Teletherapy: Pros, Cons, & Answers
I have worked in the public school setting for four years of my career as a speech-language pathologist. During my time in the school, I have experienced many positive and inspiring teachers, students, administrators, and parents. With those good times comes bad times, and for me, the bad times far outweighed the good times.
I felt it in my head, my body, and my heart. I often came home and cried after work. I felt exhausted. I could do nothing more than sleep and lay on the couch on the weekend. I knew it was coming - burn out. I was so stressed, and I was so upset that I was stressed. I put so much time and money into becoming an SLP, and after only four short years, I was doubting my entire career.
Who am I as an SLP? Am I good at anything? Why don't people "get" what we do? Why am I constantly being compared to a teacher? What the heck is going on with all of these politics in the school setting? Why can't I just do the job I was hired to do?
Over the summer I fell into a deep depression, and I was dreading the start of the new school year (my 5th year as an SLP). I was so far gone. I started the school year, but I was only able to stay until September before needing to take a medical leave of absence. I just couldn't do it anymore.
I found teletherapy a month or two after I took my leave. I had no clue what it was about. I had so many questions. What is teletherapy? How do I provide services? Is it the exact same as being in the school? What do I need to do it?
WHAT IS TELETHERAPY?
According to ASHA, teletherapy is the application of speech and language therapy from a distance across telecommunication technology. This service links clinicians and patients/clients for assessment, therapy, and consultation.
WHAT ARE ALL OF THESE TERMS?
Teletherapy, telepractice, telehealth, telemedicine. The terms go on and on. So what do they mean? Telemedicine and telehealth are terms often used in the health care setting. Additional terms are speech teletherapy, teleaudiology, telerehabilitation, as well as telesupervision. All of these terms refer to the fact that the services are provided from a distance through the means of technology. Teletherapy is the act of providing therapy. Telepractice is the location of providing support. The other terms are quite obvious via name. ASHA adopted the telepractice in lieu of telehealth or telemedicine to depict to others that speech-language pathologists are not solely in the health care field.
Telepractice venues include many locations - schools, rehabilitation centers, medical centers, clinics/private practice, universities, home health care, childcare settings, etc. It's an all-encompassing term, and many times varying companies will provide services in specific locations.
WHO DOES TELETHERAPY?
Many speech-language clinicians, occupational therapies, and mental health staff (social workers) are now providing teletherapy services. ASHA polled the SIG 18 Telepractice group to obtain a better idea of who provides services, how long they have provided services, with what populations they work, etc. You can find those poll results here.
SO REALLY, DOES IT WORK?
YES! It really does work! I have worked with students online since January, and I am already dismissing a few from my caseload. I am seeing huge growth - much faster than I ever saw in the schools. ASHA has a boatload of research studies proving that teletherapy is JUST AS or MORE effective than in-person services. You can take a look at some of the references that ASHA uses to discuss effective teletherapy here.
HOW ARE YOU SEEING SO MUCH PROGRESS?
Through teletherapy, I am actually able to see the students for the recommended amount of time per week as written in their IEPs. I don't have to cancel sessions due to meetings, writing paperwork, or collaborating. For the first time, I am regularly seeing students 2-3x a week! It feels like I'm finally able to do my job.
WITH WHAT POPULATIONS IS TELETHERAPY IDEAL?
I work with students in grades Pre-K through 8th. I work with a variety of disorders - articulation, language, ASD, hearing impaired, CAS, and SXI. I work with students across the severity spectrum. Some students are in the severe range and require more hands-on support (via a paraprofessional) and others can sit and participate independently.
WAIT, YOU SAID THAT YOU CAN WORK WITH SEVERE POPULATIONS? HOW DOES THAT WORK?
The teletherapy company that I contract with requires an in-person paraprofessional to aid in sessions as needed. The paraprofessional must remain in the room as long as students are online. These professionals aid in correcting behavior, remaining on task, and even may participate by helping with hands-on tasks (crafts, etc.).
The company also requires that students are served in a distraction-free environment. This may mean an empty classroom, an office space, or the library when it is available.
It is true that teletherapy services are not appropriate for ALL students. This needs to be determined at the student's IEP meeting, and teletherapy needs to be considered as an individual recommendation for all students.
WHAT KIND OF TECHNOLOGY IS NEEDED?
A secure wifi connection is required, and many companies will have a therapy platform available if you contract through them. I use my Mac (Windows is accepted as well), a wireless headphone set with a microphone built in, and a strong Internet connection. A webcam is also required if it is not already built in to your computer. It may also be easier to have a phone that has texting capabilities as texting with the paraprofessional is easiest during speech and language sessions if you require help.
WHAT SORT OF EMPLOYEE ARE YOU? WITH WHOM DO YOU WORK? WHAT DOES PAY LOOK LIKE? INSURANCE/BENEFITS?
