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School Based Teletherapy title with multicolored colored pencils on the sideCOVID-19 has left school systems around the country scrambling to try to educate children while their buildings have to stay closed. While educators are challenged in so many ways, special education providers are dealing with the extra task of making sure our students with special needs can continue learning even while their whole worlds have been turned upside down.

Challenges for Related Service Providers

Occupational and physical therapists, used to being very hands-on with the students they serve, are now tasked to serve children with complex needs when they can’t even be in the same building. After giving this much thought, I felt the need to write about the transition to distance learning and offer some guidance to others that may be struggling. If you’re in a hurry and want to get straight to the guide, scroll down to the Road Map to Educationally Relevant Services

How We Got Here: COVID-19

Schools began closing around the country as early as March. As soon as this started to happen there was a panic among therapists on social media. The message was the same from many. “How do I do teletherapy?” We OTs are a dedicated and resourceful bunch and the internet was quickly flooded with resources for transitioning to teletherapy. It quickly became clear how differently school systems around the country were handling the closure. Some were requiring IEP services continue through a distance learning/telehealth model seemingly unchanged and uninterrupted. Others, at least initially, said that school buildings were closed and therefore related services were not being provided. The disparity only furthered the confusion and anxiety about what a school therapist SHOULD be doing for his or her students. 

The Rush to Serve Students

The entire country was in crisis. Parents were now keeping their children at home 24 hours a day. Some had to do this while trying to work from home for the first time. Many had lost their jobs and didn’t know how they were going to pay bills. Were families really worried about the related services on their children’s IEPs?

Pressure on Related Service Providers

While parents were facing these issues, therapists and educators were also feeling the heat. Related service providers experienced pressure from all sides when school buildings began to close.

  1. Many parents WERE questioning when and how their kids were going to get therapy 
  2. A lot of school based therapists are contract only and if they cannot invoice for treatment they won’t get paid
  3. Some school districts were putting pressure on related service providers to find ways to deliver “billable” services 
  4. Therapists were worried about their students, their progress, and their ability to cope with the changes

Now We Can Get Out of Crisis Mode

The pressure is real. No doubt. Let’s all now take a deep breath and talk for a second. There are several things that have to be considered when you provide an IEP service through a telehealth or distance learning model. We’ve been at this for a little over a month now and we can’t be sure how much longer it will last. Now that the dust has settled from the initial blow, it might be a good time to go back and evaluate what we’ve been doing and how we can go forward to provide some really killer services to our kids. We have lots of opportunities if we choose to take them!

A Road Map to Educationally Relevant Services Through Teletherapy 

You’ve taken the webinars, downloaded all the free activities, and planned out your teletherapy sessions. Now you might be wondering how you can make sure you’re providing services under the educational rather than medical model. It’s a legitimate concern and might not have a straightforward answer. I have a few points for you to consider as you think through this. 

Get Everybody on the Same Page (er…Platform)

You absolutely need a reliable, safe, and accessible virtual platform when providing services. But I think it’s also important to consider the platform where instruction is taking place. I HIGHLY recommend you have conversations with your team and administration about what platforms are already being used. First and foremost, you’re not going to find yourself dealing with legal issues because you used a platform that turned out to be unsafe and wasn’t even what your district was recommending. But we also want to avoid overwhelming families with multiple platforms!

Simplify for The Family’s Sake

If you’re having trouble getting students to show up for sessions, chances are their inboxes are totally flooded with emails about “school”. Adding another platform and meeting time may be too much. Distance learning platforms may not have all the nice features of software built for telehealth. But, regardless, isn’t it important for us to work within the constraints of the platforms teachers have to use for delivering instruction? Remember, your job first and foremost is to help facilitate access to the learning environment! We need to understand the educational environment (in this case, the virtual environment) in order to adapt it for our students. 

Collaborate, Collaborate, Collaborate

We do this anyway, right?! Same premise here as working through the same platform. If we’re working separate from the teachers, how do we know what the needs are? Working on IEP goals is great but are we supporting access to online learning? How are they expected to show their knowledge? Lots of handwritten work is being replaced by electronic submission. Handwriting is still important but so is figuring out how they’re going to keep learning and participating with their peers! If you’re working on one and missing another then our work is only half done.

