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Tele-WHAT?? Working on Social Skills during Social Distancing Times

Telehealth. Telepractice. Teletherapy. Virtual Visits. Virtual sessions... It's like we don't know what to call it.

Zoom. Theraplatform. Theranest... And then there's so many different options for your provider to choose from.

Before COVID, I was curious but reluctant to jump into the virtual boat. I took a few courses and understood it needed specific equipment and there were a bunch of HIPAA considerations. That was the extent of my knowledge though.

As I noticed things getting more serious in mid-March, I knew my practice delivery model would be impacted. I hunkered down for a full weekend and dedicated that 48 hours to studying and understanding what exactly virtual sessions are and how to best deliver them. I am not saying I'm an expert in this domain, not by any means. However, I have taken notes and advice from those who are experts. I've grown to love my little studio production sessions and the theater my office space became.

In marketing my new service, I found a mixed bag of reactions. Some parents were thrilled! I received new referrals even! Other families were hesitant and just as reluctant as I initially was. "Are you sure this would help my child?" And some others flat out refused. (Which is 100% okay!)

Based on the reactions and questions I received, I want to help put some of your minds at ease about this new world we've been thrust into. Some of these things may turn out to be for the better. I plan to continue offering virtual sessions after our shelter-in-place is lifted, and I will explain that more later.

What Platform Do You Use? Why?

Many larger companies and corporations offer their sessions through Zoom. Zoom is an excellent platform with an extensive amount of tools and capabilities, depending on how much you pay. Yes, they offer a "free" version, however if your provider is using the free Zoom, they are not being HIPAA-compliant. HIPAA requires double encryption security, meaning that the video and audio are encrypted at both ends of the session. This makes hacking and obtaining personal health information extremely difficult. This is also why your provider cannot use programs such as FaceTime, that have not been approved by HIPAA.

Let's Play Speech Therapy uses the virtual session capability that is built into the Theranest Client Portal. This means you will only need one login to access your appointment, access records and pay your invoice. I decided on this platform as it keeps things convenient and concise for you, the client. I also enjoy the simplicity of the platform. I used other platforms with built in apps and found these added features often lagged or caused other hang ups. They just weren't worth the extra headaches.

How Does a Session Actually Work Then?

This is where the true magic happens (or fizzles...). Remember with technology, there will be a learning curve and there will be unexpected frazzled moments. It's important to stay calm and flexible during all the potential hiccups, although I definitely try to minimize them.

Many of my clients are using a direct approach to their therapy still. Our sessions are essentially identical to my in-office ones, except I'm adapting the materials for digital presentation. Whether they are PDFs, Google Slides or online games and videos, practically all my materials can be presented in a digital format.

A few examples, based on primary diagnosis...

Articulation/Phonological Therapy

In the clinic, I primarily use phonetic placement drills and other motor-kinethetic approaches with visual prompts for target words. Many of these visual prompts are easily displayed using screen-share or by mirroring my iPad onto my computer's display. Here's a screenshot:

Together, we go through the target sounds, words, phrases, sentences. As needed, I can make my video larger in order to provide better gesture or visual cues of articulator positions. I actually love how the child can also see himself during this practice! It's like a mini built-in mirror, something I often use in the clinic to improve self awareness.

Language Therapy Sessions

Language is a large area, so much of this depends on what aspects of language we are working on. For my older children and students who are working on spelling, reading, reading comprehension, etc.; similar to my articulation students, I have many of the materials updated for digital presentation. I use Google Slides to adapt books, which also allows me to put in fun animations and motivating characters. I also use Boom Cards for more drill-based or discussion-style approaches. Again, using screen share, I can highlight areas of text to help draw the student's attention there.

Without screen sharing documents, which can get rather boring, language is such a wide array of concepts! Science experiments, cooking lessons, art classes... these are all rich, language-based activities that target many of our student's goals and can be easily adapted for a virtual session with some previous planning.

For early language and communication development, I incorporate a much more theatrical approach! Despite not longer providing home visits, I still have plenty of toys to break out. Puppets, action figures and other familiar scenes work their way into our sessions. I have a document-camera that I use to give a special view of a table. On this table, I will have my toys and/or drawing materials. Children will tell me what the toys are doing, or what I should draw, and I will make their imagination come true. Often times, children will run to grab their toys and we will share in this experience together.

Some children aren't interested in "virtually" playing with my toys though. That's okay! They may enjoy the funny and hilarious things that *I* will do and act out. From Simon Says, to Hide'n'Seek to Dance Party, I will often find myself parading around my office space to the tune of "The Ants Go Marching".

