Teletherapy for school-based practitioners

 

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 TeletheALTH

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 the 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 and 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 TElethealth

 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:

  • Technology
  • Attendance
  • 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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8 Genius Therapist Inspired Toddler Hacks

My New Favorite Parenting Hack Book

Did you register for “What to expect when you’re expecting?”, My mom asked me on the way to my shower.

“No- there’s an app for that!” I told her, laughing.  I knew she wouldn’t get the joke, but I really did have the app.  It’s a pregnancy milestone app that tells you everything you need along the way.   Truthfully, all the books I registered for were for the baby, not me.   I didn’t think I needed it.  I have the internet.

Genius Therapist Inspired Toddler Parenting Hacks

But when my friend Amy gave me a gift on my last day of work, she said, “You’ll love this book- It’s so you.  I know you love a good hack.  I learned a ton from this book, “Parent Hacks, 134 Genius Shortcuts for Life with Kids”.

She was right- this book was right up my ally.  It was filled with short but brilliant “Parenting  Tips”, but any and all of them would be helpful for a therapist or teacher, too. Therapists who travel from school to school to see different children have brilliant kid hacks.  They know how to save space and money better than anyone.

These OT Inspired Hacks are aimed at parents of toddlers, but they’re great for any parent or therapist who works with children. Here are my favorite!

8 Toddler Hacks Every Parent Should Know

  1. Store your puzzles in an accordion folder.  This limits all those pieces from flying all over- especially if you’re a traveling therapist or a parent who prefers toys over electronics.

2. Store your coloring books in a dish drain container – the slots in a dish drain are perfect for separating coloring books- and you can stick your crayons in the utensil spots- Genius!

3. Clean up glitter with play-doh.  YES! Glitter is sooo fun, but what a pain to clean.  Playdoh is a great idea- and who cares if your play-doh gets glittery? That only makes it more fun!

4.  Turn your portable crib into a ball pit.  Wow- one of the things I don’t like about ball pits is that it’s so tough to keep the balls inside- they always end up everywhere.  But the walls of a pack n play are tall- making it so much easier to have all the fun without the mess.  Love it!  This would be a great idea for a therapy room, too.  Another good one?  Use an empty laundry basket!

SIMPLE WAYS TO KEEP SMALL TOYS IN PLACE

5. Contain small parts with a cookie sheet.   I’ve spoken about this one- but it’s worth sharing.  A cookie sheet is FANTASTIC for keeping messes contained, from shaving cream to clay to beads and Legos.  (I also LOVE the EZPZ for this purpose.  Its initial purpose is to keep kids from spilling food off the tray, but it works great for fine motor activities).  The edges keep them from going all over the table, as well as the floor. I always have a cookie sheet in my trunk and my therapy bag.  Plus, they’re only a dollar at the dollar store!

6. Turn an under bed storage box into a sandbox.  I actually like these for any kind of sensory bin.  They’re nice and big, so the child can actually get inside if they want.  But I’ve used them for rice bins, weather-themed bins (fake snow is always a hit), and fake “coffins” at Halloween time! (see my garden dirt recipe here)

PARENTING and THERAPIST ORGANIZATION HACKS

7. Use a wine bottle tote as a car organizer. This hack is great for parents and therapists!  The tall skinny vertical compartments are great for curling up activity booklets, crayons, sensory bottles, etc. I love to use an empty wipes jar as a fine motor and hand strengthening tool, they’d fit in there perfectly!

8. Use a hanging shoe organizer to organize craft supplies.  These shoe “pockets” are great for organizing glue, paint, crayons, coloring books, etc.  Plus, it takes up vertical space, which is perfect for a small therapy room or a child’s playroom.  This would even be a great way to organize the trunk of your car!  Cut the pockets and hang them around the edge of the car- then you can find all the toys you need for each kid!

Related Reading:

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Time-saving School-Based Occupational Therapy Resources…

It’s HERE!  It’s HERE! The Ultimate Therapy bundle is available this week only….. and then it’s gone!

Are You wasting Precious time when you could be taking shortcuts?

-If you’re sick of spending hours searching for new therapy ideas

-If you’re looking for ideas, tips, and strategies in a quick, easy-to-share format

-If you’re feeling motivated and inspired to up your game in your therapy practice this year…

 

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11 things on a School OT’s Summer To-Do Wish List

Whether you finished strong or crawled to the finish line this past week, you made it to the end of the school year!

