Monday, June 29, 2015

The 3:1 Therapy Model: What is "Student Support Week"?

Welcome to the final post in my series of posts about the 3:1 Therapy Model for Speech & Language Therapy. This model was implemented after a couple particularly rough years in our district. SLPs were feeling a lot of burn-out and started researching some ways to alleviate the pressure they were feeling. The found the 3:1 Therapy Model, which is backed by ASHA, and asked administration for an opportunity to use it. Our district just completed it's 6th year using this model. The SLPs are much happier and dismissal rates have actually improved!

If you think this is something that could help you and your students, I would suggest reading the first three posts of this series and doing some research on ASHA's website. At the end of this post, I will include some links to some other great information regarding the 3:1 therapy model.

You can learn more about what the 3:1 therapy model is here. More information about getting started can be found here. And information about how it affects Medicaid billing can be found here.

This post will focus on the "Student Support Week" (at least that's what our district calls it). I've also heard it called "Indirect Services Week," "Coaches Week," "Collaboration Week," and "Meeting Week," among other things. This is the 4th week of your cycle if you are implementing a true 3:1 Model. Some schools make it the last week of each month or they make it one week of each quarter. This will ultimately be up to you and your team to decide. This week is used for: testing, meetings, screenings, medicaid billing, collaboration with teachers/other providers, RtI progress monitoring, providing make up sessions, etc. We try to schedule all meetings that speech language pathologists need to attend during that week. We do this during our monthly special education provider meeting so everyone is there and on the same page. Sometimes it doesn't always work out and we have to have a meeting earlier or later than that student support week. And that's okay! We just make up the minutes sessions during student support week.

This year I also supervised a Clinical Fellow, which was an awesome experience. But it did require A LOT of extra work from me. The student support week was a lifesaver when having to make up sessions I missed due to my responsibilities as a CF supervisor.

One really big (and valid) complaint that we've heard from other districts trying to implement this is that they are afraid it will be viewed as "unfair" to other service providers. The SLPs in our district do hear from special education teachers is that it's not "fair" that we get a "week off" to do paperwork. We are incredibly lucky that our administration supports this model so vehemently that we don't have to worry about what those kinds of complaints will lead to. These are some tidbits of information that our administration generally shares with these teachers when they get these kids of complaints:

  • SLPs have 50-60 kids on their caseloads that they are attending IEP meetings for and writing IEPs for. Special education teachers in our district have no more than 20 on their caseloads
  • SLPs do all their own assessments while school psychologists do the cognitive assessments for special education testing
  • SLPs also have RtI responsibilities
  • SLPs bill Medicaid for their services, special education teachers do not
  • SLPs complete their own speech and language screenings
  • SLPs may also have to supervise Clinical Fellows due to a high turnover rate in our district
  • SLPs in our district do not get substitutes when they miss a day of work for inservices, illnesses, etc, so they must make up student minutes. Special education teachers receive a substitute, therefore, minutes do not have to be made up when they take a sick day. 
We are by no means saying that one job is more important or more work than the other. But the responsibilities are just different. I know that there are a lot of things that special education teachers must do every day that I don't have to do at all. However, my set of responsibilities certainly gives me more than enough work to fill my "week off." ;) 

I hope that this series was helpful. I also hope that if you are feeling overwhelmed at work, that you are able to find a compromise with your administration that works for both of you - no matter what it might be! If you need more info on the 3:1 Therapy model, here are some great links: 

Monday, June 15, 2015

The 3:1 Therapy Model: Medicaid Billing

If you are feeling overwhelmed and overworked, this series of posts is for you! It might be time to start talking to your administration about ways you can improve your working conditions. You can read the introduction post here and the Getting Started post here. This is the third post in this series!

