Shortage of speech therapists in SAISD brings mix of worries
In early November, Brenda Slocume and her daughter Stephanie Mejia, 11, were still waiting for school to start.
Stephanie breathes through an open trachea and is considered medically fragile. Slocume had signed her up for homebound learning at the start of the year to protect her from COVID-19.
“We can’t risk it,” Slocume said of classroom learning. “We can cover our airways, but unfortunately, her airway is down here (below her voice box) and there is no mask for her.”
Stephanie, a sixth-grader at Tafolla Middle School in San Antonio Independent School District, couldn’t log on to a single educational course and wasn’t getting the speech, physical and occupational therapy that the law requires the district to provide.
Slocume, who has five kids at home, called repeatedly and finally obtained a meeting, known in the legal language of special education as an ARD, or Admission, Review and Dismissal. There she learned that it was a paperwork error that had delayed Stephanie’s school year by 14 weeks.
Online learning began — but special education services were still delayed, for a different reason: a major staffing shortage.
Speech therapists at SAISD say it is common to be assigned more than 100 students each. Twenty-five of them signed a letter in October to the district’s director of special education, Aaron Aguilar, warning that “unsustainable caseloads” made it impossible for them to do their jobs ethically.
“We are missing regularly scheduled therapy sessions in order to attend ARD meetings, manage the numerous initial
referrals requiring assessment, write IEPS (individual education programs), consult with the campus teams, supervise interns … the list goes on,” the letter reads.
As of last week, the district had seven speech therapist vacancies out of 33 budgeted positions, but that will rise to 11 in December with resignations, said Gerard Cortez, the SAISD assistant superintendent for disability and learning support services.
Many such specialists, who are also called speech language pathologists, or SLPS, resigned last year because the working conditions were so challenging, several current and former SAISD speech therapists said. Cortez said they left because they didn’t want to work during a pandemic — he called it a “lifestyle choice.”
The district also has vacancies for other special education specialist jobs, including coordinators and one director, Cortez said.
“I understand the frustration,” Cortez said. “People want things to happen immediately. It is not like we have a store where you can just go purchase SLPS. They have to be qualified.”
The problem isn’t confined to SAISD. Northside ISD has 45 special education vacancies, though none are for speech therapists. North East ISD has four speech therapist vacancies and three school psychologist vacancies.
In their letter, the SAISD speech therapists said they are forced to provide services to groups of students that are too large to meet the requirements of their IEPS and that their high caseloads don’t always leave time to test students regularly, which prolongs therapy and hampers students’ progress.
“Our most pressing issue comes down to our ethical responsibility as service providers. Our license is our livelihood,” the letter said. “We are feeling pressured to remain in compliance so that the district does not have a headache, but ultimately we are putting our careers on the line.”
In interviews, several who signed the letter said supervisors have asked them to sign off on IEPS of students they are not familiar with.
“We have so many students that we aren’t able to provide every (therapy) session,” said April Duvall, who has worked in the profession for almost 20 years and just started at SAISD this year. “But because we are meeting due dates for paperwork, the compliance reports look OK.”
Said another, Hannah Leib, “My license is on the line because my coordinator is asking me and my fellow speech language pathologists to sit in on annual IEP meetings or present evaluation results for children we have never worked with and documents we have not prepared.”
Leib is concerned that the lack of specialists will damage students in the long term. When high-quality services are provided to children with less severe impairments, they “should progress and be able to be dismissed (from the need for services) before they leave elementary school,” but kids in middle school are still receiving such services, she said.
Cortez acknowledged the stressful amount of work but disagreed strongly that speech therapists are ever asked to do anything unethical.
“That could not be further from the truth,” Cortez said. “Workload is not an ethics issue.”
Cortez agreed that speech therapists sometimes are asked to go over assessment results and progress reports for students they haven’t worked with directly but said this was not unethical.
“Because you are licensed and certified and able to interpret progress, then you may report on progress that the student has made on their speech therapy,” Cortez said.
“Many times, we have to have speech therapists that are sitting in on ARD meetings, and they may not work directly with that student, but they are able to look at the speech notes, they are able to look at the progress notes and they are able to comment on how well the student is progressing on their IEP goals,” Cortez said.
A historic problem
The pandemic has caused staff shortages in virtually every job field, but San Antonio ISD — and most school districts — have had trouble for years hiring enough special education workers.
The shortchanging of special education students became a statewide scandal in 2016 and led to increased federal oversight of Texas policy, though the goals of the reforms were still unmet when the coronavirus pandemic arrived.
Cortez said SAISD hasn’t been fully staffed with speech therapists since 2006.
