Contract Teletherapy for Schools: How TheraKids Built a Speech Program From Inside an OT/PT Company

School districts across the country can't find enough speech-language pathologists. The shortage is real, and it's not going away. But Melissa Keller and the team at TheraKids found a way to turn that problem into an opportunity by launching a contract speech therapy teletherapy program inside a company that had been sending OTs and PTs into schools since 1997.

It's not the path most SLPs picture when they think about teletherapy. Melissa didn't start her own company or join one of the big national platforms. She stepped into a coordinator role at a well-known therapy contracting firm in Southwestern Illinois, one that already had deep relationships with school districts, and built the speech teletherapy arm from scratch.

Selling Teletherapy to Districts That Have Never Heard of It

TheraKids had a head start that most teletherapy startups don't: name recognition. After more than two decades of placing OTs and PTs in schools, districts already knew and trusted the company. But that didn't mean the sales pitch was easy.

"Many school districts are not familiar with teletherapy," Melissa says. "So part of my job is going out with our business owners to pitch this idea to them."

Some districts came to them with immediate needs, like maternity leave coverage or long-term sub positions they couldn't fill. Others had never considered teletherapy as an option. Melissa's approach was simple: check local district websites for job postings, reach out to the special education coordinator, and ask if they'd be interested in learning more.

The response surprised her. District after district either already knew TheraKids from their OT/PT work or said they'd never heard of teletherapy but wanted to learn. Since launching in August 2019, they've already secured contracts and added three speech pathologists to staff.

How the Contracts Actually Work

The contracting model Melissa describes is straightforward, which is part of what makes it appealing to districts.

Once a district signs on, they choose which students would benefit most from teletherapy. There's no technical limitation on diagnoses, but districts get to decide which kids they think will do best with virtual sessions. From there, Melissa's team calculates how many days and hours a therapist needs to cover the caseload, factoring in not just direct therapy time but lesson planning, documentation, annual review meetings, and IEP paperwork.

The district pays a flat hourly rate. No minute-by-minute billing. No variable invoices month to month. A part-time contract might look like a therapist available two days a week, six hours a day. The district knows exactly what they're paying before the contract starts.

For the therapists, it's an employee model, not 1099 contract work. They get the same flat rate for their scheduled hours whether they're in a session, writing progress notes, or prepping materials. "Our therapists know that their paycheck's going to remain steady week to week," Melissa says, "which is kind of a bonus compared to some of the larger companies."

The Support Person Who Makes It All Work

One detail that separates successful school teletherapy from frustrating school teletherapy is the primary support individual. This is someone in the building, assigned specifically to the teletherapy caseload, who handles the logistics that a remote therapist can't.

They walk students from their classroom to the computer. They sit nearby during sessions in case of tech issues or fire drills. They let the therapist know about absences and schedule changes. They're the on-the-ground partner that makes virtual therapy feel seamless.

Not every district can afford to hire someone for this role. Melissa's team has gotten creative when budgets are tight. Sometimes a special education teacher monitors from across the room. Sometimes an existing classroom aide picks up teletherapy duties during slower morning hours. "We've been able to kind of piecemeal here and there as needed," Melissa says.

The flexibility matters. Districts that feel like they can't afford teletherapy because of the extra staffing need are more likely to say yes when you show them three or four different ways to make it work.

COVID-19 Proved the Model Before Anyone Expected It To

When Illinois schools shut down in spring 2020, most therapy providers scrambled to figure out how to keep serving students. TheraKids' speech program barely had to change.

Students who already had teletherapy through TheraKids logged in from home instead of from school. Same therapist, same platform, same session structure. "It's actually been a fairly smooth transition," Melissa says. "The families have been very flexible."

For families without reliable internet or a compatible device, the team put together packets with worksheets, websites, and therapy activity ideas, either mailed home or left at the school office for pickup. They documented every contact attempt, every resource sent, every check-in call.

Meanwhile, the OT and PT side of TheraKids, which had always been in-person, had to pivot to sending home packets and doing family check-ins with no direct services. The contrast wasn't lost on school districts watching both sides of the company operate during the shutdown.

New districts started reaching out. "We already have one additional contract that'll be starting in August," Melissa says, "and I would expect that we'll have even more due to the current circumstances."

Recontracting and What Comes Next

As the school year wound down, Melissa was already looking ahead. The recontracting process involves sitting down with current districts to reassess: How many students next year? How many days and hours? Has the caseload grown?

