Michael, for the hundredth time, keep that microphone and camera on!!!
How many times this year have we had to say this to our students, or variations of this comment? Umpteen times! I know I have. But before I get into the trials, tribulations and successes of teletherapy, lets flashback a little.
In March 2020, the world changed. Never before in the history of mankind, had anything impacted literally every corner of the world at the same time, in such a manner. For the first time, almost every human in this world was being touched directly or indirectly by a phenomenon – the invasion of a virus, COVID-19. Countries were being locked down, cities were under curfew, travel was curtailed everywhere, and suddenly schools were closed or went virtual.
Literally overnight so many of us had to learn new skills. Needless to say, it was hard for almost everyone. In the world of speech pathology, while some of us were already doing teletherapy, most of us had never engaged in it. A million questions arose, and our industry scrambled to provide resources. Within a few weeks, we started to take courses and webinars in teletherapy, presented by those few people who had experience in it. Those courses were invaluable. American Speech-Language Hearing Association (ASHA), SpeechtherapyPD, and so many more platforms made this possible for the rest of us (these were the ones I personally used).
Its now been almost 9 months, and along the way I, like so many of us, have learnt so much about teletherapy, and would like to share it with you, my readers, in the hopes that it may be of use to some of you. I have divided up the information under certain categories. I absolutely do not mean to say that these are the only pertinent topics under the vast area of teletherapy, but these are what made practical sense to me. Personally, I learn from examples, and therefore I have attempted to provide you with real life examples under each category.
Photo by Jayeeta Purkayastha.
When all of this started, I was still working full time in a school, therefore there was no set up at home, apart from my personal laptop. As I took webinar after webinar trying to cram in as much information as possible in those initial weeks, I was trying to find a starting point. I wanted to know what I needed to simply get started. Working in teletherapy over the last many months, I can finally say one thing: we do not need to overthink or over complicate this step. I was able to get started with just my office laptop, a reliable and preferably a HIPPA compliant videoconfering platform (I use a Zoom account purchased by my school system; see this link for the government’s direction on using video conferencing platforms: https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html ), and a list of online resources. For added convenience, I also bought a second monitor and hooked it up to my office laptop. This allows me to see my students on one screen and open up resources on the other screen and share that with my students to work through. Additionally, a document camera, provided by my school system, has become a very handy tool, and allows me to use paper resources that I already have. But, to be honest I mostly use online resources. I am able to hook up my IPad to the system as well and use the apps on my IPad during therapy. One last thing to keep in mind is lighting. Since we are communicating through the cameras on our computers, its essential that our visage is clear. Having said all this, of course one can make this set up as fancy as possible – multiple screens, ring lights, better cameras, green screen and so much more, and there are enough examples on the net, if anyone is interested.
Resources to use during teletherapy:
Photo by Jayeeta Purkayastha
This brings me to the next most important part of this process, which is, once you have set up, how do you do actual therapy? First and foremost, I would strongly suggest that you spend a good amount of time to collate a list of websites with speech pathology resources. Also, do make a note of online games, websites with online books, language activities, websites of local libraries for reading resources. Make sure to use the websites and play with your resources personally before using with your students. If you are attached to a school, most school systems regularly use educational websites, which can easily be adapted and used by speech pathologists even if they aren’t labeled for speech pathology specifically. While there are a multitude of resources available, I feel each resource has to work with you, or has to make sense to you personally. I find that I regularly use the following:
I sometimes make my own material using PowerPoint, pear decks, and on boom learning. I also use apps on my iPad regularly and share the iPad via zoom for my students to access. You can be as creative as you want. But I have found that even if you aren’t the Instagramming type, the creative type of person who can churn out activities with multiple scenes and bitmojis and make things fancy, you can still be a successful tele-therapist. Just find these interesting resources that someone has already made and as long as you are comfortable using those resources in a variety of ways, you will be fine! Trust me! The key here is to be well prepared, just as you would be for your in-person sessions, and have enough ideas and resources to fall back on, if needed. For example, one day I had planned to read a book with my student on Tumblebooks, and then go through ‘wh’ questions based on the book. When the session started, the student’s Internet connection seemed very poor, so, when I tried to play the video on my shared screen, there was a big delay. Clearly, that was not going to work. I had to abandon that activity, but I switched it up by giving him a link with a static book, which he opened on his computer and read aloud. I then had him share his screen and we went over ‘wh’ questions.
