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Presence Spotlight for Clinicians: Christine Limongello, MA, EdS, NCSP

“The best professional decision I’ve ever made”— A school psychologist transitions to teletherapy


I grew up in Brick, New Jersey, and I currently live in the town next door so I’m pretty close to home. I got my undergraduate degree from the University of Delaware in psychology, and my masters in school psychology and my education specialist degree from Rowan University in New Jersey. After graduating I worked in the traditional brick-and-mortar role of a school psychologist for eleven years. For five years, I was the case manager for the district’s elementary level self-contained program for children with behavioral and emotional needs. I was looking for a change and transitioned to teletherapy in 2017.

First and foremost I’m a mom—I have a daughter who is 11 and my son is 9. I like to go paddleboarding. I like to go to the beach. I like to go walking at the Boardwalk at sunrise.

What inspired you to become a school psychologist?

The role encompassed everything that I was looking for when I was an undergrad. I really wanted to work with all different populations. I didn’t want to just work in a psychiatric facility with students or children who had those types of difficulties. I didn’t want to just work with children with autism. I wanted to work with everyone, and I think that school psychology really spoke to me from that angle, because you seriously do see all kinds of things, educationally and psychiatrically. So it was a very good fit for my own personal strengths, even with organization and time management. I like paperwork. I like writing reports. It still is a good fit so that worked out well.

What made you want to be a teletherapist with Presence?

Initially, I was drawn to teletherapy for a better life/work balance to fulfill both the role of a clinician and a mother. Now that I’m in the field, I like the fact that I can work with different populations around the country. I find it very interesting that the criteria for specific learning disabilities can be completely different from state to state. At one point I had a student at a brick-and-mortar setting in New Jersey who did not qualify, but would have in California, and I had a little girl in California who did not qualify, but would have in New Jersey.

I do like being able to work with different areas around the country. In Illinois, I’m able to take my background in intervention and referral services and provide more resources to the school district that I’m working with. It gives us a better ability to share knowledge from one state to the next—I don’t know that we would have been able to do that prior to this. So that has been very helpful.

You were an early adopter. How did it even come up for you to explore teletherapy?

I was really feeling a lot of burnout with the behavior and emotional program. I found the Presence website, and it looked very interesting. There were a lot of teletherapy doubters in the beginning when I had mentioned this. They would typically say, “Oh, you can’t test online, that’s impossible!” And then I met with school psychologist and Presence Clinical Account Manager Lisa George, and I remember saying, “I just trust this person. This sounds like a really great adventure.”

I’ve often said this is hands down the best professional decision I’ve ever made. This was a great, great opportunity. I’m so glad I listened to her. She kept saying, “I think you’re going to like this transition from what you’re doing now to teletherapy with Presence,” and she couldn’t be more right.

What were you most surprised about when you made the transition to be a teletherapist?

Primarily I’ve had 3 major districts. Even though I’ve never met a lot of these people that I work with, I would say that I have built very real connections with everyone. In the district I have now, I have four schools. I’ve been there for four years. We have a very easy relationship. We have our system down. We know what we’re doing. It’s interesting to me that even though I’ve never met these people in person, we have very real connections, and we seamlessly get everything done.

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.

It was a new way of thinking about completing evaluations, meetings, and observations remotely. Once a system was in place and running smoothly, I found that there really was not much difference. The Presence onboarding process was phenomenal. It was such a great training process. There were different modules that showed me exactly what I needed to do. It was very clear cut, and was explained very well, so I feel like that really helped answer a lot of my questions.

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

It’s so varied. When school is in session and my children are back to school, I wake up very early—I typically write reports in the mornings and then my children get up. I help them get dressed and get breakfast. I put them on the bus, and then usually my meetings begin. I typically start at 8 or 8:30 my time but Illinois is an hour behind me, so it works out perfectly with our time difference.

Collaboration is a significant part of my position. I meet with staff on developing interventions and creating individualized, measurable and meaningful goals. We talk about systems-level supports and interventions for specific student needs.

