A North Country Therapist Shortage Means Waitlists for Kids in Need of Early Intervention

Statewide, there’s a shortage of Early Intervention providers — those are therapists that work with young kids on their speech and movement. That means infants and toddlers with developmental delays and disabilities are having to wait longer and longer to receive services. 
 

Say you’re the parent of a two-year-old child, and you notice that they seem to be a bit behind in their speech. There’s a federally mandated program that exists to address that: Early Intervention Services. It's run through municipalities, and in the North Country, that means at the county level.

Parents can get in touch with their county, have their child evaluated to see if they have developmental needs, and, if they do, get connected to services like speech and physical therapy.

The whole idea is to get kids help when they’re young, said Christy Bezrutczyk, the HealthySteps specialist at Mountain View Pediatrics in Plattsburgh. She said they can make enormous progress quickly. 

"Watching the children make that progress is why we all do it," Bezrutczyk said.

She said Early Intervention Services are so critical because they tackle developmental issues early; a small issue at two years old can become a big one later, if unaddressed. 

"So if we have a child who is struggling in the birth to three [years old] range and not getting services, by the time they turn four and can access services through the preschool program, habitual behaviors are probably set in," Bezrutczyk said, " and the child is really going to be ... much more delayed than if we were able to intervene sooner." 

When it works, it's magical, Bezrutczyk said. "First words, seeing a kid say 'mama' for the first time, taking first steps." 

But here’s the problem: therapists are leaving the program, and there aren’t enough left to work with all the children who have needs.
 

Across New York and the North Country, Early Intervention Services programs are reporting a severe lack of therapists and providers. Here in the North Country, Clinton County has over 50 kids on their waitlist. Franklin County has 18.

"We are in a real predicament right now," said Rebecca Kelly, who manages Early Intervention for Lewis County Public Health. She called the current lack of providers a crisis.

"Thirty percent of the kids that we have on service are on a waitlist," Kelly said. Most of them are waiting on speech therapy, counseling, and special education services. Kelly said there are several dozen children on the waitlist for a preschool spot with special education services.

Many counties are offering telehealth services, but Kelly said those are limited.

A toddler or an infant is not going to stay engaged with a screen where a therapist can follow them around the room and engage in what they're doing. But teletherapy has played a role that, at the least, is better than nothing.

Nothing is what a lot of kids are getting right now. Kelly said that’s heartbreaking, especially because, post-pandemic, kids are needing more intensive services. That means their delays and issues are bigger, and they would really benefit from immediate help.

"So we've identified that the child does have developmental delays, and then we have to break the news to parents that we just don't have a provider. So I lose sleep over those kids."

There just aren’t enough therapists. And that’s because they’re leaving Early Intervention.
 

Since September, Rebecca Kelly said Lewis County has lost three providers to school districts. It's a crushing blow to the area's Early Intervention Services, but she said she can't blame them.

School districts offer health care, state retirement, and, crucially, a salary. Early Intervention doesn’t, and actually treats providers like contractors. They’re paid hourly, at a state-determined rate that is lower than it was 20 years ago.

Providers are only paid for time spent with a child. Kate Ryan, who worked for years in the North Country as a speech-language pathologist and behavior analyst, said the way providers are paid doesn't account for everything else involved.

"It's not just spending the time with the child. It's also communicating via text or phone or email with other therapists. It's writing the notes, it's writing the reports," Ryan said. "So there's so much more than just the actual doing the services, which the rate doesn't necessarily compensate accurately for."

Today, Ryanis the director of the Adirondack Birth to Three Alliance, a group that advocates for more resources for early childhood. 

She said another reason the North Country is losing therapists is that Early Intervention doesn’treimburse mileage. That’s a problem in rural counties, where therapists often travel long distances to see children. She said as gas prices have gone up, along with the cost of living, paying for your gas and car repair has become a bitter pill to swallow. 

It's not financially possible for many providers, Ryan said, and that's why people are leaving.

"The reality is [in the current climate] there are very few new therapists either relocating to our area, or choosing to stay in Early Intervention and preschool," Ryan said. She knows of a local agency that provides Early Intervention services that "just lost three physical therapists who all chose to move to Colorado."

The reimbursement rate is significantly higher in Colorado than in New York.
 

The low reimbursement rate, the lack of benefits, and the unpaid time spent on paperwork are all reasons providers and therapists are leaving the Early Intervention field. 

That needs to change, says a statewide coalition called Kids Can’t Wait, which is campaigning for the New York state legislature to increase the reimbursement rate for Early Intervention providers by 11% this year.

It’s not a game-changing increase, Ryan said, but it would be something. "I think it's an important first step to highlight the needs of Early Intervention, to hopefully build the momentum to get, you know, providers and families more of what they need."

Christy Bezrutczyk, from Mountain View Pediatrics in Plattsburgh, said the big dream would be to turn Early Intervention providers into state employees, treated the same way teachers in the K-12 system are. That’s the best solution she sees for the very real crisis of care that’s unfolding now.

"I think the house of cards was crumbling, and now it's crumbled," she said. "It's coming to a climax because kids are on waitlists for over a year now! For Clinton County to have over 50 kids on a waitlist, that's unheard of."

Kelly, in Lewis County, said providers need better working conditions and pay because a shortage of them means children and families pay the price.

"I know there's no immediate fix. But, we can't continue this way. Our kids are suffering."

This story originally reported by Amy Feiereisel for North Country Public Radio.