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Presence Spotlight for Clinicians: Jennifer O'Keefe, M.S.Ed., CCC-SLP

Insights from a Teletherapy Early Adopter


I grew up in upstate New York, in between Albany and Saratoga Springs in a town called Clifton Park. I lived there for about 35 years until moving to North Carolina. I live in the Raleigh area now. We’ve been here for about 10 years. It was a great move. I have two teenage children and there’s a ton of stuff for them to do down here which is really fun. They’ve both started high school this year which is very exciting and a little bit of a reality check as well.

Fun fact: I’m in my fourth year as a professional triathlete—I’m one of the oldest female triathletes in the United States at the age of 46. In the professional field there’s no age category so my competitors are anywhere from 20- to 30-years-old and this is their full-time job. For me, it’s more of a passion and a part-time job. A neighbor challenged me to do an Iron Man—I thought he was crazy but I ended up having second thoughts and went to the World Championships in Hawai’i. I placed fifth and got my professional license after that. It’s been quite a fun ride and I honestly do it for the love of fitness and also just to be a good example for my children—you know you can work hard, put your mind to anything, and good things happen.

My kids are big swimmers. I told them when they were growing up, ”You guys can do anything you want but we just can’t be couch potatoes.” My son was a state champion in the hundred backstroke when he was 10-years-old so he’s having fun. They’re both having a great time.

What inspired you to become an SLP?

I have a dear family friend of my mom’s who was a speech pathologist and owned a private practice in Saratoga, New York. I shadowed her in the field. And then the other piece was my strong relationship with communication—if we have trouble with things like swallowing, or communicating, quality of life changes. And so I think I have a great deal of passion and desire to help people with these challenges.

What made you want to be a teletherapist with Presence?

My move to North Carolina brought me to Presence about 10 years ago. Moving from where I’d always been in the northeast and coming down to the south, I wasn’t quite sure which direction I wanted to go in. That’s when I came across Presence. I think there were about 150–200 clinicians at the time. It was very, very new so it’s been super fun to be with this company for as long as I have been and watch how it has evolved. I’ve made some incredibly strong bonds with a lot of people, both at headquarters as well as with clinicians.

Finding Presence was more like a job search. At the time I had young children. And so the idea of being home was a big perk of course because you can still be a mom and have a career. I had worked for eight or nine years in-person in schools in New York. I know it is really challenging working outside of the house, so working from home was intriguing to me. And then there was the opportunity to provide help in a really unique form—our platform is very unique in my opinion. In all the years I’ve been with the company, I’ve seen lots of different platforms. Ours is truly just the best. It’s very engaging—whether you have a three-year-old or 23-year-old, there are so many ways to engage and have fun in therapy.

I worked with a few districts in Alaska. I learned about the culture of areas that I would have never learned about before if I just stayed locally. It’s efficient too. I like to be efficient. You can see your clients. You can do your documentation and data collection while you are in session. I could go on and on with examples and the reasons why it’s just a fantastic choice.

I fell in love with the company’s innovative mindset. The idea of providing therapy services to a child in a small, rural town in Alaska or desert county in California who would likely never have a local SLP is very fulfilling.

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

First, I love my Presence family! I have developed friendships with the most amazing colleagues around the country. After 10+ years they’ve become like family. Second, the opportunities are unique and ever-changing at Presence. I never feel “stuck” as a professional with the vast amount of projects and clinical opportunities. Third, we have phenomenal leaders who support us daily. I am grateful for my clinical account managers (CAMs) and headquarters staff who work incredibly hard for us.

I love the flexibility. As a professional athlete, the flexibility of my schedule with Presence allows me to train and have the best of both worlds!

For a roadmap of my time with Presence, I was initially an SLP doing treatment and assessments for a few years and then I transitioned into a lead role for six or seven years before the clinical account manager position came along. At that time, as a leader, I wasn’t doing therapy, treatment, and assessments anymore. I was involved in a range of projects like demos, spotlights, interview committees, office hours, and marketing campaigns. I would also travel locally to meet any local school districts or clients of ours to give them a face with the name.

Now I’ve come full circle back to being an SLP, giving treatment and assessments, and working with leaders. I’m also an IEP spokesperson for one specific district that has been with us forever. I have a really special relationship with them so that’s one of my roles with Presence. I don’t do any treatment for them. I just attend IEP meetings for their preschool and assessment team.

I appreciate all the variety of tasks and roles that I can put together. For example, over the summer I was an assessor for a rural school district in California. They had a boatload of COVID-backlogged assessments to get done so I had the opportunity to do that. This variety would not happen if I was just sitting in a regular school district in the county I live in—it would be the typical day-in and day-out, which can really burn somebody out. I’ve been an SLP for 20 years or so now and I don’t feel burnt out. I feel like I’m constantly getting these fun new, innovative opportunities.

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

I was most surprised at how efficient my day became working online. Our platform lets me record data in-session, document and track progress for easy reporting, and have client information right at my fingertips…all in one comprehensive site.

I am always incredibly amazed at how responsive our Tech Support Team is. They are fast, helpful, professional, patient, and pleasant!

How do you build connection? What have you learned over the years about how to do that in this environment?

I think one of the biggest things, as a lead and now as a therapist, is winning the hearts of the people who don’t buy into the model in the beginning.

I remember that was a daily kind of challenge—how can I help this teacher get to know me and understand and accept this model that they’re just not used to yet? Or how can I help a student who gets major anxiety when they have to look at themselves on the computer screen or know that they’re going to be face-to-face on this video? Over all the years, I think I’m grateful for this aspect of the job because it’s taught me a lot about communication in general—emails, phone calls, and consistent communication.

