Bridging Education Gaps through Teletherapy - Kate Eberle Walker, CEO of PresenceLearning

RISHI DESAI: Hi, I'm Rishi Desai and today on Raise the Line, I'm happy to be joined by Kate Eberle Walker, CEO of PresenceLearning, the leading provider of online special education therapy services for K–12 schools. She's also the author of The Good Boss: 9 Ways That Every Manager Can Support Women At Work. Kate has more than 20 years of experience leading education companies. She was the CEO of the Prisoner Review, a leading provider of test prep admissions and tutoring services, including online, on-demand tutoring under the tutor.com brand. Founded in 2009, PresenceLearning partners with schools to expand their capacity to serve all students with IEPs or behavioral mental health needs. Their large national network of over 1500 speech language pathologists, occupational therapists, and school psychologists deliver services through an award-winning proprietary teletherapy platform. Thank you so much for being with us today.

KATE WALKER: Thank you for having me. Great to be here.

RISHI DESAI: Awesome. So Kate, I'd love to start by getting a sense for, how are you doing with everything that's going on in the world? How are you and how's your family?

KATE WALKER: We're doing great. I mean, as great as anyone can be doing. We were just talking about how it's been over a year now since any of us have been on an airplane, which is strange to be staying so close to home. But it's been really nice in other ways, to get to have weekday lunches with my daughters when they have a break from school and I have a break from work. So we're finding the silver linings.

RISHI DESAI: That's awesome. Yes, lunches in the middle of the day with kids is something a lot of parents are now coming accustomed to and might even start missing once kids start going back to school.

KATE WALKER: It's so much healthier, too. I mean, I'm actually eating lunch, right? And actually taking the time to eat lunch.

RISHI DESAI: The same is true on my end. I'm definitely cultivating a lot of good habits because I'm trying to model them for my kids as result. You have such an amazing background in education, and obviously it's an interesting time with education right now. I'd love to know your background. What got you started? Especially your interest in online special education therapy and PresenceLearning.

KATE WALKER: I've always had an interest in, call it the intersection of technology and education. To me, the most valuable thing we can do as companies in this area is figure out how to use tech to bring the right experts closer to the students, to the kids who need them. That was a big part of what I did when I was running tutor.com. The whole idea was, kids need help from subject matter experts, and so let's build something that makes those experts accessible and affordable just at the right moment when kids need them. When I got to know PresenceLearning and what they were doing, it was, to me, the ultimate business to get the opportunity to run because they were doing exactly that. They had built a tech platform that was bringing the specialists, the special education clinicians, closer to the students and giving a lot of kids access to the experts that they weren't otherwise getting coming into their schools. They were doing it in the area of education that I think needs it the most. These are the kids in the public education system who have learning disabilities, have special needs, and they need the support.

RISHI DESAI: So for those that don't know PresenceLearning, what is teletherapy? What does that look like? What was happening before PresenceLearning came on the scene? What's standard, and what does PresenceLearning do differently?

KATE WALKER: Probably the first thing that's helpful to know about how special education works in schools is that there's actually a federal law, the Individuals with Disabilities Education Act, that requires all public schools to provide support to students with learning disabilities. There are over seven million kids across the US public education system who have a disability and have required services that are delivered through their public schools. A lot of that is speech therapy, speech language pathology, occupational therapy, or other types of counseling. And despite the fact that schools have teams to do this work and they have that federal mandate to do it, before teletherapy came along, a lot of those services were just going unmet mostly because of a hiring need and capacity gap, so to speak.

There are only so many of these professionals; they're highly skilled and only a subset of them do work in schools. So schools would try their best to recruit, to hire, and in some cases they'd have shortages on their staff and that would trickle down to the kids who wouldn't then get their therapy sessions or wouldn't get the full requirement delivered. And so teletherapy really came to be in education in that context of saying, "Well, we can help connect those therapists to the kids." 

It started out in the very rural remote parts of the country, where you had these very large districts by square mileage, geographic measure. They weren't able to get the talent in their areas and hire them and have them physically come to the schools. So they became the first innovators who bought into this idea of, "Well, what of the work can we do online? What could allow us to make use of a part of the workforce that lives elsewhere, but wants to do the work?"

RISHI DESAI: I'm just thinking through the lens of a teacher. Is there a challenge? Let's say I have a classroom full of 20 students. Let's say two of the students are on an IEP; do they have those students sit in front of a computer and then interact with the teletherapist? Is that what's happening? And then the other 18 kids continue with their curriculum?  I'm just curious about the logistics of that. The reason I ask is that I have a four year old and getting him to spend time in front of a computer has been a Herculean challenge for me. So I'm just curious, logistically, how does that work in a classroom setting?

KATE WALKER: It requires another adult. So typically what happens, if it's happening inside the school is, there'll be a learning coach or someone will come and get the child and bring them to another quieter space to sit in front of the computer, and they'll stay in the room. So they won't be directly involved in delivering the teletherapy, but they'll be the supervision on the scene, so to speak, to make sure that it happens. These days, that person, that learning coach, is very often the parent.

