As the nation continues to grapple with the COVID-19 pandemic’s effects on the academic achievement and mental health of our children, we hope education leaders and policymakers will use this moment to innovate and expand programs and services that support children who need them the most.
The majority of Presence clients are in rural and urban underserved communities, and we disproportionately serve low-income, non-white student populations. Presence works with administrators struggling with the lack of resources in staffing and funding for on-site special education programs daily.
We know firsthand—both from the research and data that exists and from the countless stories of parents, students, and teachers—that teletherapy services are an equitable way to ensure children receive the services they need to reach their full potential. We are on a mission to ensure continuity of their services through this pandemic and beyond.
Now more than ever, we can use technology to support the needs of our children and create a system that addresses all aspects of their learning, regardless of their ability level or local resources.
As we work to ensure our children have the support they need to be successful, policymakers and education leaders can take action to ease licensing and administrative barriers, and improve access to and funding for teletherapy services for kids.
Prioritize the mental and behavioral health needs of kids
During the last two years of the pandemic, children experienced greater rates of anxiety, depression, and suicidality as they have been impacted by grief, economic instability, and isolation from friends and social supports.
Children with disabilities have seen their challenges compound. According to the National Center for Education Statistics, seven million (14 percent) of public school students receive special education services. Of children with behavioral and mental health needs, 80 percent rely on school-based services. When schools shut down, many students were left without the lifelines they so desperately needed and at a time when mental health professionals were already in short supply.
In response, some of the nation’s leading authorities on children’s health recognized that the current state of children’s mental health constituted a national crisis. The American Academy of Pediatrics, the Children’s Hospital, Association and the American Academy of Child and Adolescent Psychiatry released a statement saying the “worsening crisis in child and adolescent mental health is inextricably tied to the stress brought on by COVID-19 and the ongoing struggle for racial justice and represents an acceleration of trends observed prior to 2020. In December 2021, the U.S. Surgeon General Vivek Murthy released an advisory on protecting youth mental health. It contains several recommendations, including recognizing that mental health is an essential part of overall health, ensuring that every child has access to high-quality, affordable and culturally competent mental health care, and supporting the mental health of children and youth in educational, community and child care settings. The advisory also calls for the expansion and use of telehealth for mental health challenges and the need to address regulatory barriers.
As children head back into the classroom, teachers and schools must be equipped with the tools, staff, and resources they need to address the mental and behavioral health needs of their students.
We encourage federal and state leaders to increase funding for children’s mental health including school-linked mental health services.
We encourage federal and state leaders to allow for the use of teletherapy to provide mental and behavioral health in schools in order to ensure all children who need the support can access them.
Ensure equity of services through teletherapy expansion
Teletherapy is impactful in serving vulnerable communities—creating greater access to therapists where there are shortages (rural communities and low-income areas) and supplementing therapists where there is significant caseload (densely populated urban communities).
In a 2018 survey by the American Speech-Language-Hearing Association (ASHA), 54% of school-based speech-language pathologists (SLPs) reported unfilled clinical job openings in their districts. The Bureau of Labor Statistics has also noted that 41,900 additional SLPs will be needed to fill the growing need over the next decade.
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.
State licensure and certification requirements can create significant challenges to district and school leaders utilizing teletherapy to meet student needs. In order to provide the services our children with special needs depend and count on, we must find a way for our providers to become licensed and certified in multiple states with far less administrative burden.
We encourage state leaders to enact provider compact legislation, such as the Audiology and Speech-Language Pathology Interstate Compact (ASLP-IC), which will help facilitate the interstate practice of audiology and speech-language pathology and improve access and choice of providers while addressing barriers to services, providing continuity of care, and facilitating telehealth as a mode of delivery.
We encourage Congress to permanently waive the teletherapy licensing requirements that were put in place by the Center for Medicare and Medicaid Services, as well as restrictions for in-person supervision requirements for licensure in order to meet the needs of schools and districts during the COVID-19 pandemic.
Prioritize funding for children with special needs
When Congress passed the Individuals with Disabilities Education Act (IDEA) in 1975, they promised to cover 40 percent of the extra costs of special education. More than 45 years later, the federal government is only covering about 14.6 percent of the costs leaving states responsible for the majority of funding at a time when the number of students being served continues to grow.
As districts are faced with increasing needs, especially due to the COVID-19 pandemic, funding for our children with disabilities is more important than ever. Due to lengthy school closures, thousands of students have had their evaluations and assessments postponed or delayed. Without proper diagnostics, students have been left without the supports they need. In order to ensure children with disabilities have access to assessments and services, districts must be appropriately funded.
We encourage states to pursue new revenue sources, federal and state, to serve children with disabilities and eliminate assessment and evaluation backlogs.
We encourage Congress to fully fund special education services provided under IDEA and Title I on a mandatory basis.
Fund and expand broadband access
As schools shifted to remote learning, the technology gap among students widened. According to a Common Sense Media report, “between 9 million and 12 million U.S. students still lack adequate internet access at home for remote learning.
Without adequate internet access and technology support, students across the country are not only unable to fully participate in learning opportunities but are also unable to access the teletherapy services, such as behavioral and mental health counseling and speech language therapies, they need to succeed and thrive. One key way to promote equity among students is to ensure that everyone has access to the technology they need at home.
In November, President Biden signed a $1 trillion infrastructure bill into law, allocating $65 billion to expand broadband access. While funding to expand access will help bring technology capabilities to students, a recent EdWeek article showed that the number one reason students lack internet is due to affordability. “Almost two-thirds of offline households have access to home broadband connections in their areas, but can’t cover the cost.
We encourage states to prioritize broadband access and affordability to support students in need.
Protect and streamline Medicaid funding
Children make up half of all Medicaid recipients in the United States, many of whom receive their necessary health services in school. Under IDEA, schools are required to provide necessary services such as speech, occupational therapy, and mental and behavioral health to students with disabilities. School districts can then receive Medicaid reimbursement for the screening, diagnosis and treatment of students’ health problems. Medicaid accounts for approximately 20% of an average school’s budget, with public schools receiving approximately $4 billion in reimbursements each year. In order to adequately serve our children with special needs, we need to remove any reimbursement barriers that prevent students from getting the services and help they need.
We encourage Congressional and state leaders to provide Medicaid reimbursement for any school based service, including teletherapy services identified in the student’s Individualized Education Plan (IEP), Individualized Family Service Plan(IFSP), Individualized Healthcare Plan (IHP), Behavior Intervention Plan (BIP), or 504 plan.
We are encouraged by the renewed focus that the Biden Administration and states are giving to the critical issues outlined above. In particular, states like New Jersey, South Dakota, North Carolina, California, and Nebraska have taken steps to remove barriers to high-quality care during the pandemic. We look forward to continuing to partner with states, districts, and schools in 2022 to ensure that students across the country have access to high-quality services and support.
Who We Are
Presence is the leading provider of live online special education related services to K-12 schools. During the pandemic, we have delivered more than 500,000 therapy sessions, reaching students with special needs across 43 states. We partner with schools to expand their capacity to serve all students with IEPs or behavioral and mental health needs. Our full suite of services includes individual and small group therapy, assessment, caseload management, IEP development and meetings, family resources, and more—all backed by a team of clinical experts to ensure the highest levels of service and clinical care.