Once you have your set up in place and also have all your material at the ready, you now need to be aware of student management. Just like when we provide therapy to students in person, we have to figure out how to deal with different personalities, different disabilities/impairments, groups, individual etc., similarly in the virtual set up, you have to decide whether you want to see students individually, or in groups (if you have that luxury of choosing) and therefore how would you form your groups, and finally you have to work with the personalities of your students. I have a caseload of 50 elementary students (grade 3 to 5). Some of my 3rd graders need extra redirection and multiple reminders to stay engaged. I sometimes do that by using games and giving them control, but most of the times I make them participants in their therapy by giving them a say in choosing what they want to do (from a doctored list of options) and by keeping it fun. I have a 5th grader with Autism who does not like to turn on the camera or the microphone. Imagine my plight when I was trying to figure out how to do therapy virtually without being able to see or hear my student. I tried a variety of methods, made videos of myself, so that she could at least practice her articulation, but how would I track data! I slowly got her to the point where she agreed to whisper her target words into the microphone. I made a big deal of telling her how my ears don’t work as well anymore, cause I am so old now, so maybe she could speak up a little..:). Well, whatever it was that worked, we are now able to practice a little bit of articulation over microphone (still no camera) and we practice language by typing out sentences, using target words/concepts.
Let me now present to you a few pros and cons of teletherapy, as I have read and experienced.
I must admit that I thoroughly enjoy teletherapy. I love working from home and this system lets me do that efficiently. I feel as if I have formed a warm and intimate relationship with all my students. I use a platform called GoGuardian (that my school system provided) through which I am able to chat with my students, remind them of sessions, and most importantly provide my students with a space where they can reach out to me, when they want. And they do! Frequently! Initially I even had to talk to some of my students to stop spamming me with ‘Hello’. In the last couple of months, I have noticed that some of my students regularly reach out to say Good Morning, or Goodbye and feel comfortable enough to drop a quick message, if they are feeling sad or happy. I love that I am able to communicate with them and be there for them, while modeling appropriate communication in a real sense. I see most of my students individually, which allows me to completely focus on them and I am able to tweak my therapy on the go, as needed. In fact I don’t think teletherapy is in any way lesser than in-person therapy. ASHA has a wonderful handout on teletherapy, you can view that here. The other thing that I like about teletherapy is that one is able to reach clients wherever they may be, as long as they have a reliable Internet connection. A therapist’s time is better used in preparing for therapy, rather than commuting.
The most important thing to remember is that teletherapy is not for everyone. Not all therapists will thrive in this format and definitely not all clients will be able to efficiently access this system. One of my students who has been diagnosed with Other Health Impairment and suffers from, amongst other things, ADHD, and he finds it very hard to stay focused for extended periods of time. It is taxing on both him and I, equally. I have to constantly find activities to engage him and have to switch them around to keep him interested. He has to work hard to stay in one spot and focus as best as he can. While I can see that in-person therapy would have been challenging for him as well, but if I had him in front of me, I could control the environment a little bit more. Right now, if he decides to leave the session, there isn’t much that I can do, apart from calling his mom or guardian and then have them bring him back to session, which is precious time lost. Evaluation is sometimes quite challenging as well in a virtual format. Many therapists miss the face-to-face interaction and all the other fun that we are able to engage in when we are all in school. Seeing students in groups can also be challenging, since you would need strict rules of conduct in place and would have to make sure to consistently enforce them, especially with the younger students. On another note, the success of teletherapy depends significantly on the student’s Internet connection as well, and you are at the mercy or technology, even though it is technology that is making this possible.
There is a lot more that one can say about Teletherapy, and definitely there is a lot of information available online. My biggest tip for all of you out there that’s getting started in teletherapy is, to not get overwhelmed with all the information out there. Keep it simple! Just get started and plan your sessions with as much care as you would your in-person sessions and jump into it. The rest you will pick up as you go along. Our family of Speech Pathologists is a resilient, resourceful, creative family, and just as we teach our students to be confident, roll with life and be positive, we need to apply those principles in our life as well. Hey, suddenly we all have become students again! Let's just keep learning and passing it forward!
Author: Jayeeta Purkayastha, M.S CCC-SLP