Managing your caseload, data, and end goal of exiting your students!

The Missing Link for SLPs Podcast Full Transcript Mattie Murrey-Tegels 00:04 Welcome to this episode of a Missing Link for SLPs podcast. We are in the middle of our Day in the Life of a School Based SLP, and I tell you, I have so much fun listening to these two SLPs from the schools talk about what they love. I'm hoping you're enjoying these conversations as much as I am. Missing Link for SLPs is really becoming the spot for SLPs to come, and listen, and hear conversations with other SLPs who are passionate about what we do in our field. We talk about the good, the bad, the ugly, the challenges, and why we are doing what we keep doing after all these years. So, welcome, welcome. Glad you are here. This next episode is with Michele Rothstein, and she's a school based speech pathologist working full time in an elementary school for kids K through six, and she has her side hustle of running SLP Badness, which is a TPT store and all sorts of fun there. She serves as a coach for school based SLPs to help them meet their ever growing demands in their caseload while meeting the needs of their students. Michele strives to provide high quality treatment, based on the strong connection she has with her students and their families. Michele believes that therapy success stems from strong caseload management and accurate data collection. In her 23 years as a school based speech pathologist, Michele has served as a department coordinator, as well as an IT consultant to the other therapists in her school district. Outside of work, Michele is a mom to a teenage daughter. She is a fitness instructor who loves teaching step aerobics. And family and fitness occupy her time when she is not working at school or coaching other SLPs through school madness. So, I love the SLP coaching. I do, and I’m going to love this conversation with Michele and Katie as they talk about a day in the life of a school based SLP. Katie Widestrom-Landgraf 02:03 I am joined with another amazing school based SLP, Michele Rothstein. Michele, we're so glad you're here. Can you tell me where you're joining us from? Michele Rothstein 02:15 Yes. I am joining you from a suburb of Philadelphia in Pennsylvania, located in Bucks County. Katie Widestrom-Landgraf 02:23 Wow. I am just so excited and delighted that you're here to talk with us tonight. And one of the things we like to do when we start this conversation is kind of just learn about your whole journey to becoming an SLP. So, when you kind of think back, tell us a little bit about yourself and the path that got you to being a school based SLP. Michele Rothstein 02:45 Sounds great. I'll start with where I am now. I am a school based SLP in a suburban Philadelphia School District, actually in the county that I have grown up in my entire life. I work and live in the same school district, and I have been here for 23 years. But my journey to become a school based SLP started really in my sophomore year of school. I was out at the University of Pittsburgh, and had taken some courses in biology and chemistry and it didn't quite feel right. And I started my sophomore year, I changed up my coursework, stumbled into my first communication sciences and disorders undergrad class, and from there, the rest is history. So, I finished and got my undergrad degree at the University of Pittsburgh. I came back home and went to Temple University, received my Master's. And like I mentioned before, pretty much, I've lived in the same county most of my life, except for my period of time in Pittsburgh. And that is now where I work as well. Katie Widestrom-Landgraf 03:57 That's wonderful. Now, did you always know that you wanted to work in the schools? Michele Rothstein 04:03 Yes, 100 percent. I was always, always going to be a school based SLP. So, I was always – Katie Widestrom-Landgraf 04:1. Wow! Michele Rothstein 04:12 Yes. From day one – never wavered. I did not really enjoy the other clinical experiences I had that were outside of working with children or in the medical setting. I knew that I was meant to be in the schools. And like I said, never wavered from that initial thought. Katie Widestrom-Landgraf 04:34 Okay. So, tell us more about your destiny, your fabulous school based experience! Tell us specifically about the setting you work in. Michele Rothstein 04:44 So, I actually work for – I guess somebody could look this up if they wanted to, but it's the third largest school district in Pennsylvania. So, behind Philadelphia, and behind Pittsburgh, is my suburban school district. So, I am probably about one – maybe at this point, 24 or 25 SLPs in my district, which, as you know, is a substantial department for the school district. And so, I have worked almost exclusively at the elementary level in my time. That is where my passion is. I also have almost – well, I should say, I've always worked with autistic students and children in a range of what we call our regionally based autistic support program. That has always been where my passion lies. And so, I have been across elementary schools across the district in my time, supporting those programs, as well as usually the rest of the population of the building. So, I currently service my elementary