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OTS 57: Telehealth Platforms, Evaluations, and Ethics

Updated: Jun 28



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Welcome to the show notes for the Episode 57 of the OT Schoolhouse Podcast.


In this second episode of the 2-part teletherapy series, I discuss the pros and cons of the most popular telehealth platforms being used by public schools districts and some tips on how to use both Google Meet and Zoom. I then go into what a school-based occupational therapy evaluation may look like through a telehealth model. We will look at what assessments tools may or may not be possible. And finally, in the end, we will discuss ethics as they relate to telehealth and how to ensure that you are providing equitable services.


View the first episode in this teletherapy series at otschoolhouse.com/episode56


Earn a certificate for 2 hours of professional development by listening to episodes 56 & 57 and purchasing the Professional Development Podcast Course!


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Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs.


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

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Episode Transcript


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Jayson Davies   

Hey there, and welcome back to this two part series on telehealth. This is episode number 57 of the OT school house podcast. And my name is Jayson Davies. Thank you so much for being here as we get started. Well, not really started. We're continuing down the route of looking at teletherapy in schools. If you haven't already checked out episode 56 of the OT school house podcast, definitely check out that one, either right now or after you listen to this episode. In that episode, Episode 56 we talk about guidelines, practice and research, and in this episode, we're going to continue on to talk about platforms, evaluations and ethics related to occupational therapy in the schools and teletherapy. And just a quick reminder that you can earn two hours of professional development for listening to Episode 56 and this episode, Episode 57 on teletherapy in school based occupational therapy by heading on over to OT schoolhouse.com forward slash episode 56 or ot schoolhouse.com/episode 57 there you will see a link in order to purchase and complete the professional development quiz that goes along with these two episodes. Pretty easy way to earn some professional development while you're driving from one school to the other, or just listening to the podcast while you write up your evaluation. So check it out if you would like to earn some professional development for listening to a podcast that you've already listened to. All right, let's go ahead cue the Introduction music, and when we come back, we'll dive into the content. 

 

Amazing Narrator   

Hello and welcome to the OT school house 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   

All right, and welcome back to the OT school house Podcast, episode number 57 you know, I realized as that Introduction music was going on that I forgot to let you all know that when you do purchase the episode 56 and 57 teletherapy, professional development podcast opportunity, you will also receive the slideshow that I have put together that goes along with these two episodes. So not only will you have had listened to the audio portion of the podcast and got in all that information, but you're also going to have the slideshow notes that go along with that, so keep that for your own records. It makes it really easy to just go back and reference what I said throughout this episode. So go ahead, check it out. It is@otschoolhouse.com forward slash episode 57 and you will see the link right there for you. Okay, so as I was reviewing episode 56 just to you know, make sure I had everything and that I wasn't going to repeat myself in this episode. And also, as I was writing up the outline for this episode, a few things occurred to me, and the first is that this professional development, or even just this podcast in general, is very different from most podcasts or most professional developments that we might listen to a lot of times. We pick out a professional development opportunity based upon what we hope to need in the future, or what we hope to be able to do when the school year starts, or maybe even further out, or maybe we're looking into a new job, and we want to know how to hop into that new field seamlessly. But in this case, this is different, because this isn't something that we're really desiring to do a lot of us? Yeah, maybe a few of us are actually going to seek out a an online position with a company that does teletherapy. But for the most part, if you're listening to this episode, you are listening to it because you need it right now. You are being thrown into a teletherapy model that you never thought you would have been in, I don't know, only eight months ago, right? And so it's a little bit different this type of professional development opportunity. And now the other thing that I realized is that I didn't really introduce myself in Episode 56 and what's nice about the podcast is that oftentimes I don't need to introduce myself because you've listened to episodes whatever before, some of you have listened to all 56 episodes, and so you have gotten to know me a little bit. But for those of you who haven't listened to all 56 episodes, or maybe this is only your second episode that you're listening