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How States Can Open up Access to Teletherapy


Prior to the pandemic, practitioner and clinician shortages—especially in rural and heavily populated school districts—left students without access to effective speech-language pathology, behavioral and mental health counseling, and occupational therapy. As of 2019, nearly 1 in 5 students—about 8 million children—did not have access to a counselor in their school. In recent years, more than half (54%) of school-based speech-language pathologists (SLP) reported that job openings for clinicians exceeded job seekers in their type of school and geographic area. School closures in response to the pandemic have exacerbated issues of access for students, leaving districts at a loss for how to provide the appropriate duration and frequency of services to students with the highest needs.

As the nation continues to grapple with both the short- and long-term effects of the COVID-19 pandemic on academic achievement, special education services, and mental health of our children, the hope is that state leadership can work with schools to innovate and expand programs and services that support children who need it the most. Passing the Audiology & Speech-Language Pathology Interstate Compact is one way we can help expand access and ensure continuity of services for many of our children requiring speech-language services. The ASLP-IC will allow licensed audiologists and speech-language pathologists to obtain the privilege to practice across state lines without having to become licensed in each state. So far 10 states have signed on to the Compact (Alabama, Kansas, Kentucky, Louisiana, Oklahoma, Nebraska, North Carolina, Utah, West Virginia, and Wyoming). The bill is pending in Texas and several other states are considering it.

Read on as author and advocate Kelly Wolfe sheds light on what this bill means and why it is crucial to a future where all students have access—equal access—to special education and related services in America.

Insights and Advocacy

Since the start of the COVID-19 pandemic, the education system that many of us knew was flipped upside down. A system that traditionally provided services in-person and that relied upon physical and peer interactions was, without warning, forced to shift to remote learning. Computers replaced books, virtual libraries replaced placed-based ones, and kids became just as accustomed as adults to saying, “You’re on mute!”

While the COVID-19 pandemic has drawn attention to gaps in access to high-quality, school-based therapy for students in special education programs across the country, the unfortunate reality is that these gaps existed long before the pandemic, and continue to get worse. Practitioner and clinician shortages—particularly in rural and heavily populated districts—leave students without access to effective speech-language therapy, behavioral and mental health counseling, and occupational therapy.

School closures in response to the pandemic have exacerbated these issues of access, leaving districts at a loss for how to provide the appropriate duration and frequency of services to their students with the highest needs. A ​survey​ by the U.S. Government Accountability Office found that the sudden shift to distance learning made it more difficult to deliver special education services and meet the vast needs of students’ individualized education programs (IEPs).

Enter Teletherapy or Telehealth as Part of an Innovative Learning Plan

The good news is that there is a solution. The use of teletherapy in schools is one way to continue to evaluate and assess childrens’ needs and to provide them with developmentally appropriate services during and after the COVID-19 pandemic. In rural areas facing a shortage of qualified clinicians, for example, teletherapy provides access to timely evaluations and therapy. In large urban districts where the need for speech language pathology, occupational therapy, and mental and behavioral health services can place unreasonable demands on onsite staff, teletherapy provides a means to supplement onsite clinicians, and help with caseload management. And for every school in America, having a contingency plan in place—a way to meet the need of students and staff continuously, no matter what disruptions happen in the world around them—is essential.

Even with the new challenges school districts, teachers, and students were facing, there were a few instances where the transition was seamless because a sustainable solution was in place. Technology was already being used effectively and successfully in some cases. Many schools across the country had already recognized the value of adding teletherapy to their service delivery model—extending their school team by tapping into a network of online clinicians who could provide assessments and services through a high-quality teletherapy platform such as the Presence platform. And, during the pandemic, many more schools turned to Presence’s newest platform offering, Kanga, to support their own school teams in delivering services to students remotely.

School-based telehealth, when implemented according to research and best practice guidelines, helps provide students with access to clinician expertise and high-quality care. Highly skilled, fully licensed and credentialed therapists and school counselors use similar methods and evidence-based practices online as they would on-site. Teletherapy can also support students in their home environment, if they need to be there for medical reasons or need to be there because the world around them is disrupted. For students with special needs, continuity in services is critical in ensuring they don’t delay progress or lose critical skills that may help them communicate with others or thrive independently.

A highly engaging and meaningful online therapy experience will combine the therapist’s or counselor’s services with a content library containing therapy materials, games, and activities to personalize the therapy experience. There should also be real-time progress tracking and a secure, high-fidelity video-conferencing platform.

Breaking Down Barriers with Remote Learning: Interstate Compact

In order for teletherapy to be most effective, providers need to be able to deliver services no matter where they live. Removing restrictions and breaking down barriers across state lines is key to ensuring all children can access the services they need to be healthy and successful.

Interstate compacts are an effective tool in ensuring quality of care while removing administrative and licensing barriers that prevent providers from serving kids. Most recently, the Audiology & Speech Language Pathology Interstate Compact (ASLP-IC) was enacted after ten states passed authorizing legislation. The ASLP-IC will allow licensed audiologists and speech-language pathologists to obtain a privilege to practice across state lines without having to become licensed in each ASLP-IC state. This will lead to increased access to care while also decreasing barriers for providers by establishing consistency in the licensing requirements.

Now that the ASLP-IC has been enacted into law in ten states*, the ASLP Commission will convene to establish rules and policies for the interstate compact system which is expected to be functional by next summer. Additional ASLP-IC legislation is still pending in several states. As states consider making permanent the changes and waivers that were made to accommodate COVID-19 disruptions, I hope they use this point in time to extend flexibilities and take advantage of the success we have seen with technology.

Technology in education isn’t just endless Zoom meetings. For many children, technology provides them an ability to connect with the necessary relationships, resources, and supports they need to thrive.

Join the Movement

The COVID-19 pandemic has provided a pivot point. We can either embrace the lessons learned along the way and work to create a better system for our kids or we can return to business as usual. School district leaders and elected officials should use this opportunity to ensure that all children have equitable access to the support they need. And for many of them, that means access to technology and the providers who can serve them. We should be codifying the use of teletherapy into law, including school-based services, ensuring adequate Medicaid reimbursement, and providing cross-state licensing flexibilities so that no child goes without the therapies and services they need.

If you are a school or state leader interested in learning about how teletherapy can help, get in touch today for a free consultation. For more by Kelly Wolfe, read Advocating for Children.

Note: As of August 2022, the ASLP-IC has been enacted into law in 23 states:

Headshot of Kelly Wolfe

About the Author

Kelly Wolfe is an external affairs leader with expertise in public policy and government and community affairs. Her long career spans advocacy work at a large children’s hospital; government affairs work, as both a lobbyist and state senate policy advisor; and serving in the classroom as an elementary-school teacher. She is passionate about children’s education and development issues.

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