OTS 165: Paving the Path to Change High Caseloads in 2025
- Jayson Davies
- Dec 30, 2024
- 12 min read
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Welcome to the show notes for Episode 165 of the OT Schoolhouse Podcast.
Are your caseloads pushing you to the brink?
In this episode, Jayson digs into the pressing and widespread issue of high caseloads faced by school-based occupational therapists. With eye-opening statistics Jayson uncovers how these overwhelming demands contribute to burnout and impact the quality of student services. But this isn't just about identifying the problem—it's a call to action.
Tune in for innovative strategies and practical steps to create change and sustainability in school-based OT.
Listen now to learn the following objectives:
Learners will identify the critical factors contributing to high caseloads in school-based occupational therapy and their impact on service quality and practitioner retention.
Learners will understand the broader implications of high caseloads on related service providers and school systems, including the need for collaborative advocacy.
Learners will understand two different approaches to start addressing high caseloads.
Guests Bio
In 2017, Jayson founded the OT Schoolhouse website and now supports school-based OT practitioners via courses, conferences, and the OTS Collaborative community.
With experience as both a contracted therapist and an "in-house" employee for two distinctly different districts, Jayson has had the opportunity to appreciate the differences between both small-rural and large-suburban districts.
For over five years, he has been helping therapists implement proactive tiered interventions, support IEP teams with goals and services, and feel more satisfied with the job they are doing as school-based OT practitioners.
Quotes
“83% of those practitioners indicated that their workload impacts their ability to provide adequate services to students. That's 8 in 10 practitioners saying that their high caseload, whether it be speech, OT, or PT, that their high caseload is basically making it impossible for them to give their students the services that they need.”
-Jayson Davies, M.A, OTR/L
“We need to flip the script from let's figure out what the problem is with high caseloads to how the heck are we gonna fix this problem with high caseloads. Because it is not a question as to whether or not we have high caseloads. It is a fact, and we need to figure out how we are going to change it.”
-Jayson Davies, M.A, OTR/L
“ We know the impacts of high caseloads. It means that people leave the field. It means that those who stay struggle within their field and don't actually feel competent or don't feel like what they're doing makes a difference within the world.”
-Jayson Davies, M.A, OTR/L
Resources
Episode Transcript
Expand to view the full episode transcript.
Amazing Narrator
Hello and welcome to the OT school house podcast, your source for school based occupational therapy, tips, interviews and professional development. Now to get the conversation started, here is your host. Jayson Davies class is officially in session.
Jayson Davies
Hey friend. Welcome to Episode 165 take two of the OT school house podcast. And now you might be wondering why I said take two, and that's because I just recorded about one half of take one of episode 165 and basically just threw that file in the trash on my computer because I got halfway through, and I realized I was trying to share too much within that episode. I was trying to share with you three trends from 2024 and the three trends that I see coming in 2025 AI, the need for play based OT, basically, or the research on Play. And then I got to the third trend of 2024 and that was caseloads. And I got to that point, and I decided, You know what, this episode right here, as we're transitioning from 2024, to 2025, needs to be all about this one topic, and that topic is the astronomically high case loads that we currently have in school based occupational therapy. And what can be done about it, because I really feel like this is an inflection point, not just in occupational therapy, but for all related service providers. We are not the only ones experiencing high case loads. Speech therapists, physical therapists are also having trouble with it. Teachers are having trouble with it as well. And something's going to give, something will give, and we are starting to see some of that, because practitioners are leaving the field. Teachers are leaving the field. Those who are staying in the field are struggling. And this isn't new news, right? Over the past five, even 10 years, research has been coming out stating that practitioners and teachers have such high case loads that they are leaving the field. And that brings us to today, or at least to, you know, this time period here, as we transition from 2024 to 2025 and I do think that this is an inflection point, right? We know the impacts of high case loads. It means that people leave the field. It means that those who stay struggle within their field and don't actually feel competent or don't feel like what they're doing makes a difference within the world, and we're seeing that. Just back in January, the Department of Education in Oregon released a report, and this report was kind of in tandem with, I guess, House Bill 2618, it was titled school based occupational therapy, physical therapy and speech language pathology, workload methodology, a report to the Oregon Legislature. We'll link to that in the show notes over at otschoolhouse.com/episode 165, anyways, the two primary outcomes that I wanted to share from this report was that of the 600 about 550 or so participants that they surveyed, 83% of those practitioners indicated that their workload impacts their ability to provide adequate services to students. That's eight in 10 practitioners saying that their high case load, whether it be speech, OT or PT, that their high case load is basically making it impossible for them to give their students the services that they need. That's ridiculous. In addition to that, 62% of licensed practitioners indicated that they are considering or planning to leave the field, while only 38 say that they plan to stay. Definitively. When I read that, all I can think is that this problem is going to get a lot worse before it gets better. 