Transitioning to Teletherapy
“We left university for spring break…and never came back.” You may have heard this statement as students, such as your friends, family, and classmates across the United States, reflect on their Spring 2020 semester. This was the reality for many students globally, including graduate students enrolled in Speech-Language Pathology programs. Graduate Clinicians in Speech-Pathology, known for their organized and preparatory nature – began racking their brains as uncertainty set it. What’s going to happen to my coursework? How am I going to continue providing services to my clients? As the leaders they are, clinicians began creating contingency plans; after all, problem-solving is one of our top priorities and certainly in our nature! I am eager to share my experience “problem-solving” unprecedented issues this past semester and discuss inclusivity in telehealth.
My Experience as a Graduate Clinician
As a first year graduate clinician, I have had the opportunity to serve many populations. For example, in the fall semester, I worked with adults with neurogenic disorders.
During the Spring 2020 Semester, I worked with adults and children with Autism Spectrum Disorder and Developmental Disabilities. After the fall semester, our coordinator sent out a survey to select our preference for the spring semester. I eagerly made the decision without a second thought and was looking forward to the semester starting, as I had never worked with this population clinically.
Notably, a key factor contributing to my interest in becoming a Speech-Language Pathologist was the countless hours I spent in my mother’s Special Education classroom. I watched her create functional lessons, made a handful of new friends, and observed communication needs and special education services.
What Did Therapy Look Like?
Now, it was my turn to serve diverse populations and prioritize communication needs. At the onset of the Spring 2020 semester, each graduate clinician in our rotation was responsible for planning and hosting group therapy sessions for adults with ASD and DD.
Additionally, we were tasked with planning sessions each week for 10-weeks. Although time-consuming and a bit frightening, our team was up for the challenge! Our team decided on a central theme for the semester – “Around the World in 10 weeks.”
Each week, a clinician created a plan for the session, typically consisting of activities that involved the entire group, then breaking down into smaller groups and engaging participants in three small group activities centered around functional communication.
Clinician Collaboration
Some clinicians discussed “wins” among their clients, and discussed positive clinician-client interactions and experiences.
We loved seeing progress each week and appreciated receiving constructive criticism to better prepare sessions for the next week.
Finally, clinicians were a soundboard for one another. We problem solved situations that arose and continually coordinated opportunities for communication. It seemed as if each week, our sessions were better than the last.
The Uncertainty
As we left university for spring break, many students felt uncertain about the future. We were eager to enjoy a relaxing week of vacation; however, students continued to wonder what our next steps would be.
During spring break, the university announced we would not return to campus for the remainder of the Spring 2020 semester. Fear set in, and many questions flooded our brains.
What will happen with client therapy sessions? How will we continue molding our clinical skills? Will our clients lose their opportunities for communication? What about the sense of comradery our group therapy sessions promoted?
The Changes
Students across the globe – those that relocated last-minute, those that continued to learn as coursework transitioned online, and those that felt uncertain and anxious about the future – you are resilient. Your hard work and actions do not go unnoticed.
Similarly, my team of graduate clinicians that lead weekly group therapy sessions combated their anxious plans and set forth by creating a plan. We virtually met weekly to decide how to proceed for the semester. Should we stop group therapy? Should we continue? If we continue, how do we proceed, when the premise of the group centers around every-day communication? Each team member agreed – we needed to keep going!
We worked on researching and brainstorming how we could continue our sessions most effectively in a digital format. Our plan, developed throughout a period of two weeks, considered the communication needs of our clients.
We concluded that one method of promoting effective communication would be to divide our group of 10 into two small groups – allowing for enhanced engagement and enabling participants to communicate.
Our goal was to allow carryover from previous sessions and to maintain a similar environment to the maximum extent – therefore, we were eager to keep our theme – Around the World in 10 Weeks. Our digital sessions allowed us to continue targeting our theme, but in a new manner.
