher in her
previous career, and a school setting is where she is comfortable working. She interviewed
with four different districts and ultimately narrowed the choice to two districts. The posi-
tion she accepted was with a district that puts a cap on caseload. The caseload cap was the
deciding factor for Jennifer, but there were other reasons that swayed her decision between
the two finalist districts during the recruiting process.
For the school district that she didn’t choose, she was impressed by the people with whom
she interviewed. They were very excited, outgoing and welcoming. Jennifer almost accept-
ed the position there due to the interesting personalities. The school district that she chose
wasn’t quite as welcoming, but when she told them she might go work for another district,
they “pulled out their guns” and told her that they really wanted her, and offered to make
her position easier.

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How did they make it easier for her? Jennifer completed her degree on a scholarship and
with a loan. The scholarship required that she work with preschoolers. The loan had a pro-
vision for pay back based on work with Title I schools. The school district she chose put her
in a situation where she could have her scholarship and loans requirements fulfilled. Those
elements certainly would make her life easier. The districts she eliminated during the recruit-
ing process weren’t as outgoing, they didn’t seem to take a real interest in Jennifer and they
didn’t have a cap on the caseload.
Now that Jennifer is on the job, does she feel like the school district she works for under-
stands her skills and her education and what she can bring to the table in terms of providing
services as a SLP? When she walked into the classrooms in elementary and the preschool,
she wasn’t provided with the materials she needed. She says she has been put in a situation
where the school district has been having trouble retaining SLPs because there isn’t a good
understanding of the SLP role in the classroom were and the resources needed.
Jennifer sees a big issue with retention in school districts. District leaders are putting new
SLPs into positions where other district SLP have not wanted to be, and there is a reason
why they haven’t wanted to be there. There is a reason why SLPs are having difficulty doing
their job; there is a level of frustration. Jennifer can see why someone would want to quit
and go to a private practice setting where his or her job is easily understood. This new SLP
graduate thinks recruiters should understand that during the first year on the job new SLPs
need to be nurtured. They are still in a level of learning and they need an environment that is
supportive of them.
Jennifer doesn’t talk about money being a factor in her decision. We know that districts
have a certain amount of money to work with, and there is little that can be done about it.
But, the things that were important to Jennifer in making her decision were about capping
caseload, meeting the other SLPs and having some support and understanding of the role
of an SLP.
Some of the other things we heard from other SLPs who were new to working in schools
is that they were offered jobs without an interview. This sends a negative messagethat the
position is not worth having. It looks like a desperate situation, and that can scare off a new
grad. When graduates see a lot of positions being filled with less than highly qualified staff,
when those holes are plugged with people who don’t have the background education and
knowledge to provide adequate services, it also sends a negative message about the value
of SLPs in that district.
Overwhelming new SLPs with too many responsibilities can also be a factor that impacts
your recruiting efforts. One way to make the work environment more attractive is to hire
SLP assistants. ASHA now has great resources on their website about the appropriate use,
scope of practice and supervision of SLP assistants. These assistants are not aides, some-
one who doesn’t necessarily have any special training or certification or licensure require-
ment, whereas a SLP assistant is a trained person who is licensed. There are, across the
country, two-year programs at community colleges offering certification as a SLP assistant.

