Autism Awareness Month Provider Spotlight: Elyse R., MS, OTR/L

Elyse R. graduated with an Occupational Therapy degree from Rush University Medical Center in Chicago, IL. Her career in OT has focused on both outpatient Pediatrics and school-based practice. She has had the opportunity to work in both Texas and Nevada, and also in Mexico. Elyse started working in telepractice with Presence Learning in 2015.

Please tell us about your experience serving students with ASD via telepractice. 

I worked with the EasterSeals Autism program; I had a full caseload at this site, with very challenging cases. The team at the school was supportive, and would receive my treatment plans each day and the PSP would prepare everything for the students in the mornings for each session. The school site was very good at ordering and purchasing items to better support the students. We saw very positive gains with each student who was seen via teletherapy. The students benefited from the consistency of online services, since it was so difficult for the site to maintain onsite therapists. I also currently work with a school in WA state, and the majority of my students have Autism. 

One of the students didn’t even want to sit in front of the computer. He would be by the door. We brought him in little by little in each session, even having him just standing and doing some of the activities, even doing just half a session, depending on the tolerance of the student. Initially this student couldn’t write his name. At the end, he actually was able to sit down at the computer, and use a pencil to copy his first name. We’re talking about pretty significant gains from initially not being able to sit down and not having any functional fine motor skills to being able to sit down, focus, follow through with instructions, and write his name. These are huge things.

My PSP was instrumental in helping him achieve these gains. She assisted all of the sessions. She’s amazing. She would get the treatment plans and go above and beyond. She would do visual schedules for me. Anything I recommended, she would have everything ready to go. I think it was because she saw the gains that these students were making and she had never seen that before because there wasn’t always a lot of follow through at the school site unfortunately. There had been a lot of change in rotation of staff, so she wouldn’t see this normally. I think she was blown away by seeing what they could do. It was good to see her perspective shift after almost 10 years at the school. 

What age range are you currently serving?

I serve students between age 5 and 21.

What advice would you offer school partners considering teletherapy as an option for their students with ASD? It would be good to know what some of the challenges have been and how you’ve worked through those challenges, when applicable.

The key for me was having an amazing PSP supporting the students. To build the relationship with the PSP, I would consult with her. Before we started working with students, I would do an online meeting with her. Then I would meet with her right before sessions would start to go over how we could best work with the students—for example, having me send treatment plans. We would always have a back and forth, or we would consult after we met with all of the students and go over things. She would also scan each work sample the students completed on a daily basis which was super helpful for me as a therapist to see everything up front and close. 

I think another important part that helped build our relationship was that I had a lot of contact with administrative staff and they saw the successes. Also, I had a weekly consult with one of the school-based OTs who was on site and I would meet with that OT weekly. It is quite incredible to see what students can do in a session and what we can gain. I think seeing those gains motivated my PSP to go above and beyond. It’s important for school staff to see the gains students make.

Do you have any tools or resources within the platform that you found helpful? Or any external resources to share? If so, please tell us about them. 

I did a lot of hands-on activities which seemed to work better. For those that were able to use a mouse, we would play memory games, and use different worksheets on the platform, depending on the skill level. 

I scan resources I have and use those with students. With my treatment plans I would attach all the documents I would want them to have and the PSP would print them out daily. I have a lot of physical materials myself. An example of physical materials I might use would be pegs and a peg board…I have them and they would have them there on site. So I can model for the student using the same materials. When a student needs a special material like loop scissors instead of regular scissors, I could show the staff and send them links to order materials for particular students.

What would you tell another clinician who is critical or skeptical about students with ASD being served via teletherapy?

I would probably ask them first, “Why do you think it wouldn’t work? What are your doubts?” I would ask them to explain to me how they plan their sessions. There is a lot of preplanning required—planning my treatment plans, sending them the night before, having the PSP prepare all the materials, and if we need to modify certain things, then we do that too. I think a lot of people are naive in thinking teletherapy is easier. It actually requires a lot more preparation than onsite. 

A lot of people think students are not going to be able to sit down and look at the screen. First of all, they don’t need to sit down and look at the screen. It doesn’t mean that they’re not taking in the information or processing things. It just depends on how the clinician thinks they’re going to structure their session. We would give frequent rest breaks for students who are not able to attend for very long so working for a little bit and then a rest break. There are all these misconceptions about teletherapy. A lot of students like the camera. You can start to see students who would never look at you go from no eye contact at all to actually sitting down and looking at you intermittently, or then from intermittently to looking at you longer. You can do interactive themes, and online things, sharing your screen. A lot of students find that very interesting. You can change up how you present material instead of always doing the same approach—that’s a key step in engagement. 

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