Authors: The School Speech Therapist

Apr 11, 2020 byTeresa Sadowski MA CCC-SLP

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We’ve been out of school now for 4 weeks here in the northeast because of Covid 19.  While I only have a small private practice that I put on hold, I have been wondering how school speech language pathologists across the country are managing their caseloads, especially those therapists who are put in positions where they have 30-50-80+ students on their caseload. Even when working in schools some very creative scheduling, often with help from an SLPA, has to take place to manage a large caseload.  

If you’re an SLP with a large caseload you’re often seeing kids in groups of 3-5 (basically each student is getting 6-10 minutes per session to work on their specific skills, less if you’re a big data collector).  I think of these as Band-Aid services, doing just enough for the students to say they’ve been to speech therapy.  Now I am not criticizing because I’ve been in that position and I know why/how SLPs end up in that position.  That’s a conversation for another time.  However, after this is over I hope SLP’s use this experience to help advocate for lower caseload numbers.  

Teletherapy sounds like the perfect solution on paper.  I imagine school administrators might think this is easy peasy.  I participated in a day long in-service on teletherapy and it seemed to be working well for those presenting.  However, it was clear that the presenters honed their skills over time and were basically experts in teletherapy, the same way many of us are experts in articulation/oral motor, working within a specific population or literacy.  This was not a step by step conference on how to set up teletherapy but more about how it can be used and aspect that need to be taken into consideration.  

I actually thought some of the advanced things the presenters were doing within the teletherapy format were very cool and innovative.  However, a few things were pointed out (either during the conference or in conversations among other SLPs) that were significant that I can bet school administrators haven’t even taken into consideration when they tell their SLPs to just do teletherapy.  

  • Rural and lower economic students may not have the internet access or updated equipment to participate in teletherapy.
  • Parents need to have significant buy in and need to be present during teletherapy sessions. First because they have to be able to help their kids connect to teletherapy, second they may have to be facilitators for their child to access therapy and third is a safety issue, you don’t want to be alone on line with a student of any age.
  • Seeing kids in groups during teletherapy is tricky.  Even with the so-called relaxed rules around HIPPA because of Covid 19, permission is needed to see kids in groups on line.  With the parent factor, you really never know if parents have history with each other.  Plus do you really want parents to find out that you see their kids with so many others?
  • Because there are only so many hours in a day it will be almost impossible to follow any IEP to the letter of the law much less with students who receive extensive services. When all this is done it looks like parents will be allowed and entitled to request compensatory services.  I can’t even imagine what that will look like for some, even if only a few parents take advantage of this.
  • Bottom line is, it is impossible to see large numbers of students through telepractice 
  • There will be technical glitches on both ends.  Right now I’m reading about a lot of glitches.  I assume this is primarily because of volume and many people who are new to the platform that don’t know how to troubleshoot.  Is your school IT team prepared to trouble shoot these glitches, calling parents if needed?
  • If a glitch happens, do administrators realize you’ve lost a session and how much time went into troubleshooting.  Is there a plan B if the teletherapy platform chosen won’t connect?  (This week my personal PT had to use a different platform, connecting through her phone, using her personal number).
  • When using teletherapy it is unlikely that you will be able to schedule students back to back.   If a half hour session ends at 9:59 you are physically unable to make the connections and be ready to go for your next client/group at 10:00 on the dot.  If you do get behind, you have no secretary to call and let the groups know. (Again not criticizing because it has happened to me, during traditional therapy it often happens that once you’ve dropped off and rounded up the next group of students you might be 5-10 into the next session).  Scheduling half hour sessions 45 minutes apart seems to be the norm to avoid getting behind.
  • Until you get very good at teletherapy and build up appropriate materials, teletherapy prep is going to take some time.  I would imagine in some cases a pre-email is sent with materials to print out.  While that is time well spent, unless pointed out to administrators they will not even think about it.  

Do phone calls and emails work any better?  Perhaps in some cases, who knows? These are very unusual times.  I think most people are grasping at straws and trying very hard to make remote learning work.  My thoughts are that teletherapy has a better chance of working well in a private practice or clinic setting.  If a school wants you to try teletherapy and sets up/pays for the platform, offers at least minimal training and want all district SLPs use the same teletherapy guidelines, try it out and consider it a learning experience.  Keep track of the pros and cons so you can report on it later. Also keep track of all contacts with parents and students phone, email or teletherapy.  

If your school administration is leaving it up to you alone to set up and use teletherapy, I would say no. That type of situation just leaves you hanging, especially if you don’t carry your own personal liability insurance.  I checked with Trust Risk Management, my liability insurance provider and my policy covers teletherapy.  Without school investment, there is no IT support when you need it.  If something goes wrong you will be blamed.  I’ve worked in schools long enough to know that when this is all over the blame game will be massive, so be prepared.  

I would love to know how school SLPs, especially those with large caseloads are managing.  Please comment on glitches and successes.  Is teletherapy even the term schools are using? Did your school jump into on line learning too soon without the proper research/training? One other thought …it’s too bad CEU’s are not available for those of us who are working on developing our skills in the use of teletherapy.  So many SLPs and educators in general are putting a lot of hours in to developing a totally new skill set.  I will bet that in the next few years teletherapy becomes a graduate course.  

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