The State of Therapy in K-12 Schools - 2021
Report

The State of Therapy in K-12 Schools - 2021

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This report analyzes a survey of school administrators from 400+ K-12 institutions across the U.S. to assess the state of therapy and special education in K-12 schools including how COVID-19 has impacted the delivery of therapy and accelerated the digital transformation of therapy in education systems, nationally. Findings of this survey include:

The coronavirus/COVID-19 pandemic has upended nearly every aspect of life across the United States, with few areas being impacted quite as much as the K-12 education system. The past year has seen parents struggle to balance working from home with distance education, students grappling with online learning environments, and educators struggling to keep up with a revolving set of needs.

And while every element of the education system found itself needing to adapt quickly as a result of COVID-19, on-site therapy and special education presented particular and unique challenges.

To understand these challenges, we surveyed school administrators from 400+ K-12 institutions across the country in an attempt to better understand how educators have adapted their special education and therapy systems during COVID-19. In particular, we wanted to see how the pandemic has accelerated digital transformation in schools, if certain types of schools have struggled more or less to adapt, and whether public schools have faced different challenges than private and charter schools.

With technology and the internet playing a huge role in tools like online therapy services, we also examined whether rural educators have faced different challenges than their urban or suburban counterparts.

How many students receive therapy online?

And how has COVID-19 changed that figure?

COVID-19 and distance learning are now practically synonymous, but it’s easy to forget just how innovative the idea of nearly universal online or distance learning seemed at the beginning of 2020.

Our survey asked respondents what percent of their students currently receive online therapy, and what percent received online therapy before the COVID-19 pandemic began in spring, 2020.

A clear majority of our respondents—62%—said that none of their students received therapy online prior to COVID. A figure that has dropped to a mere 11%.

While online student therapy has clearly grown since the start of the pandemic, the majority of our respondents said that only 1% to 10% of their students receive online therapy today.

Next, we examined how those trends differed between public schools and private + charter schools:

Prior to COVID, private and charter schools were far more likely to have at least some experience with online student therapy than public schools. 42% of private + charter school respondents said they had no students receiving therapy online, while another 42% said 1-10% of their students were.

Most public schools didn’t have any students receiving therapy online prior to COVID, and only about a quarter of public school respondents had 1-10% of students receiving online therapy.

Interestingly, none of our public or private + charter school respondents had 76-100% of students in therapy who received those services virtually prior to COVID.

After COVID, public and private + charter schools saw huge increases in online therapy.

Currently, 90% of public school respondents have at least some students receiving online therapy, with 1-10% of students being the most common response.

The majority of private and charter schools are providing online therapy to 11% of their students or more, with 17% of private + charter school respondents saying 76-100% of their students currently receive online therapy.

Next, we wanted to understand how rural, suburban, and urban schools compared.

Prior to COVID, all three types of schools were equally unlikely to have any students receiving online therapy. Over 60% of urban, suburban, and rural respondents each said that none of their students were receiving online therapy pre-COVID.

Post-COVID, it does appear that rural schools have a slightly greater proliferation of online therapy services than their urban and suburban counterparts. Particularly at the top end of the graph, where a full quarter of urban respondents said that 76-100% of their students currently receive online therapy.

Rural and suburban schools have also seen increases in online therapy across the board, though, showing that COVID brought increased demand for online therapy no matter where the school was located.

How prepared were schools to deliver online therapy prior to COVID ?

And how well have they adapted since?

The previous section clearly demonstrated how COVID has increased the capacity of schools across the country to provide online therapy and services to their students. To gain a better understanding of how smooth—or not—this process has been, we asked how well our respondents felt their schools were prepared for the pandemic, and how well they think they’ve adapted.

Most respondents felt their organization was not adequately prepared before the pandemic hit.

When we compared public school respondents to private and charter school respondents, though, we saw two very different stories.

58% of private and charter school respondents felt their organization was adequately prepared to deliver online therapy to their students prior to COVID-19. Only 23% of public schools felt the same way.

On the other hand, urban, suburban, and rural schools felt equally as unprepared to deliver online therapy prior to COVID-19.

Despite most schools feeling unprepared, it seems things had changed significantly by fall of 2020.

Three quarters of all respondents said that they felt they were able to adapt over the summer of 2020 and effectively deliver therapy by the fall.

With a majority of private and charter schools saying they felt prepared prior to the pandemic, it’s no shock that nearly all of them said they were able to adapt effectively. More impressive, perhaps, is that 72% of public schools felt they were able to adapt by last fall.

A clear majority of urban, suburban, and rural respondents felt their organization was able to adapt by fall of 2020, but it appears that rural schools were slightly more likely to struggle.

How have schools’ on-site practitioners adapted to delivering therapy online?

