As the school psychologist shortage grows, some districts have turned to teletherapy to provide mental health care for students.
Little data on teletherapy in schools exists, says Eric Rossen, director of professional development and standards at the National Association of School Psychologists (NASP). “Anecdotally, I’m hearing that more schools are accessing some form of online or telehealth service in some capacity,” Rossen says. “It’s unclear whether they are using that to supplement existing services. Or as a replacement for access to a live, consistent, school-employed mental health professional.”
In rural or overpopulated districts, teletherapy can provide counseling, consultation and assessments where there may otherwise be none. But even in these cases, district leaders should not stop trying to hire in-school mental health professionals, Rossen says.
“By relying purely on telehealth services, which are focused only on individual direct service delivery, schools lose access to all the other services that are typically available to students, such as preventative services, crisis response, consultation and solution-focused counseling for general education students,” he says.
Online speech therapy in Maryland
With one federal study predicting a deficit of more than 10,000 full-time psychologists by 2025, the Maryland Health Care Commission plans to award two $200,000 telehealth grants to increase access and connect special education students to specialists this year.
Charles County Public Schools in southern Maryland has applied for a grant. However, it began using teletherapy services for speech therapy in the 2016-17 school year.
“Finding qualified speech-language pathologists to stay with us has been difficult—housing is expensive in our area, and other districts pay more,” says Kelly Bryant, related services agency liaison for the district. “We have to provide this service by law. This is a phenomenal option if you don’t have an in-person therapist.”
The district’s teletherapy provider offers five online speech therapists who coordinate individual and group sessions for about 70 students annually.
The online option removes the stigma of speech therapy for many students. Instead of getting pulled out of class, students discreetly receive a pass to go to their sessions.
Teletherapy does not offer any cost savings, Bryant says. A paraprofessional must assist each student working with the teletherapist—helping with the technology and ensuring participation.
Getting buy-in from administrators and parents was difficult, since teletherapy is a relatively new field, Bryant says. Charles County plans to offer regular informational sessions to show parents how a typical teletherapy session operates.
The district continues to look for speech-language pathologists while also exploring teletherapy options for behavioral issues, Bryant says.
Engagement and continuity with teletherapy
Teletherapy challenges for districts include ensuring student privacy and confidentiality, and obtaining proper licensing for professionals working across state lines, says Rossen, of NASP.
Further, while some early research on the method is promising, “I don’t think we have a good understanding of the long-term impact of having predominantly online services,” Rossen says.
Administrators need to consider how telehealth professionals will engage with other school staff and participate in the decision-making process. For example, an agency professional might work with a student, write a report, perform a service, and do nothing more. Another might work with the same student or school throughout the year.
Continuity is key, Rossen says. A telehealth worker who builds a rapport with a student and the in-school team throughout the year is likely more effective than one who provides service once.