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Guide to Conducting Therapy Online: Innovate & Engage in Six Steps

From the experts in the field of special education and related services comes the definitive guide to conducting therapy with your students through an online platform—and unlocking the potential for teletherapy in any environment. The pandemic has reshaped how we do school, and adding a therapy platform and teletherapy to your service delivery model helps to support diverse student needs and continuity of care. Use this guide to make the case for enhancing how you serve your students and then learn how to make the most of the online modality.

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Introduction:

Online Therapy is Essential in Today’s World

A global pandemic may be a once-in-a-century occurrence (we hope), but school disruptions are not. And the lessons we learned from the pandemic should be applied today so that we are prepared and our children are prepared for the future that awaits. There’s no going back to the way things were—and do we really want to? A rethinking of how we do school is underway, and some of the possibilities bring with them exciting new opportunities for students and staff alike to get the most out of a school day.

Mental health challenges and a recognition of different learning styles have been front and center. Wildfires, snowstorms, tornados, hurricanes, and flooding have been on the rise in recent years. Technology, with the capacity to deliver personalized learning, has become an important tool for educational experiences in and out of school.

Some children who tend toward introverted personalities have discovered they could think more clearly and produce higher quality work when a quieter, online experience was either part of their school day or comprised their school day. Children with social anxiety, health challenges, or those who were bullied may have found that a remote solution helped them to thrive. In-school providers who were about to leave their jobs because of caseload burnout, because the commute was too long, or because family demands were too pressing may have found that a remote work opportunity kept them in the workforce and gave them flexibility to continue to do the work they love.

As our nation’s children shifted among remote, hybrid, and in-person school models during 2020 and 2021, we witnessed clearly what we thought was true all along: One size never fits all when it comes to education.

Mini-Glossary: Teletherapy can also be called online therapy or telepractice, telemedicine, or telehealth. In terms of mental health care, it can be called telepsychology. In the context of schools, these terms share a common meaning: a licensed clinicians’s delivery of services and care through the online modality.

Online Therapy (Teletherapy): Why It Makes Sense

Online therapy or the ability to conduct “teletherapy” through a platform is a key piece for schools in solving the complex puzzle that is education today. It enables schools to diversify services to meet the needs of students, to design for today’s workforce, and to integrate technology support into the classroom. These are essential to the future, and they are essential to preparing today’s students for a complex world and digital age.

“The PresenceLearning platform enables me to reach more students than I would otherwise be able to. I have cut way back on my clinicians’ windshield time so they can spend more time serving students and less time driving. And, I have been able to retain two clinicians who needed to move out of the district for personal reasons—they now use the PresenceLearning platform to continue to work with our students. It’s a win-win for them and us!” –Mike Lowers, Former Executive Director, Central Kansas Cooperative in Education

Published research studies suggest teletherapy may be effective in many instances and leading professional organizations recognize that therapy delivered through an online platform can be effective, including:

  • American Speech-Language-Hearing Association (ASHA) 
  • American Occupational Therapy Association (AOTA) 
  • American Psychological Association (APA) 
  • National Association of Social Workers (NASW) 
  • American Counseling Association (ACA) 
  • U.S. Department of Health and Human Services
  • Health Resources and Services Administration (HRSA)

“The pandemic has accelerated the shift toward telehealth,” says clinical psychologist Adam Haim, PhD, who heads the Treatment and Preventive Intervention Research Branch at the National Institute of Mental Health (NIMH). “The whole paradigm of sitting in a room with a clinician and receiving an intervention in a 45-minute session has essentially been flipped on its head.”

Teletherapy is a modality that has been in use for some time, and, if there are silver linings from the COVID-19 pandemic, one of them is that many in the school community have turned from skeptics to believers of this approach.

“We were apprehensive at first, but we did a lot of the training and the PresenceLearning team was great about making sure we had the right equipment. Our skepticism for using an online platform to serve students quickly turned into appreciation,” said Ellen Biller, director of special education for Page County Public Schools in Virginia.

The power of live, online services on an online therapy platform are not only in what they support, but also in what they open up: services that are deeply personalized, flexible, and ready to meet students where they are. In addition, an online therapy solution helps schools meet the moment in a workforce that is changing and seeking more flexible work opportunities. Remote work is here to stay and may well be part of a future where there is less struggle to find qualified clinicians—special education and related service providers, and school psychologists and social workers in the immediate community.

Amy Clark, director of psychological and social work services in The School District of Lee County, for instance, relied on added clinical support to help address the growing behavioral and mental health needs in her district. Her district turned to teletherapy and remote evaluations in order to address their backlog in evaluations and increase capacity for developing students’ coping skills and supporting mental health care.

