Serving Students With Severe Disabilities and Impairments via Telepractice

This month, we sat down with our Head of Clinical Standards and Outreach, Kristin Martinez, M.A. CCC-SLP, to learn more about how students with severe disabilities and impairments can benefit from teletherapy. During our interview, Kristin explains student candidacy and adaptive approaches to serving students with more severe impairments.

What are some common misconceptions about student candidacy for teletherapy?

One of the most common misconceptions about providing speech-language services via teletherapy is that this cannot be a successful service delivery model for students with more significant needs. At PresenceLearning, we have the benefit of a decade of experience providing online school-based services. Our students have progressed, met IEP goals, and graduated from services regardless of their primary disabilities or level of impairment. However, there are essential factors that must be considered in order for teletherapy to be a successful service-delivery model.

The American Speech Language and Hearing Association (ASHA) outlines four student-related factors to consider when determining a student’s appropriateness for teletherapy services:

1. Physical and sensory characteristics
2. Cognitive, behavioral, and/or motivational characteristics
3. Communication characteristics
4. Client’s support resources (e.g., technology, support personnel)

Reference: ASHA Practice Portal: Telepractice Key Issues

When it comes down to it, however, SLPs providing services via teletherapy are continually conducting informal assessments of a student’s progress and the effectiveness of evidence-based practices, therapy environment, and duration and frequency of services, just as they would if they were providing services onsite. It is no more appropriate to make predeterminations regarding each student’s potential success with a plan of care when the service delivery model is online vs. when those services are to be provided onsite. The most significant differences between implementing a treatment and service delivery plan in teletherapy vs. onsite services are related to the presence of appropriate technology, and the appropriate level of support provided by onsite staff.

How do PresenceLearning providers support students with severe impairments using the technology and tools available in our Library/Platform?

The PresenceLearning platform was built specifically for therapy by clinicians to meet the needs of students with a range of abilities. The PL platform integrates the planning, assessment, and treatment of students in one location, therefore allowing the provider to create the optimal learning experience with ease. PL providers can customize the therapy room and activities in ways that reduce visual overload and distraction by changing color filters, increasing the size of therapy activities and draw attention to specific auditory/visual stimuli. PL collaborated with district partners to project the therapy room onto a smartboard allowing students to engage with the therapy activities via a touchscreen and eliminating the need to sit at a traditional desk. The open source functionality of the platform enables providers to integrate curriculum based content into their therapy sessions, which also promotes collaboration with school staff. Beyond that, the PL platform provides the flexibility that is needed for therapists to offer individualized services that meet the needs of each student. Targeted equipment utilization and some platform features are available, however, that lend themselves particularly well to working with students who have more significant needs:

• Site Share and Screen Share: While the PL library includes tens of thousands of activities, our product team has also developed the capability to use Site Share and Screen Share so that PL therapists can integrate external websites and apps into their therapy sessions. This functionality is particularly useful when working with students who utilize AAC devices, as therapists can share specific AAC apps that support the students’ specific low- or high-touch systems.
• Videos: The PL platform allows for direct upload of educational and therapeutic videos. While there is a broad range of incredible video content available, PL therapists have specifically integrated some highly engaging and targeted pragmatic language/social skills videos into their therapy sessions.
• Second camera: When clinically indicated, such as when providing services to students with AAC devices, PL will provide external cameras that can be set up to provide a second video feed of the device, allowing the therapist to not only view and hear the student during therapy, but also the AAC device including visual input of how the student accesses and interacts with the device.

In addition to the clinical benefits of the platform for students, the PresenceLearning platform is built to perform with minimal internet speeds and internet bandwidth, therefore putting the fewest possible technology requirements on school districts and therapists (while still providing the best possible audio and video quality).

What is the role of onsite staff in supporting services for students with significant needs?

The role of an onsite support person (here at PL we refer to this person as the Primary Support Person or PSP) is critical to a student’s success with teletherapy. The degree to which a PSP must be involved falls on a spectrum from line-of-sight supervision (appropriate for the majority of students who are largely independent on the computer) to 1:1 support throughout each therapy session. 1:1 support is typically the case for our students with significant needs. As a general guideline, the level of support required for a student to participate in the general education setting is similar to the level of support needed to successfully participate in teletherapy.

For instance, it might be the case that a student with significant attention or behavior needs might struggle to sit in front of the computer throughout the entire session. In this case, the treating SLP can collaborate with the PSP to come up with a plan that includes physical breaks as well as reinforcement for increased attention to activities. The SLP still directs the timing, length, and use of physical breaks (and external wide-angle camera allows the SLP to still view the students’ environment if he/she moves away from the computer for large-motor activities/brain-breaks), as well as the nature and timing of reinforcements. Many students respond positively to platform-based reinforcements such as stamps or short videos including favorite characters, but in some cases a student might respond best to physical rewards such as Goldfish crackers or stickers, which the PSP can administer.

Another example of the importance of the PSP role in supporting students with significant needs (and a scenario that is commonly misunderstood for those new to teletherapy), is working with students who are non-verbal, who cannot physically access a computer mouse, and whose primary form of communication is via AAC. In this case, it is most likely that 1:1 PSP support will be required throughout every therapy session. The SLP would collaborate with the PSP to:

• Maximize placement and use of the external camera to ensure AAC device integration;
• Make any adjustments to either the video or audio so that the student is receiving the best input from the SLP and the therapy room, regardless of whether his/her physical orientation to the computer needs adjusting; and
• Facilitate skill carryover. Ideally (and most commonly), the PSP is also the paraprofessional who supports the student all week, and she/he is able to facilitate carryover of work done during therapy sessions!

How does PresenceLearning support providers to ensure that all of our therapists have access to support students with special needs?

One of the great advantages of working with PL is the provider community itself! PL has nearly 1,000 clinicians providing online services, so the collective experience is incredible. PL offers an online forum called The Lounge, where therapists can join groups (including a group specific to working with students with significant needs), ask questions, and post responses and resources. In addition to the support and advice of fellow teletherapists, PL is highly committed to maintaining clinical quality at the center of what we do. Therefore, in addition to access to our Help Center, there is a large in-house clinical services team that is available to answer questions in The Lounge, via email, or through topic-specific clinical workshops that are available to new and veteran therapists. And at every district we serve, a clinical quality manager supports services, so therapists can request support specific to individual assignments and students.