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Teletherapy ... here I come

Since the beginning of March, I've been researching teletherapy platforms to find the one with the most features, good security, a reasonable cost, and ease of use. For four weeks, I have been reading everything I could regarding teletherapy. I had always planned to add this service delivery method to my private practice, but I hadn't imagined I would be doing it quite so quickly. The following is information I have gathered from various sources. I completed a 6 hour training in teletherapy from eLiveNow Therapy , www.elivenow.com which was very beneficial. I watched many trainings on SLP Telecon https://www.bethebrightest.com/. Replay sessions will be live through 5.6.2020. The Whimsical Word also had a free training on using boomcards. I read many articles in SLP facebook groups.

I'm still learning and always looking for new materials. I was nervous before I started. I had many questions racing in my head.

Would it feel disconnected? It did not. I could see my client's face and reactions, and she could see mine. I was surprised how natural it felt.

Would I be able to proficiently navigate Zoom application and go between windows flawlessly? Definitely not flawlessly, at first. But I did therapy, and it was pretty good. There was a time or two where my student would tell me that she wasn't seeing what I was talking about, but then I shared the screen and all was well.

Could I effectively provide therapy? I did. I used many of the same activities that I would do in person. I was unable to use a tactile therapy tool for articulation, but the student could replicate the movement without the tactile aid.

Would the child be engaged? Allowing the children to use the annotate feature and stamp words as we go has been a big motivator. They love using the stamp.

The weirdest thing is looking at yourself the entire time. There are settings to only see the student, but I do find it beneficial to see what they are seeing. I discovered I am way more animated than I thought.


The information I present is not all encompassing. You need to check with your state associations, school district, and possibly lawyers for specific legal details. Consider it a quick overview.


There are many teletherapy platforms and prices. Zoom was the choice recommended by many experienced teletherapists. For me, Zoom was the winner. I have heard that there have been security breeches. I have adjusted my settings and required password for entry to prevent breeches. Specific settings are listed at the end.


Required technology:

Work Environment. The space that you create should be private and calm. Doors and windows should not be behind you. You don't want people to accidentally come in during a session or to create a distraction in the background. Incoming light from windows directly behind a therapist are very distracting to the viewer. Have a professional, not cluttered, environment. Have a professional appearance for yourself as well. One therapist suggested avoid wearing stripes.

Fast Internet. The clinician and the client must have between 1-5 Mbps upload and download speed. I watched several videos. Some people said one; others said 5. You can test your speed at www.speedtest.net. Many resources suggested have an ethernet cable attached directly from the router to your computer. If you are buying a new computer, check for an ethernet port. It is not a standard feature anymore. I do not have a direct connection and am doing ok.


Computer/Ipad/Chrome book. Every therapist recommended using a computer or laptop for service delivery by the therapist. The computers used should be 5 years old or younger. If the client is accessing Zoom through an Ipad or Chrome tablet, some of the functionality may be reduced. For example, the ability of the client to annotate or select items when given control of the screen will not work.


Monitor. Ideally, 15 inches. minimum. I don't have that. I have a regular laptop monitor.


Web Browser: Chrome, Safari, and Firefox were the three web browsers that were recommended to me. Research the website of the teletherapy platform you are interested in to verify what browsers work best with their platform.


HD Webcam(internal/external). This will allow you to be seen. Suggestion from a therapist: Place an eye around the camera to remind yourself where you should be looking. Position the camera just above your eye level. You may be able to raise your computer/laptop with books if you have an internal camera.


Super comfy chair or standing desk. You can place foam squares on the floor for extra comfort when standing. That being said, don't sit for long periods. Get up every hour and move.


Additional accessories:

Headset with boom mic (clinician and client). A boom mic with headphones would be incredibly beneficial when working with the articulation students. It is difficult to discriminate the sounds without one. Keep the microphone to the side of your mouth so that your mouth can be seen.

Extra monitor. Used to keep documents open so you don't have to toggle between Zoom and open windows. You can use an old tv to be a second monitor if it has an HDMI card capability.

Document Sharing Camera. Used to present printed materials instead of scanning them in. You can MacGyver a contraption to use your cell phone as a document camera if need be. I saw a crafty SLP online use scrap wood and make a device to hold her phone. Another simply used a selfie stick in a cup. Brilliant. Necessity is the mother of invention.