to because you really wanted to dive into teletherapy, and your friend told you about this episode. Well, my name is Jayson Davies and I am the content creator, the CEO, whatever you want to call it, behind ot school house and Schoolhouse Education LLC. Yes, it is now an LLC. But anyways, I have been a school based occupational therapist for eight years now, all in Southern California. I have had the. Opportunity to be a contracted school based therapist for a district, and I've also been a quote, unquote lead occupational therapist in a small district where I actually developed their occupational therapy program from the ground up. Now I currently moved a little bit closer to home. I was driving about an hour and a half to work every day, so now I took an opportunity that's much closer to work, where I have worked now for the past two years, and I'm a school based occupational therapist every day. I do have this podcast. I do have a course all on school based OT, but I am truly a school based occupational therapist, just like most of you listening are, and so I've gone through these experiences right there with you since March 13, or whatever it might be for, for when your school stopped everything. I've been there, and we've been going through this together. We've had several episodes where we've talked about this. We've had other occupational therapists on the podcast, and we've talked about how schools are coming back together. Just a little more about myself. I am a thesis advisor for students at a local university, as well as being a school based occupational therapist and creating this podcast for school based occupational therapist. And I also have had the chance to both help the Occupational Therapy Association of California set up a conference about school based occupational therapy, and I've also had the chance to speak at a few of the conferences for the Occupational Therapy Association of California, also known as OT. Now that brings me to talk a little bit, just a tad, about the OT school house and the OT school house podcast. The OT school house was originally founded by myself and a colleague, Abby piranha, who we just thought that there needed to be a website for school based occupational therapist, and subsequently, we thought there needed to be a podcast for school based OTs. So as this episode is being released, we are actually celebrating the third year of the OT School House website, and we're about two and a half years into the OT school house podcast, so that's pretty awesome, and I'm so excited to just share all of this, because, I mean, we've come a long ways, and we now have a huge community of school based occupational therapists that listen to this podcast, that support each other on Facebook that take courses together and listen to podcasts together. So just want to say thank you to all of you for making this even possible. And I am so happy that that we're able to come together and just share our experiences together and and fight through especially this COVID 19 pandemic school year that is just about to get started. So what makes me qualified to then talk about teletherapy? I mean, I am a school based occupational therapist. Traditionally, I do work in the schools, just like most of you do, and I am not a specialist in providing teletherapy services. However, with that said, I have gone out of my way to look up research about school based occupational therapy and teletherapy in general. I've also gone and taken courses, both live and recorded courses, both before and during this COVID 19 pandemic, on what teletherapy could potentially look like and how evaluations could potentially occur throughout the teletherapy world, or teletherapy platform, whatever you are using. And so that's why I do feel like it's important to have this conversation. And I do feel like between the conferences that I attended prior the research that I have done since March 13 and the experiences that I've had since March 13, I feel like these experiences do provide me the experience to help you, and I hope that you really do find this podcast as helpful as well as episode 56 All right, so now we're going to go ahead and dive into our content that we're really trying to get through today, and so I'm going to just, and I'm going to start off by sharing with you really quickly, the three overarching goals for today. And those three goals are to review both platforms and the hardware that make providing services over a teletherapy model a little bit easier. We're going to talk about some of the pros and the cons. We're also going to go over evaluations and what that might look like through a teletherapy lens. And then finally, we are going to cover ethics. And these ethics principles that we're going to be talking about are directly related to teletherapy. Of course, there's so much to go over with ethics, and it's been on my to do list to create an entire episode just on ethics, but today we're going to focus on teletherapy ethics. All right, so let's go ahead and get started with talking about some of the platforms that are commonly used, as well as some helpful hardware that might help you get through this this time. So when it comes to different platforms that we may use for teletherapy, I know that. There are several out there. However, the two big ones appear to be zoom and Google meet. And yes, it's weird to say Google meet, and that's actually what it's called. There's no s at the end, but it does sound it sounds interesting to say it should be