It seems that schools were, for the most part, able to overcome lack of preparation and adapt to provide services in the midst of the COVID-19 pandemic. But, we next wanted to get a better sense for how much experience on-site practitioners at schools had when it came to offering online services.

First we asked if a school’s on-site practitioners (those hired directly by the district, as opposed to virtual therapists) had to deliver therapy online in the last year:

As you might expect in our new reality of online meetings and conference calls, the clear majority of on-site practitioners at all school types have had to deliver therapy online during the past year.

But we were most interested in whether these on-site practitioners had any previous experience or training in online services prior to COVID.

On-site practitioners at each type of school were most likely to have had no prior training in online therapy before the pandemic.

Private and charter schools were the most likely, with only 42% of them having been previously trained, showing that on-site practitioners across the board were forced to learn how to provide online services after COVID-19 hit.

Technology and online school therapy

One of the biggest challenges in delivering online therapy is providing adequate and proper technology to students. To see if this has been a hurdle preventing some students from accessing online therapy, we  asked how students acquire the technology for their online therapy.

71% of respondents said that the school or district provided their students with technology for their online therapy, while 27% said students have the option of using their own or one provided to them. Only 2% said students must use their own devices.

Those figures remained consistent when comparing public to private + charter schools:

And they likewise remained family consistent when comparing urban, suburban, and rural schools:

The good news is that it appears that access to devices isn’t a major hurdle when it comes to providing online therapy. As you’ll later learn, this doesn’t mean there aren’t still technology obstacles impeding the effective delivery of therapy in K-12 schools.

Biggest threats to delivering therapy and special education

In order to better understand the obstacles and threats that educators are most concerned about when it comes to providing therapy and special education, we asked our respondents to select any of the following as major threats:

  • Sourcing and hiring qualified practitioners in my area
  • Lack of technology at the school level for delivering virtual therapy
  • Lack of technology at the student level for delivering virtual therapy
  • Budget cuts

Here’s how they answered:

49% of respondents said that sourcing and hiring qualified practitioners was their greatest concern.

Lack of technology at the student level and budget cuts were the next greatest concerns, with lack of technology at the school level being the least-selected concern.

Here’s how those answers differed when comparing public to private + charter schools:

Public and private + charter schools were both primarily concerned with sourcing and hiring qualified practitioners. Public schools were more likely to be concerned about budget cuts, while private + charter schools were slightly more concerned about technology availability at the student and school levels.

Finally, let’s examine how responses differed by area type:

Suburban and rural schools are far more likely to be concerned about sourcing and hiring qualified practitioners than urban schools.

Rural schools were much more likely to be concerned about access to technology, especially at the student level.

Suburban schools, meanwhile, shared the same level of concern in sourcing practitioners as rural schools, but matched urban school’s levels of concerns in access to technology and future budget cuts.

How effective are current on-site and online practitioners?

As we saw in the previous section, sourcing and hiring qualified practitioners is a major concern schools have when it comes to providing therapy and special education services.

To better understand how schools view their current practitioners, we asked them to separately rate the effectiveness of their current on-site and online options.

Our respondents report similar student outcomes for both on-site and online practitioners.

No administrators reported that either group of practitioners was not at all effective, and only a small proportion reported that their on-site or online therapists were somewhat ineffective.

Next, we’ll see if those responses differ by school type.

Public and private + charter schools were equally as unlikely to find their on-site practitioners to be ineffective, but private + charter schools were slightly more likely to find theirs to be very effective.

Interestingly, private + charter schools only had positive experiences with online practitioners. Public schools still overwhelmingly found their online practitioners to be effective, but were more split between somewhat and very effective.

Here’s how responses differed by area type:

Urban, suburban, and rural schools were mostly equally satisfied with the effectiveness of their on-site practitioners, although rural schools were more likely to not have on-site practitioners at all.

Suburban schools appeared to be far less likely to find online practitioners to be somewhat ineffective than their urban and rural counterparts. Rural schools were also far more likely to not have online practitioners available as well, suggesting access in rural schools remains an issue for around 10% of schools.

Which types of therapy and services are becoming more (or less) needed in schools?

While most of our survey was focused on the evolution of in-person vs. online therapy and services at schools, we also felt it important to learn more about the types of therapy most needed at schools right now.

We asked our survey participants whether they’ve seen demand increase, decrease, or remain neutral for the following types of therapy and services in their school(s):

  • Speech
  • Occupational
  • School psychology
  • Mental health
  • Physical therapy
  • Special education instruction

Here’s how they responded:

Mental health therapy and services have seen the highest increase, with 50% of respondents saying they’ve seen a slight or high increase in demand. 30% of respondents said they’ve seen a high increase in demand for mental health therapy and services, which was twice as much as the next highest rated types.

