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YOU Can Help Administrators Support OT and PT School Practice!

YOU Can Help Administrators Support OT and PT School Practice!
Jean Polichino, MS, OTR, FAOTA
May 21, 2018
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Jean: Hello, everybody. Today's presentation is designed to arm each of you with the knowledge you need to work collaboratively with those who hold positions responsible for OT and PT service delivery in schools. Difficulties in recruiting and retaining related services personnel in special education is one of the most significant problems faced by special education administrators.

Introduction

As we begin, I want to share with you some acronyms.

SISP

Specialized instructional support personnel, or SISP, is the current term you will see in the literature. This encompasses those professionals who are not educators. SISP is also referred to as “related services” personnel in IDEA and “pupil services personnel” in the Elementary and Secondary Education Act.

LEA

Another acronym that you need to be familiar with is LEA, which is the acronym for the local education agency. This refers to the local public school, the public charter school, the special education cooperative, the intermediate unit, or similar whose administration oversees special education and related services.

Administrative Challenge #1-Position Vacancies (Recruitment/Retention)

Let's take a look at the issues contributing to the challenges administrators face. The first contributor we will examine is difficulty filling unstaffed OT, OTA, PT and PTA positions. We are going to spend the most time today on this issue, as successful recruitment and retention of therapists, is the foundation for successful service delivery to students. Are you working in schools that have OT and PT vacancies? It looks like about 50% of you, who are attending today, are experiencing vacancies, which is pretty common. In some areas of the country, that number could be even higher.

As you have heard, I live in the state of Texas. Here is a snapshot of where my state was in terms of SISP vacancies, or special ed non-instructional personnel vacancies, some 12 years ago in Figure 1.

Figure 1. Texas SISP vacancies. Source: Texas Study of Personnel Needs in Special Education, May 2006

This is the last time my state collected this data from the state as a whole. You can see that the estimated vacancy rate for most related services, based on the study conducted that year, was between five and 9%, with bilingual speech pathologists the outlier at over 19%. Clearly, personnel shortages for related service professionals are not new to special education.

SISP Shortage Data, 2013-14

I am now going to share with you some more recent data on specialized instructional support personnel. Again, think of that as related services shortages from the 2013-2014 school year, as published by the National Coalition on Personnel Shortages in Special Education and Related Services.

  • 49 states report a shortage of special ed & related service personnel (sp ed teacher shortage 2016-18 54% per EdWeek, 1/24/18)
  • 82% of special educators and SISPs reported there are not enough professionals to meet student needs
  • 47% of SLPs report shortages in their schools
  • NASP projects a 15,000 school psychologist shortage by 2020
  • School counselors and nurses serve many more students that are recommended

For that school year, 49 states reported a shortage of special ed and related services personnel. I did see a more recent figure, looking at 2016 through the current period, which is about 54% per EdWeek, so not too different from our own survey. Eighty-two percent of special educators and special instructional support personnel reported that there are not enough professionals to meet student needs. Forty-seven percent of speech-language pathologists report shortages in their schools. The National Association of School Psychologists, or NASP, were projecting a 15,000 school psychologist shortage by 2020. That is pretty stunning. School counselors and nurses serve many more students that are recommended. In my state, it has been probably about five years since we had one school nurse per school, even in large urban areas.

Jobs posted on Indeed.com

Here is my own survey. This looked at current OT and PT shortages (February 2018).

  • 6,943 jobs for School OTs
  • 10,696 jobs for School PTs

You can see, just in this one particular resource, that the numbers are pretty high. The shortage problem is not going away.

Specialedshortages.org 

In a 2013-14 study, the National Coalition on Personnel Shortages in Special Ed and Related Services (NCPSSERS) asserted, "There is both a shortage of professionals to fill available positions and a shortage of positions to meet the growing demand for services for America's 6 million children and youth with disabilities who receive special education services." Having the personnel necessary to do the job lays the foundation for successful administration of OT and PT services. Service delivery cannot be successfully accomplished without adequate personnel. This becomes not just a compliance issue over time, but also a quality issue.