I work as an independent contractor. I receive my pay before taxes, so I set aside a certain amount (as advised by my tax preparer) so that I can pay taxes at tax time. I have interviewed with many teletherapy companies, and I decided to work with PresenceLearning at this time. I have heard of pay in range of $36-$42 an hour depending on the company. PresenceLearning does not offer insurance and benefits, but there are other companies out there that do.
All teletherapy companies have pros and cons, so it is important to interview with many before making an official decision. You may need to be paid weekly, or you may be fine with being paid monthly. You may have a preference regarding the platform, or make-up session requirements, or paperwork requirements. What company you work with depends on what will work best for you personally. Feel free to ask other teletherapists for advice, but only you can know who is the best fit for you.
THE PAY IS SO LOW!
I have heard from others who believe the pay is low. I think the opinion on pay greatly differs depending on one's location. Teletherapy pay does not differ based on location but expenses sure do. I am currently making more than I have ever made in the schools, but I live in Michigan where the cost of living isn't too high. Individuals in California, where expenses are extremely high, may think the pay is pitiful. It truly depends on your individual situation with regard to whether or not teletherapy is right for you.
IS THE PAPERWORK THE SAME?
Much of the paperwork is the same, but I would say it's a little bit less, and it depends on the company/district with whom you work. I still complete IEP and IEP meetings, REEDs and evaluations, write assessment reports, keep data, and write progress reports. For one district, I also continue to bill medicaid.
SO IF THE PAPERWORK IS THE SAME, HOW IS THIS JOB REALLY "BETTER"?
To be honest, I actually HAVE TIME to do the paperwork. I have a smaller caseload, and I get paid for every little thing that I do. Spend an hour writing progress reports? Paid for it. Spend 10 minutes keeping data? Paid. Make a parent phone call? Paid. I don't do anything outside of my contract without getting paid for it. Those 3 hours you stayed after school to write IEPs or those Sundays that you spend on progress reports? If you're providing in-person therapy, then you're salaried, and you don't get paid for those extra hours.
Additionally, if a student is absent and the school provides less than 24-hour notice, you get paid for that. If the school has a snow day? You get paid for that as well. No longer is there "wasted time".
WHY TELETHERAPY? WHAT'S SO GREAT ABOUT IT? WHAT ARE THE CONS?
One reason why teletherapy is great is it allows clinicians to work in rural areas of the United States. These are areas that many not be able to hire in-person clinicians simply because of location. Teletherapy allows us to be more connected with these schools.
- You set your own hours and days of the week.
- You work from home, so you're not having to deal with windshield time.
- You don't have to spend as much on gas, oil changes, etc.
- You don't have to buy professional clothing.
- You get to spend more time with your pets, kids, etc. Less money spent on daycare.
- You're able to do your job - no more time spent on teacher duties, teacher in-services, parent/teacher conferences, etc.
- You have a hands-on paraprofessional in the session to help with miscellaneous tasks. This person controls behavior, may participate in the session, and calls students to the teletherapy room. They can also print paperwork for you for meetings, and can send home paperwork as needed.
- The best pro - NO POLITICS. You now have documented proof that you're seeing students, you can complete progress reports during work time without being judged, the principal no longer demands your schedule.
- Finally, if you don't like the setting, school district, or if it's just not working out with that location, you can ask to be placed elsewhere. No longer are you "stuck". You have the freedom to move around. You have the freedom to actually do your job.
- You may feel less like a part of the team. I no longer have lunch with the teachers, meet with a parent for 10 minutes before the student's session, or visit the school social worker every day to discuss a student's behavior. This is personally a pro for me, but I know others may miss that socialization.
- Technology issues. At times, there may be technology issues, which means that a session may be missed that day. The good news is that most of the technology issues can be solved by the company with whom you work.
- No benefits and insurance.
- The pay may be low for you (depending on your opinion); however, this is when you need to weigh the pros and cons carefully.
- No pay during spring break, winter break, and summer break.
Note: To provide teletherapy, you must be licensed in the state in which you live, and you must be licensed in the state in which you provide services. Some companies will reimburse you for licensing fees, but typically only when the company recommends or advises an additional license.
Still have questions? What to see teletherapy in action? Check out PresenceLearning's video library.
Would I recommend teletherapy? For many individuals, this can be a good transition. If you feel like you're not able to do your job, can't handle the caseload numbers, or are simply feeling burned out, then teletherapy may be a good transition, even if it's only temporary.
I will state that teletherapy is not for everyone. There are many clinicians who prefer to remain in-person in the schools, and that is absolutely fantastic. We need people there as well.
Delivery of service may be different, but ultimately we all want the same end result. We want our students to succeed and be happy, healthy, and independent. It doesn't matter how the student gets there. What matters is that they get there.