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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Miss Jaime, O.T.’s Favorite Visual Perception Toys for Children

The best visual perception toys for children

When parents hear the phrase “visual perception”, they often think it has to do with their child’s vision, and whether or not they need glasses. But in all actuality, visual perception is how your brain perceives what you’re seeing with your eyes.

If your child is struggling with spacing during handwriting, lining up math problems, or finding a specific color crayon in the box, this may be an indicator that your child is struggling with their visual perception skills. It’s a broad term, and professional diagnosis is recommended, but it is something to keep in mind.

For occupational therapy and improving your child’s visual perception skills, there are toys on the market that can be used to grow their abilities. I have a printable list of ALL my favorite visual perceptual toys, you can get it here.visual perception, visual perceptual toys, visual discrimination, visual figure ground

I have MANY favorites, but today, I’m going to talk about just two.

Hammer and nail toy

This toy is known by a few different names. It’s a toy with pattern cards featuring different shapes, where a child must find the correct shape and place it in the right spot. In order to achieve that, they’ll need to use tiny nails to create a replica of the shape they’re attempting to copy.

The toy comes with nails, shape cards, and a hammer, which requires hand-eye coordination from the user, as it’s required to complete the shapes properly. It develops your child’s puzzle/ problem-solving skills as well as spatial orientation. The toy is meant for younger children, so the ideal user is between four and eight, although you’ll need to carefully watch children during use, as the small nails can be dangerous.  I’ve found that even my middle school kids like this one!

On sale for $24.99!

“Shape by shape” toy

If your child is in middle school, or you’re looking for a more advanced visual perception toy, then the “shape by shape” is a good option to consider. With this shape game, there are several different shapes that have to fit exactly within a square box, in order to successfully complete the puzzle. There’s a photo that acts as a guide for completing the task, but requires the child to carefully look at the box and see how the pieces fit together.

It can be fairly challenging, but there are some hints that can be used to assist your child. This toy is meant for children from ages eight and above, all the way up to adulthood, depending on the help given to your child, and how many hints you can provide.

Developing your child’s visual perception skills takes time, but it is an important investment in time and effort.

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“Cookie Cutter Therapy”- Why it’s OK with me….

The other day I did an autumn arts and crafts project with all of the students on my caseload.

Every. Single. One.

Kindergartners as well as fourth graders.

Very often we hear about the problem of a “cookie cutter therapist”.

Meaning – a therapist that does one thing with every single student regardless of their goals or deficit areas.

A lot of people have a problem with this and so do I – sometimes.

I might sound like I’m contradicting myself because I said I’m OK with doing the same activity with every single student but here’s the thing:

One of an occupational therapist’s best and greatest qualities is creativity and flexibility. Teachers have this gift, too!

Every single child has different goals – so tweak that activity to work for them!

Change it Up!

Here are some ways to tweak this simple fall craft.

  • For really weak fine motor skills, take one piece of tissue paper in each hand. Hold the student’s hands up in the air like a “Y”. Crunch the tissues into little balls without using his other hand or his chin or even his belly to help with the crunching.
  • To work on mid crossing midline; place the paper to the other side of the student’s body.  Put the helping hand on vacation (meaning behind his back). His dominant hand has to crossover in order to glue on the leaves of the tree.
  • My student with weak grip strength had to use a clothespin to pick up each tissue ball and place it on the tree.
  • My student with really poor scissor skills had to cut the tissue before he crunched. He also cut a piece of green construction paper to make grass for the bottom of his picture.

So – if you were a random person standing at the door of my occupational therapy room, you’d see every student come out with a picture of a tree with different colored fall leaves on it.

It might look like I’m doing cookie cutter therapy but I’m not.

It’s ok to re-use an Idea

My point is – give yourself a break! It’s OK to do the same or similar activity with different students.

Just use your creative mind to tweak it to work for that student and the needs of that student.

For teachers, this may mean creating groups of students who will complete the task in a different way. For example, the red table will use clothespins to pick up the leaves and the blue table has to crunch with two hands in the air in the shape of a Y.

Once you give yourself permission to do one activity with all the kids; you’ll see how easy it is to change it up.

Need an AMAZING Activity to do with your kids this week?

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FREE SENSORY RECIPES E-BOOK

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The Therapeutic benefits of RUSH HOUR Game for OTs, SLps, and Educators

Don’t you just love when you find a toy that works on a ton of different skills?  As a pediatric OT, these kinds of toys are my absolute favorite!

One of my very favorite OT therapy toys is called the Rush Hour game.  It’s small so it fits right in my therapy bag.

Plus, it works on so many different skills!

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The real reason your students can’t sit still…Poor Core Strength!

Poor core strength is often the reason kids can’t sit still…

“Do you mind taking a look at one of my students?  He just can’t seem to stay in his chair…”

As a school based Occupational Therapist, I hear this question at least twice a week.

For the most part, kids are expected to sit at their desks in the classroom. There are times when the class breaks up into groups and move around to sit on the floor, etc., but for the rest of the day, they are supposed to sit in their seat.

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2 Magical Crayons That Will Immediately Change Your Child’s Grasp

Calling all therapists – save time by using resources that other therapists created just for YOU. Available this week only. The Ultimate Therapy bundle! Click here.

 

How to change your child’s grasp by changing their crayons

“He uses all of his fingers…  and he gets annoyed when I correct him!”

As a pediatric Occupational Therapist, I hear this from a lot of moms and teachers.  Pencil and crayon grip is important, and it can be difficult to change when a child gets older.

But there’s hope!  I promise!

CASE STUDY: HARRY

This is Harry, a 4-year-old with no interest in crayons.  In the first picture, he’s using a palmar supinate grasp, which is typically seen in 1 to 1 ½ year olds.  His mom, a teacher that I work, with approached me looking for help.  Her question: 

How can I change my child’s grasp?

Change your child's grasp

Harry’s preferred grasp was a palmar supinate, using the pinky side of his hand to control the movement of the crayon. This grasp was inefficient and immature for his age.  It also didn’t allow the small isolated movements of his fingers during writing and drawing activities.  Coloring and drawing are a significant source of the fine motor exercise a 4-year-old child should be getting.  So if the child isn’t using the right muscles for the activity, they are missing out on valuable strengthening time.
As you can see by the 2nd image above, Harry’s mom took my recommendations – and it WORKED!
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A Valentine’s Day Motor Monday: Super Simple Hand Strengthening

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The problem is that it’s impossible to leave without a few extra things.

BUT – that’s how I ended up with my latest and greatest Valentine’s Motor Centers.  

I swear I just went in there for a couple of birthday cards, but when I saw the “seasonal section” filled with Valentine’s Goodies, I couldn’t resist.

These adorable pink and red Valentine’s Day “table scatter” hearts were the perfect size for little hands to work on grasping.  I just started adding to my basket.  

Sigh.

Why resist?  It’s for the children!

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