“We wanted to identify the overall impact of this year on kids and plan ahead to get in front of it,” she said. “The PresenceLearning psychologists we deployed are licensed in Florida and have been trained in our process. They provide the same services as our in-person psychologists, just over the live, online platform. They also give us access to bilingual psychologists.”

Among the key benefits for schools are:

  • School choice: Students who have benefited from a virtual format can stay in a virtual school in the future and receive their services through teletherapy.
  • School continuity planning: Continuity is particularly critical for special education students, as lapses in services can cause students to miss developmental milestones and lose necessary skills. With an online therapy solution, your school can pivot among different models—hybrid, remote, and in-person—smoothly, and support continuity of care.   
  • Student fit: Providers may connect with their students using a therapy platform in school (from within the same building or another location) or at home as a supplement to in-person services. Providers all over are using it as primary modality for different reasons.
  • Extending your team: Overcome clinician shortages, especially in rural and underserved populations, by tapping into a network of teletherapists or by creating flexible solutions for onsite staff. 
  • Reduced travel burden & increased efficiency: Providers and staff who want to work remotely often find that an online solution enables them to do so, while also easing their travel time and enabling them to serve more students in a given day.
  • Health & safety: The online modality can help to reduce the spread of infectious diseases especially among vulnerable populations, as was seen during COVID-19.

Did You Know? PresenceLearning is the leading provider of live, online special education related services for K-12, including behavioral and mental health services. We have conducted more than 3 million therapy sessions on our platform that is designed by clinicians for clinicians, and we have served schools for more than 12 years.


Being able to receive services anywhere is part of the new normal. Here are six essential steps to help you get started on your journey to innovating and providing the students in your care with an engaging online therapy experience.

  

Step 1: Getting Started: Orienting the Clinician

Let’s begin with the most important factor in teletherapy: the clinician (or you!). If you are reading this guide, you are likely either someone who oversees a special education or counseling department and is wondering about how to get your team of in-school clinicians up and running with online services, or you are a clinician or related service provider. Either way, you’ll likely agree that the clinician—a licensed and experienced one who is trained in developing connections with students and helping them progress steadily online—is at the heart of this work.

As you begin your journey, know that you are not alone. This is not a new or uncommon form of therapy that developed out of COVID-19. It has been trusted for many years. Thousands of schools across the country have relied on teletherapy well before the pandemic, recognizing its value for enhancing and extending services to students both inside and outside of school. They have also seen clearly its value for providing staff with remote solutions and making the most out of their clinical time.

“Teletherapy can help to ensure that clinicians are spending their time in clinically-directed activities, which is really the best use of the district’s budget,” said Kristin Martinez, M.A., CCC-SLP, clinical director, SLP & OT, PresenceLearning. “Clinicians are able to focus their work and practice at the top of their license, meaning they are spending their time on work that only they are qualified to do—as opposed to tasks that could be completed by other staff. School administrators, therefore, can ensure they are getting the best use out of certified clinical staff to support compliance and student outcomes.”

Tricks of the Trade:

  1. Familiarize yourself with the current state of the literature, ethical considerations, and practical considerations in the field of teletherapy.
  2. Attend at least two formal trainings (workshops, webinars, etc.) on teletherapy. One should include information on higher-level issues. One should include more nuts-and-bolts, practical information.
  3. Practice the workflow of a full, online therapy session, from beginning to end, with someone other than a student. This will familiarize you with the juggling of materials, manipulation of digital platforms, etc.
  4. Conduct one full practice session without stopping. Ensure that you are competent at online administration procedures.

Step 2: Translating In-Person Therapy Skills to Online Skills

Online therapy is another modality of service delivery and, therefore, bears similarities to in-person therapy. But there are differences to account for and prepare for as you move your in-person therapy skills to an online platform. Getting acclimated to the new modality and knowing how to translate in-person skills into the online format are critical. Here’s how.

Training

Training is an essential step for you or for those on your team. It is integral to supporting any significant change in process—training on how to use a therapy platform, how to be prepared for a session, and how to make the most of the online modality. When planning for teletherapy, it’s important to help your staff think through what makes for a quality online session. Look for training with an experienced teletherapist who can support you in effectively transitioning from in-person services to the online modality.