Interestingly, though, mental health was also the type that had the most respondents say they’ve seen a decrease in demand (although only 28% said so). This could be a byproduct of schools across the country catching up to the rising demand for mental health services, and thus better meeting the needs of their district or school.

Special education instruction was the next most likely to have seen an increase in demand, followed closely by speech and school psychology.

Most respondents said demand for occupational therapy has remained neutral, while the vast majority of respondents said the same thing about physical therapy needs.

In order to see how needs differ by different types of school, we’ll examine each type of therapy one at a time.

Starting first with speech therapy, we see that private and charter schools were far more likely to report an increase in speech therapy demand than public schools.

There appears to be little difference between urban, suburban, and rural schools when it comes to demand for speech therapy—although suburban schools were twice as likely to report a high increase in demand.

There was very little difference in demand for occupational therapy between public and private + charter schools.

Suburban schools were less likely to have seen demand remain neutral, but otherwise, demand for occupational therapy was fairly consistent between urban, suburban, and rural respondents.

None of our private and charter school respondents reported any decrease in demand for school psychology services, while a clear majority reported either a slight or high increase.

The same was the case at urban schools, although the majority of them reported no change in demand.

Public and rural schools, meanwhile, were the least likely to report an increasing need in demand for school psychology services.

Private and charter schools were far more likely to report an increase in demand for mental health therapy and services, although nearly half of public school respondents also reported an increase as well.

Urban schools were the most likely to report increasing demand, with 74% of respondents reporting a slight or high increase. Suburban schools weren’t far behind either, with 64% reporting an increase.

Rural schools were the least likely to report an increase in demand.

The story about demand for physical therapy was extremely consistent across all school types and locations, with the vast majority reporting neither an increase nor a decrease in demand.

70% of private and charter schools reported either a slight or high increase in demand for special education instruction, compared to 44% of public school respondents who said the same.

Urban and suburban schools were also far more likely to report an increase in need than their rural counterparts.

All school types and areas have seen more increasing demand than decreasing demand, however.

Continuity of therapy or special education services since COVID-19

Next, we wanted to dig into how well students who are receiving therapy or special education services have been serviced throughout the pandemic.

Only 53% of our respondents reported that at least three quarters of their students experienced zero interruption in therapy and special education services since the pandemic began, while at least one quarter of respondents reported that a majority of their students experienced a stoppage of services due to the pandemic.

Private and charter schools were more likely than public schools to report 76-100% of their students having been able to continue services without interruption. And while very few public schools reported 0% of their students being able to continue services without interruption, none of our private and charter schools said the same.

Suburban schools were the most likely to report 76-100% of students receiving uninterrupted coverage, while just under half of rural schools and 42% of urban schools said the same.

In all it appears that urban schools were the most likely to experience widespread interruption in services, with 11% of respondents saying that none of their students were able to receive uninterrupted services since the pandemic began.

Next we wanted to see how many students were completely unable to continue their therapy in the fall of 2020 due to the pandemic.

Most schools reported 25% or fewer of their students were unable to continue therapy or special education due to complications from the pandemic, while 7% reported 76-100% of students have been unable to continue.

Nearly 60% of private and charter schools reported zero students as having been unable to continue therapy or special education, while only 28% of public schools said the same.

Still, both public and private schools were able to report that the majority of their students were able to continue therapy or special education.

Suburban schools were the most likely to report no students as having been unable to continue therapy or special education. Urban and rural schools were most likely to have seen 1-25% of students unable to continue their services due to the pandemic.

Interestingly, however, suburban schools were also the most likely to report 76-100% of their students being unable to continue their therapy or special education.

How do you feel about the future of the school year?

As we’ve examined the results of this survey, we’ve uncovered a lot of interesting and important information about how schools have (and have not) been able to provide adequate therapy and special education needs throughout the COVID-19 pandemic.

With the increase in COVID-19 vaccines across the country, and cases starting to come down, there is light at the end of the tunnel. As we approach our new post-COVID world, we are eager to see how schools are able to take the lessons they learned while providing continued therapy and special education services over the past year.

With that in mind, we’ll close this report with a final question we asked in our survey: Given your organization’s experience, are you concerned about delivering effective therapy to your students over the rest of the 2020-2021 school year?

A majority of respondents said that they were not concerned with delivering effective therapy over the rest of this school year, while a significant 41% said they still were.

Over a third of private and charter school respondents said they weren’t concerned about delivering effective therapy over the rest of the school year, making them slightly more confident than the 58% of public school respondents who weren’t concerned.

Urban and suburban respondents were equally unconcerned, while rural respondents were more evenly split between being concerned and not being concerned about delivering effective therapy this year.

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