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Presence Spotlight for Clinicians: Alexandra Richard, M.S., CCC-SLP

Finding the best of both worlds—flexibility and stability


I am originally from New Jersey—I recently moved back during the pandemic—it was a fun and interesting adventure with a then 1-year-old son, trying to work and change over to teletherapy and move back to my hometown (which is awesome). I’m happy to be back. I attended Syracuse University where I received my undergrad degree in Communication Sciences and then I actually finished my master’s degree at Syracuse University as well.

I moved to Connecticut with my husband, where we lived for four years. This is where I started my career as a Speech-Language Pathologist, in a brick-and-mortar school. I took advantage of several opportunities during my early career, to gain as much information and experiences as possible. Prior to teletherapy, I worked in several different environments, each providing a new opportunity to learn and grow as a speech-language pathologist. As I transitioned to a teletherapy position, I was able to bring with me all the key tools and knowledge that facilitates my students’ success. One of my biggest takeaways is that in order to maximize growth within a child, families and therapists need to work as a team.

Fun Fact

I love swimming. When I was in school I was the captain of the club swim team at Syracuse. I was passionate about it. I’ve been swimming as far back as I can remember. I still swim— that’s my form of stress reduction. I’m a beach girl. And being back in New Jersey, I now have actual sandy beaches unlike Connecticut.

What inspired you to become an SLP?

I only looked at schools that specifically had speech-language programs.  When I was in high school I shadowed my aunt, who is a physical therapist. She said to me, “Listen, let’s just try all of the therapies.” And while I was shadowing, I fell in love with speech therapy, and told my parents, “I want to go to school for speech therapy. I know this is what I want.” And I never deviated from that plan.

What do you think it was about speech therapy that you connected with so deeply?

I had speech therapy as a child, so that’s something maybe not everybody would know about me, and I was moved by the fact that I was able to make so much progress in such little time. Also, I’m able to work with kids because that’s really what I wanted to do. I love kids. I was always the kid that said “Oh, I’ll babysit,” or “I’ll watch them, don’t worry” at a party.

And then I found the niche: How can I help? How can I provide support to other children? That’s the “aha” that led me to speech therapy.

How did you make the transition to teletherapy?

I became a teletherapist because I wanted a family and work-life balance. I found teletherapy very interesting and the Presence platform was more interactive and modern than any other platform I used before. I discovered Presence through searching when I was looking for telehealth companies. Presence was one of the bigger ones that I found and had a lot of the features that I wanted in a platform.

I actually started with Presence prior to the pandemic—I had previously spoken with them and was onboarding for summer school. After summer school I didn’t renew, because I was going back to my brick-and-mortar school. Then I found out I was moving from Connecticut to New Jersey, so I knew that I was leaving a job, and I wanted something that would allow me to move and have a job as well. It just so happened the pandemic struck right in that time period. My brick-and-mortar school moved to an online platform, and I already had some experience with therapy online so I knew what tools there were. Then it fully shifted, and I realized I wanted to stay with teletherapy.

I have to say I’ve had experience in different teletherapy companies, and by far Presence has the best platform I have ever seen. The fact that you’re able to use an actual platform that allows you to provide therapy and have all of these different features at your fingertips is why I love Presence and that’s why I stay with Presence—because it provides the best services to my students.

Why were you interested in applying for a full-time role with Presence? What’s important for you about that?

I have to say I was very excited when I heard Presence was creating a W2 full-time position. I think the most important thing for me at this point in my life was stability. When I discovered that Presence was doing this, I said, “This is what I want.” I loved the brick-and-mortar experience, because I knew I was stable in that job. I originally came to Presence because it allowed for flexibility and the ability to create my own schedule. With the new creation of this role at a W2 full time position you have the best of both worlds—flexibility and stability.

The contract provider position really worked for me as a mom who was just coming back into my career—having that flexibility of not having to work 40 hours—so that was very helpful for me, because I also got experiences using other telehealth platforms. And I could have those experiences and then realize, I love Presence because of their platform. But I didn’t have to commit 40 hours. I could make my own schedule. I worked in California for a very long time—with making my own schedule, I was able to send my child off to school and then start at 11 o’clock in the morning my time which was ideal.

I finally have a job on the east coast which is nice now after three years working in California. So there are pluses and minuses to all of it but for me stability is the biggest at this point in my life.

Where do you find joy in being a provider with Presence?

I love that as a provider with Presence I am able to work with so many different people and have students across the United States. I enjoy the rewards we get daily from the students that we work with. I find joy in being able to see growth even if it’s just a little growth—maybe something a parent didn’t notice, but you’re able to show them how important that step is to growing so much more.

Last year through Presence I worked with a team at a school in California that was unbelievable and we were able to see so much growth in a child that you wouldn’t even recognize them, from the beginning of the year to the end of the year. They had developed so much. The parent was very worried in the beginning and by the end I could see they realized that I’m on their team. That to me is very rewarding when a parent realizes that I’m not just a number that comes in and helps their son, and then leaves…they know I am part of their team, and I’m there if they need a question answered. That’s what I really love the most about being a speech therapist.

What were you most surprised about when you made the transition to teletherapy?

I think I was most surprised by how easily I was able to have parents become involved during sessions through teletherapy. And I was surprised by the ability to have as many activities at my fingertips as I do as in person.

I think that you have to be a little bit more creative in how you use them, but knowing that you have just so many things—you can use the internet, you can use the platform, you can incorporate so many things that children love because a lot of kids are highly focused on videos, and other digital content. You can incorporate that motivation part within your session very seamlessly.

Was there a learning curve for you as you transitioned to teletherapy? If so, describe the learning process as you adapted to this new service modality.