Based on first-year results, fewer missed sessions, better attendance tracking, and the obvious COVID resilience, Melissa expected districts to assign more students to teletherapy in the following year. Spring is when districts hold their big annual review meetings and get a clearer picture of next year's needs, which makes it the natural window for outreach to new districts too.

For SLPs curious about this kind of work, the coordinator role is worth watching. Melissa spent eight years doing direct therapy before stepping into a position that blends recruiting, sales, social media, and clinical oversight. "I still want to see kids and do therapy some of the time," she says, "but I also like more of the management aspect."

It's a career path that barely existed a few years ago. Now it's one more way the SLP shortage is creating new opportunities for therapists willing to think beyond the therapy room.

Teletherapy changes the logistics, but the documentation demands stay the same. ClinicNote is a HIPAA-compliant EMR built for therapy practices and university clinics, handling scheduling, billing, and clinical documentation in one place so you can focus on serving students instead of chasing paperwork. See how ClinicNote works.

Transcript

Kadie: You are listening to Clinic Chats. Clinic Chats is a multidisciplinary therapy podcast that was created for students, professionals, clinic directors, and supervisors. Clinic Chats is bridging the gap between graduate programs and professionals, sharing personal journeys of the smallest of private practice startups, large and expanding practices, as well as university clinic triumphs and tribulations. We hope you'll find our podcast informative and helpful in your career endeavors. Clinic Chats is sponsored by ClinicNote, an electronic medical record company for private practice and university clinics. ClinicNote was designed to make scheduling, documentation, report writing, and billing effective, efficient, and HIPAA compliant.

Kadie: Today on the podcast, I have Melissa Keller, who's a speech pathologist with TheraKids. Melissa is the speech teletherapy coordinator. Hi, Melissa. How are you?

Melissa: I'm doing well. How are you?

Kadie: Good. I'm excited to have you join us today because of your unique position with TheraKids. So can you give a little background on the company that you're employed with?

Melissa: Sure. So I'm employed, like you said, by TheraKids, and the business was actually started back in 1997 by two occupational therapists. TheraKids is the largest contract company in Southwestern Illinois that provides occupational, physical, and speech therapy services to special education cooperatives and school districts. They are currently comprised of about 60 OTs and PTs combined, as well as three speech language pathologists at this time.

Kadie: Oh, wow. Yeah. So it's a pretty large company.

Melissa: The speech language pathology side of it, they've had speech pathologists in the past that have helped out with some contract services within school districts, but now they are strictly just doing teletherapy. So that's why we've kind of rebranded the way that the speech therapy portion looks, and we've just started up and have three pathologists now that are on staff.

Kadie: Okay. So they've been in business for quite some time in the OT/PT, and you said dabbled in SLP previously. Have they always been in person with the OT/PT, aside from the most recent quarantine?

Melissa: Yes. So the OTs and PTs do go out to the school districts to service those students, but recently with the quarantine, they are now doing most of their work from home, and they are doing check-ins with families. They are sending packets of information, as well as websites and apps that these families can use at home while they're under the quarantine.

Kadie: Okay. So what has your role been now that they are interested in contracting with schools for speech in the teletherapy world?

Melissa: So as the speech teletherapy coordinator, my roles primarily include at this time recruiting the speech pathologists to cover necessary caseloads because the two owners of the company are occupational therapists, like I mentioned. They felt that I had some connections with speech pathologists in the area that might be willing to jump on board with us. So that's been a big role of mine, is finding the necessary therapists to help cover the caseloads that we have, as well as taking care of the social media branch that we have for TheraKids for the teletherapy portion. So that's right now just Facebook that we are uploading and adding materials to. So we like to post materials not only for our therapists, but for other therapists that follow our page, as well as for parents right now.

Melissa: So we're finding that a lot of school districts have a need for speech pathologists, and they're having a hard time getting the speech pathologists hired. So we're kind of coming in as another option, and many school districts are not familiar with teletherapy. So part of my job then is going out with our business owners to pitch this idea to them to see if it's something that they would be interested in.

Kadie: And they have experience contracting schools in their disciplines, and you're coming in to sell them on the teletherapy being just as effective, correct?

Melissa: That is correct. And it's actually worked out really well because they've had so many districts and so many clients within these districts that actually they branch as far north as Springfield, Illinois, and as far south as Columbia, Illinois, and kind of everywhere in between. So it's been really helpful because a lot of districts are familiar with TheraKids. They just were not aware at this point that we were offering teletherapy since it is so new. So we launched this back in August.

