For Special Needs Students, It's Therapy From Afar
Can electronic delivery of services for special education in remote schools address the critical shortage of specialists?
/School Administrator, January 2020

A special education student receives counseling remotely from a specialist employed by Presence Learning.
Cheryl Hubbard-George, director of the Office of Exceptional Children in South Carolina’s rural Florence County School District 3, was struggling to find therapists to address the needs of her special education students.

Hubbard-George searched exhaustively for specialized staff to provide services for the district’s 614 students in preschool through 12th grade with individualized education plans. She had no luck. “In a small, rural community, it’s much harder,” she says. Florence County, located in the center of South Carolina, has an enrollment of 3,350 students.

So Hubbard-George opted to contract with online therapists for speech and language development, as well as a school psychologist to deal with long-term academic and behavioral goals. In her district, 174 students receive speech language services, with 37 of them doing so through teletherapy. “We thought since most of our students spend time on digital devices, this could work,” she says.

Scarce Specialists
During the past few years, more school communities have faced Hubbard-George’s staffing predicament and turned to professionals delivering their services to students in special education through digital connections.

“There is a big teacher shortage across the country that’s forcing districts to look at alternatives,” says Kevin Rubenstein, director of student services, technology and assessment with the Lake Bluff Elementary School District 65 in Lake Bluff, Ill. “These [online therapy services] companies allow the districts to provide special education services with a high-quality service provider.”

IEPs require students with intellectual and developmental disabilities receive needed services, but in many school districts — particularly rural communities with relatively small enrollments that cover a wide geographic area — there simply aren’t the staff specialists to meet the demands.

A survey of schools in 2018 by the National Association of School Psychologists points to a shortage now of almost 15,000 school psychologists in the United States. About 14 percent of public school students in 2017-18 were classified as special needs, representing seven million students, according to the U.S. Department of Education.

“If you have a school of 100 students, where 15-20 of them have an IEP and only two of them need speech-language pathologists, it’s not a good fit for cooperative services because it’s so rural,” says Rubenstein, who serves as policy and legislative chair for the Council for Administrators of Special Education. When administrators factor in so-called “windshield time” — the travel time specialists spend on the road between schools — the cost can be prohibitive.

Contractual Services
As a result, a handful of proprietary firms have emerged offering contractual services to fill the gaps through virtual means. In some states, intermediate agencies, such as BOCES in New York, have a teletherapy component. Demand by special education directors is greatest now, in order for speech-language pathologists, social workers, school psychologists and occupational therapists to meet the needs of students that smaller and out-of-the-way school districts can’t fulfill on their own or through intermediate agencies.

As Jaumeiko Coleman, director of school services for the American Speech-Language-Hearing Association in Rockville, Md., said in an e-mail interview, “Telepractice can be helpful to speech-language pathologists in schools who have hard-to-manage caseloads/workloads as well as when students served live in a region that does not have an SLP nearby who can provide the necessary services.”

PresenceLearning, a 10-year-old company based in San Francisco and New York, is the largest national provider of online student services, currently working with about 400 districts, including charter schools and virtual schools.

Kate Eberle Walker, PresenceLearning’s chief executive officer, says with increased crisis intervention mandates and anti-bullying regulations, “the fastest growing area is for school psychologists and social workers, for behavioral and mental health support.”

She adds, “In my own work with schools, there was a constant struggle for special education directors to hire therapists. The big reason is there’s a geographic mismatch. You have clinicians in the suburbs, and student needs in large urban areas and rural communities.”

PresenceLearning’s network of more than 1,000 clinicians works with the schools’ special education directors. The company supervises the online clinicians, operates private chat rooms for each specialty and runs quarterly virtual town halls for its 1,000 clinical practitioners to receive updates about the company’s upgrades to its proprietary software platform or new assessment tools. To dissolve geographic barriers (clinicians on the East Coast may be working with districts in the Midwest or West Coast, and vice versa), PresenceLearning helps therapists get licenses in states where they are practicing. Most online therapists have significant prior experience working in schools.

Live Conferencing
So what does online therapy in special education look like?

Students, either individually or in small groups, typically go to a classroom or resource room at their school, sit at a computer with headphones and meet with the therapist in a live video-conference session. Usually an aide or other paraprofessional accompanies the students to help with technical or behavior issues and to help students model what the therapist is showing them.

Therapists provide a running record of how a student is doing, and parents often have the opportunity to observe a session remotely. Online therapists also participate in students’ IEP meetings and communicate regularly with their peers and teachers in the schools, as well as with parents.

“You can’t provide therapy in a vacuum,” says Jeremy Glauser, founder and chief executive officer of eLuma, another major provider of online therapists that launched in 2011. His company, based in Lehi, Utah, follows a blended model, where the teletherapists work with onsite staff to support the students. eLuma is working this year with about 215 school districts across the country, serving students from kindergarten through the end of high school.

