As students with learning disabilities enter distance learning environments, a tangled patchwork of state regulations, a lack of therapist training, and limited access to high-speed internet threatens to limit their access to key services that help them speak, move, and acquire skills for daily living.
The sudden shift to online learning going on across the country to tamp down the spread of the coronavirus will, at best, place new burdens on children with disabilities and their families-and, at worst, lead to extended disruptions in services such as speech, occupational, and physical therapy.
For students without reliable internet access or caregivers who can devote significant time, almost daily, to support their children, "compromises are going to have to be made," said Sean Smith, a professor of special education at the University of Kansas.
Even when students receive services, the online therapy they get likely will not mirror the goals outlined in most students' Individualized Education Program, a legal document that outlines what special education services students with disabilities will receive from schools, researchers and experts say.
"Is it going to be exactly what's in their IEP? The answer is probably 'no,'" said Sue Grogan-Johnson, an associate professor of health sciences at Kent State University who oversees a tele-therapy program that provides services to small school districts in Ohio.
"There's going to be a difference between tele-practice during coronavirus and tele-practice during normal times. We're triaging to do the best we can in a challenging situation."
The federal government does not track the number of students with disabilities who receive tele-therapy, or are supposed to under federal law, but the total could swell into the millions during the widespread national school closures.
Roughly 1.5 million students have diagnosed speech or language impairment, making it the second most prevalent disability category in the nation's K-12 schools. That total doesn't include a smaller, yet undetermined, number of students who receive physical and occupational therapy.
The challenge will prove considerable for school districts. Fearing potential legal action from parents or fines from the federal government if they can't offer access to all students, some halted all online learning.
The technical problems that tend to riddle much of online communication can be especially problematic for students in special education. During distance learning, minor complications-a two-second lag during online speech services or not having similar tools on hand for occupational therapy-can cause major problems.
"We're learning that if we want online learning to be accessible to every child, we, as educators, need to be better prepared," said Kathleen Airhart, the program director of special education outcomes at the Council of Chief State School Officers. "People that are accustomed to giving in-person service, there's a learning curve."
Despite the difficulty schools may face in offering online instruction during the pandemic, U.S. Secretary of Education Betsy DeVos has reaffirmed that districts must provide special education services and supply students with disabilities equal access to the same opportunities.
"Many disability-related modifications and services may be effectively provided online," an Education Department fact sheet advised. "The Department encourages parents, educators, and administrators to collaborate creatively to continue to meet the needs of students with disabilities."
But 2018 research funded by the Education Department's office of special education programs cautioned that much of what happens in tele-therapy is "decidedly nontraditional when compared to a brick-and-mortar experience."
The study from the Center on Online Learning and Students with Disabilities, a now-shuttered research collaborative, found that researchers and early adopters of tele-therapy were "disturbed that they could see no concerted efforts to prepare providers to do this work."
The complex work includes much more than technical know-how, said Mary Rice, an assistant professor of literacy at the University of New Mexico and a study co-author.
"People that are accustomed to giving in-person service, there's a learning curve," said Airhart, a former school system superintendent and special education director for the 11,000-student Putnam, Tenn., schools.
Those people will include teachers and parents or caregivers, who will assume roles as learning coaches or ehelpers, said Rice and Richard Carter, an assistant professor at the University of Wyoming and a co-author on the study of tele-therapy for students with disabilities.
For students receiving occupational and physical therapy-where services involve student movement-a caregiver is a near-necessity. The research found that, in many cases, families stayed at home to take care of and support a child's development on a full-time basis. With nearly every K-12 student in the nation now out of school, working parents, family members, even neighbors, are being thrust into the roles with little, if any, preparation.
"What makes it different now is everybody's under emotional stress and it's more likely that parents are working during the day," Rice said. "Can you imagine your grandmother trying to figure out how to help you do online learning? Or all of sudden your neighbor is a partner in the educational process and IDEA."
Beyond finding someone willing and able to support the therapy, still more potential hurdles remain: training, comfort with technology, and language barriers among them.
"What we do is we take lots of expertise that we have in a brick-and-mortar location and then we put it all on one individual [the therapist]," said Richard Carter, an assistant professor at the University of Wyoming and study co-author. "One to ensure the services, the education, is being delivered as well as just replicate what an experience that child would have in a traditional school. So, it is a lot of pressure"
In the Chadron, Ohio, school system, a 2,800-student district in suburban Cleveland, Maggie Cook is providing virtual speech therapy for 42 early elementary and high school-age students with speech and language disabilities who are on the autism spectrum or have intellectual disabilities or specific learning disabilities.
During in-person lessons, Cook, who has worked as a speech-language pathologist for nearly 20 years, can hear sounds more clearly and provide feedback using methods that are more cumbersome online, she said.
Some of Cook's students have no internet and if they do, some of their tablets or computers don't have microphones and cameras. Other students have trouble working independently and working parents who are not available for sessions.
"They deserve the best I can give, and I am scrambling to learn new tricks to be effective and productive," Cook said.
In Ohio, Gov. Mike DeWine ordered schools closed until at least May 1 to slow the spread of the coronavirus.
"I personally enjoy the company of others, and I miss the closeness of working with students face-to-face," said Cook, the Ohio-based speech-language pathologist.
Tele-therapy is widely used in Ohio, where Grogan-Johnson coordinates the Kent State tele-therapy project, but other states are trying to adapt.
At the end of March, at least a third of states had no laws or guidance for tele-therapy for speech and language services, according to the American Speech and Hearing Association.
The association and other professional organizations, such as the American Occupational Therapy Association and the American Physical Therapy Association, have pushed for legislative solutions or sweeping executive orders from governors to ensure their members can work with students via distance learning.
In states where there are not laws on the books, speech-language pathologists and therapists are flooding licensing boards with calls to ensure they can practice online.
With states scrambling to figure out solutions, the federal government could soon become involved.
Devos has said she will ask Congress to provide "microgrants" to help with online learning during coronavirus-related closures. An Education Department spokeswoman told Education Week that the grants could be used to support therapies for students with disabilities or pay for materials needed for home-based learning, such as computers, software, internet access or instructional materials.
"Prior to COVID-19, tele-therapy services weren't seen as viable in many places," said Michele Wiley, a long-time pediatric physical therapist and assistant professor in the division of physical therapy at Shenandoah University in Virginia. "There was a limited view of how this could take place effectively."
Wiley, the former special education supervisor for the 80,000-student Loudon County, Va., schools, where she oversaw speech-language, and occupational and physical therapy services, could get a firsthand look at how things unfold: She also works part-time as a physical therapist for the Manassas Park City, Va., schools.
Much of what happens in the coming weeks and months will depend on the complexity of student needs, how districts facilitate communication between therapists and IEP teams, and how comfortable therapists-many of whom aren't trained for distance-learning-become with online platforms, Wiley said.
"It's an evolving situation," she said. "This is not going to be a one-size-fits-all type of situation."