Teletherapy: The Year Behind and the Year Ahead

This month we asked Kristin Martinez, M.A., CCC-SLP, clinical director, SLP & O, at PresenceLearning, and Stephanie Taylor, Ed.S, NCSP, clinical director of psychoeducational services at PresenceLearning to reflect on teletherapy in the 2020–2021 school year and to look ahead to the 2021–2022 school year. Read on to hear their experiences with skeptics turned believers, how preconceived notions have changed with actual experience, unexpected benefits of teletherapy that have emerged from the pandemic, and some success stories. And explore their predictions about the future as well as their best hopes for students. And if you haven’t read it already, the blog post “One Year into the Pandemic: Embracing Teletherapy for the Future,” by Kate Eberle Walker, Presence Learning’s CEO, is a great follow-on to this engaging interview. 

Reflecting on the last year of teletherapy…

Q: Some clinicians have told us that they’ve moved from skeptic to believer when it comes to teletherapy—have you seen this?

ST: I’ve both seen this and lived this. When I first heard about PresenceLearning, I was skeptical and curious about how behavioral and mental health services and psychoeducational assessments could be done remotely. I was worried students wouldn’t be able to make the same connections that they do in person. I quickly learned that was untrue. I also started to think about how I felt connected to students remotely, so of course they could connect to me. 

KM: Teletherapy would not be the growing and sustainable service delivery model it has become over the past decade if the clinicians delivering services did not believe they could meet student and client needs at the same level as they would if providing services in the same physical location. We as clinicians would not continue with a service delivery model deemed ineffective, so the movement from skeptic to believer is absolutely something I have seen in my role with PresenceLearning over the past eight years because teletherapy, when implemented in accordance with best practices and by qualified clinicians, is a highly effective model.

Q: What preconceived notions do you think people had before entering the world of virtual therapy, and how do you think those notions were likely changed? 

KM: As teletherapy has grown and expanded over the years, we in the industry have always faced the preconceived notion that teletherapy is simply not as good as in-person services, that the quality is not as high, and that student outcomes will be diminished. Both the empirical and anecdotal evidence to the contrary of this notion is extensive, so educators and clinicians are generally “won over” quickly. 

Q: Where did you see teletherapy work well?

ST: I’ve seen teletherapy work well in almost every conceivable scenario. That’s not to say that teletherapy is for every student but neither are onsite services. There are so many ways in which teletherapy creates efficiency and saves school districts time and money. Teletherapy helps redistribute supply and demand so that resources can get to places that they previously could not. 

KM: I completely agree with Stephanie’s perspective. I have worked directly with hundreds of school districts. Cases where teletherapy did not work well were almost always when the appropriate in-person support, based on each student’s need, was not present. Particularly when delivering teletherapy services to children, some degree of in-person support is required for teletherapy to be a successful model, ranging from the minimal, line-of-sight supervision, to the maximum, 1:1 support throughout each therapy session. When implemented by experienced teams, teletherapy can be highly effective for all ages and the most challenging caseloads. 

Q: What are some unexpected benefits of teletherapy that have emerged during this year?

ST: During the COVID-19 pandemic specifically, teletherapy really allowed many students to have consistency in their services but also with their therapist. Whether these were students who were already receiving teletherapy services at school and just transitioned to home, or districts that engaged teletherapy platforms for use with staff that had previously been onsite, teletherapy allowed students to keep their services and their connections to existing therapists. 

KM: What I believe was revealed as an unexpected benefit to those new to teletherapy in the past year, was the opportunity to connect with parents and guardians in a more consistent and meaningful way. It can be challenging when providing traditional services in school districts to communicate frequently or even effectively with parents—in some cases the annual IEP meeting may be the primary opportunity to discuss student needs, goals and progress. With teletherapy services being provided in home-based settings, there are more frequent, natural opportunities for the clinician to not only check in, but also to observe students in their home environments and to see greater opportunities for carryover of skills. 

Q: Are there any specific instances where you’ve found teletherapy would be more beneficial to use vs. in person?

ST: For behavioral and mental health services particularly, some students may really benefit from the “clean slate” that comes with teletherapy. Schools have reported that students who were previously resistant to counseling services began to talk more when the service was provided via teletherapy.  Some felt it was because students were talking to someone outside of their community. Students also reported that they felt more comfortable without the person directly in the room with them. We are working with digital native students, and many seem to prefer a digital method of receiving help. 

Looking ahead to the future of teletherapy…

Q: Do you see schools continuing to use teletherapy? In what ways?

ST: Many schools that were previously skeptical about engaging in teletherapy and tele-assessment have been pleased with what they experienced. They say they will continue to use teletherapy and onsite services in a hybrid model going forward. They can offer the option to students who may prefer it, save travel time for therapists, reduce the impact of student absences, and distribute staff more efficiently. 

KM: I firmly believe that yes, schools will continue to use teletherapy to varying degrees. Teletherapy has been proven as an effective approach to bring qualified, experienced clinicians to the students who need services. Staff shortages in special education impact every state, and exist across rural, suburban, and urban school districts—teletherapy is a way to bring equity and access to special education services to students across the country.

Q: How do you think schools will approach teletherapy in general now?

KM: My hope is that teletherapy will be automatically considered as a part of staffing as a way to ensure students have continuity of high-quality special education services, as opposed to teletherapy as a “last resort” mentality that has often existed in the past. 

Q: Do you have any anecdotes to share that would bring to life some of the things we’re talking about here?

ST: A high school female student was referred to PresenceLearning for mental health counseling. She started the first sessions by telling the school psychologist that she had never had a female counselor before. The only person for her to talk to in her high school was male. After rapport-building, she was able to discuss some very personal and important issues with the school psychologist. Teletherapy gave that school and that student ways to access options previously unavailable. 

KM: A special education director at a midwest school district shared with us that she has actually seen more detailed evaluation reports and higher student exit rates from special education-related caseloads managed by PresenceLearning speech-language pathologists than she has seen over the past several years from her on-site staff. She felt it was helpful to bring in varied experience and perspectives, and that she was highly impressed with the quality of teletherapy services for her students. 

Q: What’s your greatest hope for students for the future?

KM: My greatest hope for students is always that they have equal access to high-quality supports and services so that they can achieve goals and take advantage of all educational opportunities. Adequate funding is a perennial challenge for school districts—the ongoing integration of a strong teletherapy program is the best way to ensure this access is not interrupted or halted altogether by in-person staffing shortages. Our children are growing and developing so quickly, and there are crucial developmental windows that exist and need to be taken advantage of. Resources are available, so there really is no excuse anymore for school districts to ensure all students have continuous access to the high-quality special education services they need.