83% of practitioners say they already have high case loads, and 60% of practitioners now say, You know what, I might leave what's going to happen to the 40% of practitioners this day? Are people going to want to come and be a school based OT, PT or speech therapist when the caseloads are crazy, absolutely not like this is going to get maddening, in addition to the logistical concerns, right that there's not enough time and people to actually service the students that need services, I feel that this burnout is also leading to a role confusion among therapy, specifically ot practitioners, because we know that we need to move beyond handwriting and find motor skills. We cannot be the quote, unquote, handwriting teacher and our skills, I mean, support that, right? We can do so much more than handwriting and find. Otter skills. And so many of us want to branch out, and we want to support student executive functioning. We want to participate social participation, and we want to get outside of the only elementary school to support high schoolers and middle schoolers. But there's a small part of our brain that's saying, If I do that, I will not survive because of my high case loads that I have at the elementary school supporting students with fine motor and handwriting difficulties. So now you have some role confusion. There you have other therapists who are saying, look, the research is telling me that the best way to support students is through a collaborative model within the classroom. But again, if I do that, how am I going to do it? When am I going to have time to learn how to do that? Will it be successful knowing that I have 60 kids that I need to see individually as well, and so these are all coming together to kind of create this perfect storm, and that's why I'm putting this episode out right now, because I do think that here in 2025 this is the moment that we need to address this. We need to flip the script from let's figure out what the problem is with high case loads to how the heck are we going to fix this problem with high case loads? Because it is not a question as to whether or not we have high case loads. It is a fact, and we need to figure out how we are going to change it. So that is where I am going to stop my discussion about the problem and move to the potential solutions. Because it's simply just not enough to talk about the problem anymore. We have to start talking about solutions. I want to start this conversation off by saying that this is not going to be easy. This is not going to be easy for anyone. It's not going to be easy for us as the OT practitioners. It's not going to be easy for our administrators. It's not going to be easy for the teachers, for the parents, for the students. It's not going to be easy for anyone to fix this problem. This problem has been growing since, from what I understand, I mean, obviously since before I was an OT in 2012 this problem has been growing from what seems like around the turn of the century in 2020 and it's going to be difficult, like it's not going to happen overnight, the way that I see ot practitioners addressing this right now tends to be, or tends to fall under one of two categories, either a to a degree limiting our scope in order to prevent referrals, which then leads to a decrease in services. That looks like saying, Sorry, that's a behavioral concern, not an OT concern, so not really going to address that in OT. Or that's a social concern. I don't really address social skills here in OT. Maybe speech therapy can help out with that. Those are the two primary categories. But I'm sure you have seen more. Maybe you have experienced more. That's one option that I see happening right now. The second option is that we show our value of what we do and the data to support potentially higher staff counts, or the data to support investing in the occupational therapy program and whatever that looks like. Maybe that is more therapist. Maybe that's software to help therapists be more efficient. Maybe that's more tools to help therapists. Maybe that is contracting with an agency to provide therapy. But these are the two primary ways that I see ot practitioners addressing this. Currently, I have gone the route of showing value in what we do, and also providing data as to where my time is going and what supports a student is not getting because my time is somewhere else, or even showing that services are failing because of my time and energy spent somewhere else, we're going to have to choose one of these, or each of us is going to have to choose one of these, or each district is going to have to choose one of these, because at this point, there's no state law, state mandate, federal mandate, or law that is deciding that for the districts. And so each school and district is going to kind of have to do that on its own. Now I am doing my best to help the way that I can, and by putting out episodes like this, and I have a caseload to workload course that I put out, and I'm trying my best to work with both California and a OTA a little bit on this. I'm doing research, actually right now on this topic, but we're all going to have to do our part. We're all going to have to help in showing the district the value that occupational therapy has and how our data can support student outcomes over the last few months and maybe even a little bit longer. I've heard of different ways that both