Hubbard-George, the Florence County, S.C., administrator, worked with other vendors before signing up with eLuma last spring, saying she was impressed by the quality of the therapists. “They’re like part of our school, not a shadow of our school. We see her (the speech-language therapist) as part of the team.”

She and others have dealt with skeptics — parents as well as school staff members — about the remote delivery of such therapy to children by explaining how the online service works and by pointing to the ongoing communication between the specialists and the classroom teacher.

Virtual Schooling

Student Eden Cobb (left) receives some of her special education support electronically in Florence County, S.C., School District Three, joined by virtual services facilitator Patrice Nelson (center) and special education director Cheryl Hubbard-George.

Not surprisingly, these contractual services are an easier sell for online schools. Jamie Desrochers, director of special education for the Pennsylvania Distance Learning Charter School in Wexford, Pa., who’s worked with PresenceLearning for the past six years, says, “As an online school, cyber therapy fits.” Before the school worked with PresenceLearning, she says, “we did all in-home service,” a challenge when it came to supporting students in rural spots.

Desrochers contracts with PresenceLearning for occupational therapy, counseling and speech-language therapy. For students who need to boost their social skills, the PresenceLearning platform enables a small group of students to log on at the same time, to play games, practice turn-taking skills or even having conversations that let them learn how to stay on topic.

As she explains to parents, “You enrolled in a cyber charter school, and this is how we deliver services.”

Desrochers, formerly a special education teacher in the Allegheny Intermediate Unit near Pittsburgh, counts other benefits, including the “real-time access to clinical notes, to see if students showed up and see their goals and progress.” The online clinicians interact with teachers and participate in IEP meetings. A child’s therapy sessions can be scheduled around core subjects, and appointments don’t get cancelled for inclement weather.

Online therapists make it easier to provide services to home-schooled students, or students who have particularly challenging situations.

Costs and Benefits
Public school administrators in special education cite other benefits.

“When you have an onsite therapist for eight hours, you’re not getting eight hours of therapy,” says Kristy Bone, director of special education in the 4,400-student Pickens County School District, in Jasper, Ga. “With teletherapy, you’re getting 100 percent therapy. There’s no transition, no transportation. You only get therapy.”

About 46 students with IEPs in her district are receiving speech-language support services from eLuma’s remote professionals this year. The district pays a per-student fee of about $1,800 plus the cost for the out-of-state therapist’s professional license in Georgia.

Having a relationship with an online therapist who’s connected to other practitioners offers additional advantages.

“PresenceLearning has a depository of hundreds and hundreds of therapists with resources at their fingertips,” says MaryKay Berry, director of student services in the 3,800-student White County district, a full charter system in Cleveland, Ga., who has been working with PresenceLearning for the past three years. “There’s so much support to be able to go to, and so many different ideas about what strategies to use. It’s a huge resource bank.”

There can be financial benefits, although those depend on the vendor and the school district’s contract. “There’s a flat fee all year,” Hubbard-George says. “Other companies wanted to bill for every single thing. It was very annoying. There were separate quotes for evaluations.”

Jeremy Glauser, of eLuma, says his company’s all-inclusive fee model can be as low as $1,300 per student, although fees may vary depending on the overall needs at a school or district.

PresenceLearning will fill out Medicaid paperwork for eligible services provided, and the school district doesn’t have to cover insurance and benefits to therapists.

Experienced vendors also simplify the transition to technology-delivered services for the district. PresenceLearning “made the technology seamless,” says Berry. “They did all testing of the Chromebooks. Parents can access the therapy notes for their child. The whole on-boarding process is well thought out.”

Downsides Too
Still, online therapy is not the answer for every staffing issue in K-12 special education.

Bone, in Pickens County, Ga., was surprised that the vendor she first approached didn’t make it clear she would need to hire a paraprofessional to use the online service appropriately. She believed the price of the online therapists, with the additional cost of a paraprofessional, made it an expensive option.

The company also asked for a two-year contract, but under Georgia state law, Bone says, “the current board can’t bind a future board.”

Other special education directors suggested that virtual therapy is not a proper fit for serving students with profound disabilities.

Leanne Desjardins, director of special education with the North Country Supervisory Union in Newport, Vt., believes the efficacy of online service delivery “depends on a student’s level of independence. You often need a support person, which means allocating internal resources.”

Her district of 2,400 students serves a rural region with high rates of opioid addiction and students with trauma and high need. A quarter of her enrollment is made up of students with emotional disturbances or intellectual disabilities or students who are on the autism spectrum, compared to 15 percent average statewide in Vermont.

This academic year, Desjardins has expanded her use of online therapists from PresenceLearning to perform online psychological testing for students.

Ultimately, says one administrator, “It’s better than going to litigation because you’re not providing services.”

MERRI ROSENBERG is a freelance education writer in Ardsley, N.Y.