Google meets. In my opinion, names aside, both zoom and Google meets have their pros and their cons. I would argue that Zoom has more pros than cons when it comes in comparison to Google meet. However, as district employees, as most of us are, or as contracted employees working for a district, we often need to follow the policy that is set in place by that school district, and so we may be mandated or directed to use one or the other. So I'm going to go ahead a little bit over both of the pros and cons, and then give you a few extra tips beyond that. Okay, so let's go ahead and start with some of the pros for both zoom and Google meets. See I added the s on meet that time. Anyways, let's start with Zoom. One of the biggest pros of zoom is the ease of sharing your screen, your browser, a document, camera, or even an iPad, if you have one, it's very simple. There's a big green button right at the bottom. You hit that big green button and all the options appear to you. And when it comes to Google meet, they have a similar type of feature. You hit a button down at the bottom and it gives you some options, but there's just not quite as many options. You don't have the ability to just really quickly say, I want to share my iPad screen, or say you have a document camera. Same thing. You can't just share a second camera and so that your students can see both you and whatever your document camera is showing. It's just not that simple like it is with Zoom. Another potential Pro for using Zoom is the remote mouse control. And before I go on about what this is, note that if you or your students are using a Chromebook, they might not be able to use this feature, but what this is, is this is a feature where you can basically give the student you're working with on the other end of the internet at their own house, the ability to control your mouse. So say, you're using a PowerPoint slide deck or a Google slide deck, and you want them to be able to move things around on your screen? Well, if you're on a MacBook and they're on a MacBook, or if you're on an HP and they're on an actual HP, not a Chromebook, you could do that, but because they're on a Chromebook, they might not have that capability. So just be mindful, if you're trying to figure out why this feature isn't working and you're using zoom, it's likely because they're on a Chromebook and don't have that ability to do that. Another positive note for zoom is the ability to be easily set up with two monitors, meaning that you have your primary monitor, that is your laptop or or your desktop screen, but then you have a second screen attached to the computer. Zoom has a setting that is designed for having dual monitors. And when you do this, it makes it really easy to see your students all in grid mode on one screen. And then you can reserve your second screen as your your workspace, where you can bring up a website that you want to show, or you can have that showing your document camera, so that you can see what your hand is doing, or what they're seeing your hand do, at least on the screen, and then also see what they are doing. Now this next one I'm going to share with you is probably the biggest pro that I have found for zoom over Google meet, and that is the ability to have a waiting room. So in zoom if you've ever been on a zoom call or a Zoom meeting, Zoom webinar, you know that when you go in, oftentimes you'll see the screen saying, Please hold on. Shortly, the administrator will let you in, and that is when you are in the waiting room. Well, with Google meet right now, they don't have the waiting room aspect. And so what happens is, when I'm finishing up with Johnny at 129 about to finish at 130 and Samantha's about to come in at 130 well, sometimes Samantha and her parents show up at 129 and right as I'm finishing up with Johnny, I now have two kids in there, and you know Johnny and Samantha, they already know each other. They go to the same school. They might even be in the same exact class, but for that one to two minute time frame, there's that interruption, and you're trying to finish up with one student while the other student is still coming in. And that is that has been kind of a pain in my side the last few weeks, because back in the spring, when we were using zoom, I could just say, Okay, I see Samantha in the waiting room. I'm going to go ahead, finish up, say goodbye to Johnny, and then I'll let Samantha in. Well, now I have. Parents coming in, and sometimes they immediately leave real quick. Sometimes they just, you know, kind of hover in there for a minute or two waiting for me to finish. But you can see how that could be a potential privacy concern as well as just a general interruption. Now on Google, I could solve this by giving each student their own link, but that would mean that every time I transition from one student to another student, I would have to close out that Google meet and open up a new Google meet to be with that new student. And that's just a little bit more work that honestly, when you're trying to do something new and be efficient in this new world of teletherapy, it's just an extra piece that Zoom makes it easier to not have to deal with because you can stay in that one room. One kid can be in there, another kid can come into the waiting room. When Student A leaves, you can let Student B in. So I just see that as a huge benefit when it comes to using zoom over Google meet. Now, the last pro that I have listed here, I'm sure there are more, but the last one that I have listed