Now let's take a look at the reasons for the special education and related services personnel shortages reported in the 2013-14 study.

  • Poor Working Conditions (e.g., excessive paperwork, unmanageable caseloads/workloads, inadequate support, professional isolation)
  • Insufficient funding for incentive programs to entice new graduates
  • Few qualified faculties to increase preparation programs and increasing higher education costs
  • Maldistribution of professionals around urban centers
  • Rural, high poverty, and high crime areas are less desirable
  • Credentialing barriers limit re-specialization and/or paths to licensure for otherwise qualified personnel
  • Special ed and related services personnel reported from all 50 states that federal, state and local budget cuts “have impacted the ability to provide services mandated by IDEA;” 80% of respondents reported they have “too few personnel to meet the needs of students with disabilities.”
  • Budget cuts increase caseloads, impact the ability to purchase resources such as assistive technology and reduce professional development opportunities (NCPSSERS)

The first one to come to light is poor working conditions. In this case, they identified things such as excessive paperwork, unmanageable caseloads, shortages of supply of therapists or whatever the profession was, and also professional isolation, particularly for people in areas where they may be the only therapist with their credential in a school district. Another reason for shortages was insufficient funding for incentive programs to entice new graduates to come into the district. Another factor that figures in is few qualified faculties to increase preparation programs and increasing higher education costs. We have seen in both the OT and PT professions in recent years the move to a doctoral-level entry point. The PTs are there; the OTs are discussing whether they want to move to single entry at doctorate or not. A lot of the push for that comes from needing qualified faculty who understand the importance of research and who are prepared to be people who are publishing.

At the time that this particular study was done, there was a shortage of qualified faculty. Programs, who were serving maybe 30 students per year to prepare them to be OTs and PTs, were unable to begin to increase until there was more qualified faculty available. Another issue is maldistribution of professionals around urban centers. It has always been true, particularly for OT and PT, that where there are university medical centers, there are more medical facilities of the traditional healthcare delivery variety. Therefore, more jobs and more interest in OTs and PTs, who graduate from schools, are in that area. Rural, high-poverty and high-crime areas are less desirable to applicants, and therefore are difficult to staff. So shortages often occur.

Another reason for the shortages is credentialing barriers that limit re-specialization and/or paths to licensure for otherwise qualified personnel. In thinking about teachers, for example, it could be that an engineer wants to come into public schools and teach math classes at the high school level or advanced placement level, but if he does not have a teaching certificate, there is a barrier for him coming in to do that job. He will have to go back to school to get another credential and become certified or licensed in his state before he is able to teach at those levels. That can make things difficult even when you have willing candidates.

Center on Personnel Shortage in Special Education (COPSSE)

In this study from all 50 states, the Center on Personnel Shortages in Special Education (COPSSE) found that federal, state and local budget cuts "have impacted the ability to provide services" mandated by IDEA. It was also found that "80% of the respondents in this study," which you will find in your references at the end, reported that they have "too few personnel to meet the needs of students with disabilities regardless of whether there were available positions." Increased caseloads impact the ability to purchase resources, such as assistive technology, and reduce professional development opportunities.

Now we can take a more specific look at OT and PT shortages with these data from the Center on Personnel Shortages in Special Education published in 2004.

  • OT supply doesn’t meet demand nationally
  • Schools are generally not the OT candidate’s first choice for employment
  • Only a small percentage of PTs have an interest and/or specialized training in pediatric physical therapy
  • OT and PT salaries are typically higher in the private sector (COPSSE)

In this particular publication in 2004, they identified that the OT supply does not meet the demand nationally. Schools are generally not the OT candidate's first choice for employment. In the PT world, only a small percentage of PTs have an interest and/or specialized training in pediatric physical therapy. OT and PT salaries are both typically higher in the private sector. Those were contributing factors identified in this particular publication for shortages. Do the things identified in 2004 about OT and PT still seem relevant in 2018 regarding shortages? Per your answers, it looks like things have not changed a great deal.