RISHI DESAI: Got it. That makes a lot of sense. So essentially the parent also is learning from the teletherapist as well, right? Presumably.

KATE WALKER: It's a really nice side benefit or incremental benefit to this, parents getting to watch what happens and learn. It helps them know what to do with their children. One of my daughters gets online speech therapy and I love watching and learning and seeing what really happens.

RISHI DESAI: This has implications. I mean, you mentioned rural, I'm also thinking of the fact that these challenges exist beyond American borders. Do you all have a presence outside of the US, or what is that international piece, if that's part of your scope of work?

KATE WALKER: I wish we had more of an international presence. We do get requests, we get inquiries. The short answer to why not, is really regulatory restrictions. The way these types of work go is, each professional has to be licensed in the state where she lives and then also in the location where the student lives. And so, just for the US alone, that leads to an incredible amount of cross licensing logistics and coordination to help therapists get the additional state recognition beyond their own state. We just haven't gotten there too, going cross border with that and figuring out what each country's local license is, but we get a lot of requests for it. I think there's something important to be done there too.

RISHI DESAI: In my field, I'm a pediatrician, they had similar rules. Like if I wanted to practice and see a child, I'd have to be in the same state. Telemedicine has relaxed a lot of the rules with COVID, and I'm curious whether there's a similar relaxation. Maybe it hasn't happened yet, but do you foresee that happening, where maybe one day a therapist in Florida can treat a patient in New Hampshire? Would that sort of thing be possible down the road, do you think?

KATE WALKER: I think it will be. I certainly think it should be. We haven't seen those waivers or those cross-state acknowledgments come through yet in COVID, but what we are seeing is finally some more action on some of the proposed interstate compacts, where a number of states are coming together and mutually acknowledging each other's licenses. So to me, that tells me that there's more momentum here. The goal of course, is to get to full contact across all the states.

RISHI DESAI: Is your sense that this will continue to be, let's call it “the new normal,” after folks have gotten vaccinated for COVID? Maybe that it's not the same level of threat that it is today, and folks start going back to school—do you sense that there will still be this need for teletherapy at the same level that you're seeing today?

KATE WALKER: Short answer, yes. There's a couple of things that I think have changed for good and won't go back to the way they were. One is an acceptance of teletherapy. There used to be so much more skepticism or disbelief that it could really work, and we've moved past that more quickly than anyone would have expected because everyone had to try it. So many more people have seen for themselves that it can be done, that a lot more can be done through teletherapy than people would have thought prior to this. 

Teletherapy exists, it emerged, to cover gaps. There are a lot of gaps right now. There are more gaps than ever before, in what services students should be receiving and what they are receiving. They're always there because what caused all this in the first place, the capacity constraints, the hiring constraints, those are still there. The gaps are getting bigger because we have more and more children coming into the education system, getting diagnosed with needs. We're over seven million IEPs and counting, and you still have a very limited professional group to get the work done. So I think now that people have seen it and believe it, that you can do teletherapy, I think it'll be used to fill a lot more of those gaps that were already there. 

The other thing, maybe even a bigger dynamic that I think has changed for good, is the awareness of the benefits of remote work and maybe a growing preference for it from the workforce. That determines everything, right? If this is how clinicians want to work, how they're going to choose to work, then I think more interactions with students will need to happen this way.

RISHI DESAI: It's a really good point. The demand seems so clear, the way you laid it out. So many students have a need, and so many teachers are not equipped to handle that need. Then there's the supply side, the supply of expertise. Are you having a hard time keeping up with that demand? Is there enough supply of expertise out there, especially given all the other stuff that folks are getting pulled into? Experts are doing mental health counseling and other types of work—are you able to keep up with the amount of demand that you're seeing?

KATE WALKER: It is hard to keep up with the demand. I mean, the biggest restriction on us growing as fast as we want to grow and doing as much as we want to is getting the right professionals and recruiting them. What we aspire to do is really expand the workforce of who is qualified and available and interested in doing the work with kids in schools. I think we already do that in one way, which is that it used to be that you might, as a speech language pathologist,  go work in a school early in your career and spend a few years there, but those are really high-stress jobs and they involve a lot of driving around from site to site, with very heavy case loads. So what used to happen before teletherapy as a career path was an option, was they would opt out often after having children and deciding that they wanted a bit more control over their schedules.

I probably should have mentioned that there is a very high concentration of women in these professions. Speech language pathologists are over 95% women. We recruit them to basically stay and keep on doing the work with kids in schools. We say, “You don't have to leave and go to private practice; you don't have to leave and go work in a clinic, working with adults. You can keep on engaging with these kids who you want to help, and you don't have to do it in that traditional full-time on-site structure.” That's how we grew and recruited and have gotten to over 1500 clinicians who've chosen to do it that way. I think that really does expand at least thinking about who is available to do this for kids in schools.

We've really helped expand the workforce, but the other really important work to do is at the start, in the degree programs, generating more awareness of these professions. I think these are really attractive jobs. I mean, they pay well and they're really rewarding. My hope is to get more engaged, we are getting more engaged with the graduate programs and even undergraduate programs to broaden the awareness.