I have certain meeting days for my different schools. On Fridays, I work with my preschool to 1st grade teams. With my K/1 teams, we discuss referral concerns, I complete social/emotional/behavioral/adaptive/academic evaluations, and we meet to review results. We share recommendations for the child to be successful in the least restrictive environment.

I have testing that I schedule with the PSP. And I type in between if I can, and answer emails. I budget my time the way that works for me, and like I said before, I’m an early riser. Even on the weekends—I’ll write a report on a Saturday morning. I wrote a report this morning at 5 am. That’s my own system.

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

When comparing testing remotely versus testing in person, I find that some students feel more comfortable using the technology and having that as a buffer during evaluations. A lot of students have high anxiety. They’re so used to technology at this point that I think sometimes their anxiety level decreases when therapy is through the computer versus when there’s someone sitting right in front of them, giving them an IQ test or asking them reading questions. It depends on the student of course—some students are better in person, but I find that a lot of students in this generation that’s coming up are very comfortable with all the technology so they don’t think anything of talking to this lady on the screen.

Since many of the areas I serve have limited resources, I am able to reach a large number of students in various areas to help meet their needs.

How do you build trust and rapport with parents?

Early on in my career, I realized that parents’ main objective is to ensure that those working with their child have their best interest in mind. I find that speaking from a child-centered approach is useful in conveying the message that we are all working collaboratively for the benefit of the child.

Parents are invited and attend the evaluation planning meetings most of the time so that’s a huge part of it. The parent is part of the team that gives us their own concerns. We go through each domain. For example, we’ll begin, “Are there any educational needs?” and everyone will respond. Then we’ll summarize, “Okay, these are the concerns. These are the evaluations that will be done.” Then we’ll go to language concerns and we’ll talk about that. So the parents are very involved that way. I speak with them by phone, I send them electronic scales to complete for adaptive skills, executive functioning skills, behavior and emotional development. It’s all electronic so as soon as they fill it out, I get an email saying they filled it out and I’m able to include their observations into the report, too.

Describe how you work with the Primary Support Person to support your students during therapy sessions, particularly those with more significant needs?

I usually have a good working relationship with my PSPs. We’ll have our own meetings. I send them the schedule every week. If there’s a particularly difficult student coming up, either I give them a heads up or a staff member will. And we communicate during sessions. For example, I notice and share with the PSP, “Oh, it looks like he’s getting a little fidgety.” Then maybe the PSP will get the child up for a moment.

Currently, I have students in kindergarten through 5th grade. I have some older kids, too. But I also do the play-based assessments for preschoolers, so for that, I work closely with the PSP. Play-based assessments are done in a large play area and the occupational therapist, speech therapist, physical therapist, social worker, and PSP are all there. I’m on the camera so the PSP will move the camera so that we’re able to see everything, and it’s also helpful because if someone on the team is on maternity leave, they’re able to get the recording too, or watch remotely with me through the platform.

We’re able to see what skills a preschooler has to determine whether or not they qualify for special education. Preschoolers are a challenging population, just based on their age. And the fact that they most likely have special needs on top of that increases the challenges.

So the PSP is very instrumental with those assessments as well, just making sure I can see everything. And then afterwards we all meet as a team and discuss our observations. “Did you see that? Did you see this?”

If someone’s home sick, we do it remote. And as I mentioned, if somebody’s on maternity leave, then they’ll join me on the platform, too. During the pandemic we were all remote and we would all observe the parent and the child in their home.

What has your experience been completing evaluations via the Presence platform? How would you address any hesitation providers or schools might have about this evaluation modality?

When I was a lead back in 2019–2020 and we were getting new schools on the platform, they did question online evaluations. They would ask, “How comprehensive are the evaluations? Are you really able to capture the student strengths and weaknesses?”

But I think a good clinician knows how to ask the right questions. I don’t think being in the room is really the issue. It’s really about how you are using the information from staff, from parents, from your own observations, from scales. You’re bringing in all different types of information. So there’s really not much of a difference, I find, between on-the-ground versus virtual.

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