Always being professional is key. It’s simple things like always starting an email with “Hi, so and so,” or “Good morning,” or whatever it may be, “I hope things are well.” Be consistent in having a clear body message and closure for the person to read. If I’m not getting the email response, I follow up with a phone call, a text message, or any other way that I can get in touch. I think consistency and also some compassion are important because you really don’t ever know what somebody else is thinking or what they’re going through.

I think having compassion and getting to know people on a human level is important. I let them know I’m also a human, I have kids too, I work full-time too. I try to build those natural interactions and relationships that we do on a regular basis.

If you are getting impatient or frustrated, you have to really do your best to not show that but instead, try and figure out a way you can help them. Yes, we’re therapists, but I found that over the years I learned so much about customer service by trying to put myself in somebody else’s shoes and figuring out what it is they’re thinking, what’s their perspective, and what is it that they’re struggling with that’s impacting this relationship. That’s not something you’d learn in public school in North Carolina. There are many more layers online.

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

I am an early riser, often starting my morning answering emails and reviewing what is on tap for the day—double checking my schedule, IEP dates, therapy planning, and upcoming assessment planning. I provide therapy, document, attend meetings, and repeat! Several times a day, I find myself chatting on the phone with parents, fellow providers, or district staff.

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

Our platform is by far the BEST out there! The depth of our library and variety of tools built into the therapy room make services fun, effective, and never boring! In my 10 years as a clinician with Presence, I have very seldom repeated an activity! In addition, that ability to upload IEPs and hold meetings within our rooms is convenient for clinicians, staff, and families!

In our library now we have the community piece—the platform gives you the newest uploads, and it also gives you the most popular so that’s really helpful. I’ve had some clients over the years with very specific interests. For example, I had a girl with autism who really wouldn’t work for anybody, but she would work if shown pictures of cats dressed up in funny costumes.

As odd as it sounds, when you search our library for cats and costumes, you’re going to find something. So the power of that is incredible, plus our team of developers are just so creative, providing tools for games and tools for screen shares, and a lot of recordings. The emojis are always changing. I went for a four-month spurt where I decided I wasn’t going to repeat an activity ever with a student. I got very creative with the way I used things. For example, maybe I used an image as a slide before but the next time I might use it as a circle and paste or some type of game. There’s always something new.

Can you tell us a little about how you collaborate with teachers and other school staff members?

Communication is all fashions—emails, phone calls, texts, video calls. Communication and rapport with these valuable team members is truly what I believe makes the system work. For example, over the summer I had a caseload with more high needs students. I think what was working with that teacher was going back to asking, “How can I help you? This is my expertise in communication. What do you need for the students?” This one new student came to the school. He was nonverbal—he had no communication whatsoever and no picture exchange or augmentative communication device. They don’t have a speech therapist so she’s the special education teacher and trying to figure out how to help this student to communicate.

I sent her the PECS (Picture Exchange Communication System) pictures. Then I asked what five pictures she wanted to focus on in the week ahead, and I let her know that I’ll get that to her, whether it involved sending it to her in the mail, or emailing it to her so she could print it out.  So I’m trying my best to serve them. I tell them “I’m not going to be there in the classroom but do you want to turn on a video? I can watch and observe and we can talk about some ways to help this child communicate.”  I just try to be present and let her know I will provide anything that I can to further her teaching of the goals that I was trying to work on. I would work with her to understand what they were working on that week—I think their topic was something like states around the United States—and I suggested how I could help work on that—like incorporating a map in our session.

Teachers work really hard. They have a lot on their plate. So I just try to figure out what I can do to support them.

How do you build trust and rapport with parents?

Consistency and professionalism with communication is key. Always. Often. In my ten years with Presence, there are very few situations that my team has not been able to overcome with parents and staff. Simple things like reminders and text messages go a long way for helping remember appointments, but also I just try to support them and send materials or just listen, right, like “Hey, what’s going on?” or “Hey, if you can get them on the computer, I can give you 30 minutes of free time—I know that Bobby can sit there for 30 minutes and I can definitely engage him for that time,” or “You are welcome to just sit and watch and see what happens or if you want to log in from another room and don’t turn your camera, you can observe like you would through a one way mirror to see what’s going on.” I try to support them with choices, and if they can’t make the session, and things go haywire, I am compassionate and empathetic. For example, I had a parent the other day who completely forgot. They told me later, “We are so busy.” We all forget appointments every once in a while. We all struggle so just be compassionate. I said “Hey, let’s do a makeup session. Let’s start new tomorrow.”

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

Be patient with yourself. It’s a learning curve. I’ve had these SLPs on my team that have been an SLP for 25 years. If you’ve been an SLP for years, you probably know everything there is about articulation but this is a different world—so be patient. Be open minded too. Take the path of the least known and try to learn something new about yourself and learn something about a new way to deliver therapy. Branch out on some of the social media that Presence has (Facebook Group, Instagram, LinkedIn). Use the Presence online Lounge to meet and practice with new clinicians. I think that’s another great way to get started.

I think one of my other tips would be to explore—discover the resources Presence has. You’re probably going to find the answer to your questions. We have so much information out there for new clinicians so try and utilize that. I think that sometimes when we’re new, we tend to want to go right to the clinical account manager to ask “What do I do about this?” So explore and try to be a self-helper first, because sometimes you stumble across things that you weren’t necessarily looking for and you learn more things that way as well.

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