right now is the ability to use Breakout Rooms in zoom. And this doesn't really matter if you are providing one to one individual teletherapy services to students, they can just leave the teacher's room and go to your your zoom or Google meet room. However, if you are going to try, and maybe on Tuesdays, you're going to push into Mrs. Smith's classroom and you're just going to see her students back to back on Tuesday. Well, it would be nice if Mrs. Smith is using zoom, because you can go in and she can just put Mrs. Smith, I mean, can basically say, All right, I want Mr. Davies and Johnny to go to a breakout room. And boom. We just go to a breakout room for 30 minutes. Then we come back and I say, Hey, Mrs. Smith, can you send me in a breakout room now with Samantha? And she clicks, Mr. Davies, clicks, Miss or sorry, clicks Samantha and boom. Now we're in a breakout room. The same thing could actually happen with a group. So it could be Mr. Davies, Samantha and Johnny boom breakout room. So you can see how that could be really nice, because then the student doesn't have to figure out how to leave Mrs. Smith's classroom and then join your classroom. They just stay within Mrs. Smith's classroom, but they're sent to a breakout room with you, and so there's no potential possibility for that student to, quote, unquote, get lost in the internet when they're trying to figure out how to leave Mrs. Smith's classroom and get to your classroom and vice versa. Okay, so I think before moving on to the pros for Google meet, I will first give you some of the cons, the few cons that are there for using Zoom. And the first is that it is expensive and there are limitations on the free version of zoom, the official HIPAA compliant version of zoom is $250 per month per user, and that's really expensive for a district, especially if the district is already paying For the Microsoft Office suite and the Microsoft Teams capability, as well as the Google Suite ability and the ability to use Google meet. And they're not going to stop using Google, because there's just so much more than Google meet to the Google Suite. You have documents or not excel, but you have sheets, you have slides, you have calendar, email, you have everything. And so now you're going to, potentially, the district be paying for both Google and Microsoft, if they use both, and then also be paying for zoom, which is expensive. So that is definitely the primary con for using zoom, is that cost. But also there's two other things that I want to address. The first is that Zoom is not fully integrated with Google Suite. It is pretty integrated. You can download an extension for zoom, which makes scheduling pretty easy through the Google calendar. You can also get an extension for Microsoft that, again, makes it just as simple, but it's just not fully integrated versus Google meet is completely integrated with Google Classroom. If you have a Google Classroom, your Google meet link is right at the top of your Google meet, or, sorry, your Google Classroom, so it makes it easy. The other thing that I want to address is the security issues that Zoom has faced. It is true that back in the spring, there was a thing called Zoom bombing, and people were somehow getting into people's meetings. But I really must actually applaud zoom for really taking this head on. And they've done a lot since March in order to combat this difficulty. They've made it so that every room has a password. They've made it so every room has a waiting room on, as I talked about earlier, right, where people, even if they get the password and get on, they're going to be put into your waiting room. And so if you don't recognize the name of that person or the name of that computer trying to get into your room, you can just simply ignore it or tell zoom to block them, and so they just can't get in and ruin your meeting. Likewise, there are just so many settings on zoom that you can alter and make it even more secure. You can make it so that no one has the ability to share their screen except for you. You can make it so that no one has the ability to chat, or that they only have the ability to chat with you if you're in a group. So maybe you do have a small group of three kids on it at the same time, and you don't want them chatting back and forth. Well, you can really easily just click a button and boom, and now they can only chat with you in the chat box. Okay, so that kind of goes over what zoom or the pros and cons of zoom. Now I want to go over Google meet, and I know, as we were talking about the pros and cons of zoom, I kind of put in some some different positives and negatives for Google, but let's talk about them specifically, as you likely could tell from what I was talking about zoom, I am not the biggest fan of Google meet, but I will say that it does Have some pros, and just like zoom, it does have some cons. And so my first pro for Google meet is that it is a Google product, and it is fully integrated with Google, and everything just works seamlessly with Google, which, let's be honest here, most districts use Google for so much more than just Google meet, like I alluded to earlier, Google meet works seamlessly with a Google Classroom. And so if you or the teachers have a Google Classroom, or both of you do, it's really nice because the link just fits right up there. And actually Google prevents you from changing that link to any other link, so you can't change the link at the top of your Google Classroom to say maybe a zoom link, they just don't