The Caseload — She Groweth

I am the only speech therapist at the center I work at 3 days/week.  The other 2 days, I am in the field, itinerant, going into head starts, daycare, and church basements.  My center, unfortunately, has a caseload more suited for a full-time person, or at least, 5 days’ worth of a therapist.  We had that back in September, actually, but the other gal left november 4th for a new job, leaving almost half the kids at the center without speech therapy.  I picked up as many as I could while still managing the new kids coming into the classrooms I was already committed to.   At present time, I am seeing 38 kids in 3 days.  Logistics are a bitch, as I overlap with the kids only on certain days.  Many only come in 3 half-days, so I end up having to see Johnny on Monday morning, and Quadir on Thursday afternoon.  And of course, for every child who’s highly capable and only needs service 30 minutes a month, there are 2 kids who need extensive support 60 minutes a week.  So the number 38 does not tell the whole story.

What about the other 27 kids not receiving any speech therapy?  Well, we say that they’re “unmet needs” kids.  We acknowledge — to those who ask — that we have no therapist for them.  They’re still in a special ed or regular ed classroom environment, a language-rich environment with highly trained teachers, etc.  But we’re not able to fully meet their needs as per the IEP.  So they go on a wait list, waiting since November for speech to pick back up, or (for new kids) to begin at all.  All of which feels pretty yucky. 

How do parents feel about this?  Well, for the ones who don’t ask, they don’t know.  We offer full disclosure, but it’s kind of a don’t ask- don’t tell policy.  Who gets service?  Who doesn’t?  Is it based on need?  Which classroom the child is in?  Which teacher has a louder voice or asks nicely?  Nope.  It’s based on which parents know their rights.  They’re the ones who demand service, my friends.  And they’re the ones who get it.  I now have 2 extra children on my caseload who came in after November 4th, in a classroom where I do not support any other children officially.  One child’s parent seemed so anxious, so eager to have speech therapy, that I was asked by our director to support that child.  He has a new diagnosis of autism, after looking like a typically developing kid for the first two year of his life.  He has a young mother who does not speak English.  She is desparate for support, for help, for herself and her child.  So I took it.  Kind of as a favor.  The other child is the most beautiful child at the center.  He’s a tiny round-headed boy with straw-blond hair and elfin eyes.  All he’s missing are pointy ears and you might believe he had been born out of a flower with dew on his freckles.  His mother knew her rights.  Demanded service.  And probably compensatory time as well.  His level of service: 60 minutes a week.  Guess who stepped up to avoid getting taken to due process?

It’s not that we’re doing anything illegal.  Really.  Our parent agency tells us to take in children even though we cannot fully meet their needs.  We report them.  We have them on a list.  But the parents, many of whom do not speak English, do not know their rights, or are too new to the world or early intervention, just do not know. 

The second child’s evaluation report read like a parent’s worst nightmare.  Autism spectrum diagnosis, global delays, poor social connection, avoiding eye contact, tantrum behaviors, and resistant to talking.  The child I encountered when I first began seeing him in March was a different child altogether.  He’s highly social, and has a best buddy in the classroom with whom he plays cooperatively.  He makes eye contact, shows adults his work with pride, and is now imitating 3-word phrases with me.  When I gently frustrate him to elicit language (e.g., block his path so he has to tell me to move), he readily responds verbally, sometimes by signing and saying “move” or “beep beep”.  Either he has made untold gains in 3 months of just being at the center in a preschool setting (could be; what do I know?); or the evaluation was criminally wrong.  Why does this matter?  Couldn’t it just be an assessment taken on a bad day?  Couldn’t his natural development have spontaneously accouted for these leaps and gains?  Yes, and yes.  But it does matter. 

That evalation report read so ominously for this poor child’s future, that the parents flipped out.  That report, written when he was scarcely 3, freaked them out so severely that they needed to seek out every single option for intervention.  And when they found out it was not being provided, they saw their child’s future jeopardized.  If it were my child, and I read that report, I would have done the same thing.  I have to hope my children will all be healthy and have typical (nay, exceptional) development, but if I were in their place, I would have fought tooth and nail to get my child what he was allegedly provided under the law. 

