An Update on Caseload to Workload for School-Based Practitioners

How Are You Wrapping Up Your School Year?

Along with progress reports on goals, lingering evaluation reports and annual IEPs to finish, do you make time to reflect on your accomplishments and goals for the year? What would you change to work to your full potential, lessen the burden of paperwork, and commit to another year of hard work in the school system? Have you discussed the caseload to workload model for your setting?

Please read the Update below written by expert School-Based Practitioner and ERI Faculty, Susan Cecere, PT, MHS. Sue offers hope and help with how to advocate for yourself and your students.

What’s The Magic Formula?
An Update on Caseload to Workload for School-Based Practitioners
written by ERI Faculty, Susan Cecere, PT, MHS

Workload has been a hot topic for school-based practitioners for the last 20 years. The reauthorization of IDEA in 2004 and its focus on inclusion and accountability facilitated the need for states and districts to look beyond the traditional service delivery models of “direct” and “indirect” and recognize the expanding roles for related providers based on the legislative changes.

No longer were SLPs, OTs and PTs just providing support for students who were eligible for special education and related services; there was now a requirement to support educational initiatives such as Universal Design for Learning (UDL), Response to Intervention (RtI), Multi-tiered Systems of Support (MTSS) and Positive Behavior Intervention Supports (PBIS). Coupled with increasing rigor in academic programs and ever evolving accountability systems, the caseload approach – providers assigned by the number of students receiving IDEA services regardless of intensity of need and associated work tasks, including licensure documentation requirements – no longer kept providers “afloat.”

Professional organizations heard the frustrations of its members; in 2014, AOTA, ASHA and APTA authored a joint white paper, “Workload Approach: A Paradigm Shift for Positive Impact on Student Outcomes” to draw attention to the challenges faced by providers. Over time, some states added caseload caps and authored guides to practice that mention the need for a workload approach, but few states have actual methodologies for workload calculation – a “magic” formula.

In 2023, the Oregon legislature tasked the Oregon State Department of Education (ODE) with conducting a study to determine an appropriate workload methodology for public school OTs, PTs and SLPs. In January 2024, the ODE submitted the report “House Bill 2618: School-Based Occupational Therapy, Physical Therapy and Speech Language Pathology Workload Methodology” to the Oregon legislature.

This comprehensive report clarifies the terminology: “caseload” and “workload” and articulates in detail the roles and responsibilities of each discipline. A mixed method study process used to develop the report included group engagements, provider interviews, and a review of available literature and workload methodologies. The report reflects provider concerns including but not limited to: (1) inability to work to full potential, (2) feelings of being overburdened by paperwork and legal requirements, (3) students are not receiving the services they need (4) staff recruitment and retention and (5) provider shortages. Based on social media content related to caseload and workload, the feelings of surveyed Oregon providers align with national sentiment.

The ODE was able to make a recommendation for a workload methodology and metric starting point: The North Carolina Department of Public Instruction (NCPI) workload methodology. ODE recognizes further analysis of this methodology for alignment with the Oregon education system is needed to develop a workload metric that would reflect the unique needs of Oregon and its communities. These recommendations include: the inclusion of early intervention and early childhood providers, school Medicaid billing as a workload consideration, provider shortages and state level infrastructure, training, and support for school districts during implementation.

I encourage all stakeholders to engage in caseload to workload discussions to advocate for needed changes to address the diversity of student learning needs and implement best practices. SLPs, OTs, and PTs should engage in advocacy efforts at the state and local level to provide quality services for students and provide what federal legislation requires of us to support all students in “further education, employment and independent living.”

References and Resources on Caseload to Workload

American Speech-Language Hearing Association (ASHA). ASHA Workload Calculator. https://www.asha.org/SLP/schools/Workload-Calculator/

American Speech-Language Association, American Physical Therapy Association, American Occupational Therapy Association, (2014). Workload Approach: A Paradigm Shift for Positive Impact on Student Outcomes.

