When the COVID-19 pandemic hit, I was flooded with questions from therapists who were suddenly thrust into the world of OT telehealth, also known as teletherapy. Personally, I had never done it, but I’ve always been interested in learning more about telehealth for school-based practitioners. I had the pleasure of interviewing two school-based occupational therapy practitioners, who happily shared their telehealth tips, tricks, and strategies.
Interview with Lesley Geyer, MA, OTR/L & Kendra Cooper, OTR/L
Getting Started in PT and OT Telehealth
What is your number 1 tip for therapists that are new to teletherapy?
- Don’t expect perfection. We are not in ideal times.
- Do your best and provide lots of consultation.
- Find a friend to do a practice session with.
What do therapists need to be concerned about with licensure and state telehealth regulations?
- You need to be familiar with your particular state’s licensure act and what it says about telehealth. Also, check to see if your state has any telehealth statutes.
- Keep in mind, OT uses “telehealth”, but other disciplines use different terminology.
- Be sure the student is located in the state where you hold a license during all sessions.
- Notify your malpractice insurance carrier that you are providing services via telehealth
TELEHEALTH & PRIVACY
When it comes to teletherapy, a huge point of concern is privacy for students. How can therapists, who are suddenly thrust into teletherapy, comply with privacy rules and regulations? What programs do you recommend for teletherapy?
- You want to use a program that is HIPAA/FERPA compliant (Zoom and Go to Meeting have versions that are).
- Skype and Facetime are not.
- Both student and therapist should be using secure servers. Public servers are not safe options.
- Both student and therapist should also be in a private room.
Are group sessions allowed in teletherapy? Does that violate FERPA?
- We do group sessions frequently. Our students are in virtual classes with other students. We explain the group process to parents ahead of time to be sure they are OK with it. We use only first names.
- You can provide an Informed Consent form for parents to sign. Check your school’s policy and state laws and regulations to assure compliance.
What exactly is considered Telehealth?
Many therapists are providing families with videos or packets of activities. Does teletherapy have to be LIVE in order for it to be considered teletherapy?
- Teletherapy can be live or Store and Forward, where a video is recorded and accessed by the client/family at a later time. It must be a video. If it’s just packets, we consider it to be a Home Exercise Program.
Effective planning of teletherapy sessions
What is the best way to plan for our teletherapy sessions and not overwhelm the student’s guardians with handouts, worksheets, activities, education, etc, with everything else going on?
- Platforms, such as Smart Notebook/Smart Exchange and virtual whiteboards, are very helpful. Online programs, such as Go Noodle, have many videos that can be used to base a session around.
Do you have any time-saving strategies? Tips to cut back on the planning or the paperwork?
- You should continue with the same documentation you were required to do when you saw the child on-site.
- Continue data collection for goals but use caregivers/learning coaches to report and assist with data collection.
- For time-saving, prep short videos, save favorites/websites in Word docs for quick access, save individual or category type of Smart Folders. You can begin an activity and begin again where you last left off in the program.
- Send handouts, such as handwriting worksheets or sensory online links, in separate emails so that the family/you have quick access during a session to, print out/review resources.
- Daily computer cleans are simple and can improve your computer’s usage and ensure efficiency.
How do you recommend that therapists send or share videos with families? Large files are too big, should they post the videos? Use a cloud drive?
- Youtube can be used, but be careful not to include any confidential information. You can post a video and make it “unlisted”. When you share the link, parents can view the video, but it’s not public. Screen Caster is a wonderful, free, easy-to-use option to create a video to share.
Teletherapy for Challenging Students
Many therapists are finding their OT and PT treatment sessions very challenging with students who have lower cognitive levels and are non-verbal. Also, the students that have decreased attention, are defiant or have limited mobility. How would a teletherapy session look different than a direct treatment session?
- Sometimes you have to use more of a consultative model with students and guide the caregiver through therapeutic activities.
- Work with the caregiver to set-up behavior intervention plans and arrange for rewards for good behavior and work completion.
- Use what the student has in their own environment as motivators e.g. toys, pets, parent-approved videos, animated rewards, at home reward system
Do you have suggestions for OT or PT treatment activities for these types of students?
- Not all students are appropriate for PT and OT telehealth sessions and need on-site therapy. At this point, this is not possible.
