OTS 48: How I am Providing Teletherapy Services

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Welcome to the show notes for Episode 48 of the OT Schoolhouse Podcast.

In this episode, Jayson shares how he has transitioned to providing teletherapy for the students on his caseload. He talks about the technology involved, the types of teletherapy, simple treatment ideas, and even some ethics of the situation. At the end of the episode, Jayson answers several questions that were asked on Instagram.

This podcast does not qualify as a Professional Development Podcast. You can learn more about how to earn professional development credits through the OTSH Podcast for your OT/COTA renewal certification here!

Links to Show References:

• Link to Zoom's HIPAA ​Compliance Guide

• Link to Zoom's FERPA Compliance Guide

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Have any questions or comments about the podcast? Email Jayson at Jayson@otschoolhouse.com

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Episode Transcript

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Amazing Narrator   

Hello and welcome to the OT schoolhouse podcast. Your source for school based occupational therapy tips, interviews and professional development. Now to get the conversation started, here is your host, Jayson Davies, class is officially in session.  

Jayson Davies   

Hey everyone, and welcome to the OT school house podcast. My name is Jason Davies. I am so glad that you are here with me today on May the Fourth, if you're listening to this episode on the day it launches, it is May the Fourth, also known as Star Wars Day. May the Fourth be with you. Really appreciate you all being here. Maybe you're stepping away from your Star Wars binge today to listen to this, or maybe listen to this a few days later, either way. I hope you had a great May the fourth. I also hope you all had a great ot month in April. Of course, it's a bummer that a ot a had to be canceled, and it was just a weird month, but Instagram, Facebook, all the social medias were just going crazy with awesome ot content, so much advocacy, so many pictures, so many videos, so many just like quotes and all that good stuff, the A to Z, school based OT or not even school based OT, just ot in general, the alphabet. It was just all so fun to watch. So yeah, great job to everyone who advocated for our profession using whatever method they had. Really appreciate that. Today we are going to be talking about teletherapy. I'm actually just going to kind of give an overview about what I'm doing. No guest today. It's just me and you talking a little bit about the timeline that I've been following with my district, talking about the tools that I use, both the hardware and the software, talking about some easy to use treatment ideas that you can implement with very little, very little supplies, because we don't know what our parents have at their homes. And then I also want to talk a little bit about the future, what's going to happen either A, when we go back eventually, and B, just how things have been changed forever because of all this. We're also going to talk a little bit about different types of therapy. As far as providing teletherapy, right? We have either live, you know, on Zoom, or there's also more of a consultative or coaching method, potentially that could be asynchronous, where you are actually providing the therapy and the child and or the parent are watching it. Later, also get into some billing and ethics, and then at the very end, I actually have some Instagram questions that I'm going to answer kind of in rapid fire, hopefully, but we'll see how that goes. Sometimes I ramble on, but that's okay. It could just means more content for everybody. So before I get started with that, though, I do just want to say thank you. Thank you. Thank you to everyone who participated in the A to Z school based ot course. I know many of you were excited for that. I was only able to accept 30 students for this course, and I just want to say a huge thank you to every single person that came on board with me. We finished that up last week. It was an awesome experience. I got so much good feedback. I both both feedback that was just like, amazing. People really love the course, but also a little bit of feedback where it's like, Hey, this is where it can be improved for the next round. So that's actually what I'm going to be working on now, is that I'm going to update that for you all before I submit it back out to you. So I know many of you are excited to to get on that, but I'm not going to release it just yet. Even though I'm done with the first cohort. I'm actually going to update it a little bit and then get it back out to you, hopefully by June. But I also want to be sensitive to the situation that we're currently in, and so it may be extended out again, just depending on whether or not we're even going to be back in school, because this course is really designed for when we're in the brick and mortar classrooms. It's not necessarily designed for teletherapy, right? We had no idea that this was going to be happening when we started that course, but yeah, so I am constantly looking at that situation and trying to figure out when the best time to release this course is for you all. If you have any input on that, please shoot me a direct message, a DM on Instagram and let me know what you are thinking about all that good stuff. All right, so we are diving into teletherapy today. I'm going to try and slow down a little bit. Sometimes I just start getting faster and faster real quick. This is a disclaimer, and that is just that everything that I'm talking about today is solely what I am doing. It is not what I expect you all to be doing. Everyone is probably doing something a little bit different, and that is okay. I am not endorsing any specific type of teletherapy platform. I am not saying that I am using whatever are the best method, methods that a ot a puts out or that another entity puts out. I am simply talking about what I'm doing and letting you know just kind of, potentially give you some ideas based upon what I'm doing. There is no one right or wrong way to provide teletherapy, so please know that just keep doing what you're doing. You're probably doing a fantastic