Burton, S., Buckley, S., Cecere, S., Cobb, S., Figueiredo, D., George, E., Kierstead, K., Lesch, D., Mastrilli, J., Vandervalk, K., Williams, J. (2008, 2015). Occupational and Physical Therapy Early Intervention and School-Based Services in Maryland. https://pprd.montgomeryschoolsmd.org/siteassets/district/departments/special-education/programs-services/maryland_ot_pt_guide__revjune2015_2_11.pdf

Carlin, C., Watt., L. Fallow, W., Carlin, E., Shernavaz, V. (2103) Caseload Ratio Study: Final Report to the Ohio Department of Education https://education.ohio.gov/Topics/Special-Education/Service-Provider-Ratio-and-Workload-Calculation

North Carolina Department of Public Instruction. Workload Calculator Guidance. https://drive.google.com/file/d/1ceNcV1-pgs9EQ4hcZJ5cLdY7JvSp2AxH/view

Seruya and Garfinkel Workload Resources https://www.garfinkelseruya.com/index.html

Struggling with Carryover? Try Something New to Unlock Your Full Potential

Written by Joann Sorg, MS, OTR/L and featured in the recent NANT newsletter.

Have you ever felt discouraged by lack of carryover from caregivers and colleagues? Do you sometimes scratch your head as you watch a caregiver or colleague attempt to execute what you taught them and wonder, is that really what they thought I meant? Wondering what might tip the scales towards follow through and better outcomes?

At ERI, we’re continually examining our instructional methods to ensure learners are taking away the crucial strategies and research they need to do their jobs well. As NICU clinicians educating both caregivers and your colleagues, we know that you also want to teach well so the adults learn and babies thrive. Here’s a look at Knowles’ adult learning principles, various teaching strategies, and ways to merge them to deliver the content your NICU patients and their caregivers need for their best outcomes.

Principles 1 and 2: Problem-Centered Instruction and Application to Real-World Problems

This rings loud and true in the NICU setting, where caregivers confront multiple challenges around their baby’s health and development. Clinicians can pair their teaching strategy to this principle by using props, simulations, and hands-on methods for edema mobilization, positioning for feeding, handling and more. When Holly Schifsky teaches Baby Beats and Breaths and Babies Bodies and Brains, she embraces hands-on learning. Schifsky uses dolls to model and demonstrate techniques for her learners. You can use these same instructional methods with caregivers by coaching them through practice on a doll, providing specific feedback to refine their skills and facilitating their comfort and competence.

Principles 3 and 4: Motivation and Relevance to Current Roles

Caregivers’ experiences around parenting in the NICU encompass emotional and practical challenges. This may cause a re-imagining of their caregiving role and further spark their intrinsic motivation. NICU clinicians can acknowledge and validate the emotional experiences of caregivers while delivering essential instruction that aligns with the caregiver’s drive to perform in their new role. While teaching on medical complexities and feeding challenges for small babies, both Anjanette Lee and Shanna Semmler relate strongly to their learners’ motivations and roles as NICU clinicians. You can apply these same principles as you use video demonstrations, small group discussions and real-world clinical scenarios in your caregiver education.

To dive deeper into adult learning principles, including Self-directed Learning and Utilization of Background Knowledge, check out the work of Malcolm Knowles and his contemporaries in the field of andragogy.

Teaching the Teachers – Sharing Knowledge Amongst Colleagues

For those practitioners recently immersed in the 2024 NANT conference, you’re likely bursting with new and revived ideas and research to share with your teams. Perhaps you’re planning a professional development presentation and thinking of how best to hold your audience’s attention. You want to enhance the likelihood they’ll retain and apply the information you’re eager to share. How about pairing the familiar lecture and slideshow format with some additional strategies to connect more deeply with your leaners, inspire their clinical reasoning and lead to a cascade of favorable outcomes for providers, caregivers and babies?