school. I'm there by myself. It has about 550 students. We have three what we call regionalized autistic support classrooms there. So, students that sometimes that is their neighborhood school, and sometimes they are bused from other neighborhood schools to receive the supports that we have in place. And so, I do, as I say, all the things. I am the one person. And so, that makes it a very unique and very challenging experience when you're a department of one. Katie Widestrom-Landgraf 06:26 Mhm. Katie Widestrom-Landgraf 06:65 But again, I consider myself the master of my domain, because there's nobody else that does what I do. So, I get to do it to the best of my ability and the way that I would like to. Katie Widestrom-Landgraf 06:39 So, Michele, you said something really interesting there. You said, “I’m a department of one”. And I would like to talk with you more about how you manage some of the demands being that department of one. So, can you talk with us a bit about workload and scheduling, some of those kinds of things? Let's start with workload. How do you manage the workload when you have all these different factors to consider, and you're doing all of it. Michele Rothstein 07:13 So, the management piece I personally feel very strongly about is what leads to the success, or, unfortunately, the demise of a school based SLP. Because I do believe while most people would say that a therapist or clinician is probably the most important title that we hold, I would say a caseload manager is really the most important overarching title that we need to manage and execute very well in order to work through all the other phases of our job. So, when it comes to scheduling, when it comes to determining size of groups, who I want to work together, who I'm evaluating, who I'm screening, and that all falls on my shoulders. And so, it really is up to me to have the keys to the gate, so to speak. So, when I talk about being a caseload manager, one of the things that I believe really firmly in, is that in order to do the job well, there is limited space, or limited opportunities to service kids. So, while, naturally as therapists, we want to do our best and help everybody, but I would prefer to help a fewer amount of students exceptionally well, than allow everybody in to try to help and not help everybody to the best of my ability. And what I mean by that is when it comes to scheduling, I would say my caseload size, right now, I probably have about 55 students, K to sixth, on my caseload. My caseload may be somewhat smaller than the other therapists in my school district because of the autistic students I service to get a higher degree of I'm in therapy, so that warrants more in my schedule. But when I talk about there being limited space, when I'm evaluating a student and bringing a new student on the caseload, I'm already in my mind determining who I may be ready look to discharge within the next six months, next year, so that I know if I have somebody coming in, I'm looking at who possibly is ready to reduce their services, who's ready for discharge, so that I can balance the total numbers with the amount of space and time that I have in the course of a week that provide those services. Katie Widestrom-Landgraf 09:58 So, what do you do if there are more students coming on than there are exiting? Michele Rothstein 10:08 So, I actually experienced that last year to a very high degree. I'm not sure if all school based SLPs have seen an influx of significant student need. I personally, last year found that the COVID effect, where I was seeing a very high degree of students coming into kindergarten with very severe speech sound disorders that had not been diagnosed, picked up, students hadn’t received the early intervention. And so, that was a very challenging year. Thankfully, with the support of my administration, after several months, and a lot of good data to support the need for more time at my building, they were able to increase the service to make sure that the needs of the students were being met. But it is a very challenging aspect of the job, and I don't think it's something that when you start in the field, you're really prepared for as a clinician. Katie Widestrom-Landgraf 11:13 Agreed. Michele Rothstein 10:08 [After being] 23-24 years into the field, it is still something that I think is always evolving and changing, and each year is a different perspective, and a different group of kids, and it requires you always to be looking through a different lens. Katie Widestrom-Landgraf 11:31 You know, Michele, one of the ways I tried to help an administrator understand kind of the schedule, and the demand pieces, I said, if you think about my time slots available for therapy as buckets, and you think about the students that I see as beans, you can give me 75 beans to put in the buckets, you can give me 65 beans to put in the buckets, but there's an implication to all of those things. And what it is, is the beans end up staying in the buckets longer if we have more beans because there just isn't – if you have a really large group, those students aren't going to get the trials and the dosing of the intervention that can move that needle quicker in terms of progress. And I so appreciate that you're giving