What Size Should a School-Based OT Caseload Be?

Have you ever wondered if your school-based OT caseload is too large? Do you feel like there’s not enough time in the school day to get all of your tasks and responsibilities done? If you’re feeling this way, it’s very likely your caseload is too high. But what constitutes an unmanageable caseload? Well, unfortunately, the answer isn’t as simple as one number. There are other factors, including amount of service time, number of schools, assessment frequency, and other responsibilities. I’ve carried a caseload of 36 that was hard because I was making up an entire semester of compensatory time too, and a caseload of 67 that felt very manageable because it was mostly consult. Looking at your entire workload often gives a better picture than attempting to stick to a caseload cap number. Regardless, the following warning signs may be good indications that either your caseload or workload is too high.

You are working off the clock to meet deadlines

This is the number one sign that something is wrong. As much as taking work home has been normalized in the school system, I’m here to tell you that this is not something that should be expected from you. You deserve a job that compensates you for all the hard work you do, whether that means working within the hours set by your contract, or clocking in for every IEP and email you write. It is possible to work as a school-based OT without working off the clock – don’t let anyone try to convince you otherwise.

You don’t have time in the school day for lunch or breaks

Another huge red flag! Maybe you’re not taking work home, but you’re only able to maintain this because you document through lunch and barely have time to pee during the school day. This isn’t okay either. We all need time to rest and recharge during the day, and as OTs, we are especially aware of the negative ramifications of not doing so. We need to practice what we preach!

You are only able to stay for 15 minutes of an IEP meeting, or sometimes don’t attend at all

I see so many districts passing this off as normal when really, parents have a right to have all of the IEP team members present for the duration of the meeting. While it can be frustrating to have to attend so many meetings, this is really our best chance to work collaboratively in the student’s best interest. It may also be the only time you interact with the family all year. They deserve to have that time with you! Plus, staying for only a few minutes or providing written input beforehand only serves to further compartmentalize our role. Our time at the IEP meeting shouldn’t be spent reporting on the “OT goals” or the “fine motor present levels.” It should be spent discussing all that we do to support a student and how we will address things as a team going forward. 

school-based OT caseload

You are grouping students just to get all of their minutes in

This is another thing I see districts promoting as “what must be done.” Truthfully, we should not be grouping students unless the quality of service they get is either better or equally as good as what they would receive in an individual session. While some supervisors won’t like this because it means they end up having to pay more for OT services, it’s our responsibility to be ethical and advocate if we don’t think a group session is appropriately serving a student. 

You often have to cancel student sessions in order to complete assessments

At the district I worked at where I carried the highest caseload, this was something I had to do frequently in the first semester. Eventually, I was able to advocate and make changes to have a more reasonable caseload, but it did take situations like these in order for it to get noticed. If you find yourself having to do this, be sure to document, document, document as well as let your supervisors know. The district being in a position where they are potentially denying FAPE and required to provide compensatory services is sometimes the wake-up call districts need to realize they are understaffing the OT department.

You feel like your students aren’t making as much progress as they should

This is the real kicker when we have an overwhelming caseload – we’re not the only ones suffering. You may think that you can work off the clock because it’s what “has to be done” for the students’ sake, but this type of overworking almost always leads to worse student outcomes. 

You feel overwhelmed and burnt out

Ding ding ding. Listen to your body and your brain. If you’re feeling exhausted, overwhelmed, and annoyed every day, it isn’t “normal” and it isn’t okay. You deserve to have a job that you enjoy that allows you to live a life outside of it.

school-based OT caseload

You feel a sense of relief when a student session gets canceled 

This is one that sneaks up on you sometimes! We all love kids, so we can feel really guilty if we get a secret twinge of joy when a student is absent. It doesn’t mean that you don’t want to see your students – it means that you are excited to suddenly have a pocket of time where you can eat a snack, catch up on emails, and write a couple of notes. All tasks that you should have dedicated time built into your schedule for. 

You are using your free time to treatment plan

Don’t trick yourself into thinking that just because you enjoy treatment planning, that it isn’t part of your job. Yes, it can be fun to scroll Pinterest, Instagram, Teachers Pay Teachers, etc. – but it’s also a part of your process. Treatment planning is an important component of your work and you should be getting paid for it. 

You feel that work gets in the way of spending time with your own family

As much as we love our students, our work should never take precedence over our own family. If you feel too drained at the end of the school day to play with your kids, spend time with your partner, or even take your dog out for a walk, something is wrong with your workload.

It’s not always easy to know if your caseload is too high. If you ask for caseload numbers from other therapists online, you’ll find a variety of responses – some that might make you jealous, and a lot of others that might make you feel as though it’s “normal” to have a large caseload. Or that it’s something to get used to. Or maybe even that you just don’t have the skills yet to manage a typical caseload.

I’m here to tell you that if you are identifying with any of these signs, there’s a good chance your caseload is too high. This is not a reflection of your competence as a therapist. This isn’t an area where you just need to grin and bear it. This is a systemic problem for school-based OTs across the country, and we all need to push back against normalizing this.

I want to teach you exactly what to do in this situation. How to advocate – for both yourself and your students. What laws to have in your back pocket. How to manage your time more efficiently. How to start these conversations with your admin. How to collect real data that shows how hard you are working, regardless of your actual numbers. How to get out of overwhelm in the first place so that you even have the energy to start this process! This is what you’ll learn in The Dynamic School OT. If you’re ready to love your job again, please join me!

1 thought on “What Size Should a School-Based OT Caseload Be?”

  1. Pingback: Should You Become a School-Based OT? - Devon Breithart

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