Referrals rise, shortage remains for speech-language pathologists in Connecticut

Oct. 15--NEW HAVEN -- As schools become better at detecting signs of communication disorders, diagnoses and referrals are on the rise while the licensed speech-language pathologists who serve them are in demand across the country.

"We actually diagnose and treat communicative disorders and that's any person that might have difficulty in the areas of articulation, fluency, voice or language," said Glynis King-Harrell, supervisor of speech and language services in the New Haven public schools. "Speech is a basic entitlement that we take for granted because it comes easily for most of us."

Officials in New Haven Public Schools said during a budget review that contractor costs have increased as the district looks to fill vacancies in shortage areas such as speech-language pathologists.

"New Haven Public Schools has been proactive in its recruitment efforts and partnerships as it seeks to recruit, retain and hire talent. The District has also leveraged support through contractors, consultants, university and community based partners to fulfill staffing needs in shortage areas," said Superintendent of Schools Carol Birks in a statement. "With respect to meeting the individualized educational plans of our students who have been identified as in need of Speech and Language Services, New Haven Public Schools has supplemented staff with contractors and other support services."

Filling positions

King-Harrell said building and caseload assignments are made logistically.

"There's not a lot of time to travel from Point A to Point B, and we also keep data on what the identified numbers are per building and try to come up with a reasonable caseload for each person," she said.

Speech-language pathologists in the city's schools say that, of approximately 25 full- and part-time speech-language pathologists, about a third are contractors, and the number of students in the city who receive referrals fluctuates between about 1,500 to 2,000 students annually.

"The level of dedication required, especially in urban districts, is monumental," said Derlene Ortiz, a speech-language pathologist who works with students at five schools, most with a heavy English learner population.

King-Harrell said the challenges are exacerbated in urban districts such as New Haven, which is perpetually plagued by money woes because of funding austerity and a large number of high-needs students.

In Middletown schools, a smaller nearby urban district, an administrator said open speech-language pathologist jobs receive fewer applications than classroom teacher positions, but the applicants all come with many qualifications.

"We're lucky enough to be fully staffed with fully-qualified speech paths," said Sara Alberti, supervisor of pupil services and special education in Middletown schools. She said the district, which has student enrollment approximately one-fifth the size of New Haven according to state data, employs 10 speech-language pathologists.

Although Alberti said Middletown is currently fully staffed with speech-language pathologists, as a trained speech-language pathologist herself she knows there is a growing need for workers in a selective field.

Stefania Larry, early childhood coordinator in West Haven Public Schools, said filling positions within the last three years has been "challenging." Currently, there are 12.5 speech-language pathologists in the district, she said, and they are all assigned to one school each.

"We've hired former interns in the past once they've graduated, we've advertised at local universities but not every university has a program," she said.

Larry said that in West Haven many of the speech-language pathologists come to the district without much history in school-based settings.

Certification

According to the Federal Bureau of Labor Statistics, Connecticut employed 1,730 speech-language pathologists in May 2017, although not all of them necessarily worked in schools or with a student population. The annual mean wage for speech-language pathologists in the state was $93,340 according to the bureau's data, making it the highest paying state in the nation for the occupation on average.

Despite the competitive pay and the need for qualified workers, King-Harrell said there are several required certifications -- from the American Speech-Language-Hearing Association, the state Department of Public Health and the state Department of Education -- that might be prohibitive.

Ortiz said the path to earning these certifications amounts to a lot of tests and paperwork for aspiring speech-language pathologists.

After receiving these certifications, King-Harrell said many speech-language pathologists certified to work in schools may let the 061 certification with the Department of Education lapse.

"Some people may get into a setting that's only clinical, like a hospital or a clinic, and say, 'Why am I maintaining my school certification?'" she said.

Three speech-language pathologists in New Haven schools said there can be some role ambiguity when students are referred for their services, and it is their job to figure out how to best serve children who might have communication disorders.

"I don't think anybody has ever had a year where they think their workload is 'a vacation,'" said NHPS speech-language pathologist Sondi Jackson. "We have to leave time for evaluations, observations, consultations with teachers and parents," planning and placement team meetings, (student and staff support team meetings and scientific research based interventions.

"Caseloads are only one part of the workload," said speech-language pathologist Cayla White.

