Your company is able to provide teletherapy during the COVID-19 shutdown and now you have to figure out how to provide services to your kiddos that are ethical, equitable, and effective.
One of your biggest hurdles will be figuring out services for your kiddos with Challenging Behaviors. Don’t fret! It can be done!
SLPS’s with students who have varying health impairments or challenging behaviors frequently ask about managing those behaviors and adapting services. Here are a few tools-of-the-trade that have helped in the past:
Initial Set-up and Guidance
Once your kiddo is set up for services, make sure to include the family member in the sessions; especially for initial sessions. As the kiddo acclimates to online sessions, the family member may be able to provide fading cues and verbal prompts.
Having someone on the other side of the computer can be essential for this particular set of kiddos, as the parent or guardian or sibling can assist your kiddo with maintaining attention to tasks or how to work the computer. Including family members in teletherapy sessions will also help with carry-over and generalization of skills in the home.
Caregivers can also provide you with verbal feedback about how the kiddo is responding to tasks. This is essential because you are able to gear your therapy to each individual child.
For example, I have had children who work best with headphones. Blocking out unnecessary background noise can be super helpful for many kiddos, and adults.
There are some cases where headphones are not the best option. Our kiddos with Challenging Behaviors may need more guidance from the family member at home. Therefore, having sound that will reach the kiddo and the family member is essential.
Some families have waited to tell me that they could not hear me, so I constantly will ask “Can you hear me?” prior to every session. A good set of computer speakers can cost as little as $13. It is a great investment for families if amplification is needed.
Additionally, providing log-in information with easy, step-by-step instructions is vital. In some cases, I will be on the phone with the family member to assist in the first log-in attempt.
Finally, always be patient when it comes to your initial set-up. Taking the time in the beginning to assist your kiddos and their families allows us all to be successful with this service delivery.
Positioning
One of the most important aspects of teletherapy is the positioning of your client. Positioning refers to the location of your kiddo on the screen, whether it is sitting, standing, or sometimes…something in between.
Kiddos with multiple disabilities may have difficulty sitting in a chair because of health impairments, attention, or resistance to tasks in general. Additionally, we may have some kiddos who cannot use their hands to touch the computer mouse or screen.
We need to consider being flexible as SLP’s. Let the family member on the other side of the screen adjust the height of the laptop or monitor to allow the child to see from their best angle. It is okay to let the family member be aware that you need to see the child’s face and mouth. The child needs to be able to see and hear you as well. Be vocal and vigilant!
Some kiddos with limited attention to tasks may prefer to sit on a chair that spins. If a kiddo is able to follow the important directions, I will allow them to spin. You can use this as a reinforcement as well “you can spin after we practice ___ 5 more times!”
Other positioning techniques to account for can include: using a weighted lap belt to provide some sensory when sitting, sitting on a textured chair cover, having the child stand up, providing kiddos with something to hold during sessions like stress balls. Some of my kiddos will sit on large medicine balls or on the couch.
For the kiddos with limited mobility for fine motor, consider using alternative methods to request for items. For example, when provided with three pictures in a task, you can ask your kiddo “Do you think the answer is the first, second, or third?”. You can also ask the family member to prompt the child to point to their answer using an elbow hold and allowing the child to point.
Allowing your kiddo to be comfortable during teletherapy sessions will assist you both to achieving your speech and language goals. Make a point to plan with the family member about positioning, as this can seriously improve your session!
Jessica Hunnemeder MA, CCC-SLP
