Enhancing School-Based Clinical Healthcare Technology

Healthcare Technology Trends in 2024: Enabling Patient Care at Home EXPANDING ACCESS: Enhancing School-Based Clinical Staffing with Teletherapy Solutions A comprehensive guide to teletherapy benefits, platform selection, clinician staffing, and hybrid models for schools

Expanding Access: Enhancing School-Based Clinical Staffing with Teletherapy Solutions

Introduction AMN Healthcare, the nation’s leading provider of healthcare workforce solutions, generates a wide range of surveys, reports, white papers, speaking presentations, podcasts, webinars and other thought leadership resources providing insight into current workforce trends and delivery models. In this white paper, we examine key considerations and sequential steps required to implement teletherapy services at schools K-12, including:

The characteristics and capabilities of technology required to provide school-based therapy services. Potential benefits of school-based teletherapy. Challenges to implementation. The hybrid work model, combining on-site and virtual services. Parental and student outreach and orientation. Workflow and progress tracking. Real-world case histories of school-based teletherapy implementation.

The white paper begins with an overview of the context in which school clinical staffing takes place.

Market Context: A Growing Need for Clinical Professionals at the Nation’s Public Schools Public schools in the U.S., of which there are more than 98,000 serving more than 52 million students, are competing in a historically tight labor market for the services of clinical professionals, including nurses, speech-language pathologists, school psychologists and other related service providers. In its 2023 Survey of Public School Healthcare Staffing Trends , AMN Healthcare found that public schools, like many other settings, are challenged when it comes to staffing the clinical professionals they need. The majority of schools responding to the survey (52%) reported that they are understaffed with clinical professionals. Schools are having difficulty recruiting a variety of clinical professionals. About two-thirds of school administrators surveyed (65%) rated school psychologists as the most difficult type of clinical professional to recruit, followed by speech-language pathologists (63%), registered behavioral technicians (60%), speech-language pathology assistants (57%) and registered nurses (52%).

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Expanding Access: Enhancing School-Based Clinical Staffing with Teletherapy Solutions

A Shortage of School Psychologists, Speech-Language Pathologists and Other School Clinicians The federal Bureau of Labor Statistics (BLS) reports that there are 57,110 school psychologists in the U.S., with 85% (or approximately 48,500) being employed in public schools. Demand for school psychologists has spiked in recent years due to the increase in mental health problems among children and adolescents. The isolation, disruption, fear and grief caused by Covid-19 have exacerbated youth mental health problems, but these problems were on the rise before the pandemic. Adolescent suicide rates increased dramatically before 2017 (Teen Suicide Rates Rising Sharply, Federal Study Shows. Education Week. October 17, 2019) while symptoms of severe depression among teens also rose between 2005 and 2017 (Schools Grapple with Student Depression and Data Show Problem Worsening. Education Week. March 4, 2019) . School shootings have further increased mental distress among children and adolescents. While demand for school psychologists has increased, supply has not kept pace. According to Education Week, just 8% of schools meet the National Association of School Psychologists recommended ratio of one school psychologist per 500 students ( School Counselors and Psychologists Remain Scarce Even as Needs Rise. Education Week. March 1, 2022).

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Expanding Access: Enhancing School-Based Clinical Staffing with Teletherapy Solutions

Speech-Language Pathology AMN Healthcare’s Survey of School Staffing Trends indicates that 83% of public schools employ speech- language pathologists (SLPs), more than any other type of school-based clinician. According to the BLS, approximately 150,000 SLPs are employed nationwide. Of these, 60,920 are employed by elementary and secondary schools. The demand for SLPs is high, with the BLS projecting that SLP employment will grow 21% from 2021 to 2031. On average, BLS projects openings for SLPs at 14,000 per year for the next decade, with many of these openings caused by the need to replace workers who transfer to different occupations or who retire and the need to comply with the Individuals with Disabilities Education Act (IDEA) requiring that disabled children and young adults 3 to 21 receive special education services. These trends make speech-language pathologists particularly difficult to recruit.

Supply and demand dynamics in other clinical professions such as physical and occupational therapy and nursing are similarly challenging.

