Meeting with Speech Language Pathologist (SLP) for young children from Ontario.
Working for a network of clinics that transitioned to 100% virtual practice due to COVID-19.
Adopting online practice
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
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
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.
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
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
For formal language test tools, therapist shares screen of test pictures, child points to answer on screen, this requires the parent to relay the answer to the therapist, or use second camera to show child screen activity
Multiple family members are competing for household internet and network
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.
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 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
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)