We recently interviewed PresenceLearning provider Hollie F., CCC-SLP, about her work serving students with autism using the PresenceLearning platform. As we mentioned in our initial blog post introducing this special series for Autism Awareness Month, “PL providers will be busting some myths, sharing their teletherapy stories, and offering best practices for serving students with autism via teletherapy.” Hollie joined the PL Care Network in 2018.
Please tell us about your experience serving students with ASD via telepractice.
In September, I had a student who would come into the speech room in crisis. This student is nonverbal, uses a high tech voice output AAC device, and has significant behavioral challenges. Within 1–2 minutes of the transition, he would pick up the computer and attempt to break it. Together with the awesome staff at the school, we developed a plan. The plan was implemented the second the staff went into his classroom to transition him to the speech room. Through positive behavior interventions, consistent reinforcement, and teamwork, the student now transitions to and participates in 30-minute speech sessions. My heart melts when he stops in the room on days he does not have speech to tell me “Hi” using his AAC device. We have developed such a bond that he frequently hugs and kisses the computer when the session is over. This is an excellent example of how we can truly reach any student through tele-therapy.
This sounds just like you would manage the situation onsite. Are there any differences in how you need to work with the team for teletherapy?
In a brick and mortar setting I would be able to model that speech therapy starts the minute I walk in the room and it might include transition from the classroom to the speech room. I would be modeling that with staff by doing it. In teletherapy you really need to develop a bond with the staff that you’re working with. They really need to trust you. Then once you develop that bond and they trust you, they’re more willing to help you implement these plans. It hasn’t been a big challenge. Instead of doing the natural thing we would do as an onsite SLP, we actually have to communicate what we do to someone else to help them implement it. You have to open your mind a little bit and really think about what you’re doing.
Being consistent is key. I plan my communication ahead of time so my communication with staff is necessary and meaningful each time—I’m not sending them lots of different emails. I work out an email schedule in general and make sure that my communication is clear and meaningful and comes when they expect it. That’s the biggest thing. It doesn’t take long to build trust if you are mindful about your expectations. Simplify—less is more! Be clear about expectations and then do exactly what you say.
Even in just a simple transition from the classroom to the speech room for a student who is on the autism spectrum, as an SLP, we do a lot of things really naturally. We’re actually doing so much. So to train the staff and teach the staff, you have to break it down and think about exactly what it is you’re doing, and what modalities and evidence-based practice you’re using. I try to do on-the-spot teaching as much as possible because you have the example right there. But if the student is having a crisis or a major behavior at the moment, that’s not going to be the best time to do staff education so maybe we will set up a separate time. Maybe the next time in the student’s session the student could be working on something, or when they take a sensory break, that might be a good time. It just depends on the situation.
What age range are you currently serving?
I see 3-year-olds all the way to 22-year-olds.
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.
One of the biggest challenges serving students with ASD is meeting their sensory and behavioral needs. Implementing a visual schedule, sensory activities, and positive behavior interventions provide a successful environment for learning and communication. Another challenge is buy-in from school staff. Through the teletherapy model, there are many opportunities for staff training, supportive environments to learn best practices, and coaching/modeling opportunities.
When students have 1-on-1 staff members who are with them all day long, there is an amazing opportunity for their personal staff member to come with them to their therapy session. That’s the person that is implementing their communication and meeting their communication needs all day long. For students who have complex communication needs, school districts who have familiar staff become the learning partner during speech sessions are seeing much more carryover than school districts who are hiring someone to just sit in a speech room with the students during the sessions.
If a student is expected to complete their speech session in a classroom where other students are running around watching things on TV, using iPads, they are more challenged in attending and learning during the session versus students who have a quiet non-distracting environment—the most supportive environment for students who are on the autism spectrum and have a lot of complex communication needs is just a room with a table and a computer. Then you have their 100% attention.
I would love for districts to be open-minded enough to have the classroom teacher come to a session once a month, or any staff that works with students in the classroom. I’ve been in a few IEP meetings with an art teacher at a school. She is so interested in what is going on and she reaches out to me and asks me questions because for some of these students, that’s their only mainstream class. So now we have a thing where the art teacher tells the students to talk to me so they bring their project and then they can communicate with me. I think sometimes districts just have in their mind that they have a computer and the students are going to sit there, and they’re going to do their speech, and then they’re going to go back to class. But it really can be collaborative!
The minute district administrators decide that they’re going to implement this type of model for their services, there needs to be information about what it’s going to look like—the success stories, the evidence-based practice models. Teachers need to know what it’s going to look like and what to expect. If the district decision makers have a better idea of how a collaborative approach can work, they can pass that on down to their staff.
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.
The AAC Language Lab uses the LAMP Words for Life Language System (designed for people with autism learning to communicate with AAC). The website has supplemental materials designed with the symbol system—curricula, lesson plans, communication supplements, behavior management plans designed to be integrated with the symbol system. News2You is an adaptive current events newspaper. You can download a communication board that goes along with the current event. It comes out every week. They have 3 different levels so it’s tiered learning. I can talk about the same topic but I can choose the simplified version for some learners or the advanced version and the curriculum is already there. I have an account so I am able to download materials in PDF form and then upload them to the platform for use in my room. I can also use the screenshare feature.
SymbolStix goes along with AssistiveWare’s Proloquo2Go symbol system. It provides materials, staff training, and a core word of the week.
What would you tell another clinician who is critical or skeptical about students with ASD being served via teletherapy?
It is not that much different than brick-and-mortar. I am using the same resources. I am using the same evidence-based practices. I would encourage them, if they have the opportunity, to observe a session. It’s just really eye opening. Students who are on the autism spectrum frequently enjoy the computer approach. It reduces some of the physical distractions they would have if you were in the room with them.
A clinician will be most successful serving students with ASD via telepractice if they are confident and comfortable working with students who have complex communication needs in a brick-and-mortar setting. The same treatment strategies, evidence-based practice, and tools will be implemented in the telepractice setting.
Are you interested pursuing a telepractice career with PresenceLearning? Click here to start your application!