Bringing your educational content to life:

Role simulations – pair up with a colleague to practice caregiver education; In both roles, ask questions, get it wrong, address gaps in knowledge and refine hands-on techniques.
Use videos and photos for meaningful analysis and to otherwise illustrate your learning objectives.
Facilitate small group discussions as a vehicle for learning. Steer your participants toward improved reasoning and technical skills by connecting to those adult learning principles above. Tap into their motivation as clinical leaders, advocates, developmental experts and compassionate providers as you work through case applications.
Ensure your learners are on the right track – real-time checks for understanding, along with pre and post-test assessments are made easy by digital polling apps that promote engagement.

NANT and ERI embrace common values around education and clinical excellence. We’re all devoted to lifelong learning that serves our patients, from their earliest days and through their most daunting challenges.

References:

Gehl, M.B., Alter, C.C., Rider, N., Gunter, L.G., and Russell, R.B. (2020). Improving the efficiency and effectiveness of parent education in the neonatal intensive care unit. Advances in Neonatal Care, 20(1), 59-67.

Kessler, M., Schuck, R., Rosenthal, C., Stobbe, D., Sinko, R. (2020). Caregiver education in the neonatal intensive care unit (NICU): A Review of the evidence. The American Journal of Occupational Therapy, 74(4_Supplement_1).

Peterson, D. (2023, April). 5 Principles for the teacher of adults. https://ThoughtCothoughtco.com/principles-for-the-teacher-of-adults-31638.

Springer, C., Cooper, O., Elleman, B., (2023). The Effectiveness of parental education programs within neonatal intensive care units: A Systematic review. Research Directs in Therapeutic Sciences, 2(1), 2.

Updated On-Demand Course: Pediatric Vestibular Therapy

Updated Content!

With greater awareness around vestibular dysfunction and rehabilitation in recent years, ERI’s vestibular expert, Inger Brueckner, MS, PT, has released an updated edition of her popular course on Pediatric Vestibular Rehabilitation with more than 75 references from just the last five years: Pediatric Vestibular Therapy: Young Children Through Adolescents – ON-DEMAND.

What’s New?

Brueckner covers anatomy, function and development of the vestibular system, while presenting current research findings to guide effective treatment for various conditions and functional impairments. Learn how specific diagnoses relate to vestibular dysfunction; including POTS, COVID-19, cancer, cerebral palsy, hearing loss and other neurological disorders in children. Brueckner also addresses balance complexity and entropy in postural sway; multi-canal issues with BPPV; and medication effects on the vestibular system.

Earn 14 contact hours as you deepen your understanding of the connection between vestibular development, motor performance and typical skill development in children and adolescents. You will also also learn to interpret assessment findings to guide individualized treatment and promote improved functional performance in clinic, home and school settings.

Register Now & Save

Purchase Pediatric Vestibular Therapy: Young Children Through Adolescents – ON-DEMAND by June 7, 2024 and SAVE $30. Use coupon code BRUECKNER30 at checkout. *Discount cannot be combined with other offers.

Once you purchase, you’ll have access to the course and downloadable handouts for one year. You can go back and refresh your memory as often as you’d like! Watch, stop/start and re-watch the video whenever it’s convenient for you!

Join the ERI Facebook Discussion Group – Pediatric Vestibular Rehabilitation

Questions? Please contact ERI at info@educationrsourcesinc.com or 800-487-6530.

ERI Partners with NTCB to Sponsor Neonatal Therapist Scholarship

This year, the Neonatal Therapy Certification Board (NTCB) is launching a scholarship program exclusively for Certified Neonatal Therapist™ applicants from World Bank-designated lower-income countries who may lack the means to pursue the CNT certification. ERI is proud to partner with the NTCB to help sponsor these aspiring neonatal therapists with the opportunity to pursue their CNT credential.

This sponsorship will help to cover the cost of certification, enabling these dedicated individuals to demonstrate their expertise in the NICU. With over 900 CNTs worldwide, ERI believes that these passionate and deserving therapists should have the same opportunity to advance their neonatal expertise, creating a lasting impact in the lives of preterm and medically fragile infants across the globe.

What is the Role of the NTCB?