We all know that Speech Language Pathologists are hard to come by, meaning that you often get more work piled on than you can feasibly do. A lot of times it's viewed as necessary to get our students' needs met. I'm lucky that I work in a state that has a cap of 60 students per caseload. But we've all heard the horror stories of SLPs with 80 or more kids on their caseloads.  This might be a way to help manage your caseload if you're finding yourself in this situation! Even if you don't have a huge caseload, you may have other factors that make your job overwhelming. For example, our district has a VERY high percentage of students receiving Medicaid - meaning that we must spend A LOT of time billing Medicaid. We also have a high turnover rate, which generally means more and more training and supervision of Clinical Fellows. And all of our SLPs travel to at least 2 buildings - most have 3 buildings they service. All of these factors, led our district to use the 3:1 Therapy Model. It's been working for the past 6 years while maintaining our previous dismissal rates (in fact, they have improved!). If this is you - keep reading!

As I previously stated, a large portion of our students receive Medicaid benefits. This is a good source of income for our district. This is also the case in many surrounding districts. Because of this, there were a lot of questions about how Medicaid would be billed using this new model. But, we actually found that this model is much more Medicaid friendly!

As I explained here, therapy minutes used to be written in a minutes per week style. Because Medicaid will only allow you to bill for the minutes written in the IEP (at least this is the case in my state), this meant if the sessions were not made up within the week they were missed, they could not be billed. For example, and IEP is written for a total of 40 minutes per week. You miss a session in Week One, so you can only bill for 20 minutes. The next week, you see the student for their 40 minutes and you make up the session from last week - making a total of 60 minutes. But you can still only bill for 40 minutes because that was all the was listed in the IEP. With the 3:1 model, minutes are written in a minutes per month style. Because of this, you can bill for make up sessions as long as they are made up within the month. This gives you much more flexibility to make up those sessions. Which means more money for your school - which means happy administration!

Something to Consider
The 3:1 Model is technically a 4 week cycle, so it will not fit perfectly into each month. We bill our minutes per month by calendar month regardless. Most months, I actually see students more than I can legally bill for. 

DISCLAIMER: Once again, I am NO WAY telling you that this is the correct way to do this. It works for us here, but you need to check with your STATE'S MEDICAID POLICIES and your DISTRICT'S SPECIAL EDUCATION POLICIES. Make sure you do your research, as these processes do vary from state to state!

If you're still thinking this might be for you, keep checking back for our next post - What Does Student Support Week Look Like?

Monday, June 8, 2015

The 3:1 Therapy Model: Getting Started

This is the 2nd post in a series about using a 3:1 Therapy Model. Last post, I introduced the 3:1 Therapy Model to you. My school implemented the program 6 years ago. When I started working there 2 years ago, I fell in love with the model. I know many of you are still reeling from the end of the year responsibilities. So now might be a good time to talk over changes in service delivery with your administration if you're feeling overworked. You can read here about the problems my district was facing that lead to their decision to use this model.

Whenever I start talking about this therapy model with a fellow SLP, I start to get questions about how we implemented this program. I was not with the district when they implemented it, but I will explain some of the methods out there regarding implementation of a program like this.

What about the minutes written in the IEP?

In our IEPs, the program forces us to write in a "minutes per week" style. For example, 2x15 minutes each week. On a four week cycle, this would be 120 minutes per month. Since all services are now being provided in 3 weeks, you need to adjust the length or the frequency of your sessions to meet those minutes in a shorter amount of time. For example, 120 minutes divided by 3 weeks is 40 minutes per week. You could now see this student 2x/week for 20 minutes each time to meet their minutes. On our IEPs, we would still write 2x15, but in the comments section, we note that we will be seeing the student for a total of 120 minutes per month. 

We also make a note in the "Additional Comments" section of our IEP. It reads something like this: "The speech-language pathologists in the ________ School District use a 3:1 Model of Service Delivery. This means that 4 weeks of services will be provided in the 3 week time span. The fourth week is set aside for the SLPs to complete screenings and evaluations, complete paperwork, attend meetings, perform make-up therapy sessions, consult with other professionals, bill public insurance, formulate lesson plans, etc." 