allow that. That does add a little bit extra security, because unless you copy and paste that link, or your students copy and paste that link to somewhere else on the web, it's basically impossible for someone to get into your Google Classroom and find that link, especially if you're on Google Classroom, and you lock your classroom. So that is definitely a pro for Google. They do make it pretty secure. I mean, it's always possible that someone just types in meet.google.com, forward slash and some random bunch of numbers and letters, and maybe that would kind of let them into your meeting. But even then, you would get a notification if you're on Google, on Google meet, saying so and so is trying to access your room, it acts kind of like a wait list, except it's not because the only reason you're getting that notification is because the student doesn't have a.student.district.com email address. If they did have that student email address, they wouldn't be or you wouldn't get a notification saying that this person is from outside of your area. Right along the lines with it just being a Google product, is that Google and your district likely already have what is called a BAA or a business associate agreement, and basically what that means is that your district and Google have already basically done the paperwork, and they've set up their technology department to work with each other to be as secure as possible. So that is just, it's a natural positive, because that means that security is built in and that the district and Google are all on the same page, and everything is nice and secure. The last pro that I do have on my list of Google meet pros is that you do have what are called Google extensions, and there are many Google extensions out there that could potentially be added onto your Chrome browser to help make the Google meet experience better. The problem with these? Well, there's a few. Let me start with first, if you're using a district computer, the district program, you have to make sure that these are actually approved for you to use. You may not be able to download this cool extension that you just found out about unless your district has already approved it, and if they haven't approved it, you might have to go through some sort of approval process to see if they will allow it. The other thing about extensions is that there isn't a huge regulation on extensions, and so that's why the district needs to approve it, because you could maybe there is an extension that you can get because your district doesn't block anything. Well, now you're potentially putting your students data at risk because you don't know what data that extension is going to take from your Google meet. And you know, we all like to think that people are honest, but we don't know who these developers are, and we don't know what they're doing, or even what information they're really getting. The other thing about some of the Google meet extensions is that you have to have them installed, potentially on both your computer and your students computers for them to work. And so like, in zoom, there's a feature where you can, like, press the raise hand button and. And a little hand raises or whatnot, or thumbs up. Well, in Google, if you want to do that, everyone who's in the meeting has to have that extension built in. And just like an application on your phone, oftentimes you get a limited free trial and then to do what you actually want the extension to do. Because you know, when you downloaded it, it said it would do that, such as maybe give your student access to control your mouse, well, then you might have to upgrade it and pay a monthly fee of $10 a month or whatnot. And who knows if your district is going to be willing to do that. And I don't know if you really want to be putting your credit card on file for $10 a month for a program that you're using with the district. And before we move on, I will give you a short list of Google meet extensions that you might want to try out, because these are extensions that do, or at least they're supposed to help with making Google a little bit more like Google meets. The first is grid view, which would allow you to see more more of your students. If you have a lot of students on at one time, you can see more students on one screen, and that is called grid view. Another one is due Alice, D, U, a, L, L, E, S, and that is there to help you to see both whatever you're presenting from your screen as well as your students. It kind of splits your screen in half so that you can do that again if you're on Google this, or, sorry if you're on Zoom, this basically does it automatically, but this is something on Google that kind of makes it similar to zoom. Another extension that I'm actually downloading as I speak, is called the Google meet waiting room, and I already talked about how the waiting room is an essential feature. So you can bet I'm going to be trying this one out, although I'm downloading it on my personal computer. And again, I don't know if I'm going to be able to download it to my district computer. I guess I'll find out on Monday. And then the last one on my list here is Google meet breakout rooms, and it is called that. Unfortunately, this is not an extension that's actually developed by Google, even though it's called Google meet breakout room. You don't know who exactly is the person behind this developed app, and you don't know what data is going to be going to that person, so be sure that you check that before you move on and use