Introduction
Sarah B., M.S., CCC-SLP, has lived in St. Louis, Missouri her entire life. She attended Fontbonne University in St. Louis. Sarah has one 22-year-old who is now out of the home, and four children still at home, ages 14, 12, and 10-year-old twins. All four attended school last year but this year in the pandemic they’re doing homeschooling. They had homeschooled previously so this was an easy shift. When Sarah is not working, she loves to be outdoors with the family, going for nature walks. When travel is not restricted due to a pandemic, the family likes to get out and about in family-friendly St. Louis to do cultural activities like zoo trips and the botanical gardens.
What inspired you to become an SLP?
I started doing respite care with a family from my church when I was in middle school. They had a daughter with significant multiple disabilities. That got me started. I worked with other kiddos through that first experience. I started to really enjoy working with kids with disabilities. I initially wanted to go into special education. Fontbonne has a great speech pathology program so as I enrolled there, I switched gears. I’ve never regretted it.
What made you want to be a teletherapist with PL and how has your teletherapy career evolved?
We had 4 children in 4 years and I really needed more flexibility to care for my growing family. PresenceLearning offered that flexibility so that I could continue my work and care for my children. This is my 10th year with PL. It’s been fabulous. Previously I worked in a brick and mortar school and my husband actually was a stay-at-home dad. When the twins started crawling, my husband called me at work and said, “I can’t do this anymore.” Now they were all mobile—five and three and two one-year-olds all moving around. He was done. So we looked at other directions to see how we could do this. We wanted one of us at home while the kids were little if we could.
I started researching. I talked with several teletherapy companies and interviewed with PresenceLearning. At that point I was really looking just for flexibility so that I could be home. My husband went back to school. As I started working with PL, I realized it’s a fabulous company. They’re extremely supportive of their therapists. They work really hard to make sure that we have trainings, that we’re all connected through The Lounge and other events, and the newsletters. I find they are an extremely supportive and well run company which is huge.
Briefly, I went to another company just to see what else is out there and it was very brief. I quickly came back to PL. They’re well organized. The platform is fabulous.
I have continued to develop as a therapist through PL, potentially even more than I would have staying with in-person work.. It actually offers so much more as a therapist than I had working in a school in a building where there are limitations on what I can do. The platform and the options on it to choose activities is phenomenal. So I can have a student—some kiddos are harder to engage than others—she comes in and she’s wearing a Cinderella shirt. And I can say, “Hey I like your Cinderella shirt.” And as I am talking to her, I am clicking over to the library and say, “Look, we’re playing Cinderella Memory today!” And she’s so surprised and excited.
If I am in person, I don’t have Cinderella Memory. I can’t go grab that. With the students, it’s also about respecting them as people.. It’s about buy-in and connection. So once you have that with them they’re going to work, and work for you. It offers me that ability to get that buy-in and connection very seamlessly and easily. I can pull things up. If a kiddo is saying, “Did you see the Indominus Rex?” (a fictional dinosaur from the film, Jurassic Park), I can say “No, let me pull that up real quick.” Then I screen share and we watch it and talk about it. The engagement is unbelievable. I find that my progress with students is the same or better. It’s just fabulous. I feel like I am a better therapist, honestly.
How has PL supported your work with students with autism?
When I was doing my practicums in graduate school, I was at a foundation here in St. Louis, Judevine Center for Autism for one of my practicums. I didn’t have extensive experience with autism. Previous to that, I did also do ABA therapy. I was a therapist during college. In all that I just fell in love. They are my absolute favorite population to work with—the complexities, the vast range that you get within this community. You’re not going to meet two kids with autism that are the same. Of course that goes for everybody. I loved it. I love the challenge of figuring out what’s going to work with this kiddo. That started when I was in college working with the autism population. I’ve thoroughly enjoyed it. I love working with the special day class kiddos across the board, but kids with autism are my favorite.
Through PL, I’ve worked with some autism classrooms where I had the majority of their students. It definitely adds another dynamic online. Again I have kiddos who are very high functioning and we can talk about things and I can explain things. We can talk about the social skills of pragmatic language. And then I’ve worked with kiddos who are non-verbal. I’ve worked with kids who didn’t even know I was there. They were oblivious to me being on the screen. It definitely adds another layer to think about and problem solve on how to reach those kids because there are a lot of kids who can’t work with me. They don’t know I’m there, or they have very fleeting attention to the screen.