How can I start using this model while still meeting the requirements of my students' current IEPs?

A web search will show you three main ways of transitioning to this model. 

1.) Amending IEPs at beginning of school year.
- When IDEA was re-authorized in 2004, it was no longer necessary for the entire team to meet for an IEP amendment. So this is something that could be done quickly if communication with parents is strong. The proper paperwork would need to be completed and parents would need to agree to the changes & sign the paperwork (you could do this during Parent Teacher conferences, orientations, pickup & drop off times). You can find out more information about the process here.

2.) Gradually Changing the IEPs throughout the school year.
- This might work better for your students who do not have consistently involved parents. The minute wording can be changed at their annual IEP meeting. You could hold these IEPs earlier in the year to get the change done faster or gradually throughout the year.

3.) Implementation in the next school year.
-With this plan, you would notify parents of the change that would be made the following school year at each IEP meeting you hold. (So if you started notifying parents in the 2015-16 school year, you would not begin the 3:1 model until the 2016-17 school year.) In the Services Inside/Outside Gen Ed Classroom section of the IEP, you would write the minutes for the current school year as usual. The end date for these services would be the last day of school for the 2015-16 school year. Then you would write a second set of services starting on the first day of the 2016-17 school year. These services would be written in a minutes-per-month style and run through the last day of the student’s IEP. All IEPs in the 2016-17 school year would be written in a minutes per month style.
You can read more about this here.

DISCLAIMER: I am in no way trying to tell you what method you should or should not use. I am presenting methods that have been used by several districts throughout the country and thoughts presented on several different forums. It is up to YOU and YOUR TEAM to decide which method is best. Please make sure to consult all FEDERAL and STATE Special Education Laws and Policies, as well as reviewing YOUR DISTRICT'S policies on special education service administration before making any of these changes. As I stated above, I was NOT a part of the transition to this model. No matter what method you and your district chooses to use, it is IMPERATIVE that you have district & administration support.

What about make up sessions?
The Student Support Week is fantastic because it provides you with an entire week to have your meetings, but what happens when a meeting has to be held sooner than the next student support week? Go ahead and have the meeting and document the sessions that were missed. You'll make up that session during the next student support week. Many people get caught up in the idea that you can ONLY have meetings or do evaluations during that Student Support Week. And some months, that works out just fine. But we all know that there will be something that will pop up and need our attention. The 3:1 Model just provides more flexibility in scheduling. It's okay if you miss that session today, because you can make it up during the Student Support Week. The students' minutes can all be made up. It will be very, very important that you have a strong system in place to keep track of those missed sessions and the number of minutes students are seen each session. I use an attendance book. Each time I see a student, I write the number of minutes I saw them in the column for that date. At the end of the three weeks of services, I add up any sessions or minutes that were missed (ex. only saw them for 15 minutes instead of their full 20, so I need to make up 5 minutes). Then I can use that information to create my lesson plan for Student Support Week. I document any minutes they were seen during Student Support Week in the same manner. After that Student Support Week, we start the cycle over again with the three weeks of services. 

I know that was a lot of technical information thrown at you, but I hope I could explain it well. I would check around with some neighboring districts and see if any of them use at 3:1 or Cycle Model of therapy services. Have them come talk to you or help you get started. They might even be able to show you a sample of their documentation or attendance book. Then you can get some ideas. I, unfortunately, did not feel comfortable uploading any photos of my book on the internet for all to see - even with student names blacked out! :) Seriously though, take advantage of those that have done it before you. Local districts might even be able to tell you more about the legalities of making those changes for your area/state. They really are a wealth of information! 

Check back soon for the next post in this series which will talk about Medicaid Billing while using the 3:1 Therapy Model! If you missed the first post, you can go here to catch up! 

Monday, June 1, 2015

3:1 Therapy Model - What is it?

