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The article title with colored pencils underneath4 Ways OTs Can “Push In” To Virtual Learning

School based therapists probably haven’t seen the last of telehealth in their practice. Even if districts reopen, some of our students will likely be served through a distance model at some point next year. Now is the time to reflect on our practice and what we can do to best serve children in distance learning and the “new normal” of social distancing. Below, I offer some suggestions to look at how we can integrate our services into the virtual learning environment. 

**PLEASE REMEMBER: THESE ARE SUGGESTIONS BASED ON MY EXPERIENCE. ALWAYS FOLLOW YOUR DISTRICT’S GUIDELINES ABOUT HOW RELATED SERVICES SHOULD BE DELIVERED. 

How to “Push In” to the Virtual Learning Environment 

Push-in therapy has its challenges in the physical environment let alone the virtual environment. Nevertheless, there are several strategies therapists can use for “pushing in”. One resource I found was a handout by Carrie Clark, CCC-SLP (www.speechandlanguagekids.com). I’ve discovered it is still available if you sign up for her mailing list here.

Carrie’s obviously a speech therapist and uses speech therapy examples but I’ve used this handout multiple times (hint: this handout also goes great in a fieldwork binder!). She outlines 9 strategies for push-in therapy but I want to speak just about four of them that I think work well in virtual practice. In order to illustrate how they look, I’ve included a case study for a kindergarten student I worked with this year through a telehealth/distance learning model. 

A Repeating Kindergarten Student Working on Letter Formation 

This student was referred for an OT evaluation in October 2019 for concerns with letter/number formation and attention. This was her second year in kindergarten and she was still unable to write her name at the time of referral. Her case manager had been working with this student for two weeks in small groups using the district supported virtual platform. 

The platform has a virtual whiteboard but it has to be accessed with the mouse, making it less than ideal for letter formation practice. Other limitations with the platform included not having a way for students to manipulate activities on the screen themselves and teachers not being able to see students while presenting their screen. Maintaining the group’s attention and participation was a definite area of need. We also needed to find ways to incorporate fine motor and visual motor activities into the session. 

1. Therapist-Led Virtual Learning Lesson 

This push-in strategy involves the therapist essentially taking over a lesson. I’ll say this can be a lot of work but also a GREAT way to get some “buy in” from teachers who are overwhelmed with distance learning. You’re basically doing some of their work for them! If done well, you can model some great strategies.

Work samples showed that this student needed to work on letters with diagonal lines and distinguishing between M and W. We broke the session up into gross motor and hand warm up activities, watching a video of children going down slides, taking turns pretending to slide down a slide, watching a video I created of making “sliding lines” and the children practicing on whiteboards at home.

We also did a letter ID activity that was not hands on and did not hold their attention very well. I would skip that activity next time. Creating the videos beforehand worked well because I could pause the videos to check understanding, go back to review material, etc. Without a document camera at the time, this was much better than trying to demonstrate what I wanted them to do live on my little screen. 

 

2. Co-teaching with Co-Planning of Virtual Learning Activity

I love this model but, as the name implies, it requires more teacher involvement and a good working relationship between the teacher and therapist. Basically, the teacher and therapist work together to develop a session that hits on educational goals while meeting the needs of the child needing therapist support. This is a huge opportunity to share strategies, resources and rationale for our recommendations that the teacher can then use on a regular basis. 

Collaborating to Make Learning Fun

In this case, the teacher wanted to incorporate a cooking activity but wasn’t sure what type of activity would be easy and effective to do through distance learning. I recommended https://accessiblechef.com/,  a website I LOVE and use all the time these days! I wanted a quick activity that incorporated some bilateral coordination, tool use, and some directionality/form copying. We found this perfect visual recipe for a patriotic graham cracker

Even though the recipe is super simple, there are lots of opportunities to work on skills such as directionality, form copying, cutting/bilateral coordination, etc. The kids loved it and we had no problem holding their attention for the entire 30 minutes. 

Upon reflection, I would have made a video to demonstrate some of the skills like spreading and cutting. Jumprope is a great app for this (though the video gets posted publicly within the app so avoid saying a child’s name). One of the students got a lot of hand over hand assistance from her mom. It might have helped to demonstrate how to cue the child so that she could be more independent. 

3. Therapist Leads a Unique Activity for Virtual Learning Session

This is where the therapist introduces an activity that wasn’t normally part of the day (think yoga routines, breathing exercises, social skills activities, etc.). Think about this like being a “special guest” during a virtual class session. These often don’t take an entire session so you may follow up again during another session, or choose to stay and support your student through a teacher planned activity. I’ve listed some examples of what you can do

 

4. Therapist Adapts Materials or Supplements 

This method is a little different because it allows for less direct involvement in the actual session. Remember that many states require informed consent by the parent before you can provide synchronous therapy services online. If you aren’t familiar with this, please check your state regulations regarding what is required. This model of adapting materials may be an option for service delivery in instances where informed consent cannot be obtained.

Basically, the teacher plans a lesson and provides materials to the OT who then adapts the materials. A straightforward example of this would be adapting worksheets by adding boxes, adapted lines, etc. You could also create videos, visual supports, tool adaptations, or other materials for teachers to use during lessons. Consider using a collaborative whiteboard to work on assignments together in real time!

Taking Multiple Approaches

Approaches can sometimes be combined! I’ve gone to virtual learning sessions where I’ve led everyone in a hand warm up (think “therapist leads a unique activity”) then stayed to support a student using the adapted materials to complete the activity. This could be as simple as saying “anybody with the worksheet that has yellow lines” and demonstrating where the letters go on the line (though you may also need to work with the student or parent beforehand). That way the student doesn’t get called out by name. Parents can always snap a picture of the finished project. 

Perfectionists Need Not Apply in Virtual Learning 

There are going to be technology glitches, scheduling issues, etc. I do, however, feel that employing some of these strategies can help increase engagement from some teachers and families. Streamlining things so families don’t have to “show up” to multiple sessions and offering to take some of the load off a teacher may open the door to increased participation from all team members. I’ve talked about some ways to make our virtual learning services more educationally relevant in my post here

I’ve got another post where I talk more about being educationally relevant in teletherapy. So I will just leave you with a few things to remember

  1. Make sure you’re getting informed consent according to your state or district policy before doing anything synchronous (think video conferencing) with students 
  2. Reach out to teachers/case managers and try to see if you can support or help problem solve, offering to help make materials or plan activities can increase buy in
  3. Try using one of the methods above to reduce the number of times families need to “show up” for online school and make your services more relevant to the online learning they’re already doing
  4. If none of that works, do what you think is best to serve your students. If that means you’ve got to set up separate sessions then go for it. We are all doing our best!

Please leave comments and questions! What has worked for you? What hasn’t? Is there a how-to you wish existed? What training do you wish was out there for telehealth? 

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