job. I'm just here to try and maybe give. You a few tips or a few ideas that you can even expand upon, all right? So first thing I want to actually dive into is my personal feelings about this, this whole situation. I mean, it's crazy, right? And honestly, I feel like I am in over my head. I feel like districts are in over their head, and that we are all trying to fly the plane while we build it, and it is just. It's not fair. It's not fair to parents, it's not fair to teachers. It's not it's not fair to occupational therapists, physical therapists, speech therapists. It's not fair to anyone, and it is especially not fair for students with special needs. There are so many companies out there that provide online or teletherapy services, and they do a lot of work to do that before they get started. I mean, think about that. They actually set up a full on platform that is easy to use. Then they bring in therapists, train them how to provide teletherapy, and then they let them go out and try to provide teletherapy. And usually they try and bring in experienced therapists who already know how to provide therapy and can then adapt it for teletherapy. And these are actually like full on companies that are doing this. And yet, here we are within a week or two of being put on lockdown or being expected to provide therapy services for an entire caseload that we've never had training on. And I know many of you have listened to Episode 22 of the OT school health podcast to get a little bit of an introduction to teletherapy. But that is, let's be honest, that is not a full blown course where you are really learning how to use a platform in a way that it can best help your students, right? I also, as far as my personal feelings, man, this screen time is killing me. I just got off a three hour IEP. That's part three of an IEP. And my Adapted PE teacher, who is awesome, she's going to be listening to this and know exactly what time I'm recording this, but it was a part three, and we're still not done with it, but I was on basically Skype or zoom, sorry, from like 9am to 6pm and now I'm still in front of my computer recording this for you, and it's just so much screen time, my eyes are just like dying right now. It's kind of nice with the podcast, because I don't really have to look at the screen. I can just talk. But it is here I have my notes on the screen. It's just so much time on the screen, and it's tough. You know, it's a long day. Another thing personal feeling a little bit but also just it's happening, is my internet's gone down a few times. My wife's a fourth grade teacher. She's using a device or two in one room. I'm using a device or two in another room, and our internet is just right around 9am right when I start to provide services. It's just like, Nope, sorry. It only lasts for maybe 20 minutes, at least the last two or three days, but it's still a pain in the butt. It's like, what the heck. Come on, man. I really need the internet right now, and you're going out on me. So that's another thing that just kind of, it's a pain in the butt sometimes, honestly, another thing that I've been thinking about is just, and we'll get into this a little bit more later, it's just really, how is this going to change life forever? And you know, whether it's next week that we go back, I don't think it's going to be next week, obviously, whether it's August or whether it's January or beyond, how is life going to be changed forever because of this? And I hope that you're kind of pondering this too, because I don't know, I don't know where we're going to be, but I'll talk a little bit more about that in a little bit. Last thing on my mind is just, I want to say thank you so much to every parent out there, to every teacher out there, to every ot out there, speech therapist, anyone who is educating kids, working with kids, yes, for the most part, kids are at home in a loving household. But that's not the case for every student. And there are students potentially out there that rely on school so much for positive interactions for food and for so much and, you know, just really praying for those kids and they they are in a safe environment, and at the same time just saying thank you so much to all the parents that are having to do more than what they may have done two months ago, right? And they're with their student all day long, also the siblings that are stepping up and being on those zoom calls with us therapists and then working with the working with the student throughout the week, until the next session rolls around and we can see some of that progress. So thank you to everyone who is working with a student, no matter what your profession is right now, basically everyone on Earth is a teacher right now. So thank you saying thank you. Thank you. Thank you so much. All right, so now I want to talk a little bit about the timeline and how we actually got to this point where we are at right now. And I still remember sitting on my computer, surprisingly, right? It started on a computer and it's going to. Initial on a computer on March 13. It was a Friday, and I was sitting online in a conference that I was supposed to be at a hotel for, but literally the day before, or the two days before, they had emailed us asking, Hey, do you want to come in, or do you want to do it online? And most of us responded, hey, we still want to come in. And then the next morning we were we received an email that said, Sorry, we just can't do that option anymore. It's going to have to be online. So I want to give a huge shout out to Alicia and Lisa for still doing that conference, even though it just got crazy right there at the end. I don't know if they listen to this podcast, but if they do, thank you. Thank you. Thank you so much. If you know them, then you know what conference this is in Southern California that's been happening for several years now. They're pretty awesome, and so it was actually during that conference on Friday the 13th in March that myself and the other OTs in my district were all kind of texting each other. We're hearing that other school districts are shutting down, and we're just kind of waiting for the email. We know it's coming. I kind of assumed that it may not come until Sunday, because they don't want to, like cause panic while all the