Telepractice

Have you ever felt that over the years with therapies, your child has developed good skills and is able to be functional and independent, but he/she faces slight difficulties in specific areas only? If that’s the case, then instead of a full therapy program, don’t you think a tailor-made program to focus on respective areas of difficulties would be more helpful?

Do you feel that you do not stay in a place where good therapy services are available or that you do not have access to experienced therapists to help your child and your family?

Have you felt that going to a therapy center and the travel time involved might be cumbersome and not fit into your schedule?

If any of these questions generated a ‘yes’ from you, then possibly what we at PlayStreet Specially Abled Educare Trust have come up with for our new OPD programs might be helpful to you.

Keeping the current situation and the changing needs in mind, we at PlayStreet have created some new programs using the feedback from our helpful parents.

THINGS TO REMEMBER ABOUT TELEPRACTICE

During online sessions parents may have questions with respect to the therapists' involvement, as parents are working with their children. The therapists' involvement goes far beyond the session hours, and includes:

> Complete planning by the therapists

> Creation of activities by the therapists

> Active monitoring of the sessions and guidance

Parents are the main facilitators or the co-therapists in any online session. They make sure that the children are involved and participative in the therapist-led online session. It’s important that parents are mentally relaxed enough to facilitate the session. Instead of instructing the child to listen or focus, they could be the silent partner who enables participation between the therapist and the child.

Additionally, parent coaching is included that involves watching and waiting for the teachable moment! It is about affirming the parent’s competence.

If parents feel that therapists are doing less because they are outside of the parent-child dyad, then it is important that parents understand that therapists are actively waiting and watching to see what parents are doing and how to adjust and add strategies. They are always alert to give the right guidance, advice and strategy.

Therapists also give parents the freedom to parents to take some decisions during the session, enabling parents to really open up about what they need help with!

RECOMMENDATIONS

1. During online sessions, the parent’s role is to embed therapeutic strategies and goals into daily routines, everyday interactions and a few structured activities. This is what every therapist should help you with.
2. Collaboration between the therapist and the parent via phone or video is key to online sessions. The parent should be guided on just 1-2 specific goals and related strategies for a day or for the week, depending on the frequency of the online sessions.
3. If your child doesn’t cooperate in the online sessions with the therapist, then use those sessions to talk to the therapist and understand how the activities can be done at home. No child should go on for too long without engagement.
4. Don’t say “NO” to online sessions. Problem-solve with your therapist on how you can make it work for the benefit of your child.
5. Record your successes and challenges – which activity or routine was successful today? Why was it successful? Which routine or activity was challenging today? Why did your child struggle through it? What guidance do you need from the therapist? How can you build yours and you child’s confidence through this collaborative approach with the therapist?
6. Mix and balance your therapy sessions between online and face to face sessions, as online sessions empower parents to work with their child, which is the most beneficial in the long run. Parents also start to understand their child and their child’s program better.

TIPS FOR PARENTS

1. For emergent speech in minimally verbal young children, use comments instead of questions. E.g., “What is this?” should be replaced with “Wow, you have a ball.” Life is not a quiz!
2. Focus on communication more than speech. Use AAC (Alternative and Augmentative Communication) if the child’s speech hasn’t developed yet. This fosters the child’s cognitive and language development – don’t wait for only speech. If you use a speech generating device, then your child will also discover their own ‘voice’.
3. Teach basic wants, needs and feelings through interaction. Teach letters, numbers, shapes and colours though play. Don’t make learning boring!
4. When talking to the child, use less language and fewer words. Say Less. Stress. Go Slow. Show.
5. Interact face to face with your child. Always maintain eye contact with your child; get down to their physical level. Give cues only when the child looks at you. If you are working on speech, your child needs to see how you move your lips, tongue and jaw when you talk. Talk naturally. Follow our blog to learn about the hanen approach to language stimulation: https://www.playstreet.in/hanen-program/
6. Using the words “talk’, “do”, “say” or “speak” should be considered taboo in the beginning of the journey as this will increase the pressure the child feels to use verbal words. Increased pressure to speak can decrease verbal attempts.
7. Prompting is a good tool to teach skills to children, but it should be faded immediately as it makes children dependent on prompting, thus impeding independence. Follow our blog to learn about various prompts: https://www.playstreet.in/…/03/15/prompts-special-education/
8. Slow down and wait for the children to think and come up with solutions themselves. And if they are not able to solve the problem, then facilitate and simplify, but don’t jump in to help too quickly.
9. Give the child as many opportunities as possible through the day to think and problem solve different situations. Although you as a parent might be tempted, don’t try to solve or find solutions to the problems your children face. The more thinking there is from the child, the better the overall development. Otherwise, your child will become very robotic and know only how to ‘follow’ you.
10. Restrict usage of screens (Phones/iPads/Tablets) as it does not lead to interaction between parents/ caregivers and children. If using devices, use it for exposing them to cognitive activities or videos.
11. Don’t try to work on therapy goals the whole day. Pick a time when you and your child are ready and incorporate some of the goals every day into that time. Build a routine for you and your child.
12. Involve you child in small household chores. The best time to incorporate goals is during your everyday routines!
13. Find time to have fun with your children – use music, play, dance, TV, simple board games, cooking, etc. as ways to interact and have fun together. There’s so much of learning that happens during this time!

ADVANTAGES OF ONLINE SESSIONS

Experience with online sessions have shown us that:

1. When parents worked with their children under the guidance of the therapists, they discovered that their children knew much more than they expected. Hence, more opportunities were given to work independently.
2. Parents got more empowered and confident about working with their child, which created more progress in the children automatically.
3. Parents got to meet, discuss and interact more with their child’s therapist thus, fostering a better understanding of their child’s program and how to go about it at home in more natural settings.
4. Parents got more feedback on strategies they could implement, change or modify every day.
5. Household materials were used for therapy, thus reducing the need for expensive equipment.
6. Structured routines continued to be provided to the child when life became unstructured for the child.
7. Familiarity and the comfort of home reduced the children’s anxieties and they were observed to be more cooperative.
8. Children were happier to engage with their parents, and hence, more cooperative.
9. Parents got a fair understanding of how to engage their child, thus, realigning their expectations.
10. The best part was when siblings were included in the program, thus creating inclusion at home.

CHALLENGES OF ONLINE SESSIONS

1. Children not being cooperative in front of the camera, worrying parents about the session being wasted.
2. Poor internet connectivity.

Solution – Videos of parent-child interactions can be taken and shared with the therapists beforehand. In this way, the therapists will be able to analyse the video and guide parents on interactions to modify or strategies to implement. More defined goals can be given with every session as the therapists observe what has been oachieved over the week.

Structured tools like Goal Track (www.unkludge.com) can also be used for assigning, monitoring and tracking the progress of the goals.