it, because who knows what information is really going to be going to that person. All right, so one more thing before we're going to move into talking about some hardware that will be helpful for you, and that is the cons for Google meet, and I've already gone over quite a few, but I'm going to go through these really quickly, just so you have a summary of the cons that I believe to be for Google meet that is limited screen iPad and document camera sharing capabilities. Remember, with Zoom, it's very easy to share just about anything that's connected to your computer. It's a little bit more difficult with Google meet. Also, as I mentioned earlier, you don't have the ability to share your mouse control like you do with Zoom, and that may not be a big deal if all your students are using Chromebooks, because then you won't be able to do it with Zoom either. The other thing, again, also talked about was that there's no waiting room ability without an extension on Google meet, and I already talked about my experiences with not having that waiting room feature. So you might just want to keep that in mind. If that's the route that your school district is going, you might want to give each student their own link that way, there's no overlap between student when one is finishing a session and when one is starting a session. Another limitation that we already talked about was that Google meet does not have the ability to use breakout rooms, so that, again, only really affects you if you were planning on going into a teacher's room and breaking out with students from there and then the last, and we already talked about the ability to maybe solve this with the grid view and do Alice extensions, is that it's hard to see your students and whatever you're sharing. So if you're going to be sharing some sort of fine motor YouTube video to your student, it might be difficult for you to do that and see the student at the same exact time. So that's just some of the pros cons for both Google and zoom, and you can go from there to see which one will work for you. Personally, I like zoom, but I understand that districts control that. So even though I do prefer zoom, it is something that I have to live with is using Google and figuring out how to make it the best it can be. So yeah, I'm going to continue to do that. Okay, so let's go ahead and talk just a minute about hardware before we head into talking more about evaluations. When I'm talking about hardware, I'm talking about the physical pieces of equipment that you have in front of you in relationship to technology. Now the perfect setup would be you having a computer in front of you with. A second monitor, potentially a nice light in front of you, because, you know, you get dark on screen. Sometimes it would also be nice to have a an additional camera that's a little bit higher, so you don't have the camera looking up your nose, and then a document camera next to that, so that you can point the document camera at your paper and so that you can actually show the kid what you're doing with your hands. That's like the perfect setup, right? But to be honest, a lot of us are working with a lot less. We are lucky if we have a laptop with a document camera that is built into the laptop, sorry, not a document camera, a webcam built into the laptop, looking up our nose. We don't have a document camera, we don't have an additional camera to use for any purpose. We might be in a dark closet or a dark room. And if you're really lucky, you might have an iPad, and you're gonna have to use that iPad as your document camera, potentially, or maybe an old iPhone as a document camera, in a way. And even with that, you're going to have to get creative. I have been using what is called an Osmo O, S, M, O, as my document camera. And the way that I do that, because I'm using Google meet, is that I log into Google meet as myself on my computer. Therefore I can use my computer as my main hub, per se, where I actually see the student, but then I also will log into Google, meet through my iPad, and use my iPad as a document camera. The way that the Osmo works is that it comes with a stand as well as a little mirror that fits right over the camera on the top of your iPad, which then directs the picture down to the table. It then basically, kind of reorients your paper, using technology to kind of, you know, make the paper not look like a trapezoid, to make it look rectangular. And then basically it's a document camera from that point. And you can share your your iPad screen once you're on your Google meet. You can present your screen on the iPad, and your student will then see your paper your hand and what is writing. Now, keep in mind, it's great if you're just going to show writing, but it's not great as soon as you lift the paper up off the table, because of the way that it reorients the paper so that it'll fit on the screen and look like a normal piece of paper. So if you try and lift the paper to cut it, your hand in the paper, they're all going to look distorted, because it's assuming that the paper is laying flat on the table. So it's great if you're going to show writing, if you're going to show drawing, if you're going to show coloring, great. But if you're going to try and do any sort of coloring or in hand manipulation, where your hands are off the table, then it's going to be a little tricky. What I do then is that, if I'm going to do something like that, I take off the Osmo, which is that little mirror on the top. I take that off, and I make