- For students where you are determining their functioning level, ensure caregiver presence for safety and be prepared to stop a session, if you have any safety concerns.
- Use Smart Notebook simple tasks like matching activities, clicking with a mouse on large targets or using a student’s on-site toys. Use multimedia items online to aid engagement in the task: interactive programs, annotation tools
What about hands-on treatment or cues? Do you instruct the parent in techniques? How involved is the parent? Or how involved CAN the parent be?
- It depends on the age and level of the student.
- For younger children and those with more intense needs, the parent attends the session with the child and assists as directed by the OT.
- Older students may do their sessions without a parent/learning coach present.
- There is often lots of parent instruction and consultation that occurs. This includes verbal cues, demonstration of the task first with the parent, and education for Hand Over Hand and fading cueing/assist
OT Telehealth for Gross Motor Skills
What about gross motor activities? Do you do them along with the student? Show pictures of what you want them to do, etc.?
- Often, we model first, then observe, and have a learning coach there to help with any hands-on assist that might be needed. They could be done with a child following your lead and doing them together.
- A wide-angle webcam can be helpful. Videos can be a wonderful addition, music, and activities that work well in small spaces vs. a large gym.
- Consider using bodyweight exercises, animal walks, yoga, stop/freeze games, and obstacle courses with at-home items. Use a visual model with reps and dance videos. Take precautions prior to beginning any gross motor tasks. Have the caregiver move the computer/webcam around the work area to ensure it’s safe, well lit, and free of clutter.
Teletherapy and Handwriting
Writing over teletherapy is so different. What are your top tips for addressing handwriting via teletherapy?
- A separate webcam really helps with this. You can also practice ahead with pulling your screen partway down to show tabletop and then have the caregiver do this to view handwriting work if there is not a webcam available.
- Also, provide more handwriting space on the table by pushing the computer back. Often, students require a visual model on their own paper vs looking on the screen.
- Email paper types ahead, so you and the student have the exact same page. A plastic sheet protector works very well to allow dry erase marker usage and then can be used repeatedly.
For regular therapy, most therapists provide reward time at the end of their sessions. It helps our students get through challenging tasks and is also motivating. What is something fun and rewarding we can offer to our students at the end of our teletherapy sessions?
- Allow time to play on a favorite toy or App, parent-approved virtual game/video, or use of virtual reward stickers.
- Bring your or their pet in to see/share. Work with the family to develop a plan for a reward for good work during a session (a tangible treat the parent supplies)
What are your go-to treatment Ideas for kids who have very limited (if any) tools to use at home for treatment such as scissors, markers, shaving cream, etc.?
- Bubble wrap, carrying and lifting heavy objects, moving furniture, and animal walks for proprioceptive input.
- We do a lot of with self-regulation, using programs like the Alert Program and Zones of Regulation, maximize online virtual games, trivia, videos.
- Use supplies in the home. Consider “home care” types of modalities such as cooking, gardening, making homemade play dough, art and craft projects.
- See what games or toys the student has. Board games can be wonderful, using sports equipment such as child bowling sets, marbles, hula hoops, and ball based games.
Best Tech Equipment for OT Telehealth
Is there any special tech equipment that can help make sessions easier?
- If your internet connection isn’t great, use an ethernet cable to attach directly to the modem for improved internet connection speed & reliability, when using various meeting platforms & programs.
- Separate webcams (moveable, multi direction for practitioner/student) are a huge help and there are a variety of stand devices you can use with them.
- A headset improves computer audio output/input, reduces ambient noise
- A mouse and touch pad help for therapist demonstration
- Webcam mount: optional aid for webcam for handwriting or table top work. Match to your webcam base and set up needs
- External document camera: optional aid to enhance video for handwriting and closer work
What do you find to be the most common obstacles for telehealth?
We did a study:
- Family communication
- Dealing with attention problems
- Dealing with negative behavior
- Communicating with student
- Addressing motor and sensory needs
- Completing evaluations
Occupational Therapy Evaluations and Telehealth
Can you complete evaluations virtually?
Yes, but you need to use mainly checklist-type tools and questionnaires. The DAY-C, SFA, SP, and SPM are easy to use. You may use the Beery VMI, but you need to mail booklets to families and they need to mail them back to you. You can use other tools and mention in your report that the tool was used in a non-standardized manner, due to the session being virtual.
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