students were still at school on Friday. But nope, it came around noon, ish, maybe a little bit after and definitely, yeah, I don't know that I'll ever forget that day, right? The day that basically Southern California just shut down, and so we're all sitting in that online community, and boom schools are just shut down. So those are probably similar to many of you, although maybe most of you were probably at your school when you got the news, or maybe you were at home already and got the news, but whatever it might be, right, it was just a crazy day. I know for so many students, they had no idea what was going on. I mean, I know some students are just still so confused. I know one of my parents said she's basically telling her student with autism that school is sick and that's why they can't go to school right now. And you know, for kids who they don't quite understand this, that's kind of the best way that she found to talk to her student about it. So that leads me kind of to the next week, which, what do you do when schools closed and we don't know what's going to happen? We didn't know that we're going to be providing distance learning at that point. We didn't know what to expect, so we started putting together some resources, various resources that we could put onto the website, being very mindful of copyrights and all that good stuff. I know all of you have had to pay attention to all of that. But anyways, we eventually put some stuff together and sent it over to the district office, who basically made an OT resource page online. And then a week later, we had spring break, and after spring break, we came back and they're like, oh, we need you to redo it, really, because it wasn't quite enough. It wasn't everything that they needed to be up there. Remember, again, just flying the plane while we're building it right every week, something was new. And so at that point, we at least knew that we're gonna have to start providing distance learning or distance occupational therapy. And this is one thing. I don't want to say it's anything wrong with the administrators, but at the same time, remember, they're coming from a very educational point of view, and they don't know all the OT aspects. And they are used to working with employees that are credentialed, not employees that are licensed, and have a different body entity that looks over them like we As occupational therapists do, and so they don't know about occupational therapy and teletherapy, and they that has to be oversighted by your state licensure. And so I'm kind of bringing these up to and the rest of the OT team, kind of bringing these ideas up to our administrator and letting them know, hey, the state of California has these guidelines when it comes to and not just guidelines. They're actually legislation when it comes to providing teletherapy services. So letting the administrator know about what that legislation says, yeah, so that was kind of the week before, or the week leading into teletherapy services. Also that week, we were playing around with different just like you were, I'm sure, playing around with different platforms, playing around with Zoom, playing around with Google meets, anything else that might be out there. I looked at Microsoft Teams, which was confusing, but I've heard good things about it. Maybe you're using that and it's working out well. So anyways, we all got comfortable with with Zoom, and then all of a sudden, well, we're no longer allowed to use Zoom. I'm sure you've heard about all the Zoom bombing that happened. We basically got shut down, told that we couldn't use Zoom. So we all went over to Google meets, started to learn about that actually did about half a week with with Google meet. Rates of therapy, and then the district's like, Oh, hey, by the way, you can now use Zoom again, we did whatever we needed to do, which is actually they had to get an agreement with Zoom, basically saying that everything is secure. This is actually something that you should know if you have to do any type of HIPAA, if you're working with online teletherapy services. Yes, there is actually, it's called a BAA. Basically, it means Zoom is your business partner, and that everything is aligned technologically and and business wise, to make things work. I don't want to get into the specifics of that, but yeah, I know right now HIPAA is kind of relaxed, so you can kind of get away with using the free version of zoom, but in the real world, when we when this is all said and done, who knows what's going to happen with that? If they're going to go back to where yes to be HIPAA compliant, you should have the healthcare version of zoom, which is expensive and so real quick, I want to talk about those last few days before we started therapy, because I know that was hectic for everyone, and it was hectic for me. What helped was a lot of communication, so many emails, like my mind exploding because there's so many emails, individual emails with all the parents on the caseload. We actually wrote an email. I kind of drafted it like at 11 o'clock one night, and it's just okay, parents, this is the situation. Here's some options. A we can continue to provide live therapy to your student via zoom or something like that an online platform. Another option is that we can provide a recorded video for your student, and you can provide or you can do that activity with them, and we will provide ways to accommodate that activity to make it successful for your student. Option C was just, Hey, do you just want some worksheets? I mean, we can just send home some worksheets, and you can do it with your student. And option D was actually no services at all. I had no students or no parents asked for no services at all. They mostly wanted the video format where I send it out a video. And I'd say about maybe 55 60% wanted the video, and then another 40% or so wanted live. And so I have about 20 ish, maybe 22 live sessions that I'm doing every week. And so that final week was really tricky. I mean, we were planning sessions, so I was trying to figure out what sessions we were going to do. I was kind of grouping my students into levels, so I can kind of figure out what how many videos, and what type of videos that I can make for students. I know someone has had a question about that, so