Why are specialized instructional support personnel shortages a concern for special ed? What is their impact? Here are the conclusions from a systems-wide look.

  • “Shortages impede the ability of students with disabilities to reach their full academic potential and hinder the work of districts to prepare all students to be college and career-ready.”
  • “. . . the national cost of public school teacher turnover could be over $7.3 billion a year.”
  • “As a result of high turnover, high need urban and rural schools are frequently staffed with inequitable concentrations of . . . specialized instructional support personnel.”
  • Chronic shortages lead to the hiring of underqualified individuals and limits the quality of services
  • Constant retraining of staff means high-needs school is unable to close the achievement gap. (https://specialedshortages.org, 2013)

This is pretty astonishing. In that way, poverty and some of the other factors, that we talked about earlier, have a big impact if it is difficult to staff schools where that occurs.

What Are the Benefits of a Strong, Comprehensive Recruitment Effort?

  • Helps attract a more diverse and culturally competent workforce
  • Helps ensure a highly qualified workforce for addressing student academic and social needs
  • Improves the equitable distribution of SISP into rural areas as well as low-income areas

It helps to attract a more diverse and culturally competent workforce. Obviously, if people are better skilled in dealing with a diverse set of students and differences among the different cultures, even within schools in one school district, they are going to do a better job of meeting the needs of those students. A strong, comprehensive recruitment effort helps ensure a highly qualified workforce for addressing student academic and social needs. It is always better to have a pool of candidates to choose from when you are filling a vacancy than just having to take whoever walks in the door, who may or may not have the qualification and skill set that you are looking for. A strong, comprehensive recruitment effort also improves the equitable distribution of those support personnel into rural areas as well as low-income areas. If you have a strong group of incentives, for example, and I will show you a few of those in a minute, you are more likely to attract a candidate that is qualified into your rural or low-income area.

Recruiting Strategies for Related Services Personnel

Let's look at some recruiting strategies that can foster success in recruitment. These are things that you will want to think about discussing with your administration to help them be more effective in recruiting candidates to your district.

Knowledge about related services, including OT and PT, is often inadequate or incomplete. Typically, education administrators do not know much about the professional preparation or the state regulations specific to each discipline among the people that they are overseeing. As an administrator responsible for the job performance of many different related services, here are some things that I learned that your administrator needs to know.

  • Credentialing (licenses and certification)
    • Every discipline is different
    • Some have multiple paths to entry
    • Not all disciplines are regulated by the state
    • OT and PT practitioners are licensed in every state

In the realm of credentialing, and that is a term that refers to the licensing and certification of professionals that allows them to come and fill your jobs, every discipline is different. There is no one set of procedures or pathways or protocols that define how you become a professional in every single discipline. Some disciplines have multiple paths to entry. We have talked before about how PTs are now going to a single point of entry at the doctoral level. OTs are still discussing whether they want to retain their master's level programs as an entry-level or whether they want to move to a doctorate. The American Occupational Therapy Association is also looking at OT assistants and trying to determine whether they want to continue to have two entry points, an associate's degree program and the other through a bachelor's degree, or go only to a bachelor's degree program. Think about speech-language pathologists and how many different paths there are to entering into that profession for speech-language pathologists. It is very confusing in many states. Also, not all disciplines are regulated by the state. Among my workforce over the years, there have been music therapists as well as art therapists that were not regulated. Music therapists do have the opportunity to earn national certification through their professional association, but they are not regulated by the states in almost all cases. Art therapists have a certification program through their national association, but they are also not regulated by the state.


jean polichino

Jean Polichino, MS, OTR, FAOTA

Jean E. Polichino, OTR, MS, FAOTA has 28 years of experience delivering therapy services under IDEA and Section 504, and with 26 of those years managing and administering early intervention and/or related services for school districts and charter schools in the greater Houston area. She is a former chairperson of the Early Intervention and Schools Special Interest Section for the American Occupational Therapy Association, Inc. and is an active contributor to professional publication on issues related to school practice. She is currently working as an independent consultant to Texas school districts offering assistance with management of therapy services as well as professional development for school therapists.



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