Reece Barnes meets with his speech therapist every week. He walks down the hallway at his rural Burney, Calif., school and chats with her one-on-one, even though she is four hours away in another part of the state.
Reece, who’s 8 and has a lisp, and his sister Alexis, 12, who has partial deafness in one ear, have communicated with their therapist entirely online since the 1,150-student Fall River Joint Unified School District changed the way it provides speech therapy. The California district joined other schools nationwide that are now employing sometimes hard-to-find therapists via live, interactive computer sessions.
The use of online speech therapy is growing, said Janet Brown, the director of health-care services in speech-language pathology for the American Speech-Language-Hearing Association, or ASHA, based in Rockville, Md. The organization endorses online or teletherapy as long as the quality of the service is the same as for in-person therapy, said Deborah Dixon, the director of school services for ASHA.
Schools need to provide the right equipment, including computers with high-speed Internet access and webcams, and, in some cases, an aide or parent might have to supervise while the child is working with a therapist.
Online forms of speech and language therapy are drawing interest now as the number of children requiring therapy grows, and as the role of the therapist has expanded beyond helping a child form words or correct a stutter or lisp. Still, more than a decade after the introduction of online therapy, students getting online speech lessons account for a sliver of the more than 1.1 million children ages 6 to 17 with a speech or language impediment.
At the same time, there aren’t enough people joining the profession to keep up with the demand for speech therapy. And, with school district budgets shredded by the economic downturn, the salaries offered to therapists may not be enough of a draw to lure them to the districts that need them, Ms. Dixon said.
Given those circumstances, the chance to work online, from home, may attract therapists who have retired or want to work part time.
In the 2,000-student Clinton-Massie district in southwest Ohio, some students began online therapy this month. Superintendent Michael Sander said the district is spending $18,750 on the services but saving $35,500, in part because it won’t have to spend money on recruiting or benefits.
The district will keep its two part-time therapists, but students who need more time with a therapist will be able to get it with the addition of therapy from specialists outside the district via computer.
The company they work with, San Francisco-based PresenceLearning, signs annual contracts with school districts that guarantee speech therapy for students at rates that reflect those in the region.
Teletherapy is seen as especially useful for remote and rural regions of the country, where districts have a hard time recruiting teachers and an even bigger struggle hiring speech therapists. When students work with therapists online, often with therapists located out of state, that challenge is resolved.
A case in point: Speech therapist Kristin Edwards of Winston-Salem, N.C., once spent her weeks working with children at nine different sites, which meant she spent a lot of time in her car. Now, she works from home, providing therapy for four hours straight each day to children at a pair of charter schools in El Centro, Calif.
Ms. Edwards, a therapist for 14 years, thought at first that online therapy would never work. After providing therapy online for two years, she said, she’s learned “there’s very little difference.”
An aide at the school steps in if Ms. Edwards needs the webcam moved or a child’s tongue adjusted with a tongue depressor.
Pluses and Minuses
One small study about teletherapy suggests it could be promising. A 2009 study of 34 children in rural Ohio, in which half the students used online speech therapy for four months while the others used traditional face-to-face therapy for four months, then switched, found that both groups’ progress was the same.
Satisfaction surveys found that the students and parents overwhelmingly preferred the online therapy. The study didn’t include any students with autism or severe cognitive disabilities, however.
The study, published in the Journal of Telemedicine and Telecare last year, concluded that videoconferencing seems to be a “promising method of delivering speech-language therapy to schoolchildren.”
So while other forms of technology schools use may be an experiment with unknown effects, this isn’t one of them, said Clay Whitehead, a co-founder PresenceLearning, which has been providing speech therapy online for about 2½ years, including in the Fall River Joint Unified and Clinton-Massie districts. The company works in about 15 states and provides speech therapy to about 1,000 children.
And many therapists who work with children online have found that students are more engaged than they are face to face because they enjoy working with computers, said Ms. Brown, of ASHA.
Online therapy does pose some complications. For one thing, therapists must be licensed both in the state where they work and the state where their students are located.
For another, the approach complicates efforts to integrate therapy into the classroom, with a therapist helping students with speech and language skills as they work on other lessons. After all, Ms. Dixon said, “the reason the speech-language pathologist is in the school is to help the child access the curriculum and provide supports and services to do that.”
Also, when therapists work with students in person and in the classroom, their teachers can follow the therapists’ example and work closely with them on coordinating the curriculum with therapy.
“We’re not working in silos any longer. We are collaborating and working together,” Ms. Dixon said. “It’s difficult to do that” with online therapy.
‘A Long Way’
Speech therapists working online don’t just chat by video with their students.
The programs that PresenceLearning and online education provider Connections Education use are similar. One section of the screen shows images of the therapist and the student captured by webcams. On the rest of the screen, the therapist can play games with a student to work on a skill, whether it’s following directions or practicing a sound. Therapists can insert videos, worksheets, and other material into that space, and pupils move the computer mouse to circle an answer or interact with the game.
Robyn Guerrasio, the speech-services program manager for the Baltimore-based Connections Education, said therapists work on all the same skills they would if they were sitting with a child in a classroom.
Connections Education has provided therapy online for three years and now uses it with about 500 students, Ms. Guerrasio said.
Previously, the online school contracted with therapists where students lived, which required the therapist or a parent to drive somewhere. A missed session was sometimes difficult to reschedule, a problem that almost evaporates when therapy is provided online, Ms. Guerrasio said.
In a rural northeastern community outside Scranton, Pa., access to online speech therapy is a gift for Nancy DeTara, whose daughter Gianna takes classes through the Commonwealth Connections Academy.
Until Gianna started online speech therapy, Ms. DeTara drove up to an hour one way to connect with a speech therapist in person. The drive cut into Gianna’s schoolwork time, her mother said.
Now, Gianna meets with a therapist twice a week without leaving home. The 8-year-old is formally classified as having pervasive developmental disorder-not otherwise specified, or PDD-NOS, an autism spectrum disorder. She works with her therapist on such skills as listening, following directions, grouping, sorting, and making conversation.
“She’s come a long way,” Ms. DeTara said.
Nirvi Shah, Writer contributed to this article.
A version of this article appeared in the October 12, 2011 edition of Education Week as When Speech Therapists Are Scarce, One-on-One Sessions Go Online