my iPad, my main camera that shows my face. And then I tilt my my laptop down to then be my quote, unquote document camera. So now the web camera that is built into my iPad is now looking down at my hands, and my iPad is looking at my face, so that the student can see both my hands and my face. And again, that only works because I have a second monitor connected to my computer, where I can still see the student's face on the second monitor. And so all of this as you can as you can hear you're listening. You can imagine how this gets a little tricky. Best Practice, best I mean, if you can ask your principal, ask another teacher, if they're not using their document cam, try and get a hold of a document camera, it will make your life 100 times easier, because that's what they're designed for, is to be able to show your hands, to be able to show what you're writing on the paper, to be able to show anything that's occurring underneath that space. So I highly recommend that you get a document camera, if you can, that's going to be the best thing that you can do. If you can get an Osmo great. But a document camera is really where it's at. I highly recommend it. If you absolutely feel like you need some of these things, I would recommend going on Amazon, finding a 20 to $30 webcam, that way, you're not having the up your nose shot. And you can also manipulate that web camera to look wherever you want it to. I would spend maybe 50 to $100 on a document camera, maybe. And that's a long shot. I mean, I haven't bought my own document camera, and I know how valuable it would be. And then the other thing is, if you're not going to get a document camera, I would try and pick up the Osmo, just because it will help a little bit. Again, it works with both an iPad and, I believe, a Fire tablet. The other thing that you might be able to do is ask your teachers or your principal or the custodian if he has seen an extra monitor lying around. Around that you can borrow. If the kids aren't on campus, they're not using the computer lab, maybe they'll allow you to use a monitor from the computer lab, so that you have two monitors, so that you can actually, you know, see the student while the while you're presenting something from your screen on your main computer. All right, I know that's a lot about technology. That's not what you're here to really get, but I wanted to share that with you. So let's go ahead and move on to evaluations, which I know is what you really want out of this. So let's go evaluation time, all right, to understand how evaluations might work through a teletherapy or telehealth model, first, I want to just do a quick review of what an evaluation looks like in a traditional school based occupational therapy model. And that is, first, we have to do a records review. Then we're going to do a classroom observation, or recess observation, or lunchroom observation, wherever we might need to go to see the skills that that there are concerns in. Then after we do some observations in the natural setting, then we would potentially do some observations, or structured observations in the OT room or OT closet, or wherever we can work with that student. After that, you dive into your standardized evaluations, which is the area that I think most of you are scared about, trying to figure out, what evaluations can we do via a teletherapy model? We'll get into that in a moment, and after you do your standardized evaluation, the last piece really is to kind of put it all together, put your your observations, with your structured observations, with your records review and the standardized assessments. Put that all together, analyze the data, and then hold an IEP to report all that data, right? Well, that's the traditional way. Let's go ahead now, and let's break that down piece by piece. When it comes to a teletherapy model, starting with the records review. That records review, it's not really going to change, right? You still have access to look at that student's IEP. You still have access to look at the psychologist report, or whatever report might be there. You also have the ability to either mail home a parent questionnaire or send an email to the parent about a parent questionnaire or call the parent to get an interview, or use a Google form or a Microsoft form to set up some way to get information from the parent, as well as the teacher, as well as any other person who you might want to get information from. So that is your records review. The next step is, then you're in classroom, or your your observation, wherever you need to see the skill. Now this is where it gets tricky, right. Now, if you're going to observe a student in a telehealth model, you are only going to see a small box with maybe their head and shoulders, and I say maybe because a lot of times these cameras are pointing over the kid's head, up their nose and over their head, or something like that, and you're not going to see anything. And so this is where it gets tricky. Your classroom observations are likely to yield much less information now than they would have when you could actually get into the classroom, on the playground or into the cafeteria, you're just not going to see as much. And to be fair, it's not really appropriate, in my opinion, to go into a classroom and say, Hey, Samantha, I already used that name once. They will use it again. Samantha, can you please tilt your computer screen down so that I can see your hands? Oh, by the way, you're not going to be able to see whatever the teacher is