You have the summer off…What should you do? 

We have the summer off to relax, recoup, and reenergize …right? Yes! However, we are Occupational Therapy Practitioners.  We are a breed of overachievers who work hard, work more, and work tirelessly, even when we are supposed to relax.

Even though I try to balance my much-earned summer break, going off the grid in the summer only results in stress and being overwhelmed at the beginning of the next school year. Over the years, I have started to keep a Summer To-Do “Wish” List of all the things I would love to do and just don’t have time!

As a school OT, there is always a lot to do, both for your career and personally. Listed below are some amazing ideas of resources to check out, options to support you, and programs that you know you just don’t have time to look into in the midst of the school year.

 

    1. Federal Loan Forgiveness: Did you know that as an OT, we are eligible for student loan forgiveness? Many OTs have had their ENTIRE student loan paid off by applying for Public Service Loan Forgiveness program. There are criteria to meet and it can be a long and confusing process with needed paperwork and financial information. The summer is a great time to check it out and do your research and apply.

    2. NBCOT courses: If you are NBCOT certified, you have a FREE resource at your fingertips! The website offers information and resources for OTs and COTAs as well as free online training and certifications. Earn an NBCOT Digital badge this summer!

    3. AOTA Resources: Am I the only one overwhelmed and feel guilty for not accessing our national resource more?   If you are not sure where to start on their main website, start with their social media sites on Facebook or Twitter. The website is jam-packed with free resources, tip sheets, literature, information, special interest sections, and guides for ALL areas of OT and COTA work. There’s a whole Children and Youth practice section to explore, too.

    4. Learn how to be a Fieldwork Supervisor: With a recent rise in OT graduate programs, the need for OTS and OTAS placement in a school setting has skyrocketed! Many of us are either intrigued or scared to death about supervising a student. Knowing and establishing a connection with your local program(s) is key. This information will be on their websites and will typically give you a step-by-step guide on how to be a Fieldwork supervisor. For example, here is the University of Minnesota’s Fieldwork Educator information page.

    5. Social Media: Let’s be honest, you are either in or you’re out. Something was posted somewhere about something amazing and you saw it…or you didn’t. The social media craze is not just here to stay, but now it’s the main communication tool. Many are still not sure where to start. Although you may have a social media account (Facebook, Instagram, Twitter, Pinterest, etc.), are you sure you’re using it professionally?   If you want to ensure the grandparents that live across the country know what’s going on with their grandkids, keep that on a personal account. Make another account that you can have/follow for professional networking, posts, and following. Most people/pages/groups that you would want to follow have multiple social media accounts anyway. Here is a link to guide you through the “How to Use Social Media Professionally.”

    6. Update Resume and Social Media Profiles: This is one of the easiest and least time-consuming summer list items to do. Even if you have no plans to search for a job or interview, keeping an updated resume and social media profiles are key to self-reflection and growth in your career. Most of us have annual reviews, this is the opportune time to update. Have you presented at a conference, taught a related class, or even wrote professionally on social media platform? On your evaluation or review, did your boss mention something specific you did for your employer that has made you stand out? These are the types of resume-worthy skills and endorsements that will make you shine. At some point, we all are thinking about trying something new and/or advancing our career. Keeping updated social media profiles, such as LinkedIn, and your resume will provide you with a valuable tool at all times.

    7. Sign up for a Webinar: It can be REALLY hard to take time off work to attend workshops and conferences during the school year. Webinars have been a game changer for attaining CEU’s and allowing you to focus on specific skills, topics, and education in a more flexible and cost-effective way.  Don’t have the time? Most webinars can be purchased, saved, and viewed later! An issue we had in our district for Teacher Workshop Days is that the topics/sessions that were being done that day were geared toward TEACHERS, not OT’s. Not to mention these CEU’s didn’t apply to us or give us our needed license approved credits. I asked my Director of Special Services permission to for a requisition order to pre-purchase a couple of webinars and allow our therapists to complete these instead on those workshop days. APPROVED! Check out these great on-demand webinars from the Pocket OT (affiliate link). 

    8. Go Shopping: I put in a TON of requisition and purchase orders to attain trial items, motor room items, adaptive equipment, assistive technology, and all the other special education items that any classroom needs. From fidgets, adaptive utensils, oral chewies, to testing forms, I have become a master at not only shopping but being approved for these items in my school! However, I learned quickly about the ‘fiscal year.’ Most schools budget year ends June 30 and starts July 1.  At the end of the year, I know who needs what, what needs to be replaced, and what I will need for the next year (well, sort of). Putting together a shopping list in the summer and submitting it after July 1 usually gets approved. And the best part, it is like a birthday party of presents when I get to my office in the fall with everything I need ready to go.


