Indiana is struggling to give kids speech therapy. Here’s why it’s getting harder.

Indiana let emergency permits that make it easier for schools to hire high-demand speech-language pathologists lapse — and there won’t be time to address the oversight before the first day of classes.

“This is going to take legislative action to resolve,” said Risa Regnier, director of licensing for the Indiana Department of Education. “So there’s really no way to fix this for the beginning of school this year.”

The communication disorders emergency permits, which expired at the end of June, were created by a 2007 law to offer relief to schools struggling to find enough speech-language pathologists, educators say. While the number of students who will be affected wasn’t immediately available, nearly one-fifth of all special education students across the state need speech and language services.

The permits allowed schools to hire graduates of four-year speech-language programs who have been accepted to master’s programs, which are typically required for a full license as a speech-language pathologist.

But the employees who use these permits are no longer able to continue in their jobs, and the state cannot issue new permits unless lawmakers step in.

“You have to understand that we have a huge shortage of (speech-language pathologists),” said Ann Higgins, director of a special education cooperative that serves four districts in north central Indiana. “This is the beginning of my sixth year being director, and we have yet to be fully staffed … as a result, we’re constantly piecing together a puzzle, if you will, to provide speech services.”

These professionals can work in educational or medical settings, and their roles can vary widely depending on the students they serve. They might work on letter sounds with some students with milder needs, but they could also help students with more severe disabilities improve swallowing.

According to state data, 84 educators who currently have full communications disorders licenses once held emergency permits, and 190 have received them since 2007.

The emergency permits are a “last resort,” said Tammy Hurm, who handles legislative affairs for the Indiana Council of Administrators of Special Education. But they have made it possible for speech-language program graduates to work as pathologists while completing their licenses. With the permits, schools have had more flexibility around supervision, but permit-holders still couldn’t practice outside of what they’ve been educated to do.

Although the number of people affected might seem small, many districts are seeing a shortage, Hurm said, especially rural districts like Higgins’ that already have a hard time attracting people to jobs in their communities.

Because schools can rarely pay as much as a hospital or nursing home, schools are not as attractive for the already-small number of fully qualified speech-language pathology graduates. Part of that also stems from the fact that the needed master’s programs have caps on enrollment.

“A lot of the kids that graduate go directly into medical (jobs) because they pay more, they can work more days,” Higgins said. “Unless they have school experience or know that school is what they love … a lot go medical.”

This problem is not unique to Indiana. Across the country, demand for speech-language pathologists is projected to grow 18 percent by 2026, according to the Bureau of Labor Statistics. That’s partially because of growth in other groups of people that need them, such as senior citizens, and because of growing school enrollment and earlier, more frequent identification of speech and language issues.

Without these permits, four-year graduates in speech and language can generally only be speech-language pathology assistants, which means they can offer certain services with supervision, Hurm said. Salaries can be hourly or close to what a starting teacher might make.

To get over the pay hurdle, Higgins has been creative. Her co-op runs entirely on federal funds, a strategy that began three years ago so she could pay speech-language pathologists higher salaries than what collective bargaining rules dictated. More than one-third of her budget is just spent on speech services.

But critics of the emergency permits say they’re a short-term solution and place under-qualified people in roles they aren’t prepared to handle.

Undergraduate students who study speech, language, and hearing sciences typically have only a theoretical knowledge of what communications disorders are like, not the clinical, hands-on experience they’d get at the graduate level to diagnose and treat children.

When the students get an emergency permit that grants them some responsibilities that usually only come with full licensure, it can be a disincentive to finish the program, critics point out.

“The problem with that is that those folks then are not put in a position where they have to continue their education,” said Janet Deppe, director of state advocacy for the The American Speech-Language-Hearing Association. “We don’t necessarily believe that just putting a body in a place is going to make a difference in that child’s educational success and success beyond education.”

Adam Baker, spokesman for the education department, said education officials are discussing what to do about the permits now so that they can find a way forward and propose a solution during next year’s legislative session.

Higgins didn’t find out the permits were expiring until the spring — after the previous legislative session had already ended. With the emergency permits off the table for this year, Higgins has lost one employee. That leaves her with three full-time speech-language pathologists for the coming year in a co-op that serves about 1,170 students — 455 of which need speech services. To be fully staffed, she needs seven pathologists.

Each speech-language pathologist is responsible for about 60 students at a time, though it can grow to be closer to 70, she said.

To get by, Higgins is having retirees come in to supervise assistants, evaluate students, work on education plans, and write reports. She’s also using teletherapy — providing speech-language services over the internet — for high-schoolers, who generally need less intensive therapies.

The permit expiration is frustrating, she said, because it’s one more factor working against schools that have been trying to fully staff speech and language programs for years — and especially because for the majority of students, speech therapy can fix their issues. It’s not always the case, Higgins said, but many times, students’ speech or language problems are correctable with therapy, meaning they won’t need services in the future.

It puts the shortage, and the effects of losing the emergency permits, into perspective, she said.

“While there may not be many people impacted by this particular change … it just magnifies this whole shortage issue that we have with speech-language pathologists,” Higgins said. “We just lost a person that serves 60 kids.”