Cover Story: Back to School

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January/February 2004

By Liz Finch

Allison Bracken, PT, a Progressus therapist, works with student Eliza Nunez at a school in Los Angeles.

Like many speech therapists, Shaelene Ibbeteson, MS, CCC, SLP, has worked in a number of different venues over the years, and with a variety of patient groups. Five years ago, Ibbeteson took a position with Tampa, Fla-based Progressus Therapy Inc, a company that provides therapy for children in schools. Right away, Ibbeteson found that moving out of medical facilities and into a more “natural” environment was fulfilling in a way she had never dreamed.

“I like making a difference in a child’s life, and to be able to give them that help and support in the schools, where they spend so much of their time, is a great feeling,” says Ibbeteson. “The work is very challenging, but I have more independence, and I don’t have the HMOs and insurance companies telling me what to do.”

In addition to that freedom from the dictates of insurers, Ibbeteson’s new job immersed her in a supportive community of other therapists who were ready to give her guidance at any moment. “As therapists, we learn quickly that there are a lot of people here ready to help. We just have to ask,” she says.

Progressus Progress
Progressus did not begin this way. When it was founded in 1989, the company followed a more traditional staffing model, providing therapists on a contract basis to medical environments. Just as Ibbeteson was joining the company 5 years ago, however, president and CEO Michael McBurnie decided to shift his focus.

Progressus began contracting out speech language, occupational, and physical therapists to schools and school districts throughout the country. McBurnie also developed an early intervention program that involves therapists going into homes and seeing children in community settings.

“This field is very rewarding for the company and for therapists working with kids,” McBurnie says. “It’s a different kind of work compared to working in a nursing home, where therapists are helping people transition to the end of their lives. With children, therapy can sometimes turn around a disorder and make them fully functioning.”

As McBurnie was sending his therapists out to these new settings, he quickly discovered the need for localized resources to help them do their jobs better, and Progressus’ “managed therapy” concept was born.

“Managed therapy is about two things: working with schools and offering other programs besides staffing, and helping therapists with training, orientation, and follow-up,” McBurnie says. “We offer a component of added value by providing a network of many people.

For example, a preventative program in the Mt Diablo Unified School District in Concord, Calif, developed when Progressus’ therapists determined that many kids being referred to special education had simple problems, such as writing disorders. “We realized that such problems could be prevented by working with kindergarteners and first-graders,” McBurnie says. “That district was able to save thousands of dollars because fewer kids were getting referred later on for special education.” Progressus works with the government’s Department of Health and Human Services and Department of Education, sometimes contracting directly with the latter, and has certification in many states to work in school settings. The company has more than 320 employees, who work with 175 school districts in 20 states. Regional offices are in San Francisco, Los Angeles, Baltimore, and Honolulu.

Though therapists are welcome to take short-term assignments and move around to such appealing locales as Hawaii and Southern California, many of Progressus’ positions are long-term.

“Many of our employees have been in the same job for 5 or 6 years,” McBurnie says. “People like working for the company, and we have a good retention rate of employees.”

Part of the reason for that loyalty is the fact that therapists have access to a local office for management support, and that only senior therapists oversee programs in the field. Ibbeteson is one therapist who says she stays with Progressus because of the company’s support network.

“I find that, unlike other contracting companies, here the job is full-time; it’s your job and not just a contract for a month at a time,” she says.

“Our managers are there specifically to help and mentor our therapists, because younger therapists do need mentoring,” McBurnie says. “That is attractive to our people, who like the idea of going to a new place and having mentors and senior staff members already there for them to count on. They have a social network as well.”

Most of the managers also started out as therapists for Progressus, like Ibbeteson, who now serves as regional manager in Southern California and draws on her own early experiences when helping the staff therapists.

“I didn’t know everything when I started, and it was really difficult because I also didn’t know who to call for help,” she says. “I didn’t know where to get tests if I needed them; if I had questions about therapy, there was no one to talk to, and I felt alone in the school because originally I was not invited to district meetings and such. Now I work hard to make sure that doesn’t continue.”

Sheila Harris, PT, regional manager in Hawaii, also enjoys her work for those reasons. “The therapists are grateful that when they call their manager, they are talking to another therapist,” says Harris, who also previously worked in a number of different settings, including schools, a state pediatric facility, neurological wards, and rehabilitation facilities. “That means they can get concrete answers and direction on where to go with their problems. The feedback I’ve heard is that they are very grateful for that chance to talk ‘therapy talk’ with us.”

School Strategies
Having a close-knit group of coworkers to rely on helps therapists meet some of the unique challenges of providing therapy in the schools, which Ibbeteson and Harris admit can be very difficult. Ibbeteson says she was surprised to find that the children she was servicing in lower socioeconomic areas were so underprivileged that many did not even know how to play a game, hindering her initial therapeutic strategies.