Seeking Solutions – Including Teletherapy Schools are taking various steps to address clinical staffing shortages, according to AMN’s survey. Forty- four percent are using contract staffing professionals, 34% are raising clinician salaries, 31% are seeking additional staffing funds, and 29% are implementing teletherapy programs.

Of those that have implemented teletherapy, 54% are using it to provide speech-language pathology, 31% use it for psychology, 13% for occupational teletherapy, and 13% for social work services.

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Expanding Access: Enhancing School-Based Clinical Staffing with Teletherapy Solutions

The Role of School-Based Teletherapy Teletherapy is seen as a promising way to deliver services to traditionally underserved areas and is becoming an increasingly important method by which access to school related and social services can be expanded. Teletherapy is now used in schools to provide speech therapy, occupational therapy, full evaluations (speech-language, psychoeducational, and occupational therapy) and mental health services (school psychologists and social workers) in a wide variety of locations – urban, suburban and rural – that lack sufficient access to clinicians. Teletherapy became viable in schools in the early 2010s due to advances in technology and the increased demand for flexible, accessible evaluation and direct therapy options. Since Covid-19, the demand for teletherapy has surged as remote learning created an urgent need for virtual solutions to support student services. A Range of Benefits Schools can realize a variety of benefits by implementing teletherapy programs. Teletherapy expands access to high-quality evaluation and therapy services, ensuring students receive equitable care. It helps meet educational requirements by providing appropriate evaluations to identify students who qualify for academic accommodations, modifications, and interventions, and by delivering mandated intervention services on-time and within compliance requirements. Additionally, teletherapy reduces onsite clinicians’ caseloads by filling staffing gaps with licensed and experienced virtual clinicians. Because many clinicians prefer to work remotely, the teletherapy option may significantly increase the ability of schools to successfully fill open positions. As teletherapy options become more pervasive, schools that do not develop teletherapy programs are likely to be less competitive in a challenging labor market. Improved Platforms Are Schools-Specific Teletherapy platforms that meet or exceed Health Insurance Portability and Accountability Act (HIPAA) and Family Educational Rights and Privacy Act (FERPA) requirements and that are designed specifically to deliver appropriate and effective evaluation and therapy services in accordance with clinical best practices are no longer the exception. School leaders should expect and ask for services that are provided not only by highly qualified clinicians, but that are also delivered via teletherapy platforms that are not simply business platforms with a few extras but are platforms that leverage all available technology to maximize student engagement and clinical applications. Specific features reflecting clinical best practices in remote service delivery include a collaborative whiteboard, YouTube integration, built-in digital assessments, Individual Education Program (IEP) goal integration and progress tracking, co-browsing capability to support use of all web-based clinical tools and materials, and second-camera integration for evaluations and specific therapy needs.

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Expanding Access: Enhancing School-Based Clinical Staffing with Teletherapy Solutions

Challenges to Implementation In its survey, AMN Healthcare found that schools have various reasons for not implementing teletherapy. Twenty-seven percent of those surveyed indicated they have not implemented teletherapy due to a shortage of support staff, 25% due to reluctance among administrators, 23% due to technology limitations, and 22% due to parent/guardian concerns. Only 11% indicated they have not implemented teletherapy due to a lack of need for these services. Perhaps the primary challenge to the successful implementation of teleassessment and teletherapy services that AMN Healthcare has observed is schools’ and parents’ resistance to remote service provision, based either on prior poor experiences with teletherapy services implemented outside of best practices or based on lack of education around the effectiveness of teletherapy. The lack of onsite support personnel dedicated to the implementation of teletherapy services also has been a key limiting factor.

Understanding Teletherapy Capabilities An initial step required to meet these and other challenges to school-based teletherapy implementation is understanding its capabilities, its features and what it is intended to do.

Teletherapy technology should have essential features like HIPAA confidentially and FERPA compliance, as well as interactive tools like virtual whiteboards, screen sharing, co-browsing, and integrated digital assessments.

Appropriate teletherapy technology allows credentialed and experienced clinicians to provide quality services to students virtually by giving them the necessary tools to transition their evaluation and intervention skills to the

remote environment. Teletherapy should be able to provide the same level of service provided by in-person clinicians, with individualized services and continuity of care over time. If a clinician has access to best-in-class teletherapy technology, and students have access to all necessary equipment, internet, and appropriate space, the primary limit to what services can be delivered is the required level of onsite support for students during evaluation and therapy sessions.

