Telehealth refers to any healthcare service that is provided over a technology platform. Telehealth is now being used for a variety of populations, health disciplines and diagnoses. Disciplines such as Occupational Therapy, Speech Therapy, Educational Therapy and Psychology are all able to provide a variety of support and care virtually using a computer or tablet platform.
Online therapy is provided in a similar manner as therapy that is delivered in face-to-face sessions. However, live video conferencing is used to address the child's therapy goals and provide guidance to parents and caregivers.
The therapist will provide the parent with a link and instructions about how to connect to the online platform. This may involve creating a Zoom or Skype account that will be used for the sessions. Usually, the therapist will test the Telehealth platform with the parent and child before they begin their first session. The therapist will also discuss with the parent what resources are available at home for the child to use during the sessions. Many Telehealth sessions require the same objects that a child would use in the centre. For example, for Occupational Therapy, to help strengthen a child's fine motor skills and reach developmental milestones, methods such as cutting skills and drawing are often used. For Speech Therapy on the other hand, the therapist may suggest resources like age appropriate books to expand the child's language abilities. Often a parent-coaching approach is used to guide parents to do therapy-like activities with their child at home in order to accelerate their progress. This way the parent learns exactly what to do and builds confidence in helping their child.
Telehealth provides therapy options within the comfort of the child's home environment. It provides ample opportunity for parent education and support from the therapist. It is convenient and keeps up to date with the latest trends. If you live far away from the centre or if transport is difficult, this is a way to bring occupational therapy, speech therapy, educational therapy or psychology into your home.
It is suitable for all children who have access to high-speed internet, and a tablet or laptop with a webcam. Children of all ages can be supported through Telehealth by the therapist and their parent or caregiver. For sessions with younger children or those who need hands on support, a parent or caregiver is required to be present for the session. Telehealth can cater to a wide variety of children including those with Developmental Delays, Autism Spectrum Disorder, ADHD, Sensory Processing Disorder, Developmental Language Disorders, Language Disorders, Speech Sound Disorders, stuttering, difficulties with emotional regulation, and those that require counselling, educational support and many more.
This is a great opportunity for parents and caregivers to be supported to work with their child. The level of parent/caregiver participation will depend on the level of support the child requires. This can be explored with the therapist and a plan put in place in how best to support the child. Research has shown that parent coaching through telehealth has been effective in increasing parent efficacy and child participation (Little et al, 2018). Support can range from sensory needs, educational needs, emotional and counselling support or language skills.
During telehealth sessions with your child’s therapist and while at home with your child there are lots of opportunities throughout the day for practicing following and giving instructions. Instructions can be given verbally, written, with pictures, modelled or even with a short video. There are a variety that you already use throughout the day. Some might be simple routine instructions such as “get your bag”, ‘take your plate to the table and sit down”, or “put on your shoes”. There are also longer and more complex instructions such as “first colour the tree green, then clap your hands, and last draw 3 clouds in the sky”. These skills can be expanded out for older children using their literacy skills to read and follow written instructions to complete a task.
For both younger and older children, it is important that they get the opportunity to give instructions to you or to their siblings. This helps with developing their expressive language skills including use of correct grammatical structures, expanding their vocabulary and concept knowledge, their ability to order and sequence events (if giving multiple part instructions) and it can be used to practice and develop their turn taking skills. Your child’s therapist will be able to guide you for the type of prompts or supports needed to help your child successfully give and follow instructions.
Some ideas for following and giving instructions could include:
Shared book reading is a great activity that can be introduced during telehealth. Your speech-language therapist can read a book to your child through telehealth and use different approaches to engage your child with the book. This is a wonderful way to support parent-child interaction and promote positive engagement rich in language. You can also encourage your child to show their favourite book to the therapist and talk about their favourite book. The therapist can ask open-ended questions during shared reading, for example, “What is this picture on the cover?” “What happens on this page?” “Tell me about your favourite part of the book?” and support your child with their responses by modelling the appropriate language. This activity is also a great way to develop vocabulary, expand on your child’s answers and develop their ability to answer -WH questions (who, what, where, what doing, why, when). With an older child, shared book reading is also a great way to develop their inferencing and prediction skills, by asking them what do they think will happen next or why do they think the character is doing a certain action. It is also a wonderful way to introduce and develop their understanding of more nuanced emotions and body language. It is a great way to connect with your child and enjoy some parent-child time in a positive environment!
Rapid Automatized Naming (also known as Rapid Automatic Naming or RAN) is the ability to name items and symbols in a quick and automatic manner. The ability to easily retrieve information, rapidly and automatically without effort represent additional skills that are involved with successful reading. These other skills include attentional, perceptual, conceptual, memory, lexical, and visual sequential processing. Difficulty in this skill can hamper speaking, reading, and writing.
There are many different kinds of automatized naming games that require rapid naming and recall, like charades, taboo, pictionary, etc.
You will need a timer (and something to cover the sheet partially *optional*)
Lumosity is a great website for training core cognitive abilities like memory, speed, attention, and information processing to name a few. Lumosity takes scientifically-validated tasks and turns them into fun games, actionable feedback, and rich insights into your cognition. (Information taken from lumosity's website). It tracks progress, is catered to all ages, and is also available on mobile devices for easy accessibility.
During telehealth sessions there are many opportunities to practice mindfulness. Mindfulness practice can also be used throughout the day when your child is emotionally dysregulated, in a low mood or in general need of some relaxation strategies.
Some ideas for mindful breathing include:
Some ideas for mindful exercise and muscle relaxation:
Zoom is a free video conferencing platform which allows people to connect online and share resources and their screen easily.
A computer or tablet is required which has a camera, microphone and speaker. For telehealth sessions, a camera is required to allow the therapist to be able to see and interact with the child.
While a Zoom account is not required to join a meeting, it is useful to have an account. The free zoom app can be downloaded from the Zoom website (under Resources > Download Client), or from the Apple App Store or Google Play Store.
When you open up the app, there will be an option to sign up for your free Zoom account using your email. It is a good idea to test the software prior to the meeting. This can be done by going to the link zoom.us/test which will allow you to test the technology for the microphone, speaker and camera. You can also check how to turn on and off the microphone and camera.
The therapist will send an invitation to join a meeting via email. In order to join the meeting, you can click on the weblink or enter the Meeting ID and Password which will be provided by the therapist. You will be placed in a waiting room and the therapist will allow you into the meeting room once the meeting starts. You will be able to see the therapist and have options to turn your video and microphone on or off.
Here is a useful YouTube video explaining the process of setting up a Zomo account and its functions: https://www.youtube.com/watch?v=d7xXZxRDFUU
Whilst Dynamics prefers using Zoom due to its ease in setup and usability, we can also use other platforms that may be preferred by clients such as Google Meetups, Skype etc.
[Above points adapted from: https://globalteletherapy.com/advantages/]
Little, L. M., Pope, E., Wallisch, A., & Dunn, W. (2018). Occupation-Based Coaching by Means of Telehealth for Families of Young Children With Autism Spectrum Disorder. The American journal of occupational therapy : official publication of the American Occupational Therapy Association, 72(2), 7202205020p1–7202205020p7. https://doi.org/10.5014/ajot.2018.024786