Connecting Communities: The Role of Teletherapy in School Speech-Language Services

Introduction

Teletherapy, the provision of therapeutic services via electronic means such as videoconferencing, phone calls, and mobile apps, has become a prominent mode of healthcare delivery, especially in the wake of the COVID-19 pandemic. Although teletherapy was not a new concept, its adoption—particularly in fields like speech-language pathology (SLP)—was significantly accelerated by the pandemic. Prior to COVID-19, teletherapy was mainly used for specific populations, such as students who were homeschooled, medically ill, suspended, or living abroad, and for clinicians in rural areas or on leave. However, the pandemic prompted a large-scale expansion of teletherapy, underscoring its ability to maintain continuity of care during disruptions (Adams et al., 2021; Gangamma et al., 2022; Tambyraja et al., 2021). While many services are now offered in person, the experience of the pandemic highlighted the importance of preparing for future interruptions, whether due to another health crisis, inclement weather, or other unforeseen circumstances. As such, school districts must not only be prepared to revert to teletherapy if needed but also invest in enhancing its quality and accessibility. Strengthening teletherapy now will ensure it remains a viable, effective option for future disruptions and help serve students with unique needs—such as those who are homeschooled, medically fragile, or living in underserved areas—today. To better meet future needs and support all students, expanding access to teletherapy is critical, both as an alternative to in-person services and as a tool for addressing gaps in service delivery.

The Impact of COVID-19 on Teletherapy Adoption

The COVID-19 pandemic catalyzed the rapid adoption of teletherapy across healthcare sectors, including speech-language pathology (SLP). Global lockdowns forced healthcare providers, including SLPs, to quickly transition to teletherapy in order to continue care. Research reveals a dramatic increase in teletherapy use during the pandemic, with many SLPs adapting their practices almost overnight (Adams et al., 2021; Tambyraja et al., 2021). By 2020, nearly 35% of SLPs were providing services via telepractice, often within the first few months of the pandemic (Fong et al., 2021; Lam et al., 2021). This shift highlighted the flexibility of teletherapy but also underscored the need for adequate training and support for practitioners adjusting to this new delivery model. Despite the benefits of teletherapy, many children, particularly those with developmental delays, missed out on critical services during the pandemic (Belsha, 2023). The backlog of students in need of services further pressures school districts to catch up, a challenge teletherapy can help alleviate by offering scalable solutions that do not depend on in-person visits. Teletherapy also enables access for students in rural or underserved areas who may have had limited access to therapy otherwise. Looking ahead, teletherapy can serve as a key strategy for school districts to prepare for future emergencies by creating an infrastructure that allows services to continue uninterrupted. However, the rapid transition to teletherapy also revealed gaps in practitioner training, with many relying on online resources and peer support to refine their practices. This highlights the need for comprehensive, targeted training programs. In response, SLPs have embraced digital tools—such as apps, games, and multimedia resources—to enhance engagement and create dynamic, personalized therapy experiences. The pandemic also prompted temporary changes in regulatory and reimbursement policies, with some states relaxing restrictions on telehealth. This has sparked ongoing discussions about the potential permanent integration of teletherapy into SLP services (American Speech-Language-Hearing Association, n.d.).