I'll get into that a little bit later. Also just trying to figure out how to record, how to schedule all these students at a time. And of course, teachers are trying to schedule students too, and the speech therapist is trying to schedule students too. So trying to get that all worked out, it was just crazy. And then also trying to figure out what tools parents may or may not have at home for treatment materials so that final week and even still now, I mean, it's just so much communication, so much asking parents, hey, what do you even have at your home that we can use for therapy? There was craziness when it came to zoom, because everyone was like, all on deck with Zoom, and then zoom basically got canceled for everyone, because not canceled, but just about every district said, No, you can't use Zoom all of a sudden, right right before we were about to provide services. But luckily, we are able to use Zoom. I really like zoom as far as for what we're doing, in comparison to Google meets, that is not a doubt with me that Zoom is better for this. It's amazing. So I talked about March 13 being that day that we got the email about school closing. On April 13, a month later, was the day that we actually went live. I sent out those recorded videos, and we started to provide services for students. And so one month and one month, we went from being all brick and mortar school to being fully online. And that is just crazy, and that is what leads me again to say, be kind to yourself. Understand that you are doing the best that you can do as well as everyone around you. As far as the educators, everyone is trying to do the best that they can do. It's crazy. You know, you hear some teachers are seeing kids or working with kids one, maybe even two times a day, in the morning, in the afternoon, and then other teachers are working with a kid once a week. And you know what? To each their own. There is no right or wrong way to do this same thing with you. There's no right or wrong way to provide ot right now and again. I don't I don't know how to say it any other way than that. It's just do your best. Do what you can do. If you know technology and you're good with technology, then maybe you can do more if you're not as great with technology. Then there's nothing wrong with sending home worksheets, as long as you are ethically billing them as as that that you are giving, you're providing the parent with resources and not actually providing hands on therapy. All right, so real quick, before we get before we move on, our district made the decision pretty early on that we were not going to do evaluations and that we are only going to provide therapy services, and I believe that is what most schools are doing. Now I haven't looked it up myself, but I have heard from multiple sources that idea has basically put a hold on the aspect for evaluations and is not necessarily requiring that evaluations be completed within the 60 day timeline. They understand that that is just not possible. So right now, we are only doing treatments, all right. So one of the questions that I've received on Instagram is, how am I doing videos? I also received an email about this. Thank you so much for asking. And I am actually using zoom to create my videos. I have a document camera that I borrowed from my principal, and I'm using that document camera as a second camera on Zoom, and then I am recording my session. It's just me in a Zoom Room, but I'm not inviting anyone into the Zoom Room, so it's just me and my document camera there, and we are I'm pressing record. I'm recording them. I am then putting that file onto our Microsoft OneDrive that we use at schools, at our schools, and then from there, I share a link to that Microsoft One Drive video or whatever other file that I want to share. Yeah, that's it's, I know it sounds probably simpler than it actually is, but that's how I'm doing it. If you actually need help with recording on Zoom, I highly recommend that you look that up on YouTube. There's a lot of explainer videos to show you how to record on there. So these videos are actually called asynchronous teletherapy, and what that is is that I am sending the parents a video. I am showing them how to do something, for instance, how to write in Play Doh, what they can do with Play Doh. So maybe they are warming up their fingers with rolling balls of play doh in their fingers. Maybe they're making larger balls, smaller balls, different types of squares, using toothpicks to build shapes with the Play Doh in the toothpicks. And then I start to have the student use a toothpick as a writing utensil and make lines or shapes or their name or or other letters, depending on their ability levels, right? And then so I make that video and I send it out to the parents. Mind you, I am not making an individual video for every single student. I am making four or five videos a week, and they are going out to a student that I have placed into a group for those for that individual video. So I have about four groups, sometimes, depending on the level or the skill that I'm working on, I'm breaking into five, and then that video is going out to, I mean, roughly a quarter of my caseload. And then they the other half of that is that I asked them to fill out a Google Form. Actually, it's a Microsoft form to give me feedback on how that went. Some parents are even sending me pictures of their student completing the activity, or a video of them, or just the work sample. And it's awesome, because I'm getting to see the kids, and it's nice to be able to see their smile. So that's really cool, but that is an asynchronous model for teletherapy. You are not physically working with the student. You are sending a video, and it's kind of like a YouTube video, except a little more tailored to them. You're giving them the idea, not saying, just go find a YouTube video, and within that video, I'm also giving ways to accommodate the activity so that they can help their student be successful. So yeah, that's actually working pretty well. Most of my parents have given me good feedback on that. I'm also asking them, in that form, when they complete it, for me to tell me about how much time it took them, so that could potentially help me know if it's too short or too long. I'm also asking them, you know, how