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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)
- initially parents were refusing online and hoping for in-person, but as pandemic dragged on, many have opted for online
- over time trust is built and less skepticism about online therapy
- some clients still opt for phone
- some clients refuse online all-together - and there may be many reasons for this decision
- some clients still prefer in-person as they were doing in-person visits before going online
- Virtual care is likely going to stay as a service option and parents given a choice
- Assessments done in-person but follow-ups done online
- For remote communities online therapy has been an option for a while (even before pandemic)
- Motor speech / feeding / swallowing therapy still requires in-person consultation - can't be done online.
- Many families are younger and comfortable with technology
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.
- Sometimes families request other technology, but can only use the software that has been approved.
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
- 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
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- 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.
Transition to online therapy
- Colleagues helped a lot with sharing knowledge and practices
- Attended a lot of webinars
- Weekly check-ins with colleagues
- The U.S. has a lot more research and practice in online speech language therapy
- many diagnostics were adopted from US practice
Privacy
Privacy can be an issue
- Other family members can join in
- Lots of distractions and disruptions, background noise, etc.
- Hard to control - affects client's experience
- Sometimes home isn't big enough to have a secluded place
Transitioning clients
- There is no persistent record like in medical health.
- A report is written and given to the parent.
- Copies are sometimes given to a school to transition the client early (schools apply for funding early so reports may be sent before student is expected to attend)