The level of support by on-site staff ranges from line- of-sight supervision for highly independent students to 1:1 support through each therapy or evaluation session. The level of support required for teletherapy generally reflects the level of support each student needs to access technology and online learning throughout their school day.

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Expanding Access: Enhancing School-Based Clinical Staffing with Teletherapy Solutions

Steps to Teletherapy Implementation There are a variety of sequential steps schools should take to implement teletherapy services, including: 1 Determine the school district's clinical staffing needs. Needs assessment may include the number/percent of vacancies for various school clinical positions, the time it has taken to fill positions (or the time positions have remained open), the age and disability designation of students requiring services, and concerns expressed by faculty or parents about a lack of access to school-based clinical services.

Gather information on teletherapy best practices to ensure successful implementation, including review of potential caseloads, identification of appropriate space in which to conduct teletherapy sessions, required equipment and internet access, and appropriate level of onsite support for students during evaluation and therapy sessions. Keep in mind that offering remote work options is attractive to clinicians and can increase fill rates.

Be prepared to implement teletherapy services for any age group with the required evaluation or IEP services (one exception is students needing feeding/swallowing support, which requires the appropriately trained onsite personnel), as long as the appropriate technology, location – and, most important – level of onsite support (e.g., paraprofessionals, e-helpers) has been provided by the school district.

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Expanding Access: Enhancing School-Based Clinical Staffing with Teletherapy Solutions

Choosing the right technology The basic technology for synchronous and secure teletherapy services includes a reliable internet connection, computer (desktop or laptop) or Chromebook (not usually optimal due to screen size), headsets for each student participating and for the treating clinician. At a minimum, the platform used to engage in teletherapy needs to be HIPAA and FERPA compliant and support synchronous audio and video for multiple participants. However, to support best practices in teletherapy, a platform also should include: Whiteboard with tools Integrated digital versions required assessments Ability for students to interact with activities (integrated, without having to share mouse control) Screenshare and co-browsing capabilities Ability to host group sessions with individual video feeds Second camera integration functionality (to support some assessments, OT services, and other clinical needs) Ability for clinician to see non-verbal test responses as an integrated function Ability to integrate therapy materials Video integration

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Expanding Access: Enhancing School-Based Clinical Staffing with Teletherapy Solutions

Benefits of the Hybrid Work Model A hybrid work model, where a clinician is onsite for a portion of each week or month, and services are otherwise provided remotely, can allow for school districts to be introduced to teletherapy services more gradually, while also allowing the clinician to complete some of their work from home. This model does require that the clinician be able to travel to the school district for the required onsite days, so there is a smaller percentage of clinicians able to do this. However, it can be a very successful model. In some hybrid models, the clinician delivers therapy services remotely, but is onsite to complete evaluations (note: evaluations can be delivered remotely, but some districts choose this portion of work to be completed onsite). In other hybrid models, the clinician delivers a portion of the evaluation and therapy services remotely and completes the remainder of the required work onsite. Associated Costs Many school districts have budget challenges and the cost of implementing teletherapy services is therefore a key consideration. The primary associated cost of implementing teletherapy (outside of the cost of contracting or hiring a service provider) is typically the cost of onsite support personnel, such as a paraprofessional or e-helper. Schools may be able to mitigate this cost by leveraging existing classified staff rather than hiring additional staff for this need.

Areas of Support To ensure the successful implementation of teletherapy services, there are three primary areas the school must support:

1 2

Appropriate internet access and equipment (dedicated desktop/laptop and headset for each student joining an evaluation or therapy session).

Appropriate space (separate room or area of a larger room with privacy screen) that allows for students to participate in evaluation and therapy sessions.

Onsite support personnel provided at a level that is appropriate to the needs of each student. At a minimum, line-of-sight supervision must be provided, but depending on the student’s ability to participate in virtual sessions independently, the onsite support person may need to sit with the student throughout each session to facilitate the process under the guidance of the treating clinician.