much support did the student need to complete that activity. And if there's any other feedback, I have a few questions in there. It's very short. I'm trying to get parents to respond, and then other parents are going a little extra mile and emailing me those work samples or pictures, which is kind of cool. And then the other type of therapy is the synchronous therapy, which is the live zoom calls. And I want to jump into actually, some of my favorite activities so far. But first, I want to say that with the asynchronous the videos, we are not billing that as a direct treatment that is being billed as a consult. And so you are providing a resource in a way, so therefore it is a cons. Result, not a direct treatment. If it is, if you're working with a student live on a therapy session on Zoom, then yes, we are billing that as a live teletherapy session, and we use paradigm, so that's how we are billing it. All right. So I want to actually give you guys some easy activities that I'm doing. Some of these activities you can find on my Instagram page. I've been trying to make some short videos just to give you guys ideas, and I'll really quickly go over this finger Twister. I believe there is a video of that on my Instagram. Basically, the kids are creating a little Twister board with pencils and a marker or color pencils, and then we're playing finger Twister, which is a lot of isolation of finger movements, right? Another one that I'm doing is actually I'm using the zones of regulation program, and I'm making a Google Slides PowerPoint. And I've actually done this for three weeks now, and it's actually going pretty well. The kids enjoy it. I have some books and some little video clips that I can play for the students. It's also interactive, at least for the kids that I'm seeing live, because I can move the stuff around. I don't put it in presentation mode, I just leave it in editing mode, and then I share part of my screen on Zoom. And then I can move things around. So I can move pictures around so I can ask the student, all right, here's the happy face. Where does the happy face belong? In the green, red, yellow or blue? And then either myself or the student can click on the happy face and move it to the green zone. So that's cool. I've done shaving cream, just, you know, showing parents how they can use shaving cream, how they can slowly introduce shaving cream to their students, for the kids who might be a little adverse to that play doh already kind of mentioned a little bit of Play Doh, finger manipulation, building with toothpicks. I call this a grab bag activity. I don't think this one's on Instagram yet, but basically putting different items, toys into a bag and having the student just try to find those items in the bag without looking into the bag. So a lot of parents have like, reusable shopping bags that work plastic or, sorry, not plastic see through bags, but reusable plastic bags that work things like that. And you can really use you can really make that more difficult or simpler based upon the items that are in the bag, right? The more similar they are, the harder the activity is, the more dissimilar the items are. Then it's easier for the student to reach in and find those shapes without needing to look in there. Drawing with letters. That is one I have on Instagram. Basically, you draw you draw a letter. It's coming to my head, letter C, and then you turn letter C into a caterpillar with a few more drawings that's on Instagram. Check that out. And then so much you can do with Legos. I mean, so many things. Two things that I am actually going to be doing next week with my students is copying a Lego block design. So they're going to have Legos, and I'm going to show them a picture of a different Lego block design, and they are going to recreate that. If that's too easy, I'm going to take that away, the picture away, and I'm going to either do like a little visual, where I show it to them really quickly, and then they have to build it from memory. Or even for students who might have some planning difficulties and spatial awareness, is I describe how the image is built, and they have to try and build it based upon how I'm describing it, or vice versa. I can show them the picture, and they can describe to me how it's supposed to be built, and then I build it. And hopefully, as a team, we're able to build a structure that looks like what's in the picture. The other thing is a Lego code, and I'll have to post a picture of this on Instagram, but basically, for each letter, you have a different Lego block combination. So maybe green on top of red is letter A, and red on top of green is letter B. And then you can put that together in a picture, right, and have the student break the code to break the hidden message. All right, so those are some activities that I've been doing recently. Try it out, or share some of your other ones with me. I'd love to hear what your activities that you've been doing are on Instagram. I've seen so many good stuff on I mean, I told I'm telling you, man, April was an awesome month for occupational therapy on Instagram. Just amazing. So many ideas, so much advocacy. It was just amazing. All right, I've already mentioned a few of these, but I want to go over each one separately, and that is what tools and technology I am using for teletherapy, Google Slides. That's pretty easy, right? Everyone I think uses Google Slides or PowerPoint. I happen to have a web camera that I bought specifically for the A to Z school based, ot course, and that just happened to have, happened to come in like right before the whole quarantine started. So I have a web camera that is better placed than what would a like laptop. Web camera is right, and I can manipulate it if I want to. So if I want. Show my dog to a student, I can literally just pick it up really easily and turn it or if I want to point it downward, it's super easy to point it downward without moving my screen down to the point where I can't see my screen anymore. So you can get a halfway decent webcam on Amazon, maybe, but assume that they're probably selling out, but for not too expensive. So if that's something that you think might help you, a web camera, you can probably get one, a cheap one that'll do the trick for you for about 20, maybe $30 