“I thought I was offering strategies that were at base level, but there turned out to be so many levels below that,” she says. “I was able to grow that way and find more beginning spots for my kids. That also taught me that it is important to keep your hands in therapy. If you don’t know what the therapists are doing, you won’t be successful in helping them with their problems.”

“Having therapists who understand both sides and are able to meet administrators on their own schedule helps a lot in terms of business flow,” agrees Jeff Bicknell, MBA, MS, OTR-L, regional manager in Northern California. “As school-based therapists, we face certain challenges. Since the therapists are not employees of the school district, we are not ‘one of the gang,’ and we have to know how to insert ourselves and develop relationships with the staff. We also don’t have the same approach as teachers, so we have to be able to develop effective communication strategies.”

Bicknell points out that working with students who are not ill but rather have learning disabilities means that therapists have to come up with strategies for dealing with daily life. Being in the school environment helps with that, because it allows them to see what the challenges are for each student in daily life.

“We get to be consultants in collaboration with other special education professionals in finding what works for students throughout the day,” he says. “Maybe their problems will never be ‘fixed,’ but they can learn how to modify their environment to deal with those problems. We are empowering students to be advocates for themselves and find their own solutions. These are skills they can use for the rest of their life, and which will help them enter the workforce.”

Progressus also makes a point of not neglecting the skills therapists need in an ever-changing workforce by offering education options as well as a chance to move into new contracts whenever they wish.

“We have a pool of travelers to fill in, particularly in the summer when they otherwise would lose hours in school districts,” McBurnie says. “We have a per diem staffing office that finds work for our therapists and keeps up their hours from year to year, and we are expand-ing that into nonschool or nonpediatric settings.”

“The great thing about Progressus, especially in Hawaii, is that the therapists have been able to keep their resumes up from an excellent clinical standpoint,” Harris says. “They work in multiple fields, and that is not only very rewarding for therapists, but if they relocate, they will have a great resume.

“I am able to still go out and practice my trade, so this has been a perfect setting for me,” adds Harris, who does caseload work in early intervention and has branched out to work in adult outpatient therapy and aquatherapy. “My degree is in accounting, so I have been able to merge the business and therapist sides of my life. It has been a perfect blend that’s kept me challenged for years.”

Moving On
McBurnie says the company is also growing, with plans to do more in pediatrics in center-based practices and more development of its early intervention program on a larger scale with private clinics. Perhaps the biggest change, however, is the recent merger with Baltimore-based Sylvan Education Solutions.

“We were looking at growing into the Baltimore area, and I started looking at Sylvan,” McBurnie says, “They were seeing kids in the schools for reading and tutoring, while at the same time, we were seeing kids in special education. By combining, I felt we could become the premiere education company. I was impressed with what they do as a private company working in schools and having their own centers. As the discussions went on, I felt it was a good match. There was synergy.” Jeffrey H. Cohen, president of Sylvan Education Solutions, agrees. “There is an arguably exploding need for high-quality certified therapists across the spectrum—speech, PT, OT in school settings—and a significant imbalance in supply and demand,” Cohen says. “We are looking for partners to close that gap and put the supply/demand ratio back into balance. Our goal is not to supplant public education, but to supplement it through significant partnerships with companies such as Progressus.

“Progressus has taken a traditional staffing business and turned it into a partnership business with managed service. They don’t just supply bodies per hour; they have also crafted a managed therapy approach in order to leverage their administrative capabilities and reduce that burden on the school district. In doing so, they have become a cost-effective outsource solution for school districts.”

While the day-to-day work of the therapists and managers at Progressus is unlikely to change greatly due to the merger, Bicknell, Ibbeteson, and Harris all believe that the association will eventually lead to greater opportunities for those in the field.

“Sylvan is very well known in the education system, while Progressus is well received and recognized by the special education community,” Bicknell says. “Bringing the two organizations together gives us all more name recognition, support, and that many more resources.”

“I think our relationship with Sylvan will help us become more structured,” Ibbeteson says. “We grew quickly and did everything after the fact. Now with more financial support, we will be able to expand.”

For those therapists seeking to move outside of traditional niches, Harris says that opportunities like those abound through Progressus. “There is so much work now for therapists that anyone with good experience in a particular field can find a setting that suits them,” Harris says. “In the pediatric world, just wanting to work with kids is the primary thing. We can find you a job, whether it is in early intervention or with older kids in the school systems.

“Pediatrics is always fun, and it’s very rare that I have a bad day,” she adds. “That is very attractive to any therapist.”

Liz Finch is a contributing writer for Rehab Management.

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January/February 2004