districts and states are kind of handling this. You know, you have some states that have. Put mandated caseload caps in place. Ohio is one of those states that has a caseload cap. Now speaking to therapists in Ohio, the cap is not always followed, but it is there. It is something that they can point to. In other states, you have ot practitioners trying to work their way into an administrator role so that they can have an impact from within the district. In other areas, you have ot practitioners forming or joining a union so that there is a bargaining unit for them, and that bargaining unit can actually work with the district to implement some sort of caseload cap or workload cap. In other areas, still, therapists are doing their best to implement an MTSS program as a preventative model, as a way to decrease long term case loads and stabilize their workload. There's a lot of creative ways to do this, other than just hiring more people. Sometimes the end result is hiring more people. Yes, that's true, but if we are showing the data that shows that we have an impact on student outcomes, then districts will be less hesitant when it comes time to actually pony up and put the money forward to get another occupational therapy practitioner. As we move forward through 2025 I'm really excited to see the results of the survey that a OTA put out. I believe it was in August and September about school based occupational therapy. Abe Safar at a OTA, he has been on the podcast a few times. He really championed the idea of better understanding the school based ot practitioner, and our situations like this is almost going to be kind of a state of school based ot survey results when we get those results, and I can't wait to see them, because I'm interested to see not only things about caseload and workload, but like salary. And you know the difference between working in California versus working in Arizona versus Colorado, Texas and New York and all the other states like this is going to be really interesting. Every so often, a OTA publishes their national workforce survey where they kind of break down all of occupational therapy. But it will be really interesting here to see just school based occupational therapy broken down and see how that goes. Because, yeah, it's going to be really interesting to see where, or if it's just across the board, Everyone is struggling with providing the services to the students that they're supposed to be providing services to. I think that's going to be really interesting. So I'm gonna wrap this podcast up. I am sorry for ending 2024 on a little bit of a somber mood, I guess we could say. But I just felt like this podcast had to be put out really quickly. The other trends that I was going to discuss in today's episode, the first one was AI and documentation idea generation, or documentation and idea generation, the second was going to be talking about the emphasis of play, but I'm super excited because we're going to be talking about play two weeks from now in the next podcast episode. And then I was going to talk about high case loads. I was also going to talk about the future trends of more using AI, but instead of, from a documentation perspective, using AI in a way to actually support our students. So imagine helping our students use AI to overcome some of the difficulties that they experience every single day. The other one that I was going to talk about was more services in the classroom. I think that's going to happen more in 2025 I think that people are really going to be reaching out for support to do that, and I hope, I really hope, that we can achieve it even with our high case loads, or that we can do something about our high case loads so that we can get into the classroom more frequently. Because I think that is going to have the largest impact on our students if we can get into the classroom. They don't call it the PEO model for nothing, person, environment, occupation, you've got to look at all three to best support a client. We can't just look at the person in the occupation. We have to look at the environment, and the teacher and the peers are all part of that environment, so we need to be in the classroom to best support the students. So with that, I'm going to say Happy trails for 2024 and I look forward to seeing you in 2025 if you have any comments about this specific episode, please email me. Jason@otschoolhouse.com let me know. Let me know if you are combating high case loads in some form or another, or if you are simply drowning in high case loads and you need support in one way or another. This is definitely going to be a topic that I will be addressing more here in 2025 and yeah, I just look forward to supporting you related to this and every. Else related to school based occupational therapy. So thank you one more time for sticking around and listening to this to some degree somber episode in 2024 but I promise to be back in two weeks with Episode 166 that will be much more light hearted. And we are going to talk all about play and nature based settings. So it's gonna be a fun one. Stay tuned. Hit subscribe. If you haven't already, leave a comment or a review. If this podcast helped you out a little bit, really appreciate those and share it with a friend. You know, if you and your colleagues are all experiencing high case loads and not sure what to do, give this episode a share. Let them know that they're not alone and that we're going to get through this together. All right, enjoy the remainder of your 2024 I appreciate you. I appreciate you listening, and I will see you in 2025 until next time, take care.
Amazing Narrator
Thank you for listening to the OT school house podcast for more ways to help you and your students succeed right now, head on over to otsoolhouse.com Until next time class is dismissed.
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