Kadie: Yeah, that's definitely advantageous for them to use their good reputation that they already carry and then to explain the benefits of teletherapy. How have you helped thus far into contacting or finding potential districts? Has it all been districts that the OT and PT have already had contact with, or are there some new?

Melissa: It is a good mixture. So we've started with districts that we already had contacts with just because that was the easy route to start. And we knew those districts who had openings, what their needs were. There were a couple of districts that needed maternity leave coverage or long-term sub coverage. But we've also done things just like going to Google and just looking at local districts' websites and looking at the job postings and then just reaching out to the contact person or to the special education coordinator and just seeing if they would be interested.

Melissa: And it's amazing how many coordinators respond back saying either they've heard of our company before because they're either working with them now or they have worked with them in the past, or how many districts will say that they are interested and it's something that they have never heard of before.

Kadie: Silver lining, I guess, for current circumstances with coronavirus is I think telehealth is going to be much, much more prevalent.

Melissa: I agree. Yeah. You're ahead of the curve in that regard. Yes. And we've actually had a couple of districts reach out to us since all this has happened with just wanting to inquire about how the company works and what services could potentially look like for them if they decided to contract with us for the next school year. So we do already have an additional contract that we'll be starting in August, and I would expect that we'll have even more due to the current circumstances for sure.

Kadie: So once a district says, yes, we want to use TheraKids teletherapy for speech services, what happens next as far as paperwork to make it official?

Melissa: So we have a contract that they would have to sign. We then also look at their caseload numbers. So we kind of leave it up to the school district in terms of how many students they feel would benefit from our services, as well as what specific diagnoses would be most beneficial. So there aren't technically any limitations for who we can and cannot see via teletherapy, but we like to give the district their preference on which students they would assign to us based on how they feel those students would participate in teletherapy and the progress that they would make.

Melissa: So we let them kind of give us that number, and then we look from a team standpoint as far as how many days a week that would look, how many hours they would need to meet those services. So we draft that up in the contract for them as well. So they're aware of how often we will be there, what the rates will be per hour, so forth.

Kadie: As a business standpoint, do you all charge by the hour based on the services they're committing to?

Melissa: So it is a flat rate. It's an hourly rate for them. So we would come to them saying, okay, maybe your contract is going to look like a part-time contract where we would have a speech pathologist there to service your kids two days a week, and then it would take us six hours each day to meet those demands. So that we kind of look at not only direct therapy time, but how long is it going to take our therapist to lesson plan, do the documentation, prep for therapy, do the annual review meetings and the IEP paperwork. So we factor all of that in, and then they just know, the district knows from the beginning how many days that therapist is going to be there and what their hours are going to be. So we do charge them just a flat rate per hour.

Kadie: Perfect. And then from a therapist's side, are they also reimbursed for that indirect time?

Melissa: Correct. Yes. So our therapists receive a flat rate as well, and they are actually employees. They don't have to bill. I know some of the larger teletherapy companies, you have to bill minute by minute exactly what you're doing to get your payment. They know that they're going to get paid, if I'm using that same example, two days a week, six hours a day, they're going to get paid that full six hours.

Melissa: So they're not having to necessarily document, okay, from 9 to 9:30, I was planning. From 9:30 to 10 o'clock, I had a client. As long as they are available and doing their work for that six hours per day or however long it may be, they get paid the same flat rate, bearing that there's no absence like therapist absence or holidays, things like that. So it's kind of nice for our therapists to know that their paycheck's going to remain steady week to week and month to month, or sometimes depending on the larger companies that you may work for, depending on your caseload and what goes on in terms of student absences, paperwork, your paychecks could vary pretty substantially from month to month. So that's kind of a bonus for them.

Kadie: Yeah. That's definitely a nice perk of being, like you said, an employee versus a 1099 contract.

Melissa: Yes.

Kadie: I know you've had experience in providing teletherapy services as well. What does communication look like once therapy begins? Who are you communicating with on a daily basis if you're the therapist?

Melissa: So the therapist typically communicates via email with the special education teachers and general education teachers, as well as the primary support individual that is assigned to these students. So we try to find somebody within each building or for each caseload that can work specifically with the speech teletherapy students.