voice to that because I do think when we come out of graduate school, sometimes we're a little surprised at the demand and the intensity of time management and caseload management that we experience. Michele Rothstein 12:42 I really do. I hope you don't mind, I may steal that bean analogy. I may use that in the future because it really does speak to another perspective on how I look at our job. Some people have asked me along the way, “Well, if you wanted to work with children so much, why didn't you become a teacher? Why did you choose this field over another?” And I equate our job to like being the grandparent. I get to take them. I get to play with them, and then I get to send them back. Katie Widestrom-Landgraf 11:31 Yeah. Michele Rothstein 13:14 Where the teacher is the parent, like they have them all day. But the other aspect of my job that's different from classroom educators, is that our job is to work ourselves out of a job. Katie Widestrom-Landgraf 13:30 Absolutely. Michele Rothstein 13:30 When I meet parents, I often explain that right from the get-go. That like we've identified your child is having a disability in this area, or a need in this area. I am going to intervene. I'm going to provide that need. And then my plan is to do my job well enough that we get to the point where they don't need me anymore, and then the notion would be that they would exit from needing these services. So, I very much prep parents that my job is to work myself out of the job. And so, your analogy of beans in a bucket speaks to me because those beans will be in the bucket longer if you cannot provide the right intervention. So, last year, in working with one of the new students that I identified, came into kindergarten with a severe intelligibility issue and I was able – again with the support of my administration, to match the right intervention with that child. And here, less than 12 months later, I'm actually able to discharge him. Which is – I call the student my unicorn, my once in a career child, when the intervention and the needs of the student matched so perfectly. So, yes, the more you're able to match intervention and meet the needs of your students within those buckets, the sooner they're able to exit off your caseload, which is ultimately what we're in the business of doing. Katie Widestrom-Landgraf 15:09 So, you brought up something else that I think is important to highlight, and it's that notion of preparing parents and guardians for dismissal at the outset of that student entering speech language services. I think sometimes we are hesitant, or we think, ‘I'll talk about that later’. But it can help prepare parents and create expectations that are different from an instructional expectation. The idea that our goal is to make ourselves unnecessary is an important message to communicate, and I really appreciate you saying that from those first conversations, that is a part of what you're discussing with families. Michele Rothstein 15:59 Oh, yes. And I think it often flows very easily. Because a lot of times when you're first identifying a student, or sitting down with a family for the first time going over an evaluation report, developing an IEP, as a parent, one of the questions they're asking is, “How long is my child going to need these services? Forever? How long is it going to take them to meet these goals?” And while my answer is often I don't have a crystal ball, I have clinical judgment and expertise that tells me that it may take us a couple of years to get there. But I can start that conversation then about here is the first benchmark, or here is the first set of goals we're going for. Here's what I'm going to look for after that – Katie Widestrom-Landgraf 16:46 Mhm. Michele Rothstein 15:59 – if the trajectory continues during – on the path the way I think it's going to. And then, ultimately, when we get to this step, we would then be looking for the celebration of exiting your student. And I do also always try to couch it as a celebration, because sometimes for parents it is hard to then let go of that safety net, and the level of progress they've seen their students make. It's very comforting for them to maintain that level of service, and then therefore hard to work yourself out of that. Sometimes I say when you do such a good job, and parents are so happy with the services their kids get, it's sometimes harder to reduce them or eliminate them completely in the end. Katie Widestrom-Landgraf 17:33 There definitely can be that anxiety, or almost a fear based component of I don't want my child to lose something that has benefited them. So, that notion of wrapping it in the language of celebration, I think is important as well, and really helpful. Michele Rothstein 17:53 Yes. I think for parents, obviously, it's their child, it's their most prized possession they send to school every day, right? And they interact with people that start off as strangers, and over time you develop these wonderful relationships. That's probably the thing that I love the most about my job, that because I'm the only person in my school, some of my students, I do see kindergarten all the way through sixth grade, and the relationships I have not only with those students, but with those families really is a deep