What school-based therapists are telling us, and what districts need to hear

Key Takeaways

• 71% of school-based therapists report caseload growth over the past two years, reflecting a system-wide trend accelerated by pandemic-era disruptions to early intervention.
• 77% have seen student progress affected by understaffing or unmanageable caseloads, with 46% reporting longer waits to begin services and 35% saying IEP goals become harder to achieve on time.
• 68% spend six or more hours per week on documentation and administrative work outside school hours, a workload that ranks above compensation when therapists describe what would help them stay.
• 57% believe districts are not prepared or not moving fast enough to address the coming shortage.
• When therapists were asked what would most help them stay in school-based practice, better tools and therapy spaces ranked first. Compensation ranked fourth.

When we decided to commission this survey, we already had a sense of what we would find. Therapists across the country had been describing the same pressures for two years: caseloads that had grown and students whose needs had become more complex, alongside an administrative load that followed them home. What I wanted to know was whether the data confirmed it at scale.

It did. And in some places, the numbers were harder to sit with than I expected.

Sixty-eight percent of school-based therapists report spending six or more hours per week on documentation and compliance work outside contracted school hours. Nineteen percent said eleven or more. When I share that number with people outside the profession, the reaction is usually surprise. Therapists already know this is their reality. The survey puts a number on how widespread it is.

Those hours have a cost. They are hours subtracted from student care and from a working life that is sustainable over time. When therapists were asked what would most help them stay in school-based practice long-term, reducing that administrative load ranked near the top. It ranked above compensation.

What the data shows about students.

The finding I keep coming back to is the one about student outcomes.

Seventy-seven percent of therapists say they have seen student progress affected by understaffing or unmanageable caseloads. Forty-six percent say students wait longer to begin services. Thirty-five percent say IEP goals become harder to achieve on time.

These are federally mandated services. For many of the students receiving school-based speech, occupational, physical, or behavioral therapy, there is no equivalent option outside of school. For district leaders, this data connects therapy staffing decisions directly to student outcomes. That is a different conversation than the one most districts are currently having about these positions.

What I learned about retention.

The retention data from this survey surprised me. When therapists were asked what would most improve their ability to stay in school-based practice long-term, compensation ranked fourth.

Better tools and therapy spaces came first at 38%. Manageable caseloads came second at 32%. Scheduling flexibility came third at 31%.

What therapists are describing is the ability to do the work well: caseloads sized to actual student complexity and spaces that support the clinical demands. Nearly 90% remain at least somewhat optimistic about school-based practice as a long-term career. Eighty-seven percent say they feel at least somewhat supported by their districts.

Those numbers reflect a profession that is still invested in the work. What the retention data adds is specificity about the working conditions that determine how long that investment holds.

What districts can do with this.

The therapists who participated in this survey described specific, addressable conditions.

Caseload audits are a more useful starting point than headcount reviews. A district can fill every open position and still have caseloads that are too large or poorly distributed for the complexity of students being served. Starting with actual caseload data, weighted for student complexity, gives a more accurate picture of where the gaps are.

The administrative burden is a place where districts have more leverage than most have used. Dedicated documentation time within the contracted day and streamlined IEP processes are practical changes that cost less than turnover. Both also signal to therapists that their time is valued, and that tends to show up in tenure.

Planning further ahead matters. Fifty-seven percent of therapists believe most districts are not moving fast enough to address the coming shortage. The pipeline for therapy disciplines is not keeping pace with demand. Districts building staffing relationships now, before a vacancy becomes urgent, are in a materially better position than those responding after the fact.

The students depending on school-based therapy services are in schools now. The therapists serving them have been specific about what they need. This report is how we’re making sure that information reaches the district leaders who can act on it.

Download the Kelly Pediatric Therapy white paper here.