The NTCB, composed of experienced occupational therapists, physical therapists, and speech-language pathologists from neonatal intensive care units worldwide, was established in 2014. Their mission is to provide certification to neonatal therapists who demonstrate the time, knowledge, and commitment required to serve high-risk infants in the NICU. The CNT credential, awarded since 2017, signifies excellence and validates a neonatal therapist’s appropriate education, experience, and expertise through a rigorous evidence-based examination.

Is a CNT Certification Right for You?

Learn more about the process and benefits of obtaining a CNT credential to elevate your profession. If this is a path you choose to explore, don’t forget that ERI offers a variety of NICU related educational content to help you achieve the required number of CEU hours needed to fulfill your certification (along with other necessary requirements). Whether you’re an OT, PT or SLP, our distinguished faculty offer a robust selection of learning opportunities geared toward neonatal therapists that will expand your skills and knowledge, all while earning your CEUs.

Questions? Reach out to our office at 800-487-6530 or email info@educationresourcesinc.com for more information on continuous learning through ERI.

NANT 2024 Highlights

Fresh Off the Heels of NANT14

April 17, 2024
Marianne Boynton
Director of Client Relations

Last week I had the opportunity to attend the National Association of Neonatal Therapists (NANT) Conference in sunny Miramar Beach, FL. As an exhibitor at the conference, I had the chance to engage with numerous neonatal therapists, connect with fellow exhibitors and leaders in the NICU world, and discuss recent neonatal trends and topic suggestions for future continuing education courses. Once again, NANT put on an exceptional conference that cultivated a community of learning, support and research for neonatal therapists across the globe.

As a professional partner with NANT, it’s such a privilege to have a dedicated event to converse with this incredibly devoted, passionate group of therapists. Their drive to deliver the highest quality of care for babies and families in the NICU all around the world is inspiring, and it’s easy to walk away from this conference reinvigorated and eager to provide this community with the best possible learning opportunities to further their knowledge in the neonatal field.

Reconnecting with Familiar Faces

Exhibiting at NANT gave me the chance to meet and greet with therapists and allowed for the opportunity to discuss future topic suggestions, educational needs in the NICU world and to listen to new ideas. Connecting face-to-face is always so enjoyable because these therapists exude an incredible passion and devotion for this population of tiny babies.

Another big piece of the NANT conference experience is reconnecting with familiar faces. Some of the ERI faculty who stopped by our booth included Holly Schifsky, Kati Knudsen, Anjanette Lee and Christy Hupka. These faculty are so supportive and upbeat, it’s always a pleasure hearing from them and watching others have a chance to engage with these leading experts.

The conference wouldn’t be complete without a celebratory night to kick back and relax. Unwinding with friends, good food and music was the perfect way to end an eventful day of learning.

Loyalty Programs and Partnership Opportunities Available

Of course, we had to have some fun with our raffles and giveaways. We made sure everyone got plenty of goodies, and those who visited the booth were entered to win either discounted or free ERI courses (including a special NANT only discount). We had many entrants, so a big congratulations to our raffle winners: Lori Frederickson, Yenisy Randol and Sarah Walker. Speaking of special offers, did you know that we have a loyalty rewards program? Some examples include group discounts, first-time registrant discounts, and even $100 off if you’re registering for your 4th ERI course!

We also offer partnership opportunities to host a CEU course. Whether you’re looking for in-house customized continuing education, or want to host one of our popular webinars or on-demand courses with your facility, we make partnering easy and convenient so your therapists have the best possible professional development experience. Reach out to me for more information about partnering: mboynton@educationresourcesinc.com

Advance Your Learning with Us

Coming off of NANT14 just inspires us even more to continue to best equip this passionate community with the necessary tools needed to enhance their professional skills. Whether learning on-demand, via live webinar, or at an in-person event, we are dedicated to providing you with unparalleled educational offerings from some of the leading experts in the neonatal field. We’re committed to providing life-long learning that will serve to improve the lives of these tiny patients and their families.

Check in with us throughout the year as we continue to add more NICU related courses to our ever-growing library. Questions? Contact us at info@educationresourcesinc.com or call 800-487-6530.