Speech therapists working in the district believe the difficulty in hiring stems from unmanageable caseloads and subpar compensation. Their letter demanded they be paid for the work they take home.
“The only way to do this is to do paperwork at night with your family,” Duvall said. “I did 61 hours (per week) two weeks in a row trying to give kids my best.”
In response, the district has hired a telehealth company to serve at-home learners, will reclassify the speech therapy job description to increase its pay, and will supply campuses with the supplies, toys and tools speech therapists need.
“I had almost no therapy materials,” Leib said about the start of her 2020 school year. “My principal bought the materials. But the district did not have a budget for (it) prior to fall of 2021. Many, many places across the country have an annual budget for every speech therapist to grow their services.”
The therapists interviewed for this story called the district’s response inadequate. They pointed to money the district budgeted to hire new therapists as a possible funding source for overtime pay, but Cortez said they hold a salaried position that makes them ineligible for overtime.
To help retain them in an era of high turnover, the district does pay therapists a stipend of several thousand dollars on top of their salary. The amount varies depending on their years of service, the therapists said.
A speech therapist who left SAISD before the pandemic said her high caseload was the primary reason she took a job at another school district. She requested anonymity because of her current employer’s policy against unauthorized news media interviews.
She said she agreed with the letter’s contention that SAISD speech therapists can’t fulfill all of the required services laid out in the IEPS they are responsible for. That was true before the pandemic, she said.
“I was not feeling I was making a lot of progress because in order to see all of the children, you were seeing four or five children at a time,” she said. “There was no human way to do all of the required sessions when I was having to do so many ARD meetings.
“I just always felt like I could never quite catch up.”
How many is enough?
Disputes over how much and what kinds of special education services a student gets are routine in every school district. The pandemic has made those conversations more frustrating, some parents say, given the safety protocols that are especially hard on students with disabilities, the increased risk that COVID-19 poses to others and the added pressure on teachers and staff.
The Texas Education Agency says it has allowed no exceptions or flexibility in delivering special education services during the pandemic.
The agency does not require any ratio of student to specialist. Neither does the 2004 federal law that made special education mandatory, the Individuals with Disabilities Act, or IDEA. Specialists do have to report to the state how many special education students they are serving and what initial assessments say about those students.
The caseload average for speech therapists across the country is 47, according to a 2020 study by the American Speech-language Hearing Association. The same association stopped recommending a specific number for caseloads because each student’s needs can vary.
SAISD aims to cap caseloads at 50 to 55 students per speech therapist, Cortez said. When caseloads are higher than that, they get help from speech therapy assistants, and the district also contracts for some speech therapy from the private sector, he said.
A telehealth company is a step in the right direction, but a student still needs a human therapist to evaluate them and complete their paperwork, speech therapists say. And delivering speech services virtually is not as effective, the say.
In districts across the state, the decisions affecting kids with disabilities are not about those kids but are motivated by financial or organizational concerns instead of an understanding of evidence and research, said Heather Haynes Smith, a special education researcher and professor at Trinity University.
“And that is where the law is really not being upheld,” with the pandemic “being used as an excuse, instead of them riding on the urgency to really reset,” she said.
Joanna Sullivan has a son in first grade in Northside ISD who is immunocompromised and medically fragile and has developmental challenges and delays.
“Since the beginning of this year, the district has been pushing back on at-home services (for my son), period,” Sullivan said. “Partly because they don’t have staff.”
Robin Sayers has a son with Down syndrome in middle school in Northside ISD and has always struggled to get him the services in his IEP, but the pandemic has made it worse, she said. She values every bit of classroom “inclusion time” she can get for him, but that was cut back because “they couldn’t mix pods” of students, Sayers said.
Northside ISD spokesman Barry Perez did not comment on individual cases but said in an emailed statement that district and campus staff were working despite the shortage of specialists to “find ways to ensure that a student’s instructional needs” and the requirements of IEPS are being met.
“Common ways of addressing the vacancies include utilizing existing certified staff, utilizing central office staff, utilizing noncertified staff such as instructional assistants, substitutes, and adjusting staff schedules.”
SAISD has set a goal of adding 20 new speech therapist positions in the next two to three years to adequately serve the students who require it — they currently number 3,671 out of a total enrollment of 45,802, Cortez said.
He could not comment on individual students’ situations but did note that if a student hasn’t received the services their IEP requires, compensatory services will always be offered.
Slocume remembers listening in frustration during the ARD meeting this fall as SAISD and Tafolla Middle School officials argued over whether daughter Stephanie should get compensatory services because of the long delay in homebound learning.
She said she hasn’t been told what they decided.