RISHI DESAI: There's so many parts of your professional story that are interesting to me. One part that we haven't talked about is your book, The Good Boss: 9 Ways That Every Manager Can Support Women. You just talked about the fact that a lot of your workforce is women, and you talked about acquisition. I'm curious about retention. Maybe there are pieces of your book that you can allude to, but how do you keep, specifically women in the workplace, that are on your team, motivated and excited about their professional growth?

KATE WALKER: Yes, I have so many thoughts about this that I did write a book about it. The overall premise of the book is putting the responsibility on managers and companies to really understand that experience of women in the workplace. In my own experience, the workplaces that I've been in were not really built by women or designed for women, and particularly not for working moms. So what I do in my writing and do a lot in my communications with our workforce in our recruiting and thinking about retention is, I acknowledge the experience of working moms, the need for predictability in schedules, control over, not necessarily the overall workload, but which hours of the day they're committing to, the ability to let life come into the traditional workday a little more. I think there are so many women out there who are very happy to get back on their computer and do a little work later at night, or early in the morning. A lot of it is  acknowledging and trusting that these women want to work, that they're going to get the work done, but they need some flexibility and some predictability in how it's all happening. 

This year has made that more critical than ever. We've had a lot of situations where women in our clinical network had to take temporary leaves, they had to make changes to their caseload or the hours that they were available to work. Just dealing with the downflow of changing availability of childcare and school schedules, and is school going to be hybrid, or is it going to be in person, or it's going to be at home? All of that impacts the availability of the work.

What we try to do more than anything else is make it very easy to come back on your terms, whenever you're ready and remove that stigma that has been out there for a long time, that a lot of women get really nervous to leave even if things have gotten to a point where it's not sustainable. It's, "What will people think if I walk away?" Or "if I walk away now, I'll lose all of the credibility that I've built up." So we're trying to take that stress out of it and just say, we understand that things change, schedules change, and when you're ready, we've got lots of opportunity.

RISHI DESAI: That's awesome. I'm so curious to know, what are some common things that you hear from HR teams out there that you wish that they would do differently? Maybe some advice you would give HR teams in terms of how they can reduce that stigma for folks that are returning back, because they feel like their professional career got sidelined for a while, or whatever the reason was that they're feeling that kind of angst. What would you suggest that they can do to help make that less stressful for folks coming back?

KATE WALKER: I think HR departments often treat changes in work or gaps in work as a signal of a lack of commitment to work, which is probably the biggest mistake. There could be a lot of reasons that someone makes that decision to take a break or have a gap in their time at work. I think we need to give credit that whenever a woman expresses interest in a job, especially when it's coming back to the workforce, that she's thought it through and she's applying for a job because she wants to work and is ready to work. I think we ask questions or speculate rather than asking directly. So I always encourage more of, if you have a question about a gap, ask, “Why did you stop working then? Why are you ready to come back now?” But don't assume that it says something about her dedication as a worker. 

There are a lot of assumptions that are made or imputed behind the scenes. The book goes through a bunch of different examples of that. How people react or change their viewpoint of a woman's ambition after she gets engaged is one topic that we go through in the book, and how  people react to name changes once she gets married. There are so many examples. I promise I won't go through all of them here live, but the biggest piece of advice I give to managers, leaders, HR departments is, don't assume, give her credit. If you assume anything, assume that she has ambition to work and desire to work.

RISHI DESAI: That's really concrete advice. I appreciate that. The other audience that I'm keeping in mind is that we have a lot of students early on in their health care careers and young professionals just starting out. For those folks, what advice would you give as they emerge into the marketplace and think about all the options that are out in front of them? You alluded to the fact that working from home is becoming increasingly attractive to a lot of folks. What are other things that they ought to be thinking about as they start their journey in clinical medicine?

KATE WALKER: I think there are so many more options for ways to work, that it's a really great time to be starting out in your career, because you can ask yourself, "What do I really love doing?" And then figure out which of the job options allows you to do that more often than anything else. That's part of why telehealth opportunities, online teaching, teletherapy, all of these areas become appealing, because there's more actual concentrated patient time, which tends to be the thing that gets people excited and is what they love to do. Whether or not the online modality or in real modality is what gives you energy, I think there's more opportunity right out of the gate to decide that for yourself and to try it out.

The other piece of advice I always give everyone is, your first job doesn't have to be where you spend decades of your career, either. There's always value in trying out something and getting experience. I think you are in a much better position to appreciate your job once you've had a variety or a few different environments to compare it against.

RISHI DESAI: That's awesome advice, and it's an interesting point. I had not really thought about the fact that you actually may spend more time doing clinical work because you're not commuting, not getting ready and doing paperwork and all that. You're literally just going from family to family.

KATE WALKER: Yes.

RISHI DESAI:Listen, it's been such a pleasure chatting with you. Thank you so much for being with us today.

KATE WALKER: Thank you so much. I can't believe that we're done already. That flew by. It was a really interesting conversation.

RISHI DESAI: Awesome. Well, I'm Rishi Desai. Thanks for checking out today's show. Remember to do your part to flatten the curve and Raise the Line. We're all in this together.