Telepractice: Brick-and-Mortar vs. Virtual Schools
As detailed in the first two parts of my Prepare for Success series, it is essential to understand both necessary Systems and Technology as well as Client Considerations when transitioning from an onsite to a teletherapy model of service delivery. In this post, we will explore another potentially less obvious, but also important, area of school-based teletherapy services: the logistics of providing online therapy to students in brick-and-mortar vs. virtual school settings.
As 21st century educators have adapted to meet family and student needs, many traditional brick-and-mortar districts have expanded to include an online instruction model where students can attend some or all classes from home. In addition, there are a growing number of online-only virtual schools that provide families and students with alternatives to the traditional brick-and-mortar education setting.
At PresenceLearning, we prioritize onsite school-based experience in our consideration of applicants because, regardless of the student setting, speech-language services are always based in each student’s IEP and the teletherapist is a member of the school’s IEP team. It is vital as a school-based teletherapist to understand all federal and state regulatory requirements as well as the logistical nuances of providing speech-language services in a school setting. Schools expect SLPs working with their students to understand educational eligibility requirements, IEP development, and all other compliance-related factors, so previous experience as an onsite SLP is very helpful and makes the transition to school-based teletherapy that much easier. If an SLP seeking a school-based teletherapy position has strong clinical experience but has not specifically worked in the schools, I would advise doing the research and connecting with school-based colleagues to build an understanding of what knowledge and experience gaps may exist before pursuing a school-based assignment.
While there is no difference between being an onsite vs. virtual SLP in terms of scope of practice and responsibilities, there are some crucial logistical considerations specific to brick-and-mortar and virtual settings that, if not addressed, can hinder successful implementation of teletherapy services.
Location of services
While the ideal location for speech-language therapy sessions utilizing a pull-out model— whether provided by an onsite or teletherapist—is a separate, dedicated room, those of us who have spent our careers in schools know this is often not available! What cannot be compromised is a setting that provides as much privacy as possible (i.e. avoiding visual distractions for students in therapy as well as for their peers) and, of course, as much quiet as possible. While teletherapy best practice requires students to wear headsets with microphones (see the Client Considerations post regarding accommodations for students who are not able to wear headsets), headsets will not cut out all noise if the computer is placed in a busy, noisy setting such as in a hallway during passing period. To ensure the auditory quality of each speech-language session, the next-best setting to a private room is a computer that is set up in the back of a less-busy room, such as a resource room, with a visual divider like a bookshelf or folding divider. Such “speech stations” can work very well and don’t require that the school find a separate room.
As discussed in the Client Considerations post, the support person plays an essential role in successful teletherapy services. Ideally, there is one support person in each building where teletherapy services are being provided, and he/she works directly with the treating SLP. The support person is responsible for ensuring students get to therapy on time and that they log on successfully. This person is also available to provide any basic tech help (e.g. unplug headsets and plug back in, clear the browser cache each week, etc.) if needed, and provides line-of-site supervision throughout each session. Beyond this basic level of support that is required for all teletherapy sessions, some students will require additional support to participate successfully in therapy sessions. The support person might also support the teletherapist by printing and sending homework, coordinating scheduling with the classroom teachers, and communicating student absences to the SLP.
Site staff collaboration
As with any school-based educational services, the most successful teletherapy is based in strong collaboration between all the professionals involved in each student’s general and special education. The services of a highly experienced SLP can be derailed if the administration and staff are not in support of the teletherapy service delivery model. Poor collaboration can result in a lack of expectation setting for the teletherapist; lack of communication regarding paperwork, processes, and scheduling; and even negative messaging to parents. And while there are certainly school-based teams who welcome teletherapy as an innovative service delivery model and take it upon themselves to build a strong connection with their teletherapist, teletherapy is usually a foreign concept to brick-and-mortar teams. This means it is often the teletherapist who must take the initiative to build relationships with his/her school-based colleagues.
In addition to the teletherapy support person, it is vital to establish strong communication with site administration, case managers, and all related service providers. It is often a site administrator who facilitates the teletherapist’s attendance at (or direction of) IEP meetings by logging into the therapy room or calling the SLP, gathering signatures at the meeting, and handing out draft IEPs and procedural safeguards.