You will want to ensure the training topics include:

  • Practical, effective approaches for getting the most out of teletherapy in home environments
  • Online therapy & assessment basics—how to get up and running quickly
  • Strategies for managing student focus and engagement
  • Communication and training templates for parents supporting sessions at home
  • Managing and monitoring student environments remotely
  • Developing trust and rapport through screens
  • How to make the most of the content and tools in the teletherapy platform
  • How to serve as, or choose and prepare, the primary support person

Preparation is Everything

Before starting a therapy session, clinicians should check to make sure the student’s workspace is adequately set up. Also consider what the setting looks like to the student. The workspace should be professional, with minimal audio and visual distractions. Think about what the student can see in your immediately surrounding environment. Remove any distracting personal items, artwork, or other objects that could pull students’ attention.

If you or your team is utilizing a document camera, make sure you are modeling how much desk space is needed for display items. You’ll also want to elevate your computer or webcam to a level that is closest to a straight-on view of your face. A camera angle below or above your face can be distracting and won’t meet the benchmark of trying to approximate an in-person session. Make sure that you are very well lit from the front. While a room may be bright, if the majority of light is coming from behind your head, it will cast you in a severe shadow on camera. One option is to use a specific monitor light for video conferencing that clips onto a monitor or a laptop and shines directly into your face to ensure you are well lit. Rehearse and practice with the content in advance to master the sequence and flow. When you can be confident and fluid with the content and technology, you will appear at ease—and the student will feel more at ease too.

Best Practices

Here are some of the best practices from the field that will help to ensure a smooth online experience: 

  • Research platform options with an eye toward security and features that support the most seamless transition of your in-person therapy to an online modality
  • Assessments. Be sure to consider how evaluations will be completed using any given platform
  • Training from an experienced teletherapy provider is a must-have, along with ongoing professional learning opportunities 
  • Consider your students in terms of where they will receive therapy and what kind of platform can best support (and transition between) an in-school or a home-based session. Also consider your students’ ability to interact independently with a therapy platform, and plan in-person support accordingly
  • Tech support is critical. Establish a plan for it (both on your side and the student’s side), as well as a communication plan between you and your student/school/family should any issues arise during a session
  • Credentials are key. If planning to practice with clients outside of your state of residence/licensure, be aware of cross-licensure requirements for your clients’ states of residence
  • Practice! Before that first session, ask a friend or family member to log-in as a student so that you can practice execution of your session plans, you can engage with platform tools and features, and you can work on best practices for in-session communication and running an online session.

Step 3: Getting Innovative

Once you have successfully learned and practiced translating your in-person skills into the online modality, you are ready to get innovative. A high-quality platform offers plenty of opportunities to do so.

“Those who embrace the step of innovation…those who are able to say—’Now that I am remote, what can I actually do differently than when I was in person?’—that’s the step that, once therapists do that, they are moving mountains,” said Stephanie Taylor, Ed.S, NCSP, clinical director of psychoeducational services at PresenceLearning.

So what are some ways to get innovative?
Here are five recommendations:

  • Break down barriers: You are not confined to the computer screen! Get creative in stepping away from the computer (think movement breaks, observations of parent/child interactions) and by bringing tangible, motivating objects to your sessions.
  • Personalize: With a platform built for therapy, take advantage of the wealth of resources to find high-interest activities and rewards that can personalize the experience for each of your students. This not only helps in engaging them and sustaining their interest, but it also helps encourage the new skills and knowledge to stick.  
  • Get Collaborative: With a platform that supports secure access and multiple video feeds, easily bring others to your session: invite a parent to observe, then discuss skill carryover in real-time; or invite a colleague to log-in and conduct a mock interview with your student.
  • Deploy Specialized Equipment: A platform with second camera integration will allow both the client/student and clinician to share and display their in-person resources (e.g., keyboard, AAC device, favored toy) while maintaining face-to-face connection.
  • Share: Seek out a platform that allows you to upload your own materials and share them with a network of peer providers (while also drawing upon their assets).

Step 4: Choosing A Solution: The Essentials of Online Therapy

Maybe you tried generic video conferencing tools for delivering related services and found them to be clunky or ineffective. Or maybe you are preparing for growing needs in your school community and know that diversifying your service delivery and expanding your capacity are key.

Either way, finding the right solution is important, and you want one that is specially designed for clinicians and for providing therapy to students in K-12. You don’t want to work with a vendor who simply implements the technology and leaves it in your hands. You want to find a long-term partner who has clinical expertise and who can adjust to your needs. Look for a partner who offers a robust technology platform and strong track record in schools, along with ongoing support services like professional learning, tech support, and a clinical network for additional staffing support.

Select a shortlist of possibilities by speaking with other schools similar to yours or reaching out to your state’s Department of Education or to professional organizations such as the National Association of School Psychologists, or various national disability associations for their recommendations. You can also attend conferences in the field, such as CASE conferences and workshops, to learn more there.