connection. It really is something special and unique about our field, that in the schools, the other professionals in the building don't necessarily get to experience. Katie Widestrom-Landgraf 18:43 Right. So, I did want to ask you a little bit about how you organize your thinking around planning therapy. You had talked a little bit before about the use of probe data, and how you have these through lines that inform how you're doing something and why you're doing something. Could you talk more about that process or your thought train around some of those things? Michele Rothstein 19:10 Absolutely. So, I think this also goes back to when I started in the field, the notion that teaching is not testing. And when we're a new clinician, and we're learning, obviously we need specification and data to support what direction we think we need to work with a student, or what the next goal area should be. However, to me, treatment and data collection are two separate things, and I do not subscribe to the while I'm treating with a student, I'm charting with them. I use probe data that is taken at a separate time. I use, essentially, a monthly interval. So, a monthly rotation – three weeks of treatment, three weeks of therapy, one week of assessment. And so, I believe that one, that actually makes my therapy better because I am 100 percent available. My students totally attune to what cues they need in that moment, how I'm supporting them and scaffolding them. I'm not distracted by, oh wait, did I get to that student’s trial? So, I have what I need on the paper in order to move on.20:25 And then by using probe data, I'm using the same assessment tool, the same trials every time I assess that student. And so, I think of it – I explain it to people like it's an apples to apples comparison. It's not apples to oranges. And so, that way – I use, also, the term clean data. It's clean because I'm using the same set of stimuli every time. I may test it – oh, I shouldn't say that, not test it. I treat it with a variety of stimuli. But when I go back to assess a student, I'm giving them the same five sets of stimuli, the same 10 sets of stimuli, so that I am charting their progress in a way that is consistent, and I would also argue more legally defensible, and then that informs my instruction moving forward. So, then once a goal is met, then I have that documentation put into their present levels of their IEP or their progress report, and it just informs my instruction better, it documents their progress, like I said, in a more legally defensible way. And so, again, a charge in the schools, it is something that we have to worry about. Katie Widestrom-Landgraf 21:52 That is true. Mhm. So, I do know that in addition to working in the schools, you also create supports and tools for other people working in the schools. I'm wondering if you could talk a little bit about some of the resources you've created? Michele Rothstein 22:13 Oh, absolutely. Thank you for asking. So, as I started in the field, and again, realizing early on that I was a department of one, I started to create resources for myself that I initially found useful with my students. And over the years, that has turned into a coaching business for other school based SLPs, as well as a Teachers Pay Teacher's business. That is SLP Madness. Because I do believe, again, no two days are the same. It is a beautiful madness, but it is a madness, nonetheless. So, my Teachers Pay Teacher's business supports other school based SLPs, and other SLPs in private practice, supporting their data collection needs, resources for social skills instruction, as well as articulation and language instruction. And then I also have, on my website, some exclusive free resources for school based SLPs centered around caseload management organization, that I believe really catapults you into a successful year in terms of managing your paperwork, your IEP dates, and that can all be found at slpmadness.com. Katie Widestrom-Landgraf 23:39 Amazing. So, SLP Madness, is that also the name of your TPT store? Michele Rothstein 23:44 Yes. So, my – yes, well, my TPT store is SLP Madness. And you can also find me on social media for Instagram is @slp.madness, and also on Pinterest, which is SLP Madness. So, again, it’s a beautiful job, but it does have its moments where it is maddening as well. So, that's, I think, really where the name of the business, maybe 10 years ago came from is that some days I feel like you have to be mad to do this! [crosstalk] It is a beautiful madness. Katie Widestrom-Landgraf 24:22 So, I appreciate that you're talking candidly about the things that bring you joy and also some of the challenges of this unique setting that we work in. And I'd like to ask you to think about your big “why”. So, what keeps – you said you are in your 23rd year? Is that correct? Michele Rothstein 24:45 Yes. So, I'm in my 23rd year at my school district. I think it's actually my 24th year. I did do one year, but you know, who's counting. So – Katie Widestrom-Landgraf 24:54 So, what keeps you coming back? What keeps you – what has you getting out of bed, day after day, coming back year after year, for now, over 20 years? Michele Rothstein 25:06 I mean, the short answer is the kids. I mean it’s absolutely