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There are clinical hours that are supervised and required with those programs. Many states
have licensure for SLP assistants. I currently teach “Treatment Implementation for SLP as-
sistants” at ASU, so our students coming out with a bachelor’s degree have the option to
also take additional certification courses and receive clinical clock hours. Many of them are
getting their clock hours in school districts where they want to continue to work. So there
are a lot of things in place to begin to certify assistants because there is a role for them and
they are needed.
We know that many school districts can improve their recruiting and retention methods.
But as CASE Executive Director Luann Purcell reminds us, the SLP shortage is systemic and
therefore, there is no single solution. Unfortunately, there isn’t a magic wand that can fix it.
We really need a multi-faceted approach. We need to address this problem from a number
of directions because there is a growing need for speech language pathologists and the
shortage could become more of a concern given that degree requirements may shift to a
clinical doctorate in our profession. We are going to have to shift our thinking about speech
language pathologists in school districts. We need to recognize their unique roles and the
services that they can provide and start to use them as they should be used.
The first solution is the SLP Assistant, and the key here is to supplement SLP services with
them, not substitute SLP services. The problem in the past has been non-certified bache-
lors-level SLPs who may be great at ground-level therapy implementation, have been used
in place of a SLP, instead of to supplement a SLP. This creates a myriad of problems.
What we would like to see are well-trained, licensed appropriate professionals coming in as
SLP Assistants (SLP-A). These are people who are able to implement treatment supervised
by a Certified SLP. The supervision requirements are very well delineated by ASHA. One
SLP who has had the C’s for over a year --which means two years after graduation --- for
every two SLP-As and/or they can supervise three part-time SLP-As.
We would also like to see that SLP-As are practicing within their scope of practice as direct-
ed by ASHA, that they aren’t providing services to more medically complex kids and they
are not doing assessments. SLPs can supervise SLP-As in providing some of the treatment
to students so that the SLP can participate in the more complex, more dynamic aspects of
assessment, and have more time to work on early treatment and play a much-needed role in
Response to Intervention. Appropriate use of an SLP-A meets student needs while allowing
SLPs to use the full scope of their SLP Masters degree, and to be able to direct the assis-
tants to provide quality evidence-based practice.
Many of the solutions for service provision include using the SLPs expertise better. If you
access the PACE version of the value-added assessment developed by ASHA it will help you
define for yourself what your expectation can be of really using your SLPs in the most effi-
cient and effective way.
SOLUTIONS TO THE SLP SHORTAGE

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We can use SLPs in consultative models, especially in regards to Response to Intervention,
to be able to do things more intensively at a beginning level. Years ago it used to be the
student really had to fail before we could anything. Now, with multiple tiers of RTI it allows
us to do something earlier on. Our SLPs need to be utilized in these areas so that these stu-
dents don’t continue to fail and end up on SLP caseloads and staying there indefinitely. In
addition, it is attractive for new SLPs coming onboard to ensure that their workload is val-
ued. If they have classrooms with a lot of kids who have complex needs, be sure that those
students count for more of a workload than the students with fewer needs.
Another part of the solution is telepractice. Online delivery can especially help some rural
school districts having difficulty finding SLPs and managing workload. They can really maxi-
mize a SLPs time by limiting the driving time. When you have needs across multiple schools
and you are putting an SLP in a car, it is taking time out of their day that would be better
used for service provision. In addition seasoned SLPs who would otherwise have to leave
the work force can have a more flexible schedule and work from home. SLPs with special-
ized expertise can be brought into the team and matched more specifically to the students
needs, such as bilingual students or students with voice or fluency disorders.
Telepractice also allows schools some scheduling flexibility. Online SLPs can serve students
before and after school, homebound students, students transitioning from a hospital back
into school, summer provision of services, and covering vacations of staff SLPs. Really,
through telepractice you can provide these services and do it across time zones.
Online speech and language services can also be combined with “on the ground” SLPs to
balance caseload and workload. A number of districts across the country combine the of
services of an online SLP with services delivered with an SLP “on the ground.” So for in-
stance, the SLP at the school location may do the assessments, while the SLP who working
in an online environment is providing the intervention. In addition we also know that not
all students are candidates for telepractice, so some students can be served with an online
intervention program and others would work with your on the ground SLP. Further, online
SLPs are increasingly being used to provide service to small groups of students. In fact, they
sometimes work with students in multiple locations who attend the same school, and they
might also have one student from one school, another student from another school, and the
SLP in a third location. So there are a lot of different ways that you can balance a group. The
online SLP is accountable in the same way as your traditional SLPs to manage progress, to
manage IEPs, and to do the reporting in terms of working and developing the IEPs. Online
speech therapy is really just an alternate service delivery model.
You really need to think about ways to make your school more attractive to SLPs. I think it
is very important for SLPs to be valued for what they bring to the table professionally It
is important to recognize that SLPs aren’t “speech teachers”, it is an important distinction.
Teachers bring an amazing set of skills to their classrooms and to doing what they do and
should be valued for that. SLPs bring a different set of skills and should be valued for these