Green Screen. You can use a green screen behind you and place any picture for a background.

Spotlight(lamp). Will help you be seen better.

Battery Backup. Allows not interruption of therapy services due to power issues.

Ipad. You can mirror the Ipad screen and show apps from Ipad through Zoom. To access screen mirroring, click down and left horizontally on the screen.


Teletherapy tips:


The clinician must be licensed in the state that the delivery is being received in. If someone goes on vacation, you must be licensed in that state to provide therapy.


You will want to have your teletherapy platform have the functionality of being HIPPA compliant. You should sign a HIPPA/BAA certificate agreement with the company.

You will need to obtain parent consent before collecting information from children.


Before sharing any activities or websites, preview them ahead of time.


Don't sit for hours on end. Get up and move every hour.


Shut down your computer daily.


Synchronous(live) and Asyncronous (recorded) service delivery. You can decide to provide therapy by either of these service delivery models.


Have child's contact information and local emergency numbers handy in case there is an emergency or disruption of therapy services due to illness or weather.


Parent Expectations

Quiet Location

Have child sign in with initials only

Computer should be placed close to router for strongest wifi connection

Sign on to session 5 minutes prior to session.

Stay and observe session.

Inform therapist if the screen was not shared or the wrong screen was shared.

Write down any questions during sessions.


Zoom Directions

You signed up for Zoom and you have an account.


You will be able to modify settings in the Settings section.

Screen Share Host Only

Disable Join Before Host

Enable Co-Host

Disable File Transfer

Disable Allow Removed Participants t Rejoin

Enable Password


Scheduling meetings:

You can make an instant meeting or schedule a meeting.


Instant Meeting. Log in to Zoom. Select Host a Meeting with or without Video. Click on Open Zoom. Join with Audio or not. Invite Recipients. Or give them the 10 digit code that is listed on the top corner of the screen and they can log in directly at www.zoom.com. Click on the i in the upper left hand corner to find the numeric password for people that sign in through phones or tablets or the password you assigned for those accessing the link via email.


Schedule a Meeting.

Click on My Account.

Meetings.

Topic. Enter meeting name

Description. Describe what meeting is about.

When: Select Date and Time. Must schedule time on the 1/2 hour for meetings scheduled in advance.

Time Zone.

Password ( I use it for additional security)

Save.

You now have a meeting.


Inviting recipients.

You can click on the Copy the Invitation link. You will then be able to paste it into an email and send to whomever you want. You can modify text if you want.


Or you can invite people from within the meeting. You will click on the Invite button on the bottom menu, and it can directly connect to gmail.


Zoom Menu Within a Meeting

If you move your cursor to the bottom of the screen, a black Zoom menu will appear with picture icons.

Microphone. Press to mute or enable your sound.

Video. Press to display video or disable video. Video settings--> Advanced--> Touch Up My Appearance :)

Invite. Press to email participants from this screen. Or Copy the Invitation. And then paste into an email and send to your client.

Manage Participants. This will bring open the chat window and a list of the participants. You can mute all. Participants can raise their hands. Or write comments to the group.

Polls. I haven't used this capability.

Record. There is recording capability. All of the therapist suggested NOT recording sessions.

Reactions. Each participant can select from High five and Thumbs Up.


On the upper right hand of the screen is an icon to toggle between Speaker View and Gallery View. ALT + F1 and ALT + F2 will also let you toggle.


Zoom Hot Keys and Keyboard shortcuts.

https://support.zoom.us/hc/en-us/articles/205683899-hot-keys-and-keyboard-for-zoom

Some of my favorites are using the spacebar to Mute/Unmute. ALT CTRL G to regain control of screen.

Where to find additional telepractice information?

ASHA Telepractice Portal https://www.asha.org/Practice-Portal/Professional-Issues/Telepractice/

ASHA State by State Requirements

https://www.asha.org/Advocacy/state/default/


Speech-Language Hearing Interstate Compact.

https://www.asha.org/Advocacy/state/Audiology-and-Speech-Language-Pathology-Interstate-Compact/

State License Board (Ohio's is listed)

https://shp.ohio.gov/


That's it for now. I'll make another post about online resources that people shared too. Teaser: Check out www.Boomlearning.com Incredible.

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Contact  Nicole Sauer , CCC-SLP  today at  440-502-7667 or nsauer@effectivespeechtherapy.org 

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