Melissa: So this individual would then be required to take the students from their classroom to either the speech room or wherever they have designated for those students to get onto the computer and sit with them during the session, just in case there are any tech issues that arise or there are any drills, fire drills, where a student would need to be chaperoned from point A to point B, and then take those students back to the classroom at the end of speech.

Melissa: So they are a person that we contact and talk to quite a bit throughout our day because we want to make sure all of our students are in attendance that day. It's just easier to have one person to talk to if possible. We know that our teachers and the principals are very busy with other tasks. So if we have somebody assigned just to those students, we're then available to utilize them to let us know of any changes in the schedule, any absences. And they can, since they're assigned just to our caseload, they're pretty available and responsive when we need them, either via email or via phone call. But we would also communicate with the teachers and with the related service staff, especially at times when we're doing annual review meetings, progress notes, when we really want to touch base with how they're doing in the classroom.

Kadie: Yeah, I could see that support person being really crucial to make it feel like a nice flow to pick up the student, make sure that they're attending throughout the session. Have you ever had school districts balk at the double expense, I guess, for paying a therapist as well as, you know, whether it's minimum wage or whatever it may be, just having two people to pay?

Melissa: Yes. And so there have been situations where we've worked around having that primary support individual. Of course, that's ideal and that's what we would like to have happen, but we're willing to work with districts. So we have had situations where maybe a school district doesn't have the means to hire that person. So they've just segmented an area in a classroom for these students. So the special education teacher or the general education teacher is there as kind of the supervisor and the contact person and the adult in the room should there be any tech issues that arise.

Melissa: So they're not paying somebody additionally, but it's just harder than on that teacher to kind of be available for her own class of students, as well as the one or two students who may be sitting kind of segmented off into the back at a computer to meet their needs as well. So we've been kind of flexible with that. We've also had situations where we've had more than one person with these speech students. So maybe it's somebody who's already hired within the district, who's maybe already an aide in the classroom and maybe has a little bit more flexibility in the morning. So we might use a different person in the mornings and then bring somebody else in in the afternoons. So we've been able to kind of piecemeal here and there as needed as well. And school districts are pretty responsive to that as well.

Kadie: Okay. So you have a collaboration to figure out what's going to work for that particular school and building.

Melissa: Right.

Kadie: How does documentation look? Do you provide documentation to the school for daily sessions or not necessarily?

Melissa: So we use an online teletherapy platform and we do all of our notes and documentation through that platform and it is saved to that therapist's account. So they're not provided to the district on a daily basis. However, we have all of those on our platform if there were ever a question or if teachers were wondering, hey, what did you work on today in speech? Could you give me kind of a rundown? It's right there at our fingertips.

Melissa: As far as actually providing documentation to the districts, we continue to do quarterly progress notes just like you would in a brick and mortar setting. We do that specifically through the IEP software program that the district is using. So they give us access. They give us a login to their platform or to their system that they are using for IEPs and progress notes. And we're able just to type in our note right there for them. And then when it's time for the meeting, we would have either the case manager or the special education teacher print off that paperwork and make sure that it gets home to the parents and that the principal has access as well.

Kadie: You know, in Illinois, schools have been closed now for, oh gosh, is it three weeks or four?

Melissa: Too long. It's been a while. I don't even know. It's like every day is just running together.

Kadie: So I'm sure now that kids are out of school, that has thrown an obstacle in meeting students' minutes, providing services in general. How has that looked for the company?

Melissa: So fortunately for us, not a lot has actually had to change in this domain, which has really been nice. It's kind of the perk of being here in the virtual world that we've still been able to meet the demands of the majority of our students in one way or another. So for our speech population, students are continuing to receive their services at home through their personal computer, laptop, Chromebook, whatever device they have available that is compatible with our platform. They are able to log in just as they would at school and be connected on screen with their speech therapist. So it's actually been a fairly smooth transition. The families have been very flexible.

Melissa: For the families that we've been unable to reach, either via phone or email, we have put together packets or worksheets with websites, different handouts, different therapy ideas of things to do at home. And they've either been sent home via mail or they have been left in the school office for the parents to swing by and pick up. So we kind of wanted to make sure that our services didn't change for these students and that they were still getting at least offered the opportunity to continue to participate in speech via the computer.

Melissa: But we know that some families either don't have the technology needed or don't have the internet component. So that's when we would want to put together those packets. So we still feel like we're giving them something that they can be working on in these days when they're at home. We try to touch base with these families weekly or biweekly just to make sure that things are going well at home. Do they have any questions or concerns? How's the progress of their students going? So we're still documenting that as well.