Give me involved, interested parents vested in their child’s education.  Give me parents who show up for conferences and read the mail I send home.  Give me parents who show you they care, and I’ll show you better therapy, faster progress, and a happier speech therapist.

Why does blogging take so long?

Why do blog posts seem to take so long to write?  I sit down, promising Mr. Apron, “it’ll only be a quick one”, and, an hour-and-a-half later, I click Publish.  Mr. Apron says it’s because I care about my writing.  I don’t just post an awkward family photo from 1989 or a YouTube video I and sixteen million people have seen, or a Twitter-like blurb about my commute.  I don’t know if it’s that I care about my writing so much; it’s just that I want to write.  I want to get my thoughts out, or to tell a story I’ve had brewing in my head. I’m also long-winded.  This is part and parcel of being a speech therapist.  When I prepare an IEP with my coworkers, I’m asked to write-up “my piece” on the child’s Present Levels, his performance in speechie things at that time.  It answers the parent-friendly question on the IEP: “What is the child doing now?”  Well, I am routinely told by the teachers for whom I prepare these reports that I write way too much, that it doesn’t fit in the alloted space, etc.  So now, as I hand off my novella on Susie, I hedge, “I wrote too much.  Take what you want.  Trash the rest.”  And they too.  I”d just rather be thorough.  Once I get thinking about the child, going over my notes from months past, the writing just seems to flow.  Like it did back in college when I had a term paper due the next day.  Man, I could just go on and on about 19th century Norwegian peasant farmers’ uprisings, or Mozart’s use of melodic intonation, or the influence of the pork farming industry on post-war Japan.  I could churn out a 15 page paper in 3 hours.  That was about my average into the wee hours — 5 pages per hour.  It wasn’t just my verbosity; it was also my typing speed. 

When I was 7 or so, my father taught me to type.  We didn’t get our first computer until the year I turned 11.  My parents had a green-on-black Olivetti word processor at their office, but we didn’t so much as have a typewriter to play on at home.  So he took a sheet of looseleaf and a penny, and commenced to draw 4 rows of offset circles.  He pulled out an old typing manual that pre-dated Mavis Beacon by a century or so, and taught me, “a lad has a lass;  a lass had a salad; alas; sad sad lass had a dad;” On and on until I was proficient.  The next year in school they began a pilot program in my third grade class.  A computer teacher from The College came to our class with chunky keyboards with small LED readout screens.  And he taught me typing again.  The keyboards had one basic game, with several levels of difficulty.  A letter, word, or sentence would march across the screen from right to left, and you had to type it — quickly! — before it completed its journey.  At the end of the game you would learn your letters-per-minute score.  The teacher challenged us to beat his score, 200, was it?  And in my brother’s year, 3 years later, his friend Jake Kravitz finally did.  I didn’t beat his score, but I typed on an actual keyboard, a boon preparing me for college research paper marathons. 

Even today, coworkers randomly comment on how fast I type.  When I was courting Mr. Apron on AOL IM, my roommate would complain she could hear the typing from the next room as she was trying to sleep at 3am.  Imagine her nerve, interfering with blossoming young love!

So why is it these blogs take so long!  I took a nap, Mr. Apron went upstairs to blog, and it took us both an hour to re-emerge from our respective activities.  They certainly don’t look like 5 pages of research paper material.  When he puts in links, it takes even longer.  When I have to check facts, it takes longer.  When I’m not sure where I’m going because I never “pre-write” (remember that step in The Writing Process?), it takes me longer.  When wordpress’s delay after my typing is just that much longer, I have to pause to see where it catches up to me, and then go back and take the pesky “g” off of Mr. Apron’s name which always attaches itself to the end like a poo fragment on Finley’s ass.  When I have to take time to think of a clever simile (see previous), it takes longer.  When I care about what I’m writing, I hope it’s worth it for you to read.