Top considerations when selecting a platform:

  • What was this platform originally built for?
  • Is it secure and HIPAA & FERPA compliant?
  • Is it interactive?
  • Does it include an activity library that allows you to personalize the experience for each child? 
  • Does it support crisp, clear video and sound?
  • Does it facilitate second camera integration?
  • Are there dynamic camera and video modes to focus on multiple types of intervention?
  • Features that can also support assessments as needed?
  • Live, in-platform chat support to keep your sessions on track?

Content Library

In the past, providers may have had to print out, store, or lug around a range of physical materials that could work for their different students. A rich, digital content library can be more efficient, accessible, and shareable for providers, and it can also open up an engaging, personalized experience for digital learners. Look for a platform that will give you access to content lessons and games that help a student work on their skills in the ways they learn best and that allow them to move at their own pace. In particular, identify a solution that comes with a wide variety of content, so that you can not only tailor the games and activities to the student’s interests, but you can also meet students where they are in terms of their cultural background, language needs, and geographic context. Also look for a content library capability that allows you to upload your own materials and share them with other providers.

“There is a huge variety of interactive games and tools on the PresenceLearning platform, all of which keep the students eager to participate in therapy,” said Karen Totman, a school-based speech language provider (SLP), at Maine School Administrative District 75 (MSAD-75). “The students actually get to turn over their own cards during a matching game, for instance, by clicking on them—rather than watching me flip over the cards in a video. I can also customize the cards to suit both their interests and needs; I can choose a shark reward for the child who likes sharks, and easily create customized cards with /f/ sounds for the child who needs to work on that. Students stay much more engaged because they are actively participating in an activity that relates to their own life, rather than just watching me move things around on the screen as they had been doing in the spring before we adopted PresenceLearning.”

Training is essential as you start working in the online modality.
Did you know that PresenceLearning’s Therapy Essentials offers three training components?
They include:

  • Therapy Foundations: Online, self-guided modules to get you started and familiarize you with the PresenceLearning platform. 
  • Clinical Applications: Live professional learning for your school-based clinicians led by PresenceLearning Clinical Experts to apply what you learned in Therapy Foundations to real-world scenarios. Training is specific to each therapy type or role.
  • Office Hours: Ongoing live office hours led by PresenceLearning Clinical Experts to support you as you go. Drop in anytime for discipline-specific sessions.
  • Clinical Workshops: Attend topic-specific workshops with PresenceLearning Clinical Experts to expand your teletherapy skillset as it applies to the broad range of student needs and goal areas.

There are two ways to work with PresenceLearning

  1. Our Clinical Network: We can match your students with the best-fit clinicians from among our network of 1,500+ licensed clinicians. They can extend your team and provide your students with live, online speech-language therapy, behavioral and mental health therapy, occupational therapy, and assessment.
  2. Our Platform: License our platform for your district’s use and we’ll train your school-based clinicians on the effective delivery of teletherapy and tele-assessment on our therapy platform that is designed by clinicians for clinicians.

“The trainings have been incredibly invaluable. I was not taught to do speech in this way and always thought therapy needed to be conducted in person,” said Melissa Phillips, CCC-SLP at Lewis Cass ISD. “The team at PresenceLearning showed me this wasn’t the case—they were so supportive and answered all my questions so that I could jump right in.”

Step 5: Preparing for Services in the Home Environment

Work with Parents as Partners

One major change from in-person to online delivery in homes is that clinicians will need to prepare
to work with parents and caregivers as partners. When done well, the shift to in-home therapy can present a particularly special opportunity for providers to connect with parents, build rapport, and see the home environments in ways that have not been possible previously.

As the parent or caregiver witnesses services firsthand, they often gain deeper knowledge into the child’s therapy exercises and goals, which can enhance how they support their child throughout the week and provide opportunities for “carry over” of skills. For example, the nightly dinner table may become a richer opportunity to practice a child’s developing speech or fine motor skills, while online meetings with relatives can support social emotional learning (SEL) skills and bedtime may present an opportunity for practicing mental health exercises that help reduce stress and anxiety. Preparing to work with parents as partners will help ensure the delivery of quality services for students.

“The parents I work with really appreciate PresenceLearning as well,” said Melissa Phillips, speech-language Pathologist, Lewis Cass ISD in Michigan. “One mom said to me, ‘Holy cow—I didn’t realize my son could pay attention like that!’ The PresenceLearning format really helps to facilitate attention during speech sessions.”