Ortiz, Jackson and White all graduated from Southern Connecticut State University's communication disorders graduate program, although the way they describe how they became speech-language pathologists differs. Ortiz said, as a bilingual speaker of Spanish and English, she was attracted to the program as a junior at SCSU, although her intention was to work in a medical context before doing a placement in West Haven schools.

White said her initial intention was to go into broadcast journalism until two cousins who work as speech therapists persuaded her to consider the field.

"I love working with kids. I knew eventually I would want to work in a school system," she said.

Jackson, who had a career in banking and insurance, said education was "what was in my heart." A speech pathologist who attended her church convinced her to go back to school at age 30, so she started taking classes during her lunch break at work.

Jackson, who has now worked in the field for 26 years, said there has always been a shortage of fellow speech-language pathologists.

Ortiz said pathologists tend to be cautious about assigning labels to students, because "they may be going through a silent period." Jackson said she is also cautious about the difference between language disorders and language differences.

White said that, especially in the last year after a number of evacuees from Hispanic-speaking countries and territories enrolled in the city's schools, she works collaboratively with bilingual educators such as Ortiz.

For a period of time Jackson was an adjunct in SCSU's communication disorders master's program. One of the challenges from transitioning from the preparatory programs to a real-life scenario, she said, is that speech-language pathologists must be reactive in real time.

"I felt like I was the person giving students some real-world experience. I'm working as a pathologist and sharing with them what it's like day-to-day," she said. "They don't have all week to prepare for one case."

The preparatory programs in the state are also limited to three colleges: SCSU, the University of Connecticut and, recently, Sacred Heart University. All three programs are selective.

Deborah Weiss, chairwoman of the Communication Disorders Department at SCSU, said the program accepts about 45 students annually, with about 100 in the program at any given time.

"The majority of those students are two-year students, but some can also be for three years," she said.

About 200 to 250 students apply annually for those 45 spots.

Rhea Paul, chairwoman of Sacred Heart's Speech Language Pathology department, said there are about 40 seats per class with about 80 students in the program. She said there are between 200 and 300 applicants to the program annually.

Paul said she believes the global shortage of speech-language pathologists is somewhat related to a growing need under the Individuals with Disabilities Education Act.

"There has been more obligation on the part of schools to provide for kids with special needs," she said.

That is tied to increasing rates of autism spectrum disorder diagnoses; according to the Centers for Disease Control, there is a reported diagnosis of autism in one in 59 children born in 2006, whereas one in 150 children born in 1992 has been diagnosed with an autism spectrum disorder.

"Because the core of their problems have to do with communication, virtually every child who is diagnosed with autism needs the services of an SLP," Paul said.

"That's a population that speech-language pathologists are very, very involved with -- children with autism -- and that population has been growing," Weiss said.

Growing field

According to the Bureau of Labor Statistics, there is a projected to be a 10.4 percent increase in speech-language pathologist jobs by 2026.

"The number of speech-language pathologists that are needed has grown incrementally and continues to grow," Weiss said. "It's not like the need has remained static and we haven't fulfilled the need; the need keeps growing."

Both department heads said the required clinical hours needed for a degree present a challenge for students and the programs that need to place students alike. Students need 400 clinical hours to graduate with a degree in speech-language pathology, and they work at different professional areas. Although UConn and SCSU both have on-site clinics, Sacred Heart does not.

"We're limited by how many places we can put students so they can acquire these clinical hours," Paul said. "We don't have an on-campus clinic like Southern and UConn, but we do have nursing homes, where students do therapy under the auspices of an in-house therapist, and it doesn't take away from their in-house therapists because we send our own supervisors."

Weiss said Medicare requirements make student speech-language therapists less attractive for hospitals to train because of compliance issues, as they often need to be supervised 100 percent of the time.

She said expanding the class sizes within SCSU's program doesn't seem possible for a mix of issues besides finding placements for students, including fiscal restraints and a shortage of qualified faculty, as an industry with a global shortage perpetuates itself.

"For our field when we have a position open maybe we're going to get five or 10 people applying because of the shortage in the field," she said. "One of the reasons for the shortages of the field is there's such a good market for students in the field."

The speech-language pathologists working in the district say that, despite the burden of certifications, loans and the time commitment, they wouldn't rather be doing anything else.

"Giving students the ability to communicate is extremely empowering," White said.

brian.zahn@hearstmediact.com

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