another thing that I use is a doc camera, a document camera that I mentioned earlier, and that is one that I honestly I went into school one day and I asked my principal, she had a doc camera that I could borrow, and she just happened to have one. If you don't have a document camera, you can look up how to use your phone as a second camera to your computer on YouTube. There are different ways, whether you have an iPhone, an iPad or an Android phone, that you can use your phone as a camera potentially. So that way you can have a second camera, instead of trying to shift your video camera on your your laptop webcam downward to look at your hands for a student. All right, so check that out. I mean, people are creative. They're even using like soup cans, just placing two soup cans up and then putting their phone on the soup can so it looks down at a piece of paper that they're working on, and that can work as a camera. I also have a second computer screen, which is like that I've had since high school, like 10 years ago, or whatever long no longer than that 12 years ago. I don't even know anymore that I've had, and it still works. And so I'm using that as a second computer screen, which helps when you're on Zoom, because you can see what you're sharing and you can see the student at the same time on large screen. So you can actually see both what the kid is seeing on your screen and also what they're doing based upon what it what they're seeing on your screen. So that's cool. I do use Zoom lots of emails. And if you need a phone and you want it to be a little more anonymous than your phone number, your actual phone number, you can use Google Voice. I'm sure many of you have already figured that one out all right before I get into my predictions for the future, and also some Instagram questions that I'm just going to kind of do rapid fire answer to. I also want to talk about your own health and that remember, you are at work every day from 730 to 430 or whatever your time frame is, and you need to remember to take care of yourself. So remember to get some exercise in, whether it's going on a bike ride with a mask on, or taking your dog for a walk or doing an exercise video. There's so many free exercise videos out there these days. Do that every day, if you can try and get a little bit of exercise in. I also want to remind you about the 2020 20 rule. I am not good at following this, and it's hard to do if you have a 30 minute session, because 20 minutes you can't just take a break after 20 minutes, right? You're you're trying to keep your student engaged. But the 2020 20 rule, and maybe you have a lesson actually teaching your kids about the 2020 20 rule is for every 20 minutes you spend looking at a screen, you should look at something 20 feet away for 20 seconds. So like right now, we're at 34 minutes. I've been staring at the screen for 34 minutes. I need to turn around, look out to my yard for 20 seconds and just kind of look around for 20 seconds to kind of give my eyes a break that they need. All right. So I'm gonna press pause and do that real quick, all right. And so along with that 2020, 20 rule is also make sure you have a nice setup workspace. I know that is not the easiest thing in the world. We don't all have a good workspace available, but try and make something your own. I mean, even if it's spending a little bit of money to get a nice, comfortable cushion for your uncomfortable chair, do that. That's what my wife did. Make sure that your feet are nice and planted on the ground, make sure that your computer screen is up a little bit higher. Again, that's the bad thing about laptops, is that the computer screen is so low, so you're constantly looking down. Not good for your neck, not good for your eyes. So if there's a way that you can lift up your computer screen somehow, and then maybe even use a Bluetooth keyboard and a bluetooth mouse to type on, versus having to keep your laptop at a bad angle, all right? And also, I mean, I've been thinking about this. I guess this is kind of getting into my predictions, which is a good segue. But, man, workers comp. I mean, how many people are starting are gonna have back issues from sitting in front of a computer for so long and looking at a computer screen. Man, I know my back hurts after a long day. It's hurting right now. And so what point is it? Something related to work? Because, you know, you used to stand up all day, and now you're sitting down. And of course, the district doesn't know what your desk looks like. The district doesn't. What your seating looks like. I mean, they don't, they don't even know what your they don't even care, really, what your house looks like. They just want you to do the work and see kids. And I mean, there's so much more I could go into about that, but, yeah, I don't know where that's going to go as far as ergonomics and people that are going to get injured because they're sitting on a computer for so long, and how that might impact districts and other employers, all right, which leads me a little bit to my predictions. And obviously, you know, these predictions are for California, maybe even only Southern California. At this point, I'm getting closer to feeling like we will return to schools in August in some form. I don't know what that's gonna look like. I have heard a few rumors that it might look like year round schooling. So maybe there's a B, C and potentially a D track. And there are three tracks in school at all times, and so one goes to school for three months and then goes off track, and another one, they just offset right? If you've ever worked or know about a year round school, they kind of work on tracks. I've also heard potentially, about kids, half the kids going to school in the morning, half the kids going to school in the afternoon. I don't really see that working out. Likewise, I don't see kids. I don't see the system working out if kids come to school on Monday, Wednesday, Friday, and then other kids come on Tuesday, Thursday, and then they switch the week after that, I just don't see that working for parents schedules. I don't see them wanting to clean the entire school every single night, because that kind of offsets the purpose, right? If things live longer than 24 hours, then, unless you clean the school, what's