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- Clinicians at the office were not practicing during a period where partnered organization was evaluating online meeting technology for network / software, and storage security.
- Parents were initially skeptical of online therapy - how can it be effective without being in-person?
- The challenge is the speech-sound production
- Whether or not their pronunciation is good
- Depends on the child to sit and face the microphone
- Otherwise assessments can be done well online
- The challenge is the speech-sound production
- Real benefit from having clients and family in home setting
- It's comfortable and doesn't need to adjust to a different clinic setting
- Clinics can have negative associations, so home environment is beneficial
- Logistics much easier and services more accessible. Parents did not have to travel or pick their children up from daycare etc.
- Affect on outcomes:
- If parent is able to manage the remote relationship and takes to coaching well - the child makes a lot of progress
- If parents do well, the child does well - true online and in person
- How do children react to online visits?
- Kids are mostly used to it - but some children as still shy
- Turning off camera can sometimes help - which is something that isn't available in real life.
- body language, play skills, and voice quality are easily assessed online, however there are other challenges with the technology (see below)
Online platform
- Currently using Go2Meeting, but will be transitioning to Zoom Health in the next month.
- Zoom Health will facilitate going webinar style group meetings like workshops and group consultations
- Booking done through phone and sometimes email
- Was evaluating / piloting a booking platform called "Care Dove" before pandemic, but that was put on hold since then.
Technical challenges
- Network connectivity is a big problem - audio or video can degrade or cut out
- Children move around and not always face the microphone or move away from the microphone
- this makes it challenging for therapist to hear clearly, especially during assessments
- Speech and sound production is important in therapy, but quality of pronunciation and articulation can be tricky over microphone and online.
- Parents are using a variety of devices:
- laptops - nice and stable, but not mobile
- phones or tablets - more mobile, but hard to position and prop-up
Other challenges
- However, body language, play skills, and voice quality are easily assessed.Dealing with technical challenges
- look for ways to take bandwidth off internet - like switching to telephone for voice and Go to Meeting for video
- sometimes have to fall back to phone completely
- Hard for parents to position camera for both child and parent to be in the same frame for play therapy
- Can also be hard to follow a moving child with a device, especially a laptop
- Sometimes can't see what child is pointing to if important parts are out of the frame - requires the parent to interpret and troubleshoot for the therapist
- Some parents will use multiple devices - one to follow the child, and the other in a fixed location for different angles
- Multiple family members are competing for household internet and network
Other challenges
- Parents face other challenges
- staying organized and keeping appointments
- saving the link and password - sometimes emails are deleted, put into spam etc.
- English may not be first language - especially hard when troubleshooting technical issues
- However, parents seem to manage okay with instruction sheets sent in English ahead of time
- Providing informed consent takes a lot of time and therapists find it's easier if they do it one-on-one with parents instead of asking admins who have limited time.
Partnering with parents
- Equip and empower parents to be effective therapists
- Best outcomes have come from situations where parents are engaged and active in children's therapy
- Screen separation changes the dynamics - forces parents to be the hands of the therapist
- Therapist becomes the coach and parents are empowered
- Parents more connected in therapy rather than a passive observer
- Parents can use whatever is in their homes - comfortable and familiar.
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