“I have a daughter with autism and she attends a public school in Manhattan. Every year it’s a real challenge finding related service providers so she can get an education in a neighborhood, community school setting. Specifically this year, there is a real chronic shortage of occupational therapists. I’m not sure how familiar you are with autism, but this is a kind of therapy that gives kids on the spectrum the sensory inputs their bodies need so that their brains are primed to learn. So I was wondering if you have any plans right now or any actions to try to relieve this chronic shortage.” – Nicole from Manhattan, The Brian Lehrer Show caller
New York City Mayor Bill de Blasio was stumped by this question during an episode of The Brian Lehrer Show on WNYC. His response to Nicole was that some New York City schools have “specific programs in them for kids on the autism spectrum,” but he acknowledged that there was more that could be done and that he was unaware of the occupational therapist shortage in the city’s schools.
This question led The Brian Lehrer Show to do a follow-up episode solely on the occupational therapist shortage. After reaching out to a spokesperson for the NYC Department of Education, Lehrer found occupational therapist shortages are not unique to Manhattan or even the New York boroughs – it’s a national issue. To try to understand what’s behind the shortage, Lehrer had Kristie Koenig, associate professor of Occupational Therapy at NYU, as a guest. Koenig says fewer therapists are entering school-based practice and early intervention services because of the high demands placed on school-based occupational therapists and the large caseloads they have to manage.
To alleviate these caseloads and make school-based practice more manageable and attractive to new therapists, the American Occupational Therapists Association (AOTA), the American Physical Therapy Association (APTA) and the American Speech-Language-Hearing Association (ASHA) are advocating for a shift in the school-based care paradigm. When occupational therapy first became a medical profession in the early 1900s, it was created to help soldiers returning home from WWI. Because of this, occupational therapy, along with physical therapy and speech-language pathology, adopted the medical caseload model – adding case after case to a the caseload of a therapist, who then schedules appointments to treat “patients.” However, this is not ideal in the school setting as many students go underserved. The three associations suggest a shift to a more flexible model where a therapist would be available for support during whole-classroom intervention and only add students to his or her caseload if that student was really struggling.
Koenig provided an example of what this flexible model would look like. When she was still practicing in a school district, Koenig once had 18 out of 24 development kindergarten students submitted for occupational therapy within the first three days of school because they didn’t know how to hold pencils or cut with scissors. Instead of adding these 18 students to her caseload, Koenig advised the teacher to wait before submitting students and instead helped her create motor skill stations or multi-sensory handwriting lessons to allow students to learn and practice these skills. Not only would this help the students who are struggling, it would be fun for all students. If a student was still struggling after this practice, Koenig could add the case to her caseload. Adding one case instead of 18 makes a huge difference.
This flexible model is practical, but what if therapists still end up with large caseloads of students who need support? Or worse, what if a district is unable to recruit any qualified therapists? This is not unheard of since shortages do not end at occupational therapy. They apply to other related services such as speech-language pathology, physical therapy, counseling and nursing.
For schools that are struggling to fill therapist vacancies or better support staff in managing high caseloads, teletherapy is a practical and powerful solution. With an internet connection and basic hardware, schools can connect students with PresenceLearning’s network of more than 700 therapists, including occupational therapists, speech-language pathologists, school psychologists, and school social workers.