By Kelly Wolfe
Presence works daily to ensure children can access the services they need to be healthy, included, and successful. We believe every child deserves consistent support regardless of where they live or the workforce challenges in their community. That commitment drives our work to remove barriers to teletherapy and mental health care—addressing licensure issues, funding shortfalls, and administrative obstacles. Beyond delivering clinical services, Presence advocates with state and federal policymakers and regulatory agencies and partners with school districts, advocacy groups, and professional associations to expand equitable access to care for children, particularly those with special needs or behavioral and mental health concerns.
Ongoing challenges
Even three years after the start of the COVID-19 pandemic, schools and students are still grappling with its consequences. Educators face a combination of learning loss, a growing youth mental health crisis, and widespread workforce shortages across nearly every education profession. Districts are being asked to meet rising needs without enough qualified staff to deliver required services.
At the beginning of the 2022–2023 school year, estimates indicated a shortage of nearly 300,000 teachers and support staff nationwide, with special education and STEM subjects particularly affected. Special education shortages were already reported in most states before the pandemic, and many districts continue to struggle to recruit and retain qualified providers.
Federal labor projections also indicate significant demand for new special education teachers in the decade ahead, and shortages of specialized clinicians—speech-language pathologists, occupational therapists, school psychologists, and mental health counselors—compound the problem. Because federal law requires that students with disabilities receive services from appropriately credentialed professionals, staffing gaps can create compliance and service-delivery challenges for districts and states.
The pandemic demonstrated that technology, flexibility, and innovation can expand access. Teletherapy and remote service models have helped connect students with therapists and classroom supports when in-person services could not meet demand. As lawmakers begin new legislative sessions, they have the opportunity to adopt policies that reduce barriers and improve access to both in-person and tele-delivered care.
New opportunities
If we want different outcomes for students, we must adopt more targeted strategies. Policymakers and education leaders can act to ease licensing and administrative hurdles and strengthen funding and access to teletherapy, school-based mental health, and special education services.
- Address workforce shortages through multi-state compacts and reciprocity
Many professions serving children—such as speech-language pathology and school psychology—have experienced shortages for years. Before the pandemic, a majority of school-based providers reported more open positions than qualified applicants. Recommended ratios for school psychologists far exceed current national averages, and some districts face extreme staffing gaps. While long-term solutions like grow-your-own programs and provider pipelines are important, teletherapy can help meet immediate needs. However, state-by-state licensure creates administrative and financial barriers for clinicians seeking to practice across borders. Interstate compacts and reciprocity agreements streamline multi-state practice and expand the pool of available clinicians. State lawmakers should prioritize entering compacts or adopting cross-border agreements to ensure children can access services regardless of geography. - Increase and stabilize funding for children’s mental and behavioral health
Even before the pandemic, one in five children had a diagnosable mental health condition, and many did not receive appropriate care. In recent years, rates of anxiety, depression, grief, and suicidal thoughts have risen, with disproportionate effects on children of color and those from low-income communities. While federal and state leaders have provided one-time emergency funding that helped expand services and teletherapy during clinician shortages, long-term, stable investment is still needed. Policymakers should prioritize sustained funding for school-linked mental health services and explicitly support teletherapy as an allowable and reimbursable modality. Recognizing mental health as central to student health and academic success will help districts address both learning recovery and ongoing behavioral health needs. - Ensure Medicaid supports school-based services, including teletherapy
Medicaid is the largest payer for children’s health care, and many students receive essential services at school. Under federal special education law, schools must provide services such as speech therapy, occupational therapy, and mental health supports to eligible students. State Medicaid programs can reimburse districts for screening, diagnosis, and treatment, but reimbursement barriers sometimes limit access. Some states have adopted policies allowing Medicaid reimbursement for services provided to any enrolled student, not only those with an Individualized Education Program (IEP). Guidance from federal health authorities has encouraged the use of telehealth to expand access, including within school settings. State and federal leaders should ensure Medicaid policies allow coverage for school-based behavioral and mental health services delivered in person or via teletherapy and consider broader reimbursement rules that reduce administrative obstacles for districts. - Fully fund special education under IDEA and Title I
Millions of children receive special education services, and many also have significant health needs. The Individuals with Disabilities Education Act (IDEA) was originally intended to share the added costs of special education between federal and state governments, but federal funding remains well below that commitment. Recent allocations increased funding, but sustained, mandatory federal investment is necessary to close the gap and ensure students receive timely evaluations, therapies, and compensatory services. Congress should move toward full funding of IDEA and Title I responsibilities, and state leaders should pursue reliable revenue strategies to eliminate assessment backlogs, meet growing demand, and guarantee a Free Appropriate Public Education (FAPE) for students with disabilities.
About the author
Kelly Wolfe is Vice President of Public Affairs and Advocacy for Presence (formerly Presence Learning), a provider of live online special education and related services for pre-K–12 schools. During the pandemic, Presence delivered hundreds of thousands of therapy sessions to students with special needs across dozens of states. Presence partners with districts to expand capacity for students with IEPs and those needing behavioral or mental health supports, offering individual and small-group therapy, evaluations, caseload management, IEP support, family resources, and clinical oversight to ensure high-quality care.
This article was originally published by The Learning Counsel, a research institute and news media organization focused on the transition to digital curriculum in education.