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specialized skills. In addition, having SLPs at a district, leadership level is really important.
We need input at the district level keeping on track with SLP use and meaningful and effica-
cious service delivery.
Contract companies are in option as well. They are costly, but they provide certified SLPs.
Contract companies go to great lengths to make sure that their employees are licensed and
certified and have completed background checks. So a fully certified SLP can be utilized via
a contract company versus a highly qualified directly-highered staff member.
Small but creative support methods are important too: Being willing to give a caseload cap,
being willing to assign a new SLP to a school that is serving lower socioeconomic students
so that her student loans could be forgiven to a certain degree. These types of small, but
creative support systems are some of the most important things district administrators can
do to make the job attractive to SLPs. Above all, recognizing that speech-language pathol-
ogists have this unique and diverse skill set that covers a broad range of cognitive-linguistic
difficulties is very important.
I have another suggestion from Luann Purcell. She advocates for alternative models, that we
think about other ways to use our SLPs. So for example, Luann suggests that we schedule
SLPs in our classrooms, which of course will help teachers learn how to work with our kids,
and integrate new classroom strategies, including the idea of online speech therapy.
We hear a lot of questions from district administrators about other approaches to providing
services with staff that may not have a masters-degree. For example, you may have spe-
cial education staff that have only a bachelor’s degree, and may not have the GPA required
to be admitted to a graduate program. These individuals may do an amazing job in your
schools with the children, and I know you would love to see them get accepted into a mas-
ter’s program..
Now for these individuals, if they are being utilized where they have their strengths, it is
wonderful if we can supervise them so that they can continue to provide services. If they
do get admitted into a masters program, they will have to learn to provide services beyond
what they do with your students. With the SLP license and certification they will need to
learn to work in an ICU and see ventilator patients who have swallowing disorders and need
speaking valves for their trach’s. So they have to be able to perform in a graduate program.
Front-line treatment implementation isn’t the same as planning and providing services
across the scope of practice and the lifespan. One skill does not necessarily translate to the
other.

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For those who are compatible with a master’s program, there are online courses that can
help them take transferrable credits that could raise their GPA and make them more com-
petitive. What’s more, if they take some online classes, graduate programs are more willing
to look at classes that are related to the profession than they are for, say, an undergraduate
history class. So the GPA for SLP classes is going to be far more relevant for that person. If
they take those classes, raise their GPA, take the GRE, and get recommendation letters, they
could potentially enter one of the part-time employment programs that let them work while
completing requirements for a masters. If they are not able to do that, we really need to
maximize the skill set that they are showing you and supervise them and allow them to do a
great job as a SLP Assistant.
When you have an assistant, regardless of their degree level, you are going to differentiate
between skill sets. It is important to supervise more heavily when they start working in your
district. Assess what they are capable of doing, provide a lot of modeling, provide support
and detail about the type of implementation you expect from them. You may ease into their
caseload by starting with one type of student, and add on a little bit more as you determine
the best fit. So, although a student with a bachelor’s degree is going to have a far deeper
understanding about communication disorders, the clinical clock hours are going to typical-
ly be the same for both 2-year and 4-year programs to get the SLP-A certificate.

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About The Author
Karen Roth, M.S., CCC-SLP, Clinical Associate Professor at Arizona State University, has
worked as a SLP in school districts across three states and has presented nationally on
topics related to the SLP shortage including presentations on creative scheduling and col-
laborative IEP writing. She recently coordinated a workshop for Arizona school-based SLPs
regarding the use of SLP-Assistants as a way to address increasing workload demands while
preserving the quality of services to students.
Karen Roth, M.S., CCC-SLP

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At PresenceLearning, we love to see children thrive, which is why we are making the
promise of live online speech therapy (sometimes called telepractice) come true.
With the ongoing shortage of SLPs (speech language pathologists) and budget pressures
in school districts reaching crisis proportions, innovative modes of delivery have become
essential for giving children the speech therapy services they need.
A large and growing body of research, starting with a seminal study by the Mayo Clinic in
1997, demonstrates that live online speech therapy is just as effective as face-to-face therapy.
Our mission is to make live online speech therapy practical, affordable and convenient while
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• the most engaging games and evidence-based activities
• time-saving collaboration and practice management tools targeting SLPs and educators
Join the growing group of SLPs, educators and parents committed to seeing children thrive
as part of the online speech therapy revolution.
About SPED Ahead
About PresenceLearning
SPED Ahead is an opportunity for school administrators and special education specialists to
catalyze discussions about new ideas and promising practices that help exceptional
students achieve. With a series of free interactive online events and related multimedia web-
based resources, we will explore answers to tough questions and shape effective leadership
strategies for addressing special needs students’ challenges for literacy skills, scholastic
achievement and peer relationships.

Understanding and Managing the Growing SLP Shortage

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