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Expanding Access: Enhancing School-Based Clinical Staffing with Teletherapy Solutions

Choosing the Right Clinicians It is important that clinicians have had previous onsite school-based experience prior to delivering services virtually. Clinicians must have all required national and/or state credentials and licensure and must be able to effectively communicate as remote members of an onsite school team. Selecting the Right Staffing/Implementation Partner There are a variety of services and experience that should be expected of an outside partner tasked with staffing and implementing school-based teletherapy services. The staffing provider should be expected to hand-select and vet clinicians to ensure they meet high standards, provide full-time W2 clinicians to offer consistent, reliable services, and allow school districts to interview candidates directly, enhancing transparency and compatibility. A comprehensive, all-inclusive flat billing rate helps with budget management, avoiding hidden fees. Additionally, agencies that provide paraprofessional support services can help bolster the effectiveness of therapy programs, ensuring a well-rounded approach to student care. Parental Outreach and Orientation It is up to each school district and IEP team to determine the model by which health evaluation and clinical intervention services are delivered. For instance, some school districts utilize speech language pathologist assistants (SLPAs) under the supervision of licensed speech language pathologists (SLPs), while others use a combination of onsite and remote services.

Whatever the model chosen, it is important that parents understand how teletherapy works and the potential

benefits it can bring to students. Education on the effectiveness of teletherapy services as well as demonstrations of what teletherapy services look like can be helpful in engaging parents with their children’s services. Once teletherapy services have started, some districts choose to host parent nights where parents can meet their

children’s teletherapists virtually and see a demonstration of some teletherapy activities.

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Expanding Access: Enhancing School-Based Clinical Staffing with Teletherapy Solutions

Student Outreach and Orientation Students generally make the move to virtual services with little to no orientation needed. Children attending schools now are digital natives, and technology and various versions of online learning are already woven into their general education. Those students who require a higher level of support throughout their school day will also require this level of support to participate in teletherapy sessions. Workflow and Communication Teletherapy services are very similar to onsite services, with the primary difference being the mode of communication required among team members and parents. With one or more members of the IEP team being remote, communication might require greater intention and creativity, such as the teletherapist hosting weekly virtual office hours for teachers and parents. Otherwise, the workflow aligns with that required of onsite clinicians. Progress Tracking Clinicians delivering intervention services virtually track student progress and complete documentation just as they would if delivering services onsite. Some teletherapy platforms offer the ability to add and track IEP goals, which can provide greater efficiency for clinicians.

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Expanding Access: Enhancing School-Based Clinical Staffing with Teletherapy Solutions

CASE HISTORIES The path to school-based teletherapy services can be illustrated by two real-world case histories, described below:

Case Study 1. FARGO PUBLIC SCHOOLS

Fargo Public Schools is the third largest school district in North Dakota, comprising more than 11,300 students and parents in grades K-12. The district includes 16 elementary schools, three middle schools, three high schools, one alternative high school, and one K-8 special education school. Challenge The Fargo School District had been facing challenges hiring onsite SLPs and School Psychologists to meet the growing demand for essential, mandated services. Despite concerted efforts to attract qualified in- person professionals, they realized they needed support to access remote clinicians with the qualifications and experience necessary to maintain regulatory compliance and to ensure high-quality, effective services for their students. Solution Partnering with the Fargo School District to understand their unique needs, AMN Healthcare School Solutions recommended a teletherapy solution that could be scaled quickly. Within a week, AMN Healthcare filled two virtual SLP and two virtual School Psychologist roles. AMN Healthcare clinical teletherapy experts worked with the Fargo team to build a customized solution that supported the district’s unique and most urgent needs. Implementing remote services for Fargo School District included the provision of secure and user-friendly technology, digital assessment and therapy materials, and coordination with the district to ensure appropriate onsite support. Working together, clear expectations for communication and availability of teletherapists during the school day were established to ensure the school district’s need for collaboration and integration into the overall education team structure was met. The Fargo School District team’s innovation and leadership, combined with AMN Healthcare’s staffing expertise, created a new, scalable, and effective service delivery program were met.