    9. Make Items for your OT Closet: From weighted lap pads, fidgets, glitter jars, and adapted pencil grips. Now is the time to stockpile that calming caddy or compile sensory bins.  Check out Miss Jaime, O.T.’s Pinterest page for ideas.

    10. Templates and Datasheets: How many times have you needed a quick data sheet of the upper and lower case alphabet to track formation? Or what about that beautiful statement you read that explained how visual processing issues can affect reading? Build your template resources and create data sheets now so you can easily print off or cut and paste quickly druing the school year. Consider the statements you write in evaluation summaries for sensory processing, or what how your OT services will look in the least restrictive environment. You can make an entire Google Doc folder for templates and have specific ones for specific areas you test for (sensory, fine motor, handwriting, visual processing) services in least restrictive settings, summaries templates for evaluations, accommodations, and modifications, or assistive technology.

    11. Build Relationships with Your Team: As everyone says their final goodbyes on that last day, we all promise to get together over the summer right? Then do it! The relationships we have with our co-workers, teams, and other staff are precious and absolutely imperative. Make it a point to call a couple of co-workers and go out for a coffee, have lunch, take a walk, meet at the dog park, or whatever toots their horn. We all have stressful jobs.  Having a safe place to vent, share accomplishments, and express ideas and goals help build healthy workplaces and personal relationships with those we spend more time with than our own families sometimes.

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7 Myths about Mindfulness & Kids

Are you practicing and teaching mindfulness?

Mindfulness programming with children and in schools is becoming a more popular practice. Whether you are a parent, teacher, or therapist, is there anything stopping you from practicing mindfulness yourself or from using it with children?

What is Mindfulness?

Mindfulness is the practice of focusing awareness of what is happening in the present moment, accepting thoughts, feelings, sensations, and observations with kindness. Mindfulness is a skill we can develop in order to improve attention and self-regulation.

Many occupational therapists use mindfulness as an intervention tool with students on their caseload. However, occupational therapists can also advocate for universal mindfulness programming in their school/district by educating administration/staff and consulting with teachers on mindfulness implementation.

Below are 7 Myths that may be preventing you or others from implementing mindfulness.

Myth 1 – Mindfulness is just sitting silently.

Meditation is one method of practicing mindfulness, but there are many other components and ways to do so. Explore all types of mindfulness practices to find which ones work best for you! Two examples include:

  • Mindful Movement: Try yoga, tai chi, or simply bringing mindful awareness to walking.
  • Mindful Eating/Tasting: Choose a food or meal and eat very slowly, paying attention to the texture and taste.

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My Favorite Parts of #AOTA19

Last week was a complete whirlwind – whew.   I’m finally getting settled at home,  but I wanted to share my highlights of the American Occupational Therapy Association conference in New Orleans, LA.

  1. Reuniting with old friends from across the country and making new ones!

    Every year, two of my girlfriends from Utica College and I attend the conference together, and it feels like we are right back in college.  This year, I also got to hang out with my friend and fellow OT blogger Colleen Beck (From the OT Toolbox) and two other admins of my USA School Based OTs Looking for Change group (Serena Zeidler and Joan Sauvigne-Kirsch).  We had so much fun and definitely had some major brainstorming over the last few days.  It’s amazing what a bunch of OT brains can come up with!   I also attended the AOTA reception for the Communities of Practice. I’m in the state leadership group, so I had the chance to mingle with all the ladies I work with all year long.

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Why do Occupational Therapists want Educational Credentialing?

You may have heard the buzz about Occupational Therapists advocating for Educational Credentialing. Especially if you work in the education world.

What is Educational Credentialing? 

State Education laws vary from state to state.  But in every single state in the USA (except for four), OTs and PTs are not under the “umbrella” of teachers. They do not have “educational credentials”.

Why not? 

This started in the past.  Way in the past, because OTs and PTs were considered “medical” (like the nurses).  However, educational laws have changed to a more inclusive educational community. This changed how OTs and PTs are employed.

Now, school therapists support children’s academic success.   Unfortunately,  the state education departments haven’t revised their terminology and laws to include OTs and PTs as “educators”.  YET.

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