The school-based therapy workforce is under sustained pressure. Caseloads have grown steadily for two years, driven by a wave of students whose early intervention access was disrupted during the pandemic. At the same time, the funding environment supporting school-based services is facing pressure that many districts have not fully reckoned with.
To understand the current state of the profession from the people doing the work, Kelly Pediatric Therapy surveyed 255 school-based therapists across the United States, including speech-language pathologists, occupational therapists, physical therapists, school psychologists, and behavioral therapists in public, private, and charter schools in every region of the country. Here is what the data shows.
1. Caseload growth is system-wide, and the cause matters for how districts respond.
71% of therapists report their caseloads have grown over the past two years. The growth is consistent across regions and therapy disciplines.
The cause is specific. Pandemic-era disruptions significantly reduced access to early intervention services for young children. Those children are now school-age, and the developmental needs that went unaddressed are arriving in school-based caseloads. This is not a short-term surge. Those students will move through the K-12 system over the next several years.
Districts that respond by filling vacancies are asking a narrower question than the data warrants. The more useful question is whether caseloads are distributed in ways that reflect actual student need, and whether therapy program structure can absorb continued growth.
2. Student complexity is changing what caseload counts measure.
64% of therapists say the complexity of student needs has increased over the past three years. Therapists report growth across several student populations, with mental health and anxiety-related needs and students with autism spectrum disorder seeing the largest increases.
This matters for how districts assess therapist capacity. A therapist managing 45 students with relatively contained needs is in a different position from one managing 45 students with multi-layered diagnoses, behavioral complexity, and IEPs requiring coordinated intervention. Complexity data adds the dimension that enrollment numbers miss.
Nationally, demand for behavioral health services in schools has grown substantially while the workforce pipeline has not kept pace. Districts relying on headcounts to assess therapy capacity are likely underestimating actual workload.
3. The administrative burden is a retention variable districts can address.
68% of therapists report spending six or more hours per week on documentation and compliance work outside contracted school hours. 19% report eleven hours or more.
When asked what would most help them remain in school-based practice long-term, therapists consistently prioritized working conditions over compensation. Better tools and therapy spaces ranked first, manageable caseloads second. Compensation ranked fourth.
The hours spent on compliance work after the school day are felt by the people doing them. They are hours subtracted from student care and from a working life that is sustainable over time. Dedicated documentation time and streamlined IEP processes are practical levers that cost less than turnover.
4. Understaffing is already reaching students, and the broader funding environment is adding pressure.
77% of therapists say they have witnessed student progress affected by understaffing or unmanageable caseloads. When caseloads become too high, 46% say students wait longer to begin services and 35% say IEP goals become harder to achieve on time.
These are federally mandated services. Delays carry legal consequences alongside developmental ones.
The funding picture heading into fall 2026 adds pressure to an already strained system. Medicaid reimbursement, a significant source of funding for school-based therapy services, faces uncertainty as states absorb the effects of federal spending reductions passed in 2025. IDEA funding covers less than 12% of average per-pupil special education costs, far below the 40% Congress originally committed to when the law was enacted. Some districts have already responded with cuts: Fort Worth ISD voted in April to eliminate part-time SLP positions and all SLPA roles district-wide.
The structural gap between what schools are legally required to provide and what they are funded to provide is widening. Districts that plan therapy staffing with the same rigor they bring to teacher pipelines, forecasting need and building staffing relationships early, are better positioned to maintain service continuity when gaps occur.
5. Therapists are committed to the profession. The pace of institutional response is where the gap is.
57% of therapists believe most districts are not moving fast enough to address the coming shortage. Nearly 90% remain at least somewhat optimistic about school-based practice as a long-term career.
The gap between those two numbers is where districts have room to act. When therapists were asked what would help them stay, the top answers were better tools and therapy spaces and manageable caseloads. Compensation came fourth. Districts that invest in those working conditions are likely to retain experienced therapists at higher rates.
ASHA workforce data indicates that roughly half of school districts already report SLP vacancies they cannot fill. Occupational therapy assistant roles are among the fastest-growing in education-related fields. The structural pipeline gap describes the current reality under which most school-based therapists are working.
For district leaders evaluating caseload pressure or the structure of their therapy programs, the full Kelly Pediatric Therapy white paper is available here.