This is the first post in a series that will discuss implementation and benefits of using the 3:1 Therapy Model for Speech and Language Services. If you are feeling burnt out, taking a ton of work home each night, and falling behind in your professional responsibilities due to lack of time during the work day, this series is something you'll want to read! It's a huge undertaking to get the process started, but so worth it in the end. I have spent the last 2 years working in a district that has been using this model for 6 years. It is definitely something you'll want to present to your administration if you're feeling overworked!

We all know that providing therapy, completing evaluations, writing evaluation reports, completing screenings, providing RtI services, writing IEPs, attending meetings, completing continuing education work, billing Medicaid, and writing lesson plans can take a TON of time. Throwing in a Clinical Fellow or Intern to supervise, trying to get some prep done, or having to travel between building can kill huge chunks of time as well. Yet we are all expected to complete all these tasks with flying colors. It's a recipe for disaster. And a few years ago, my school experienced the disaster.

This happened before I started working at this particular school, so I don't know the WHOLE story. But I can fill you in on the factors that lead to the disaster. My district has an incredibly high poverty rate, with the majority of students qualifying for free or reduced lunch - so that means most of them have Medicaid services I need to bill for. This year, of the 52 kids on my caseload - 48 of them required me to bill Medicaid. That's a high percentage of medicaid billing. Furthermore, my district has a high turn over rate for SLPs. We're talking at least one new SLP each year. Which requires training - and usually those new SLPs are CFs, which require supervision. Every SLP in our district travels to at least 2 buildings, most to 3 - another HUGE time sucker. They were all taking home hours of work each night just to get the basic needs met. Therapy was not nearly as effective because prep time was nonexistent. The result? Three very burnt out SLPs that were falling behind on their work and providing only basic therapy.

Thankfully, they went to the administration with their concerns. As a team, they started looking for alternative approaches to therapy implementation that would provide for more time for indirect services while still meeting the needs of the children. They decided to pilot the 3:1 Therapy Model, which is supported by ASHA, for a year. Six years later, the district is still using the model. Dismissal rates have actually improved over the last 6 years. Medicaid is getting billed regularly and timely. IEPs and evaluations are being completed within the timelines WITHOUT DIFFICULTY. Missed sessions are consistently made up and students minute per month totals are being met. And the amount of work that SLPs take home has been greatly reduced. So, if this sounds like something your district needs, keep reading!

What is the 3:1 model?

It always surprises me that when I tell people that we use a 3:1 therapy model, their first question is "What is that?"  So, let me begin with the basics. The 3:1 Therapy Model is a method of service delivery where students are seen for services for 3 weeks in a row. The fourth week is set aside for the SLP to complete evaluations, administer screenings, provide make up sessions, attend meetings, and complete indirect service tasks (Medicaid billing, writing IEPs, etc). We call this week, "Student Support Week." But I have also seen it referred to as, "Indirect Services Week," "Coaches Week," "Collaboration Week," and "Meeting Week." This model allows for time to be spent during the work day on those extra tasks, thus reducing the amount of work taken home. Similar models include a "Cycles Model," where you may set a different amount of time for each. For example, you might spend 9 weeks providing services and then have 2 weeks for indirect services. We like the 3:1 model because we know we have one week each month to make sure we are getting those evaluations done within the 60 day timelines.

Is there evidence to support this model?

Yep! In fact, ASHA supports this model. It may seem counter-intuitive since the students are only receiving services for 3 weeks instead of 4 each month. But, evidence has shown that consistency matters more than amount. Since this model allows time to make up missed sessions, consistency of services provided increases dramatically. You can find more information about addressing "caseload" vs. "workload" and the different approaches to service delivery here. ASHA addresses several different service delivery models under the "Service delivery" heading. There are also several studies that have determined that job satisfaction in much higher with this model. You can read some information about that here. You can also find more information about the implementation and evidence supporting the 3:1 model here.

Check back later to read the rest of the posts in this series. Follow my blog to make sure you don't miss any of the new information. Up Next: Getting Started!