One seemingly minor but often overlooked detail is ensuring that the site administration and staff know how to contact their SLP (and vice versa!) For instance, if the district’s internet goes out and school administrators or staff are not able to log into your therapy room for an IEP meeting, do they know how to reach you? Do you know how to reach the person facilitating the IEP meeting if it’s after hours and the front office staff is gone? Attention to such details is so important and can mean the difference between the teletherapist becoming a seamless member of the IEP team vs. increased frustration with and negativity toward this model.
Working with families
While some students enrolled in online schools (particularly if the online academy is part of a brick-and-mortar district) will travel to a physical school site to log in for teletherapy sessions, the majority of students receiving online speech-language services will be logging in from home. Therefore, the teletherapist works directly with parents/guardians to schedule therapy sessions, and the parent/guardian acts as the support person during therapy. This can be an advantage for the teletherapist in many ways as there is less coordination involved with scheduling. It also means the parent/guardian will have a certain level of investment in the success of an online service delivery model, given their choice to use this model for their child’s general education.
Of course, there can be some inherent challenges as well. When the parent/guardian is also acting as the support person during therapy, it can be natural for him/her to be either highly involved in/directive of therapy or, conversely, the parent may be present in the home, but working on other things and not as available to support therapy sessions. In both cases, it is important that the teletherapist establish strong communication with the parent/guardian, answer any initial or ongoing questions with empathy and understanding of each family’s circumstances, and set expectations for the parent/guardian role in teletherapy sessions.
If the student is attending an online school that is part of a traditional brick-and-mortar district, the teletherapist’s team will likely be the same as if he/she were providing services within a school setting. However, virtual school teams are typically all online administrators, teachers, and related service providers, so the dynamic is a bit different. Again, there can be some advantages for the teletherapist as everyone on the IEP team provides instruction or services online, so there is a shared understanding of this service delivery model. Everyone, including parents, will be joining meetings virtually, as opposed to the teletherapist being the only virtual attendee.
In some cases, virtual academies also maintain case management with the special education teachers, regardless of the student’s primary disability area. As such, in some cases SLPs will not be the case manager if providing services through a virtual academy, even for students whose primary area of eligibility is speech-language impairment. Some SLPs see this as an advantage of providing services to a virtual school, while others see this as a missing piece! As is the case with collaborating with brick-and-mortar teams, communication is key. Being a teletherapist often means taking on greater ownership of initiating and supporting communication with your teams.
Virtual student access, attendance, and best practices
As with any teletherapy scenario, all basic Systems and Technology must be in place. Given that some families select online education because they are geographically distant from brick-and-mortar schools, this can also sometimes mean poorer internet access and bandwidth. It is up to each teletherapist/teletherapy company and school system to determine if a family’s internet access is sufficient to support effective online speech-language services.
Assuming the necessary systems and technology are present, what remains for the teletherapist is initiation and maintenance of strong communication and collaboration with parents/guardians. While some parents who move their children to online school are highly structured and work to maintain daily schedules that mimic typical brick-and-mortar schools, others take a less structured approach and may not always maintain a consistent schedule. As a result, there tends to be a higher rate of absenteeism for students attending speech-language therapy sessions from home as the homeschool schedule may look different day-to-day. Or, particularly for older students, parents may include logging in for therapy as part of the student’s responsibilities, as opposed to brick-and-mortar sites where there is likely a support person still ensuring each student gets to therapy on-time.
In addition to communicating about and setting expectations regarding speech-language therapy attendance, the teletherapist might also want to establish general norms for attending sessions from home. It can sometimes be the case that students logging in from home might do so in their pajamas and from a room where siblings are playing or watching television. It can prevent difficult conversations down the line if online therapy communication and best practices are established at the beginning of services to ensure the best possible services for each student.
I look forward to any comments and feedback, as well as sharing the final topic in this series, Clinician Considerations.
About the Author:
Kristin Martinez, M.A., CCC-SLP, received her M.A. from the University of Colorado at Boulder, and has been a speech-language pathologist for 19 years. Kristin served students in her local school district and in private practice for 13 years before starting as a telepractitioner with PresenceLearning in 2013. Kristin has presented on the topic of teletherapy nationwide and currently serves as the Clinical Director, SLP & OT, for PresenceLearning.
More on Telepractice:
Equity and Access to Speech-Language Services for Students via Teletherapy (.1 ASHA CEU)
Presenters: Kristin Martinez, MA, CCC-SLP
and Char Boshart, MA, CCC-SLP
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