Solving the school therapist shortage
In rural Washington state, an occupational therapist might drive three to four hours to see a student—that is, if a district can find one to hire.
Last year, an occupational therapist job posting went six months without a single application being submitted to Educational Services District 112, which provides special education services to 28 rural districts across six counties near the Oregon border.
And that sent the district’s special education director, Michelle Murer, searching to find another way to provide occupational therapies to rural students. She found the answer this past fall, which bypassed the difficulty of geography altogether: a burgeoning model known as telepractice, in which students receive services from therapists online.
In the last five years, more district leaders have been turning to this online model to deliver speech and occupational therapy. In telepractice, a therapist takes on all of the responsibilities of an in-person therapist—from participating in IEP meetings to having therapy sessions—but does so remotely.
It’s a solution for staffing shortages, especially in less populated areas. “School districts have had a real problem with finding enough speech and language pathologists,” says Luann Purcell, executive director for the Council of Administrators of Special Education (CASE).
On average, about 47 percent of speech language pathologists report staff shortages occurring in their schools, with the highest shortages in the nation’s western states, according to the National Coalition on Personnel Shortages in Special Education and Related Services.
And yet many students need therapies, especially for speech. About 18 percent of children ages 6 to 21 who are served through IDEA Part B have a speech or language impairment, according to the U.S. Department of Education.
For Murer, telepractice has given ESD 112 staffing options the district didn’t previously have. She has noticed a difference in the quality of occupational therapies that students are receiving. “We’re able to get highly qualified people, as opposed to the person who’s willing to drive,” Murer says.
How telepractice works
Students in telepractice therapy sessions work through the same exercises and build the same skills that they would with an in-person speech or occupational therapist. The difference is the use of the internet and videoconferencing to connect students with therapists who may work out of their home office hundreds of miles away. “It pulls a lot of speech and language pathologists who haven’t left the profession but have left working full time,” Purcell says.
In speech therapy sessions, a pathologist may hold a flash card up to a web camera, which is broadcast on the computer screen and, for example, prompt a student to practice “R” sounds. And in occupational therapy, the therapist—with the help of a paraprofessional by the student’s side—may guide students through fine motor skill exercises, such as using scissors.
Telepractice providers, such as PresenceLearning and TinyEYE, are helping districts to connect students with therapists and to ensure legal requirements have been met. For example, most states require therapists to be licensed by the state in which the student is being served.
In many ways, telepractice is a new way of delivering tried-and-true therapy approaches. Children and teenagers are digital natives, and the technology hasn’t hampered the therapist-student relationship, Purcell says. The same therapist will work with the same student over the course of the therapy, and the relationship and trust grows as it would in person.
To connect with telepractice therapists, students use computer stations that are equipped with web cameras and microphones. For speech therapy sessions in regular classrooms, students will often put on headphones so as to not disturb the rest of the class.
Earlier this school year in Barstow USD in California, Director of Pupil Services Joni James adopted telepractice to lighten the number of cases for her speech pathologists, reducing one therapist’s load from 85 cases to about 60.
Because of the district’s location in the desert—“It’s not a place people want to live,” she says—James has had difficulty attracting quality applicants. “Telepractice gives us some relief,” she says, as the student population keeps growing.
In telepractice speech therapy, students are often self-sufficient. Once shown how to log on and use videoconferencing, they can work independently in the back of a classroom or resource room, seeking out in-person assistance only when technology issues arise. For occupational therapy, on the other hand, paraprofessionals are often needed to assist students.
Hiring an occupational support paraprofessional has been a key part of the telepractice program in the Sultan School District in Washington, Executive Director Robin Briganti says. When the district transitioned last winter, Briganti realized she needed a dedicated in-person liaison to connect with therapists who work as far away as Maine and North Dakota. Plus, she says, “We needed to have a contact person districtwide to be a key communicator with our online provider.”
The Sultan district hired paraprofessional Erin Ramsey, who splits her time between occupational therapy students and English-language learners. She handles the technology, positions webcams and works with student logistics—everything from walking them to a dedicated resource room to canceling and rescheduling sessions when they’re sick.
In some school buildings, Ramsey brings an occupational therapy cart from classroom to classroom. The cart is loaded up with a television, laptop, phone and webcam, enabling sessions to be mobile. Sessions might range 15 to 45 minutes, but average about 30 minutes each.
Students in a classroom dedicated to autism, especially, have the benefit of being served in their own environment, instead of moving to different rooms. Students have enjoyed the telepractice model, and interacting with the therapist, whose picture is broadcast on the television screen, Ramsey says.
“I call myself the gypsy because I get to go to different schools,” she says. “Preschool, middle school, the autism room—I love. I get to work with everyone.”
Studies appear to back up the student results that districts using telepractice are seeing. Researchers at Kent State and Bowling Green State universities studied 13 rural Ohio K6 students with speech sound disorders and found they demonstrated a greater mastery of speech sounds when they did telepractice therapy.
Researchers found that 84 percent of students mastered IEP speech sound goals through telepractice, compared to 47 percent of students who achieved mastery through in-person therapies. The study, “A Pilot Exploration of Speech Sound Disorder Intervention Delivered by Telehealth to School-Age Children,” was published in the International Journal of Telerehabilitation, a research journal that covers rehabilitation programs using online communication.
In the first year of deployment five years ago at John Swett Unified School District in northern California, about 40 percent of the district’s speech therapy students were using telepractice, via PresenceLearning.
“We picked kids with a variety of needs—mostly articulation issues, but also some language processing issues,” says Barbara Walker, district director of special education. The speech language pathologists are professional, and “their way of working with the students is absolutely effective. They’ve also done well with our many English language learners.”
Murer, the special education director for ESD 112 in Washington, adds that in previous years she saw in-person therapists who kept students in therapy too long.
“Some therapists grow their caseloads for job security, because of the way that their contracts work,” she says. “They don’t really have that in telepractice.”
In addition, administrators say working with a telepractice provider has been helpful for specific requests, such as a Spanish-speaking therapist who can assess students in their native language, thus eliminating the need for an interpreter and reducing the number of students who are misidentified as needing therapy.
Some students seem to prefer telepractice. In a study of an 11-year-old boy with autism, researchers at the University of Massachusetts, Amherst found that he made more progress during telepractice sessions than in-person therapy.
The study documented the progress of the student in using transition words to sequence the action when recounting an event or telling a story. It revealed the student used more transition words during videoconference sessions than he did during in-person therapy. After switching back to the latter, his use of transition words declined.
The study, “The Multi-faceted Implementation of Telepractice to Service Individuals with Autism,” says the use of technology may provide a more predictable social environment and help reduce the amount of anxiety and autism-related behaviors. “They go into sensory overload” during in-person therapy, says Purcell of CASE. “(Telepractice) is 2D instead of 3D.”
In Barstow USD, James has seen similar success with students on the mild to moderate side of the autism spectrum. “Because they’re on the computer, they’re just more attentive and connected,” she says. “They seem to really get it and love it.”
Mackenzie Ryan is a freelance writer in Florida.