Virginia Capitol Connections Summer 2022

Virginia Capitol Connections, Summer 2022 26 audiologist shortages and (b) increased out-of-pocket expenses if their needs are immediate and require out-of-network support. In healthcare settings, performance expectations can be another contributor to workplace stress and burnout. Ms. Mowfy notes that “caseload expectations vary by productivity requirements anywhere from 75-90% expected productivity a day.” That is, 75-90% of an SLP or audiologist’s time is supposed to be spent directly with patients, providing skilled services. “This can really inhibit planning time and intervention prep when not advocated for by the leadership team on site,” says Ms. Mowfy. In school settings, performance expectations are structured a little differently: every child receiving speech-language therapy has an Individualized Education Program (IEP) that outlines their speechlanguage therapy goals and prescription, often written as a monthly or weekly dosage (e.g., 240 minutes/month, 60 minutes/week). The same is true for students receiving audiology services. While in theory, students are receiving a full dosage of high-quality, evidence-based services in accordance with their IEP, school schedules and rising student populations (especially post-pandemic) result in a different reality. Kenzie VanDerwerker, a practicing SLP at a Virginia pediatric hospital and former school-based SLP says, “It's nearly impossible to give good, evidence-based therapy to a student when they are being seen in groups of five with various goals in a 30-minute session with having to pick up the students, walk in the hallway, get situated at the table, and then allot time for dropping everyone off. You end up with a 20ish minute session shared with five students, so four minutes each.” Despite also having additional responsibilities outside of providing direct treatment (e.g., writing IEP goals and prescriptions, writing session notes, writing progress notes, collaborating with school staff, contacting parents), school caseloads have not gotten smaller. The unfortunate reality, as Ms. VanDerwerker notes, is that “there's just not enough time within the school day. So, we pick who we prioritize—how would you feel if some child you loved wasn't the priority?" Lori Carozza, a Lead SLP of aVirginia public school system, notes similar concerns with high caseloads, stating that they “reduce our students to numbers rather than individuals. The result is IEPs are ‘pumped out’, often being cut and pasted together for lack of time to be individualized.” Many states have passed legislation that limits the size of speechlanguage pathology school caseloads, with some state maximums set as low as 30 (i.e., Alabama, Louisiana), though Virginia’s extraordinarily high, at 68. With such a high limit to the number of students one SLP can have on their caseload, professionals are at-risk of burning out and students are at-risk of receiving ineffective treatment. Ms. Carozza says, “Caseloads of over 50 decrease the effectiveness of service delivery and the integrity of therapy. SLPs are forced to have large groups which are minimally effective, which prolongs the duration of services over the student's career.” Unsurprisingly, large caseloads also impact an organization’s ability to retain high-quality SLPs. Ms. Carozza adds, “High caseloads are a deterrent from hiring qualified, experienced SLPs who understand the negative impact. Therefore, speech-language pathology departments often have Clinical Fellows and newer SLPs who miss the mentorship from veteran colleagues.” To help with increased demands on SLPs specifically, you may think SLPAs are a possible solution. However, without a state-level registration or licensing system for SLPAs, their services cannot be regulated or monitored (outside of the organization for which they’re employed), nor can their services be reimbursed by most health insurance providers/ programs. Additionally, because there is no state-level registration or licensing of SLPAs in Virginia, school systems often judge the qualifications of SLPAs based on whether they have an “SLPA license from other state or [certification from the] American Speech-LanguageHearing Association,” says Ms. Carozza. In the Commonwealth ofVirginia, there are no state-level checks on SLPAs to ensure they possess adequate knowledge and training to deliver evidence-based speech-language therapy services under the supervision of a licensed SLP. That means organizations, like Ms. Carozza’s public school system, are left to clarify the roles/responsibilities of SLPAs themselves. Ms. Carozza states that “the school administrators, staff, and parents need to be informed about the boundaries of the SLPA role, what the SLPA is allowed and not allowed to do.” Virginia Healthcare Providers Seek Reform from page 25 To help resolve the issues SLPs and audiologists are facing, we humbly ask for your support in our initiatives to increase health insurance reimbursement for speech-language pathology and audiology services, lower caseload/workload expectations, and ensure state-level oversight of SLPAs. If you would like to learn more about these issues or how you can help, please reach out to Madison Brumbaugh, SHAV’s Vice President for Governmental and Professional Affairs, by sending an email to Madison Brumbaugh is an SLP and assistive technology professional with experience in the public school (including public charter school), private practice, and home healthcare settings. She currently serves the Speech-Language-Hearing Association of Virginia as the Vice President for Governmental and Professional Affairs. Becky Robinson President and Founder Virginia resident since 1988 WWW.ALLEYCAT.ORG Virginia INNOVATION HAS Already Arrived IN ” “ — Becky Robinson © 2022 Alley Cat Allies. All rights reserved. When Becky Robinson established Alley Cat Allies in 1990, she sparked a global shift in which thousands of communities changed their fundamental thinking about cats and modernized laws and policies to save their lives. Today, Becky and Alley Cat Allies continue to charge toward our ambitious goal: A world where every cat is valued and protected. We’re joined by more than 800,000 supporters, including 45,000 right here in Virginia. Virginians are ready to embrace humane programs rooted in evidence-based science—the best path forward for cats and the Commonwealth. V