That again has made me a better therapist because I basically have to work with my staff or if the parents are there, work with the parents extensively. The planning is more extensive online. We actually have to work and do roleplays with the PSPs. “Here’s what we’re going to do. Here’s how I want it to look.” Because I can’t be there to do hand over hand, we need to think things through in advance.
I’ve been trained with Pyramid for the Picture Exchange Communication System or PECS. It’s actually a very sequenced program and you need to follow the steps if you want to be successful. You can’t just say “Well let’s kinda try to get him to do this.” It’s more like: “This is what we have to do if we want to move forward in the best way with this student.”
It’s one of those things where you become better at your skills when you have to teach them to someone else and you have to explain everything in detail. I find if you don’t explain the Why, then people leave it out because if they don’t understand the Why, then it just becomes an extra thing. So I’ve definitely grown as a therapist working with these kids because having to continually explain to people exactly why we’re doing it, how to do it, the intricacies of what we’re doing. But it’s been great. There are definitely times when I wish I was right there, but it’s been great. I’ve worked with autism classrooms where I’ve had the bulk of their kiddos. I’ve also had just a few students with autism on my caseload. The range is humungous.
I really enjoy doing picture communication. It’s a fabulous communication system for nonverbal kids or kids that are emerging verbal. Teachers are so busy. I have mailed the communication materials to schools. I’ll just make it and mail it to them. I mostly just use standard binders. You have pictures of what the student is interested in on the front of the binder and the student takes it off and hands it to the communicative partner. Because they are nonverbal, this is a tangible, concrete way that they can see “Oh gosh, that’s M&Ms!” It goes up in complexity, to where they’re making sentences. I’ve had kids with hundreds of PECS in their book to where they can flip open and know “I want M&Ms please,” and they rip off and hand the sentence strip to you. It can facilitate speech although I always tell people that’s not our goal with it. Our goal is functional communication and more complex communication. But a lot of times I’ve seen it facilitate verbalization as well.
It’s so exciting. Schools are just pushed. They’re pushed to the max with everybody. So being that resource and the advocate for that child with that communication is fabulous. In one school I had a kiddo who was in 3rd grade. He was largely nonverbal. People would say “We kinda know what he wants.” He was in the regular classroom a lot. I set up an entire system for him and he went from not being able to express himself to making complex sentences within six weeks. And so just being able to be that resource for those pushed schools…they want to help the student but they don’t know how. They don’t necessarily have the expertise or resources to do it. Being able to be in there is fabulous.
In another school, I was working with most of the kids in the autism classroom. We set up PECS for several children—kiddos who had severe behaviors such as head banging, throwing things, screaming. It was like an overnight switch because suddenly they could communicate. So it is hugely rewarding and exciting, even just seeing the staff’s faces when some of these kiddos are communicating because they were just managing behaviors most of the time. Staff members have told me, “Suddenly he can tell me what he wanted and I see he understands cause and effect.”
What do you enjoy about being a provider with PL?
I came for the flexibility and stayed because PL offered so much more! I love the support and respect that PresenceLearning gives their therapists and the offerings for continued education as a provider through Office Hours, Workshops and The Lounge. My clinical account managers are wonderful resources and I enjoy being able to work with communities and students around the country.
What were you most surprised about when you made the transition to be a teletherapist?
The biggest surprise was seeing the outcomes for my students remain the same and often even exceed outcomes from in person therapy. The students are already geared towards technology and are extremely responsive to the activities available in the library.
When I started teletherapy, it was out of a necessity for my family. I hadn’t thought a ton about it. I assumed it would be effective but that I would lose some of the progress my students had made. Once I got into it, there’s definitely a learning curve to get the swing of everything. I find the biggest thing is building relationships because they have to buy into what you’re doing. And once they buy in, you’re golden. Once you’re their friend, and they know you care about them, for the most part you’re going to get a lot out of them.
Because technology is a native language to the kiddos, they know how to maneuver and they enjoy it. There’s certainly an aspect of kids getting addicted to screens, but we use that to our benefit because they’re drawn to it, it’s native to them, and they love it. We’ve got that going for us from the beginning. Again, being able to get that buy-in is critical. As they’re talking and I can pull up something that is directly related to what they’re talking about, their interest and engagement jumps hugely. Being face-to-face, of course there are whiteboards and iPads, but with the PresenceLearning platform, it’s seamless. It’s so quick. When you have that relationship, you have the buy-in, you have the engagement, you’re going to get tremendous progress.
What do you find most challenging about being a teletherapist? And how do you work to overcome these challenges?