Social Skills Sessions

I've noticed many of my children who struggle to maintain eye contact are flourishing with virtual sessions. The anxiety of having another human being directly in front of you has been reduced. Not to mention, the student now has complete control over my presence. He can control how loud I talk, which way I'm facing, how bright my face is and even end the session with just a quick -click-. Can you imagine suddenly gaining that much control in an area that gives you great discomfort?

Social skills aren't taught. They are developed through engaging and continuous interactions, that are hopefully increasingly positive in order to reinforce us to continue interacting and engaging. With my social skill sessions, I provide some video modeling to the best of my ability and topic discussions with lots of visual prompts, charts and other memory strategies. The big focus in social skills though would be the discussion and reflection. I do not want to change anyone's personality, however it is important to understand the "social code" and how to use it as one sees fit.

A note about video modeling using my Theranest portal. Unfortunately, at this time, when I share my screen, it does not share the audio of what is playing. This means I cannot share the audio of a YouTube or EverydaySpeech video during our sessions. I joined several other therapists in a request in with Theranest to change this. In the meantime, I am figuring out another way around the audio issue.

What if my child cannot pay attention to the computer?

This can be a challenge. Infant and toddlers, in general, shouldn't be at the computer screen for a full 30-60 minutes for a speech therapy session. Many older children and students are not able to understand and access virtual sessions in a direct manner, whether it's due to attention, compliance, visual differences, etc. In these situations, I recommend a coaching model approach.

As a young speech-language pathologist, the coaching model was another delivery model that I cringed at when it was first explained to me. "You mean, you want me to teach you what I do?" Yes. That's exactly the point. Oh, and explain the rationale behind it too. My initial reaction to that was borderline offended, as if I would be replaced because I taught someone else "my magic sauce". Get over yourself! As I gained more experience, I became much more comfortable and even welcoming of the coaching model approach. If I can teach you how to do what I do, then I can let you work the magic while I go teach and help another family! This magic sauce isn't mine. It's not some secret recipe that only I can concoct. No, it's something that I've learned extensively and have every right and intention to share for your benefit. The things you learn with experience ;-)

The coaching model fits seamlessly into virtual sessions. The family prepares a play area within the camera's range. I love if the caregiver is able to wear a wireless earbud or AirPod so I can provide tips and feedback in realtime without the child being disturbed, but that is definitely a luxury. Then, I watch how the family and child interact during the activity, whether it's building with blocks, playing with cars or dolls, a sensory game, book reading, etc. It's important that we don't lose sight of following the child's lead during the coaching model. Yes, it's important to be organized and have a few activities prepared, but make sure the child is allowed to choose which activity to engage in, when the activity is over and then what activity to do next.

Feeding AKA Virtual Picnicking

Feeding is another domain that can work its way easily into virtual sessions. Bring the laptop or iPad into the kitchen or on the table. Let's all prepare this food together! After food prep, we can get back into the coaching model discussed earlier, and have our meal or snack time. Because virtual sessions allow me to eliminate my travel time, I may be more flexible in the times we meet, which could open up times that are closer to a naturally occuring mealtime. Now, many children do not like to eat for an audience, so again, virtual sessions allow for an aspect of control. You can turn the camera to a certain angle, you can put it a further distance away so the child doesn't feel "watched". I can also break out my snack and we can have a virtual picnic! What fun!

Curious for More?

My mission here was to give you an idea about what speech services provided virtually would generally look like. I'm thankful for being thrust into this, although I do wish the circumstances were different. I've found many positives about virtual sessions including the flexibility it allows me to provide with scheduling, the increased attentiveness and independence I've found with many clients, the ability to use my same materials digitally and virtually, and the ability to continue providing services regardless of circumstances that previously would have discontinued services. It's not all roses though. I've found some clients are more easily distracted and will leave the room. Once they leave the room, I cannot follow, so it can be very hard to bring them back. There are some clients who cannot access virtual sessions for a variety of reasons and the coaching model doesn't always work for everyone. Some family dynamics are more comfortable with watching me interact and learning from my "debrief" after.

Ultimately, I feel as though virtual sessions are a crucial new tool to have in my toolbelt. I plan to even expand my range and get dual licensure in North Carolina in the coming weeks. The flexibility virtual sessions provide along with the increased motivation and independence it allows some clients to achieve. My approach will always be a comprehensive and dynamic one; consistently adapting to the needs of my families. In order to ensure effective and efficient adaptations, it's important to have numerous methods and approaches at your immediate disposal.

If you're curious on learning about how virtual sessions can benefit your family specifically, let's chat! Shoot me an email at or call me at (571) 310-5953. Together, we will find a way!

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