Challenges and Limitations of Teletherapy

Despite its advantages, teletherapy faces several challenges, many of which persist today and would likely resurface if teletherapy were needed again. A significant barrier is that many SLPs lack formal training in teletherapy technology, which can hinder their ability to deliver effective sessions. Additionally, not all clients have access to reliable internet. The Federal Communications Commission (FCC) reports that approximately 19 million Americans lack access to high-speed internet, particularly in rural areas (Lindgren et al., 2016). This digital divide limits the effectiveness of teletherapy, resulting in poor video quality and session interruptions (Cravens et al., 2019). Some school districts, such as those in Colleton County, have attempted to address this by providing hotspots, but these efforts are often hampered by logistical challenges such as lack of transportation. In contrast, Georgia’s partnership with T-Mobile to provide buses equipped with hotspots offers a more flexible solution (Connect, 2024). Another challenge is that not all parents are comfortable with technology, especially in rural communities where digital literacy may be lower (Madigan et al., 2021; McKee et al., 2021). This can result in hesitancy and lower participation in teletherapy, further compounded by cultural factors that may discourage families from seeking therapy services (Lawton, 2024). Furthermore, the need for parental involvement in sessions, especially for younger children, can create barriers for families with limited availability or technical expertise (Fairweather et al., 2021; Pierce et al., 2020). These challenges can leave clients with few alternatives, forcing them to travel long distances for in-person therapy or forgo treatment altogether. This is particularly concerning for children with complex communication needs or those requiring consistent therapy, such as those with autism spectrum disorder, Down syndrome, or language impairments, where interruptions in services can exacerbate challenges.

Recommendations for Improving Teletherapy Access

To overcome these barriers, several recommendations can improve teletherapy access and efficacy. First, expanding internet infrastructure is essential to ensure that teletherapy can be delivered effectively in underserved areas. Investment in broadband initiatives can help bridge the digital divide (Fairweather et al., 2017; Gangamma et al., 2022). However, progress is uneven, with states like California making strides while others, such as South Carolina, face slower implementation due to limited funding, political resistance, and rural demographics. Second, offering targeted training for both SLPs and clients can increase engagement and improve outcomes. Workshops for clinicians on using teletherapy platforms, as well as user-friendly guides for clients, can help ease the transition (Eguia & Capio, 2021). Unfortunately, my school district did not provide this type of support, though I was able to access resources on ASHA’s website that focus on teletherapy in rural areas (Module 1: Introduction to Rural Telehealth - RHIHub Toolkit, n.d.). Third, addressing cultural reluctance to teletherapy through targeted resources can encourage broader participation. Fourth, fostering partnerships with local organizations to promote teletherapy services can increase awareness and utilization (Cravens et al., 2019; Fairweather et al., 2021). For instance, ASHA offers resources to help families navigate teletherapy and its benefits, as well as advocacy materials for insurance reimbursement and policy change (American Speech-Language-Hearing Association, n.d.). Finally, clinicians should be well-versed in the materials and tools used for teletherapy, and school districts should monitor data usage to assess therapeutic progress and refine interventions. Data-driven approaches can improve the precision of therapy and ensure that services meet students’ evolving needs.

Personal Reflections on Teletherapy

Reflecting on my experiences with teletherapy during the pandemic, I encountered many challenges, particularly with navigating the technical aspects and maintaining therapeutic rapport in a virtual environment. However, I also experienced moments of success, such as engaging a shy child through a creative online game. These successes were often tempered by the frustrations of sessions that did not go as planned, but they reinforced the importance of flexibility and innovation. One of the key advantages of teletherapy is its ability to reach underserved populations, particularly in rural communities where access to services is limited. While I did lose some students during the transition, I gained valuable insights into how to improve the teletherapy process for future use. It is clear that underserved communities face significant challenges in accessing teletherapy, including limited technology, poor internet connectivity, digital illiteracy, and mistrust of technology. While some regions are well-equipped, others, including my own, have significant gaps. To reduce these disparities, investments in teletherapy infrastructure and support must be made at a national level, not just in select areas.

Conclusion

In conclusion, teletherapy offers a promising solution for delivering SLP services, particularly in underserved communities, but it is not without its challenges. To improve access and effectiveness, investments in broadband infrastructure are essential, along with targeted training for both clinicians and clients. A culturally competent approach, combined with partnerships and advocacy for policy change, can further increase teletherapy’s reach. By addressing these barriers, we can create a more equitable system that leverages technology to meet the needs of all clients, ensuring that teletherapy remains an effective tool for service delivery, both during disruptions and beyond.