QUICK TIP: Identify a District Champion: Leverage a district champion in your school or district who can highlight the benefits of online therapy to colleagues and parents. Ask them to share exciting moments of progress with students or how the technology works in order to help gain understanding and buy-in from skeptics. This person may be you, your director of special education, your director of counseling, or another enthusiastic, onsite provider.

Communication is Key 

Some schools use a combination of emails and phone calls to introduce the idea of online therapy to parents initially, and follow-up with regular and frequent check-ins. To help parents feel confident that they can facilitate effectively and support their children in teletherapy, schools transitioning to home services provide a checklist and clear instructions for parents. Parents should also have easy access to tech support to minimize down time and frustration.

Here are a few key questions to consider for working with parents as partners:

  •  What is the first choice channel to communicate with parents?
  •  How will you reach out to parents who don’t respond?
  •  What schedule and frequency would be best for communication with your parent community?
  •  What information do parents need to be able to facilitate their childrens’ teletherapy sessions?
  •  How will you handle tech support (both pre- and mid-session)?

Collect Data about Student Resources at Home

Student resources can vary wildly across districts and across home settings even more. In many homes, a single computer may be shared with siblings and a parent or caregiver. Understanding what technology and internet access students have at home is an essential foundation for creating a plan that will work.

Here is your checklist:

  • What equipment do students have? Internet, computer, tablet, phone, etc.?
  • How can you reduce the need for shared equipment between students?
  • How can you prioritize equipment if there is short supply?
  • Where would the service take place in the home? 
  • Can coaching or guidance documents be created to help the parent or caregiver prepare?
  • Is the location conducive for therapy?
  • Who is at home with the student? Who is available for support if needed?
  • Will interpretation or translation services be needed for setup and/or support of teletherapy?

Tech Check

A therapy platform, like the one offered to school-based teams through Therapy Essentials, includes specialized features and equipment, such as a dynamic video camera, audio, and a synchronized workspace.

Ensure your equipment is functioning properly:

  • Check both the upload and download internet speed to verify they meet the minimum requirements of the platform you are using. There are many free services available to do this.
  • Have the primary support person (PSP) who may be a caregiver in the home, or student enter the platform you will be using to verify they can.
  • Walk the PSP or student through giving the platform permission to access audio and video.
  • Include the headphones that will be used and make sure they are also plugged in and tested at this point. Some platforms don’t automatically recognize earbuds and headphones, so they may have to be selected as the desired device.
  • Have the PSP or student turn on the camera to make sure it will actually stream and that no security features are preventing the camera from working (this is most applicable to school internet that has security settings enabled). 
  • Ensure all notifications are turned off, such as from email and messaging programs.
  • Instruct the PSP that there should be no recording of sessions.

Step 6: Evaluating Success: Student Engagement

Finally, you can determine the success of online therapy by being clear in your goals. The best measure of a therapy session is student engagement and ultimately, sustained progress. When delivering sessions using a platform designed for therapy, student engagement can be measured similarly to how you would measure engagement when delivering services in-person: through observation, student response, and student participation in activities.

  • Get to know your student. What do they like? Customize the content and activities around their interests. 
  • Check in & build rapport. Ask how it’s going (both their day and their learning) and help your student feel connected to you and comfortable in asking questions.  
  • Reinforce & assess learning by summarizing the learning for your student. Also ask your student to share back to you what they have learned.
  • Start slow & increase time together. If attention span is an issue, start with an expectation of five minutes, then look to increase the time of each session incrementally. As you increase your student’s engagement for longer periods of time, you know you are making progress. 
  • Connect & gather feedback from the child’s parents and your colleagues on their education team regularly to gather further insights and give insights into how they are doing.
  • Ensure a safe & private space for behavioral and mental health sessions, whether 1:1, or small group, to put students at ease.

“Innovation is happening in special education,” said Kate Eberle Walker, CEO of PresenceLearning. “We’ve talked to a lot of school leaders, and many of them are adding technology into their services with equity and access in mind. Schools have seen clearly how an online therapy solution can personalize the experience for students and staff. They have seen how it can remove barriers to serving students. And they know they need to be prepared for a world where we exhaust all options, including online services, before we say we cannot serve a student who needs therapy support.”


GET INVOLVED

This guide will be updated to include new information and research over time. We look forward to your feedback, welcome your shared stories about implementing a therapy solution in your school, and would love your input on what resources we should provide next!
Contact us at info@presencelearning.com with your ideas.


LEARN MORE

Intrigued and want to learn more?
If you’re interested in learning more about a therapy platform, teletherapy, or the work of PresenceLearning, please schedule a free consultation today. Discover how thousands of providers and school districts are diversifying their delivery of services as part of an innovative approach to behavioral and mental health, and special education.

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