Co-authored by Rachel Irons, M.S., CCC-SLP
Going once! Going twice! Sold! To the agency with the most providers! What is up for auction, you ask? Why, just your children.
A recent change implemented by the New York City Department of Education (NYCDOE) has initiated a city-wide overhaul of the way your children are being serviced by occupational, physical, speech-language therapists, and more. As a result of a bidding war, the NYCDOE has awarded contracts to agencies that will enable them to effectively takeover any and all therapy sessions that were up until recently, being provided by independent practices selected at the parents' discretion.
Why is this happening? Because a preposterous error made two years ago by the DOE has finally come back to bite them.
According to the Individuals with Disabilities Act (IDEA), schools receiving public funding must provide all children with disabilities, from age three through 21, "free appropriate public education" in the "least restrictive environment" with all required services (i.e. speech therapy, occupational therapy, counseling, etc.) so that they may benefit from an education. Many schools are able to fulfill these requirements for their students with special needs. However, for those schools that cannot adequately service such students, parents have the right to obtain these services from outside providers at the public's expense.
In the past, parents whose children required outside therapy were able to procure a Related Service Authorization (RSA) form that allowed them to obtain services from independent providers at no personal cost. The parent had the benefit, and legal right, to interview different therapists before finding a perfect match between provider and child.
Of course, nothing gold can stay, and this past August, the DOE decided to put its' contracts up for auction, with large agencies all vying for the opportunity to lay their claim. It all started when an audit by the New York City comptroller revealed that in 2010, the DOE did not provide related services to more than 25 percent of students because the DOE did not have "a sufficient pool" of contracted therapists to meet all of the incoming mandates. The audit posed a multitude of reasons for the lack of resources: not engaging in open-ended solicitations for RSA providers more frequently, imposing overly restrictive requirements on staffing, not assigning or awarding contracts based on a "systematic needs analysis." In addition, the audit claimed the DOE did not consistently ensure that an internal or contracted therapist was employed before assigning independent contractors. Consequently, parents were obtaining services from independent contractors through RSAs by therapists that, according to the NYC comptroller, "may result in higher rates paid under lesser performance standards, monitoring constraints, and insurance requirements" and who might be "incapable of satisfactorily providing services to students."
Not providing services to over 70,000 students is not a minor oversight that the DOE can simply brush off. A complete revamp of the system is in order. To ensure that this issue never happens again, the DOE is amassing enough contractors to fulfill all the requirements for services.
In line with the recommendations given by the audit, the DOE is continuously soliciting for related service providers, establishing a more exhaustive method of finding DOE personnel and contract companies before utilizing independent contractors, and awarding contracts that consider any and all factors that affect the need for services.
As one can predict, the notion of bidding for contracted services from the DOE had plenty of agencies vying for job. The outcome of the bid determined which agencies would provide evaluations and therapy to those students needing additional services in New York City and the ability to "renew for three more years," according to the application for All About Kids, one of the largest agency providers of evaluation and therapy services. While this does seem to balance out the numbers problem, where does this leave all those independent contractors and private practices that have been servicing your children for years? Powerless, confused, and with empty offices.
One thing is clear however: the DOE is looking for quantity over quality. As stated in the application for All About Kids, "the bidding process requires agencies to demonstrate they have enough qualified evaluators willing to cover the awarded work." In other words, all an agency needs in order to provide services to your children is to create an army of therapists that can handle any and all cases they are assigned. The application form to sign up for assessment cases with All About Kids does not ask for your work experience, area(s) of expertise, references, or educational background. It merely asks for your license number. In fact, the DOE allows therapists to sign up with more than one agency as long as they do so as an "independent contractor" or "an employee with part time status." What this tells me, is that the DOE does not see your children as people, but as case numbers to be assigned to one of a thousand therapists, who is not only providing therapy to your child, but to countless others.
With the number of children diagnosed with special needs on the rise, the DOE seems to have concocted a quick fix solution to keeping up with supply and demand. However, the DOE, being a large, and sometimes detached institution, has neglected to take into consideration one of the most vital components of the provider-child relationship: the actual relationship. The beauty of allowing parents to seek out and choose their own service provider was that they could hand select a therapist that could best meet their child's needs. In addition, they could be sure that their child was not one of thirty, but one of maybe ten, ensuring a more personalized therapeutic approach.
The continuity between provider and child was also greater, with private practices and independent contractors maintaining cases over longer periods of time.
But it wasn't just a provider-child bond that was forged over the years... it was a provider-family relationship that was established. As a speech therapist working for a small, local, private practice, I have developed close relationships with my children, as well as their families. While working on articulation, social skills, or language therapy, I have simultaneously watched them get taller, seen pictures of family events, heard about their basketball playoffs, and high-fived them when they got good grades on their Language Arts tests. The value of working with the "whole" child -- being familiar with their families and social lives, cannot be underestimated. For the autistic child who has difficulty maintaining conversation, having background knowledge of their weekend or daily routines gives the therapist a starting point to engage in conversation. The therapist more easily understands children who are severely unintelligible when there is a personal relationship between them. Most importantly, that level of familiarity, which can only grow over years of close interaction, yields a trust that lets the child know we truly are there for them. As anyone who works, knows, or lives with a child with special needs, you know how important routine is. Depending on the severity of the child's disability, it can take weeks, months, maybe even a year for an autistic child to allow a new therapist into his or her life. It is really once that bond is established, that progress begins to take shape. An abrupt and unannounced change in service providers can severely impact any progress that was made, and could lead to regression.
As one of the owners of my private practice wrote to her local chairperson, "We are not a factory." Providing services to children with special needs should not be a race to see which agency can meet the mandates of the most children. It should be an interactive process between provider, child, and family that grows over the years. It is surreal when I think that right now, someone who I have never seen nor spoken with, is providing therapy to my school aged children that I have put my heart and soul into for the past several years. While the future is still uncertain for small private practices like mine, it does not have to be as it is right now. Parents, if you were told that your child could no longer receive services from your previous provider, find out who your district administrator is and make some noise. Know that you have rights in regards to the type of services you receive. And in the meantime, if an agency calls, make sure to inquire about the potential new therapist's credentials and experience. You don't have to allow your child to be just another prize won by the highest bidder.
Rachel Irons has been a speech language pathologist for over five years, but it feels like her entire life. Growing up with a mother who's an SLP, and a grandmother who was a special education teacher, Rachel felt a close connection to language and learning from an early age. She received her Bachelor's degree from the University of Central Florida and her Master's degree at Hofstra University. She is currently working in a small, private school for children with learning disabilities. After work, Rachel continues to provide therapy for a tight-knit private practice, working with children with various speech-language and cognitive difficulties. In her spare time, Rachel can be found spending time with her husband and friends.
Follow Jaime Openden, M.S., CCC-SLP on Twitter: www.twitter.com/bignityventures