Kadie: I imagine for the families who are able to continue to log in from home and receive teletherapy services, I imagine the school district is just so relieved in that sense.

Melissa: Yes.

Kadie: For families who are receiving packets, you're doing the best you can, obviously, but even schools who might not have teletherapy offered at all, do you think there's going to be some sort of grace period for not meeting specific minutes as long as you're making attempts to contact and help during this time?

Melissa: Yes, I think so. I think there just has to be. It's something that's going on worldwide. So I think it's not going to be uncommon for a lot of therapists through our company or elsewhere to just have notes and notes of documentation of parent contacts. So we do the best that we can to reach out to these families. We try different modalities as well. If we're calling and leaving voicemails, they're not returning, we might send an email and touch base that way. We will also collaborate with the classroom teachers and the special education teachers because sometimes they've had luck contacting these parents and maybe we haven't. So we can kind of relay information through them as well. And like you said, we're just doing our best to document every attempt that has been made as well as what homework packets or check-ins that we've done just so that it's there, documented.

Kadie: So I'm sure as we start thinking about wrapping up the end of this school year, you all are looking at the upcoming school year as well. Is there a recontracting period or what is the process in that regard?

Melissa: So we plan to meet with the districts that we currently have contracts with now to see if they wish to continue for the next school year. At this time when we meet with them, that's when we really take the opportunity to reevaluate their needs in terms of how many students they may want services for next year as well as how many days and hours. Because since this is our first year, we're still kind of learning the ropes and trying to figure out how recontracting will look for schools.

Melissa: And speaking with some of the therapists that we have on staff now, we are anticipating just with the progress that we've had as well as the current state of things here in the country that we will probably have more clients next year for each contract that we have. We really feel like the interruptions in therapy, the absences, being able to meet minutes has all been improved through teletherapy. So we feel like the school districts may be more inclined to give us more students.

Melissa: So when we meet with these districts, we will look at all of that. We were looking at kind of March, April to be our period where we would be contacting new districts to see if they were interested in services. We know that in the spring is when the majority of districts have their large annual review meetings and have a better idea of what their needs may be for the next school year. So that was kind of our target.

Melissa: And well, since all this has happened, it kind of just happened to fall at the same time when we were going to be meeting with other districts as well. So like I said earlier, we already do have one additional contract for sure that's going to be starting in August. So we're kind of taking the time now and through the summer to reach out and contact new districts. But we also know that these districts are very busy right now with trying to just get through the end of the school year.

Kadie: Yeah, I was going to say it's like right now they're probably realizing how beneficial teletherapy can be, but they're also probably so busy. So it's kind of a toss up if now is a good time to reach out to them or not.

Melissa: Right. And some of the districts we had contacted prior to this back in the fall or in the spring and they have shown interest for the next school year. But they had asked that we contact them again March and April or through the summer once they know for sure what their caseload numbers may look like for the following year. So we will definitely just kind of work with them and getting through the school year and then probably really hit it hard through the summer for contracts for next year.

Kadie: Is there anything you'd like to add as far as your new role in a company that was already pretty large, but in their expansion, has there been any great takeaways over this first year?

Melissa: It's been a change for sure. So I have done therapy in the past for eight years now, and it's all been with students just as an SLP. I've never held a coordinator position before, but I am loving it actually. I enjoy the opportunity to really research some districts and really work with the personnel there to figure out what their needs would be. Since I do have a little bit of a background in teletherapy prior to signing on with TheraKids, I feel that I have some good information to share with these districts who are very unfamiliar with teletherapy. So yeah, I really feel like the new role has been a good fit for me. I still want to see kids and do therapy some of the time, but I also like more of the management aspect of it as well.

Kadie: Yeah. It seems like a really great balance for you. I've definitely been wanting to speak with you or the owner of TheraKids. It's been on my mind, and I thought right now is a really great time because everyone is very intrigued in approaching teletherapy these days.

Melissa: Absolutely.

Kadie: Well, thank you for your time, and stay safe in the upcoming weeks, hopefully no longer than that.

Melissa: You too. It was great talking with you.

Kadie: Thank you for joining me and listening to Clinic Chats. If you have a moment, please leave a five-star review for Clinic Chats to help other SLPs find our podcast. If you'd like to share your own personal journey through private practice, please email me at katie at clinicnote.com. That's K-A-I-D-E at clinicnote.com.