about the connection and the love that I have with my students, and that I believe they have with me. What also keeps me back is I work on a great team. It keeps me coming back, is that I work on a great team with other exceptional professionals. But really, at the end of the day, I get paid to play with kids. I get paid to talk to kids. I mean, I could talk to a wall if I needed to. But something somebody said to me, I'll never forget, in my first job when I was a CFY, and of course, I was super nervous, and there were a million things I didn't know, but I also didn't know what I didn't know at that point, but I was fearful. And somebody said to me, “Michele, there is absolutely nothing that you could do that would harm this child. Everything you do will bring this child some benefit, even if it's you sit, and have a conversation with them for 30 minutes. The 30 minutes of love and attention that they may not be getting in another aspect of their life”. So, that has always stuck with me. Anytime I supervise, whether it's a graduate student, or a CFY, I pass that same advice on. And so, what keeps me coming back? It sounds so cliche, it’s those – it’s their smiles. It's their love. And it's the connection. That really – that still does it for me. Katie Widestrom-Landgraf 26:50 Wow. So, you know, what's interesting is that there are always unique tidbits, and differences, and details when I do these interviews, and there's also these through lines and connection is one of those through lines. We do have the benefit of getting to know these other developing amazing humans, not just for a week, or for a month, but in many cases for years. Michele Rothstein 27:24 For years. Katie Widestrom-Landgraf 27:24 And I think that can be what makes you sort of forget the not so great days, and remember these like magic moments. I know that sounds a little corny, but when I think back– Michele Rothstein 27:37 No, not at all. Absolutely. Absolutely. Katie Widestrom-Landgraf 27:42 – yeah, that you keep. Do you have a magic moment that comes to mind, by the way? Michele Rothstein 27:46 I don’t know that I have a magic moment. I actually think I have magic kids. Katie Widestrom-Landgraf 27:52 Yeah. Michele Rothstein 27:53 So, there are certain kids, over the course of my career, that I do feel like have given me far more than I have ever given them. And so, I wouldn't necessarily – but again, it comes back to the connection that I've had with them, and they've had with me. So, not necessarily – yes, there are always celebratory moments, and there are always wonderful moments that happen through the course of the career, but I would almost say I have more magic kids than individual magic moments, if that makes sense. Katie Widestrom-Landgraf 28:30 It absolutely makes sense. As you're saying that, I'm thinking – because I've also been in the schools for over 20 years, and I'm thinking about some of those magic kids where after your time is through with each other, you think, hmm, I'm forever changed having known you. Michele Rothstein 28:50 Yes. [crosstalk] Katie Widestrom-Landgraf 28:52 And what a great job! Michele Rothstein 28:56 Yes. It is. Katie Widestrom-Landgraf 28:56 Yes. Michele Rothstein 28:54 It is an excellent job. So, for anybody who's listening, who is wondering about the schools, teetering about the schools, I would say, absolutely do it. Absolutely do it. If you think you have an interest in working with children, and you are somebody that thrives on being able to establish a connection over a longer period of time, I would absolutely encourage any new therapist, or even a therapist that's been in the field forever that's looking for something different, to absolutely try the schools. Katie Widestrom-Landgraf 29:37 Wow, Michele. This has been just a delightful conversation. I thank you so much for your time, and for your insights, and for your candor. We appreciate you so much. Michele Rothstein 29:52 Yeah. Thank you so much for having me. Mattie Murrey-Tegels 29:59 So, I don’t know about you, but that episode was absolutely humming with synergy. Katie and Michele were just talking and pinging off of one another. And I know you can't see the visual, but the whole time Katie was nodding, nodding, nodding, nodding. Just such a great conversation. I am so glad you took the time, grateful you took the time to listen to us, to follow the conversation. Please take a moment and share this with anybody who you know might be interested in listening to the Missing Link for SLPs podcast. We are doing this series A Day in the Life the School Based SLP, and next, our series is going to be a bunch of mini-series based on ASHA’s Big Nine. So, we have great things to come as we unpack the really neat world of being a speech language pathologist. Please visit us at freshslp.com. That's our primary website. Also visit us at badassslp.com. That's my coaching for SLPs website. We are on YouTube. We are on all of the platforms for podcast listening, and we would really love your support. So, listen, follow, subscribe, share. Do all of those things. And also, reach back to us. Let us know what you're thinking. Take the time, drop a comment, ask a question, and we would love to hear from you. Have a great day and take care.