Goal Areas
Here are some items we explored and targeted weekly:
3D Virtual Tours to allow for exploration of multiple countries, top tourist attraction
Greeting phrases in numerous languages
- Cultural awareness and sensitivity- cultural customs such as traditional dance, traditional items, and souvenirs
Takeaways
Here are some items we explored and targeted weekly:
1. How to Maximize Communication: It is essential to maximize your communication as a clinician and your client’s communication. Optimizing your client’s communication can take a variety of forms. To promote communication, during group therapy, we encouraged turn-taking. Turn-taking is a valuable skill and possible during teletherapy! We typically “went around the room” and urged participants to share their thoughts. Another method of promoting communication means involving group participants as communication brokers. Encourage participants to lead an activity or call on other team members to participate! Additionally, as a clinician, consider your options for optimizing communication. It may be difficult to communicate using a digital platform. Some uncontrollable factors such as network signal may arise, and reading nonverbal cues digitally can be ambiguous. My approach consisted of embedding social communication strategies, such as animating my verbal responses and expanding utterances. I found it beneficial to model communication by reducing my speech rate so that my communication partner could better receive my message!
2. Dispelling negative thoughts about performance outcomes: I certainly understand – many clinicians feel as if they were “thrown” into teletherapy. First-year graduate clinicians, as they navigate clinical expertise, report writing, and rapport- building, indeed felt apprehensive. My advice to you – Believe in yourself. Believe that: you are equipped to continue advocating for your clients and communicating effectively with each individual. Although this is a new journey, you have prepared by working with previous clients, all-nighters reading evidence-based articles regarding intervention, and creating treatment plans for multiple classes. Consider the valuable information learned from professors, supervisors, and colleagues; don’t discredit how much you have grown in the past year! Additionally, you may find it necessary to alter a patient’s goal as you transition to a new service delivery format. That is okay! As long as goals are measurable and meet your client’s communication needs – go for it.
3. Take advantage of the telehealth digital platform and continue promoting multimodal communication: A massive pro of teletherapy is that many digital platforms can assist in augmenting communication. Sounds unbelievable, right? I found Zoom’s platform to be user friendly and found its features to be extremely beneficial. Some Zoom features allowed participants to “raise hand,” select “yes,” and select “no.” Although minimal, these features promoted an additional communication method and were of great use when participants were tasked with selecting items and sharing their thoughts. Additionally, research supports the use of multimodal communication. It is still possible to promote multimodal communication with teletherapy! I found it valuable to promote communicative functions through the use of choices – encouraging participants to make selections via verbal expression, sign language, and/or AAC, both low (paper and pencil) and high tech (devices, iPads, Tobii DynaVox).
4. Consider expectations prior to session: As clinicians, we want everything to run as smoothly as possible – our data collection, our session, and our words. We must offer ourselves some grace and be realistic – our priority is to focus on our client and their communication needs. We can expect some hiccups as we navigate digital sessions. For example, there may be network connectivity issues either from our end or our client’s. We might experience lag or time delay, and finally, we might have reduced opportunities to transition to more naturalistic contexts “outside the therapy room.” As a clinician, we should set expectations for ourselves, and recognize that it is okay for things not to go perfectly, as we are putting our best foot forward. Additionally, as sessions transitioned mid-semester to a digital format, I found it useful to provide session expectations with my clients before session. Typically, I would communicate expectations at the previous session’s conclusion so that my client has ample time to prepare! For example, I would remind them to sign into Zoom 10 minutes before to ensure there are no connectivity issues, to sit in a quiet environment for the duration of the session, and to sit up at a desk or table to allow for enhanced focus.
5. Stay up to date: As you navigate telehealth and reimbursement, it is critical as clinicians to stay up to date on both federal and state laws regarding service delivery and insurance reimbursement. Graduate Clinicians, SLP-As, and clinicians can find many resources available from both their national and state associations to ensure adherence to guidelines. Additionally, graduate clinicians must pay special attention to supervision requirements as set forth by guidelines.