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Expanding Access: Enhancing School-Based Clinical Staffing with Teletherapy Solutions

Outcomes The addition of remote SLPs and School Psychologists to the Fargo team ensured regulatory compliance and uninterrupted, effective student services. Without these roles, onsite SLP caseloads would have significantly increased, impacting service quality. School-based teams praised the virtual providers for their collaboration and resourcefulness, while parents and guardians shared positive feedback, emphasizing the meaningful impact on their children's academic and personal growth.

With these additions, the team:

CONDUCTED

40-45 REDUCED CASELOADS TO PER CLINICIAN VS. 60-70

PSYCHOEDUCATIONAL EVALUATIONS

Case Study 2. MESA COUNTY VALLEY SCHOOL DISTRICT Mesa County Valley School District is the largest school district on the Western Slope of Colorado, serving 21,000 students in 47 schools and programs. It includes

a diverse student population that is 30% minority, with 52% of students receiving free or reduced cost lunches. Though located in a scenic area, the district is geographically isolated and recruiting school personnel can be difficult.

Challenge Early in the summer of 2021, Mesa County Valley School District reached out to AMN Healthcare to fill seven vacant school psychologist positions to work across 12 schools. The district had job postings open for months and despite their best efforts, had received no applicants for onsite services. nd other clinical

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Expanding Access: Enhancing School-Based Clinical Staffing with Teletherapy Solutions

Solution Working closely with the school district, AMN Healthcare examined their requirements and resources and developed a plan to determine the best way forward. The team proposed a hybrid solution of four onsite school social workers to provide some of the services also provided by school psychologists, and two to three virtual school psychologists to provide the evaluations and services that only school psychologists can provide. Outcomes The school social workers and the virtual school psychologists covered 12 schools throughout the 2021–22 school year. The virtual school psychologists were available to the school teams during the regular hours through phone, email, or by video conferencing. Additionally, a team lead provided support to the mental health team, holding weekly meetings and was available throughout the school day as needed. She also met with special education coordinators and the special education director as needed as well as assisted when a school psychologist required coverage.

The team provided:

230 Evaluations

~ 4,000

Functional Behavior Assessments

Mental Health Minutes

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Expanding Access: Enhancing School-Based Clinical Staffing with Teletherapy Solutions

How Teletherapy Transforms Student Support: Hear from a School Leader and Clinician

Discover how teletherapy is making a real difference in schools. Hear directly from a special education director and clinician as they share their experiences, challenges, and the positive impact on student success.

Delivering Critical Services to Limited Access Districts

Bridging Gaps in Mental Health Services Through Teletherapy

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Expanding Access: Enhancing School-Based Clinical Staffing with Teletherapy Solutions

CONCLUSION

Staffing psychologists, speech-language pathologists, nurses, physical and occupational therapists and other clinical professionals is a challenging task in today’s tight labor market. Many schools report that they are understaffed and are seeking solutions to this problem. Teletherapy is one such solution. Implementing teletherapy services, including a hybrid work model featuring both virtual and on-site services, can increase staffing levels and help expand student access to evaluation and direct therapy services. Implementation of teletherapy requires a number of sequential steps, including school district education, needs assessment, the appropriate technology, clinicians with school experience, a capable staffing partner, and on-site support.

When meeting these requirements, teletherapy services may provide a significant enhancement of school- based clinical staffing options and expand student access to required care.

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Expanding Access: Enhancing School-Based Clinical Staffing with Teletherapy Solutions

About AMN Healthcare AMN Healthcare is the nation’s leader in healthcare workforce solutions and is the largest publicly traded healthcare staffing organization in the United States as rated by Staffing Industry Analysts. A comprehensive healthcare staffing provider, AMN Healthcare assists hospitals, medical groups, government entities and other healthcare facilities in the staffing of nurses, physicians, executives, and academic leaders. AMN Healthcare also provides a suite of technical staffing solutions and support services, including medical language interpretation, predictive staffing analytics, telemedicine, revenue cycle solutions and others. Through our School Solutions division, AMN Healthcare provides schools K-12 nationwide with a range of clinical staffing services, including the placement of nurses, physical therapists, speech-language pathologists, behavioral health professionals and other clinicians, both on-site and through online platforms.

For additional information about this white paper and AMN Healthcare’s school staffing solutions, contact:

client.services@amnhealthcare.com

Discover AMN Healthcare's School Staffing Solutions.

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