the purpose of distancing the kids? If things live and then they come through and touch something, and now every kid's sick again, right? So those are gonna be tricky. I don't know what's gonna happen, but, yeah, I also know that looking forward, because we have postponed evaluations, there's going to be a lot of evaluations to come back to whenever we come back, right? So that's another thing also, last on the last episode, Episode 47 you heard from Tony win, the special education lawyer, and he basically told us at the end of that podcast that he's already working with parents on a plan for what happens as far as makeup services go, as far as evaluations that were postponed goes. And so I am not looking forward to seeing what happens with that and how much makeup services we may or may not have to make up. And yeah, the last thing, really, I just don't know how things are changed forever. I mean, is HIPAA ever going to go back to being as stringent as it is now. Or are they gonna say, hey, it worked, so let's just keep it kind of relaxed as it is now. What about kids? Are more kids going to enroll in homeschooling or online schooling? I mean, they're already doing it now, right? So maybe some parents will find out it's it's nice and they can just do that. Will public schools start offering an online component, or will they offer online learning to maybe high schoolers or other populations of students that have kind of shown that, yeah, they can do it and it is effective. I mean, and again, what does that ultimately do to special education? Does Special Education kind of go away where maybe students are being educated on a computer and then come into a school for services. I don't know. I just know that things are probably going to be have changed forever, good, bad, whatever, things are going to be changed forever. All right. I want to wrap this up with rapid fire Instagram questions. All right, drum roll, please. I'm gonna try and do this quick. Weezy ISC wants to know, for those not doing teletherapy, when does it become unethical to do so, even if legislation says no, I don't know, our legislation says yes, we can provide teletherapy. I know there are some places that's probably still say, No, I know most services have relaxed that, but to answer the question, there's just so much hidden in that question. I don't want you to get sued. I really don't know the answer to it. I'm sorry. I wish I could give you a straightforward answer. That is a tough question. I think that is something that you really have to talk with your entire team at the school to figure that out. And I mean, if your students, if general education students, are getting an education, then IDEA says that your special education students also need to be getting the services in their IEP. That would be tough. I would be having a conversation with my admin if there was legislation like that. I would also be potentially calling my state to figure out, hey, you guys got to do something, because we need to be able to provide services, all right. KK, page 15 says or asks, How are occupational therapists supporting? Students and moderate, oh, sorry, students in moderate to severe, special day class placements, you can use the coaching model, where you're working more with the with the parent, and teaching them how they can help their student. I've also sat in on a few of the Zoom calls for my teachers, and so for one, for instance, one of our students was having difficulty attending to a zoom call. So I sat in and basically I just listened and watched that student, and kind of, now I'm gonna go back and work with the parent and say, hey, you know what? He was all over the place, but that's partially because we're sitting at a table that's so poorly, so poorly positioned for him. He can't touch the floor. He's leaning on you because he can't stabilize himself. Let's try something else. Another occupational therapist, Kelly, alt right, who actually was on episode 25 or 26 one, about the sensory integration, had a brilliant idea to put the kiddo into a laundry basket and kind of stuff it with some some blankets or pillows or something that way we can kind of support him, and he feels a little bit more interested in the activity, all right. Other ways that you can do that is by sending those videos out so that the parent can do it on their own time. That does help. I mean, parents are struggling, right? It's, I mean, I have a parent who has two students with autism and kind of an adolescent, so it's a handful, and she's struggling, but she, like, really appreciates all the support that we're giving her. All right? JDC, Mom x3 says, I need more ideas for activities with limited supplies. I am trying to be very mindful of limited supplies. With our parents, I am keeping things very basic. For some students, I'm even almost treatment planning the week before, when I'm on the session with them, we finish a session, and then I say, hey, what do you have? As far as toys? Let me see some of your toys that you have, and then I'm almost on the spot planning what I'm going to do the week later based upon what they have in their toy in their toy box. I'm making their toy box my toolbox, basically. Alyssa RAM, 87 Hello, Elissa. Always nice to hear from you. What's your take on parents wanting super late sessions, like after 6pm No, I'm just gonna say no, everything's gotta be during a school day. Some of my IEPs have been later at night. I am not liking it. Services should be during the school day. Callie B wants to know who determines using school based teletherapy. That should be a team decision. I know your school wants you to do it, but work with your team to figure out what is the best way, and that includes the parents, what is the best way to provide the services mini sasu Si su would like to know some advice for new grads starting in a school setting this summer and doing teletherapy. Oh man, take it easy and know that this is not the norm, especially if schools come back in August on digital platforms the way that we are right now. Take it easy and try your best. Definitely communicate with the other occupational therapists that you know. Reach out to me if you need a little assistance, reach out to another OT, get into the school based ot Facebook groups. There's so