Yes, there is absolutely a learning curve with teletherapy. The biggest learning experience that I needed was to use the technology that I had at my fingertips effectively. I also realized that as a therapist you learn to manage behaviors with the face-to-face interactions. With teletherapy, you need to use the knowledge you have and be creative.

If you were going to offer a tip to a new provider about being creative, what would you suggest?

Being creative in sessions is realizing that if students like one thing, how can you expand on just that one thing? Say they like trains for example, how can you incorporate those likes and those positive things that are very reinforcing into something that’s going to be useful in learning speech therapy? You have all of these programs that you can use, so it’s just finding the way to use them appropriately in a session now that you have this information of what the student likes and dislikes.

How have you learned from other providers?

I use the Lounge a lot. I’ve gone to a couple of office hours, but I have to say the Lounge has been my biggest resource. For example, I haven’t had as much experience with AAC devices, and using the platform, I relied on my counterparts to help walk me through the best way to incorporate AAC. My biggest learning curve last year was incorporating that into my sessions effectively because when you’re hands-on you can get help and you can support. But you really need outside help to help facilitate what you need to be done on the other side of the screen. I was able to meet with some of my colleagues who had a lot more experience in that area, and brainstorm how best to do it.

How has the Presence platform enabled you to help your students in the schools you serve in new ways?

The documentation side of Presence is something that nobody else has—in particular, the fact that you’re able to take data. I don’t think SLPs realize how time consuming that is until you’re able to do it as quickly as you are during a session on the platform. And even in groups, you’re able to do it. As SLPs I feel like we’re always trying to find ways to quickly take documentation, especially data, and have it in a cohesive group and know that everybody’s getting a turn, while when you’re on the platform, it’s right there. It’s right on the side—you can tally and get percentages, and then it’s calculated into the goal. When you’re in a brick-and-mortar setting, there’s no technology that helps you do that. You’re taking data yourself and making sure that your students are making progress on their goals. When I transitioned to telehealth and specifically Presence, I realized that ability to take data on the platform is something that you can’t replace.

Could you walk us through your daily routine? A “day in the life of a Presence therapist,” if you will?

My mornings always look very similar to the day before. I wake up, I get coffee. Coffee is my go-to. I love my cup of coffee in the morning—it gets me started. And then I get my son up. Last year he started a two-year-old program and I’m able to play with him until he goes to school.

I plan out what I have to do for that day, whether it’s planning a meal, or planning out things that need to be done in the house. Then I sit down at my desk because when I sit down at my desk, I’m in Presence mode. Typically, I look at my schedule, answer emails, plan sessions, check out what new products and activities are in the library, collaborate with staff. I’m usually in sessions and meetings from 8:30–3:30 pm. I do wrap-up emails and documentation after my sessions are finished.

I try every break I have to be with my son if he’s not in school, even if it’s just to say, “I love you, and I have to go back to work now.” He knows that my work is upstairs, which is an awesome thing too, because he knows that I’m close by.

My parents watch my child when I am working. This past year I was able to drive my son to school, because I was on California time, and sometimes I would pick him up depending on my schedule. Most of the time, I always try to drive, so I can say, “Have a good day at school and I’ll see when you get home.”

What do you do at the end of the day to recharge?

My decompression time after my busy day is always making sure that we have dinner together as a family. That’s how we recharge. Working in California last year was a little tricky, because sometimes I had late meetings. But I could relax knowing that my husband would say “I’ll take care of dinner. You just come down when you’re done.” It was very nice to have that ability to know that even if I work late, I still have the time to see my family and decompress.

You had mentioned previously that you worked on a really great team. What made that team great?

Their effectiveness in communicating and having those meetings outside of just the PPT or IEP meeting made them a great team. I was in constant communication with them. If a student was absent that day, I was able to switch them to another time, so that they wouldn’t necessarily miss their sessions, because if a team speaks and communicates effectively, you can provide as much service as you possibly can to those students. In a brick-and-mortar setting, people are right down the hall. As a telehealth provider, it’s a little bit different—they need to be able to email you and know that even though you may not respond right that moment, you’ll be able to communicate back to them. I’ll miss this team but I hope to build that again because it is such an effective way to provide speech therapy to students.

Can you tell us a little about how you’ll help build your next team and how you’ll collaborate with teachers and other school staff members?

Teachers and staff members are a vital part of a student’s progress. I work every year to try and build a strong foundation with schools and their teams. Open communication and the ability to learn from one another are so important.

I always like to just get on the phone and talk to them and figure out their best method of communicating and see how we can bridge the gap between how I communicate, and how they communicate. Whether it’s time zones, email, phone, text messages, I identify how we can communicate effectively and fast so that we are effectively supporting our students. They get the information that they need, and I do as well.

How do you build trust and rapport with parents?

I always send out an email to all families at the beginning of the year so they get to know who their child’s therapist is. Building trust and rapport in a teletherapy or face-to-face environment is not different. A parent needs to know and understand that you are in their child’s corner and that they as parents are part of the student team to help make progress.

I think that it’s important for other providers who are not Presence providers to realize that what you do in the brick-and-mortar school is very similar to what you do in telehealth. They need to know that even though you’re not face-to-face, you’re just as big a part of the team as the people that are face-to-face.

What tips do you have for other providers getting started with telepractice?

Be patient—there’s a learning curve, but you know your skills as a speech therapist will always apply. It’s just trying to figure out the platform and learning how to navigate the system. But I think that there are so many helpful things in the Help Center, and there are so many people that you can reach out to. And now you’re not the only SLP which is a very different style than a brick-and-mortar setting—usually there’s maybe one SLP or you’re the sole SLP in the school. But now you have a whole entire team and a whole entire company that are all in the same boat. You could reach out to anyone and they’d answer you. That’s a big thing, knowing you have that resource.

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