Also remember that doing something in front of a teacher goes a long way. Modeling activities for parents is definitely a great way to increase practice but having their teacher on board only increases the chance that they will work on that skill again. I’ve found that lots of teachers have struggled with incorporating hands on activities into their lessons. Many felt more comfortable after they saw me model a fine motor activity for their students. 

Build Relationships and Communicate with Families 

A silver lining to this otherwise dark cloud (if we choose to see it) is that we are seeing a lot of transformation in how we educate students. One change I’ve seen right away is parent involvement. While this has caused a lot of stress for some parents, I think that service providers have really been pushed to communicate more frequently and purposefully with parents than ever before. We can use this to gather some information we might not have known just from meetings! 

Families in Crisis

I think this is probably the most important part of the whole process right now. I’ve heard lots of folks saying they’re struggling to get parents to respond, show up for teletherapy sessions, etc. Remember Maslow’s Hierarchy! I’d say that “scheduling, remembering, and participating actively in your child’s teletherapy session” is somewhere in that top part of the triangle. Lots of our families are struggling with the foundation, physiological and safety needs. I recommend your first contacts with parents come without demands. Just reach out and check on them. Maybe they could benefit from a call with the school social worker or somebody to connect them with food and financial resources. 

Even if you’ve been in contact with the family. It’s never too late or too often to come back to the questions of “how’s everybody doing?” Some families are going to WANT therapy as soon and frequent as possible. Others will not and we just have to accept where people are right now. Maybe they’ve got everything they “need” but their child with poor self-regulation skills is turning the house upside down (something YOU can actually help with!). Just remember that we can’t solve everyone’s problems but we can listen and offer support and advocate for them. Once you’ve established that level of safety then it might be easier for them to participate in treatment. 

Go Back to the IEP

Depending on your district, you may be operating off an amended document that addresses specifically what services will be provided during closure. Try to avoid giving blanket service recommendations for all students. IDEA is clear that each student has different needs and will require different services/supports. Depending on the goals on the amended IEP or 504, OT services may not even be needed right now. They may not need any of their services right now. I have a student on my caseload doing so well with distance learning that he needs NONE of his 504 accommodations. Makes you wonder! 

Document and Log (EVERYTHING!) 

School OTs have long dealt with the issue of large caseloads and unrealistic expectations. Contract therapists also deal with their pay being tied to “billed services”. Much of the time you might have spent working directly with students is now being spent working through logistics, reaching out to families/teachers, waiting for students to “show up” to teletherapy, participating in phone meetings, etc.

You want to have detailed documentation of what you do all day. It’s more important now than ever. Be specific, how much time was spent in each activity? Who did you talk to? What did you talk about? I recommend having a documentation tool that records date, time spent, type of activity, what student it was for (this is important), and notes about what happened, why it was important. 

Don’t Be Afraid to Change 

Don’t fret if things you planned aren’t going well. Maybe telehealth isn’t the answer for a particular student! If you’ve tried co-teaching with a teacher and find you need to have a couple individual sessions with a student, that’s OK too. Perhaps you’ve been going at it alone and haven’t made much progress. Try setting up a co-teach opportunity with the teacher or speech therapist! Do what us OTs do best…change our plans!!! 

Always Know That You’re Doing Your Best!

Are you feeling like you’re doing everything in your power to help a student continue to make progress and access their education while schools are closed? If the answer is yes, then you’re golden. If you’re unsure, try asking yourself the following questions.

  1. Did I collaborate with the teacher(s) and other service providers (speech, PT, etc.)?
  2. Have I communicated with the parents about what they’ve been doing or are able to do?
  3. Are my interventions tailored to meet the family’s needs? (ex. Foregoing virtual sessions for packets and phone consultation when internet or computer access is an issue)
  4. Am I following my district’s guidelines about approved platforms, procedures, documentation, etc.? 
  5. Do my treatments address a need documented in this student’s IEP?
  6. Are my services addressing a parent concern or question related to accessing distance learning or functioning within the home environment? 

Going Forward

Don’t worry if you answer no to any of these but that might be an area to consider going forward. Going back to the beginning isn’t a bad thing if it makes your services more meaningful to the student, their family, and your teammates! Trust yourself, your clinical knowledge, and your desire to do what’s right for your students! 

Please drop a comment or a question. How has teletherapy been going for you in your school based practice? 

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