A Message From Our Founder: Moving services to a virtual modality during these unprecedented times.
"I have never seen anything like this," is something I find myself saying daily during these times as I hear of new closures and measures being taken to reduce the rate of spread of COVID-19. The Therapist Support Network agrees in entirety with these recommendations to help reduce the curve and help our medical and service workers prepare for the spread, knowing that these recommendations will save many lives.
In the mean time, many therapists are turning towards virtual service provision, e.g. teletherapy or telepractice, as a potential solution during times of quarantine. Although it can be done in many circumstances, organizations and therapists have a continuing obligation to ensure that virtual services are aligned with on-site service standards. Here's our recommendations when considering to change services to a virtual modality.
What clients are appropriate for teletherapy?
I will preface this by saying that I have supervised or provided services to individuals with complex needs virtually and felt the services were comparable to those received in-person. With that said, this is one of the biggest questions that I get when an individual is switching to teletherapy, "Who is appropriate for this?" I always recommend therapists replace that question with "Do I have the capability to modify the environment to make this parallel to on-site services or not?"
Here are the categories that the American Speech Language Hearing Association and other governing bodies recommend assessing prior to servicing individuals virtually. I recommend having a checklist that you complete every intake before the swap to virtual: client/student cognitive/behavioral skills (IQ, attention, motivation), physical abilities (ability to sit, ability to access a keyboard), environmental resources (access to internet, access to a facilitator, and a device), communication (ability to understand directions, native language), and literacy skills.
Now, if an individual has a deficit in above areas--that doesn't necessarily mean they aren't appropriate for virtual services. A deficit in these areas means that you as a therapist or company need to asses to determine if you have the capability to assist with that deficit. Some examples include troubleshooting internet connections and providing alternative solutions, changing therapy to a more active teletherapy session outside of a sit down setting for a child that has attention deficits, having a hands-on facilitator to assist with Alternative and Augmentative Communication (AAC) intervention, etc. There may be times when you or your organization don't have the capacity to make the necessary modifications--and there may be times when you do--but the metric of success is the confirmation that the intervention itself is equivalent in effectiveness to if the individual received services on-site.
Be ready to train caregivers
This is anecdotal in nature, but facilitators, i.e. the individuals on-site with a child during service provision, have always been the key to success in my services I've provided virtually. As a therapist, if you're moving to virtual services during this time, you will need to be prepared with a facilitator training that is transparent and easy to follow. There may be times where the facilitator is passive in nature and strictly there in case of emergencies or need for technological troubleshooting. There are also times when the facilitator will be active and acting as your hands or helping gather materials. I recommend outlining what your expectations are of the facilitator and providing that to all involved--of course, email me if you'd like me to send you list of typical expectations.
The Laws involved
My biggest concern when I think of a large amount of individuals switching to virtual services is not only the risk to fidelity BUT the risk of compromise to laws in place. Let's start with HIPAA/FERPA--ensure that the platform you're using is a secure platform. In addition, ensure that you are providing your services in a secure location without other individuals present.
Another consideration is licensure laws-- if your client decides to leave the state, you have a legal obligation to obtain licensure in that area unless that state licensing body allows for temporary provision, which you would need to get in writing directly from that governing agency. The same goes if you as a therapist decide to stay in a different state than licensed during this time. Licensure where you and your client/student are located have to be addressed prior to getting on-camera.
One final consideration--and a discussion that needs to be held if you're a school therapist considering moving your caseload to online--is the discussion around IEP services when a school is closed. If your school is moving to online, this is an easy discussion. If your school is closing, then your obligations to FAPE and IEP services are now very different. Turn to your state governing body and school to look for their recommendations but prepare to not provide any services until you hear a plan of action for opening.
I know the majority of us know that virtual service provision is not simply taking your clients or students and moving them behind the computer. Virtual service provision is a wonderful solution in times like this but it does require some planning and preparation. If you're a therapist being asked to switch services online but you have no experience doing this ask for support and ask for training.
A final consideration, pursue a platform that helps during this time. Many platforms, in addition to adhering to privacy laws, also come with built-in materials that can help decrease therapist burden.
In summary, virtual service provision can be an answer to ensuring services go with as little interuption as possible during this time. However, support and education is essential to confirm therapists are well-equipped to make that transition with no compromise to quality of services. As always, I'm here to support during this time: firstname.lastname@example.org or (417) 501-5853
A More personal note:
In times of heightened tension, I automatically go to a place of "how can I fix this" which can appear very robotic in nature, so I wanted to take time in this blog to have a more personal conversation to therapists. I know that many individuals are experiencing a reduced pay or without pay right now. My heart hurts for anyone going through that during this time and my hope is this is done soon--answers are found soon--the curve is flattened soon--and there is little impact on your family.
Stay safe and healthy-Elise