much support there as well, but take it easy and just try your best and know that parents will be appreciative basically with any therapy that you're providing, and they'll love you even more once you get back into the classroom and really see what you can do. All right. Katiari wants to know what are the requirements to comply with IEPs during these unprecedented times. Man, just try and follow the IEP as best you can. If it's individual, you can do individual services. If it's group, you may have to let the parent know that due to confidentiality, you may not be able to do groups. Every district is doing this a little bit different. You're really gonna have to look to your district for guidance on how they want to do this. District States know that IEPs are not necessarily being followed 100% but you're providing services to the extent possible. Oh, she also wants to know, will we be required to make up sessions? After all this work depends. Honestly, I'm just gonna say the squeaky wheel gets the worm right, or gets the grease right. So my guess is, for some students you will, for some students you won't, that is probably unethical. And by a district that's that's kind of a little unfair, right? But this the reality, and it was also the reality before services went all online. Some services, you know, you should be keeping track of missed services, and even you might have to be that squeaky wheel and say, Hey, I missed this many services, and I need help. Up when we come back, whenever we come back, because I need I need help, and you may or may not get it, and I'm sure your district is worried about that as well. So have the conversation with them. Leslie MCR, have you found a good way to get data on writing objectives? Not really. I'm trying to get objective. I'm trying to get data by having that Microsoft form, as well as getting work samples in the form of pictures from students. Sarah Schwartz wants to know, would you or sorry, she would like to know how to best support nonverbal kids who are extremely distracted on camera the same way that you would even when you are in the room with them. You've got to be very engaging. You got to have good facial expressions, be very active, and also work with the parents to do the same thing. Also, for some students, you may have to have or you may have to ask the parent to potentially be a little more hands off or more hands on, depending on the situation. Right? Every student's a little bit different, but keep them engaged with stuffed animals. Keep them engaged with your own personal animal. Try to find engaging activities. We have three more here. Garrido Ellen would like to know what platform I'm using to have sessions, and is it HIPAA compliant? I'm using the free or at least, I'm assuming it's the free version of zoom that is being provided to school districts. Is it HIPAA compliant? Technically, no, but HIPAA is relaxed right now. So yes, keep in mind that actually HIPAA has, or, sorry, Zoom has, a HIPAA compliant platform for healthcare practitioners, and you can't even look up the price until you ask them for a quote. So I'm assuming it's expensive. Actually, I will put documents or links to documents that Zoom actually has about HIPAA and fairpa, basically them saying that they're not officially compliant, because no one will give them a compliant title, or at least not the HIPAA or fairpa agency or whatever, but they believe that they are, for the most part, they do their best to remain compliant. Also, when you are using zoom and you're scheduling meetings, you know, don't put kids names in the meetings. Don't share information over a share screen that is HIPAA or fairpa, non compliant, right? Don't be sharing information on your screens. Sydney parrot would like to know what's the optimal length of time for a teletherapy session. I mean that that just varies Kid to Kid, right? I'm trying to basically do 30 minutes for the most part, because that's what's on the IEP. But the parents see it themselves when a kid is just zoomed out, as I call it, because I'm zoomed out right now. But yeah, I mean, parents are pretty they can also see when their kid is done with the session, right? And so be Be kind, be gentle, be real with the parent. And say, hey, you know what? I think it's time to kind of let your student have the play. Don't do whatever they want. And then lead into May, if you still have five or 10 minutes left of that session, talk to the parent and see what concerns they have. How do How can you help the parent to help the student? Okay? And last question, Madeline k5 would like to know about equipment and legislation. I talked a little bit about the equipment that I'm using, a webcam, an extra cam, or, sorry, an extra screen, a document camera is nice to have. Legislation. I can't keep up with it right now. There's just so much going on. Idea is changing little tiny bit. You still have to provide services, but it sounds like they're relaxed on evaluations, as I said earlier. But each state is also very different. I just don't know everything on that. So, all right, we're at 50 minutes. I am going to say goodbye. I hope that helped. I did not mean for this episode of the podcast in any way to be a professional development course. This is simply what I'm seeing, what I'm doing, and maybe you can get some tips out of it. So let me know if it helped. Shoot me a Instagram message, or even better, share this on your Instagram story feed. I would love that be sure to tag me so I can say thank you and and probably even share it myself on my own wall. Also, I would love for you guys to leave me a comment down in Apple podcast app, if that is where you listen, if where you listen to podcasts. Oh, man, I am done for the day. It is 644 I am out. Take care. Everyone. Stay safe. Stay healthy. Know that your parents and the kids that you work with are appreciating what you do. So yeah, until next time, take care. I will see you on episode 49 of the OT school house podcast. Bye, bye.  

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Thank you for listening to the OT schoolhouse podcast for more ways to help you and your students succeed right now, head on over to otsoolhouse.com Until next time class is dismissed. 

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