The most challenging part is still missing in person contact with students, such as the hugs and high fives, but we do virtual high-fives and I’ve even gotten a few “camera kisses” from my little friends! For the older kiddos—once you get to first grade—they’re ok with the virtual, they don’t need the hands-on. But when you’re working with preschoolers, they’re hands-on, they like manipulatives, they want to sit on your lap sometimes when you’re working in person. This is more of a challenge, especially now. Most of my kiddos are home now because of COVID. Working with parents brings its own set of challenges. When you’re working with a Primary Support Person (PSP), you’ve developed a lot of rapport. Sometimes parents turn on the screen and they walk away. And I get it. So you have a four year old sitting with you. There’s nobody there. They can’t sit on a lap. They’re rolling around on a bed because they’re four year olds. I use lots of manipulatives like puppets. I didn’t do it at first because I thought what difference does that make. They can’t touch it, but the kids hugely respond to it. They love blowing bubbles virtually. Me having the manipulatives still makes a huge difference for them. I have my magic speech box (an empty kleenex box). I’ll have a toy car driving on the box, or on my head and asking “Where’s the car?” They crack up. With my littles, I use manipulatives on my end as much as I do virtual programs.
I crack up that they get so excited to do bubbles and they can’t pop the bubbles. I’ll catch one and say “Oh can you help me pop it?” They love it. I didn’t do that at first. It just didn’t occur to me when I first started that that would make any difference for me to have the manipulatives. For the little ones where we don’t have the touch, if a parent is with them, I’ll say “Oh why don’t you snug on mom’s lap while we work?” Or if they’re with the PSP, I’ll say “Oh can you give the PSP a high five?” So you pass it off especially with the preschoolers and kindergartners.
By and large, I don’t think the virtual takes away from their learning. I think my online kids probably enjoy my therapy sessions more than my in-person kids.
How have you been helping parents and caregivers who are now acting as the primary support person with their child?
It’s been challenging—they’re parents and they’re in the midst of chaos like everyone. But it’s been fabulous to be able to have contact with parents. When you’re in brick and mortar you don’t have that weekly/daily contact with parents. I feel like my relationship with parents during COVID-19 has been better with them being with their kids. Just being able at the end to say “Hey, go grab Mom,” and I can directly show them what I’m doing.
Communication is definitely the biggest thing with staff and parents. I email, I text, I talk to them on the screen, give them guidance. It also gives me a view into their home so that I can see that sending them a sheet is not going to work for this family because they have five kids. It’s chaotic because they have five kids. It lets me see what’s going on in their home so I can give them carry over activities that make sense for the family. I think the parents respect that and enjoy it. I’m getting a peek into what life is like and how I can assist them because me giving them things that they can’t do is not helpful.
How has the PL online platform enabled you to help your students and the schools you serve in new ways?
Our library of activities is second to none on PL. I briefly worked with a different telehealth company a few years ago and there is NO comparison. Being able to jump screens over to the library and pull up an activity related to a comment from a student or a toy they are playing with that day gets instant engagement and excitement from my students.
The jumbo screen is one of my favorites, and definitely being able to mute their mouse. The child will say, “Oh, you turned my mouse off.” Well I need you to be able to listen and then we can turn the mouse back on. Those are huge because I’m not there to say touch his arm and say “Hey buddy,” to get his attention. But if I turn out the mouse and I’m jumbo screened, there’s nothing he can do. The jumbo screen is really helpful to get attention and highlight articulation movements. I especially enjoy the little rewards on the side where you can do little animations. “Do you want to pop balloons or catch butterflies?” We’ll do the butterflies one…”Get em, get em, get em!”
Can you tell us a little about how you collaborate with teachers and other school staff members?
Collaboration with teachers and staff is mainly done via email, although I always offer for people to call or text if needed. I enjoy being more available for my schools and parents than having a typical school day.
How do you build trust and rapport with parents?
I initially send a welcome letter to parents introducing myself, giving background information and my contact information. If my students attend a virtual school, I am able to speak directly with parents during the last few minutes of our sessions. If students are working from home, I find parents quickly buy in to our online platform once they see how engaged the students are in therapy. I keep consistent communication with parents on student progress and carry over work for home practice. I find reliable communication the best way to maintain trust with families.
What tips do you have for other providers getting started with telepractice?
Definitely engage with what PL offers as far as keeping up with newsletters, getting into The Lounge, getting into different groups that they offer where you can sign up for early childhood or augmentative communication so that you can go in and be connected. It’s easy to isolate because you are physically isolated. Definitely get engaged with the PL community, not just in your schools, because there’s a tremendous amount of resources that you don’t even have when you’re in a district. You have access to hundreds of people.
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