Success Story: Financial and Workload Incentives for Improved Recruitment and Retention

Connie Williams, MA, CCC-SLP
Early Childhood Lead School Support Related Services
Guilford County Schools in Greensboro, North Carolina

What did you do?

Our previous Director of Related Services Corinne Gutosky began with a salary study. She looked at other counties in North Carolina, particularly those similar in size to Guilford County. She then used this information to create a proposal for our Director of Exceptional Children. In addition, the county had already been facing challenges filling some teacher positions, such as math and science, so they initiated a $10,000 sign-on bonus to help fill these positions. Using that model, we were able to get this bonus for SLPs (and school psychologists) but using Medicaid Fee for Service as the funding source.

Support from leadership was absolutely crucial to success. The Director of Exceptional Children did a "deep dive" into the budget and closely examined where Medicaid money was being spent. She clearly understood that these funds should be spent on the Exceptional Children's department and worked with the Finance department to ensure that this took place.

What were your greatest challenges?

Getting therapists to consistently log for Medicaid. There was quite a bit of resistance because the logging is so time-consuming, and the therapists resented the fact that they were generating money that did not come back to them. Most [therapists] felt that it was an unfair burden, and so it was difficult to get them to buy in. The Medicaid revenue is how the retention bonus, professional development, and reimbursement for ASHA dues and state licensure are provided. Once staff understood this, their documentation compliance improved and brought in more revenue for the district.

Gaining the ear of leadership. No matter how great your ideas are, decisions like this are ultimately made by executive directors and those in upper leadership positions. Having someone in these positions who is willing to listen and actively work toward finding solutions is a huge challenge and, unfortunately, not always something you can control.

What was the outcome?

Recruitment initiatives include the following:

The district provides a $10,000 sign-on bonus with a 2-year commitment.
- New hires get $5,000 within the first 60 days of employment.
- If they agree to come back the second year, they get another $5,000.
The district pays for licensure as well as for ASHA certification and dues.
The district adheres to a workload model.
The district hires part-time SLPs, OTs, and PTs. It's important to be flexible!
The district has an assistive technology team.
The district has an evaluation team, which helps with Spanish evaluations and with evaluations where the 90-day timeline is in jeopardy.
The district holds monthly speech meetings.

Retention initiatives include the following:

The district provides a $3,000 retention bonus every year.
New employees get a supervisor or mentor.
Ten regional leads answer questions, run monthly meetings, and house regional lending libraries.
Office hours are held during the first year as a place where new SLPs can go regularly to ask questions.
Computers are provided (choose between MacBook or ThinkPad).
The district pays for an SLP Now subscription for professional development and provides LessonPix for visual supports.
Microsoft Teams is set up to include forms and tips so that everything is in one place.
The Multi-Tiered System of Support (MTSS) model is specifically explained in writing so that administrators know how SLPs are to be involved.
The district holds a materials exchange at the beginning of each school year.
Each year, the SLP has the opportunity to transfer to a different school—if a school is not a good fit or if the SLP wants a certain age group.

What advice would you give?

It's important to continue to communicate with administrators and school principals. The roles and responsibilities of SLPs are different than the roles of classroom teachers. Therapists essentially are medical providers in an educational setting. It's unlikely that the school nurse is asked to do daily duties or serve on multiple committees, and therapists should be viewed in the same manner.

Also, focusing on a workload model rather than caseload numbers—and responding as quickly as possible when workloads begin to get too high—is helpful.

I want to stress that although we've made strides in retention and recruitment, this is a work in progress. We continue to deal with personnel changes and advocate for better working conditions for our therapists. We are happy with the changes made so far, but we realize that we still have a long way to go.