Therapies Curtailed by the COVID-19 Pandemic

Background: During the Coronavirus-19 pandemic (COVID) >1 million children in New York City and Long Island adapted by switching to virtual school. The Individuals with Disabilities Education Act (IDEA) gives children with disabilities rights to free and appropriate public education and related services. COVID disrupted typical practice and forced adaptations to school and therapies.

This study aimed to characterize changes to therapy services received by children with developmental or behavioral conditions (CDBC) in the NY COVID epicenter during the pandemic, such as transitions to virtual therapy.

Methods: An original voluntary Redcap survey was electronically completed by 312 caregivers of CDBC. The survey asked if CDBC received applied behavioral analysis (ABA), speech therapy (ST), occupational therapy (OT), physical therapy (PT), and/or special instruction (SI) pre-COVID (before 3/2020) and/or during the COVID pandemic (3/2020-8/2020). The percent of CDBC receiving each service that then stopped receiving it during the pandemic was calculated.

For CDBC that received a service both pre- and during COVID, prevalence figures were calculated for switching to virtual therapy, having service disruption (stop/restart), and a decrease in satisfaction. The percent of CDBC who were initially improving pre-COVID but not during COVID was also calculated for each therapy. Chi-square tests were used to investigate associations between virtual therapy and caregivers gaining the ability to observe therapy and reporting virtual as a preferred location for therapy.

Results: All service types experienced a decrease in CDBC who received services (Table 1). Decreases for ABA were 40%, ST 14%, OT 24%, PT 30%, and SI 33%.

77-84% of CDBC that received ABA, ST, OT, PT, or SI both pre- and during COVID switched to virtual therapy. 40-60% experienced service disruption. 21-35% of caregivers reported decreased satisfaction for each service. Of the CDBC who were improving pre-COVID, 17-31% stopped improving.

A switch to virtual therapy for ST or OT resulted in a 39% and 65% increased likelihood of caregiver observation compared to those who did not switch, respectively (Table 2). 18.9% of CDBC in ST and 13% in OT had caregivers who preferred virtual therapy; there was no association between caregivers expressing a preference for virtual therapy and switching to virtual therapy.

Conclusion: COVID overall negatively impacted the distribution of therapy across services. Despite the majority of CDBC converting to virtual, out of CDBC who had therapies pre- and during COVID, many caregivers noted discontinuation of improvement and decreased satisfaction. Yet, Virtual Therapy did provide opportunity for caregiver involvement and a significant minority may prefer Virtual Therapy. During the pandemic, a large portion of children were not provided required services to which they have a right; therapists must prepare to transition to provide quality services to meet needs of CDBC, which may include Virtual Therapy.