saying, because your computer screen is going to be tilted down. No, that's that's not fair. We don't want to do that, but at the same time, we do want to still do that observation so that we can see at least what we can see, you know, what? Maybe we will see that the student is attending, or maybe we'll see that the student's in an office chair spinning in circles. You know, what information does that give you? Maybe it gives you a little bit of vestibular seeking activity going on. Or maybe you just noticed that the student can't attend, and maybe you're seeing that in their glasses. They're watching a YouTube video. Or, I mean, yeah, you're not going to see what their hands are doing, but at least you can get some sense of what's going on. Are they at least able to attend? And then you're going to back that up with those questionnaires that we talked about a minute ago, finding out what the teacher knows this early in the school year, I might recommend that you reach out to the previous school teacher as well, because they might have been the ones who actually put the referral in, and the current teacher may know very, very little. I just got done with an evaluation. I talked to the new teacher, and she said that she hadn't even heard the voice of the student yet, and we're a month into school. That's how limited some of these interactions are when it comes to providing a teletherapy or telehealth model evaluation as well as distance learning. All right, so. With that huge limitation when it comes to that observation within the classroom, or whatever you want to call that you really are going to have to make it up with your structured observations, and you're really going to have to make the most of it. You're going to have to get in touch with that parent to try and put together almost a little toolkit to have available when you're going to do your structured observations. Likewise, you're going to have to communicate with a parent to make sure that in the next step, they have the materials that they might need if you're able to do a standardized assessment with the student. So let's start with those structured observations. How can you go about doing those? Well, I would put together a list of materials that you are very familiar with that are common in the house, that you could get the most information from. So actually, put together a short list of items that you might want to have available. And those might be crayons, pencils, paper lined and White Paper, Scissors, depending on, you know what, if the student's right handed or left handed, make sure that you have appropriate scissors, or that the parent has appropriate scissors, a small paper bag or a pillow case that the student can't see through. That way, you might be able to have the student reach in and grab tools to see if that tactile perception is there, that they can find the tool. Whatever you're requesting, small, very varied toys, maybe different colors that you can do some sorting with, maybe some cars or Legos, dolls, dice, whatever you might be able to hide in the bag and have the student find or use for sorting or use for any sort of manipulation skills. Of course, coins are always great as well. You can look at the ability to manipulate one or multiple items within the hands. If they have some form of maybe an Old Spice bottle that is all out of spice, you can you put all the coins in there and see if they can get the coins out. You could also have a spice bottle that has the small holes where toothpicks fit in and out of and you could use that, as far as your assessment goes, any sort of blocks, Legos. You can use those for building to see if they can reconstruct something that you show them. You can do something similar with plastic cups along with more they don't have to be plastic. They could be paper or foam, but you can cut them up, you can stack them. You can play the drums on them. You can see some hand supination as they flip that from one side to the other. So plastic cups is one of those things that you can see a lot with. And of course, if you're going to be evaluating a little kid play doh is a must. Tongs and tweezers to really see what kind of grasp we're using. Do we have the strength to keep those tongs closed or not? And a tennis ball, you can see some of the bilateral coordination skills just by using a tennis ball and doing some various activities with that. Of course, you're going to want to see some handwriting samples. You might want to also have an interview in that structured observation with either a the student, or both A and B, the student and the parents, that's your that's your additional opportunity to understand what concerns are, there are present and what the parents are thinking, as well as what their long term goals are for the student. And that then brings us to the final and probably most difficult part of a teletherapy evaluation, and that is the standardized evaluation processes. And as we get into this, I want to emphasize how important those structured observations that we just talked about are, because those structured observations are going to help you decide what evaluation tools you're going to use. Now, if there were no sensory processing concerns when you spoke to the parent and did your structured observations, then you might be able to rule out a certain set or or even a specific tool that you might use for most of your other students. Likewise, if there are no concerns with, I don't know, maybe bilateral coordination, crossing midline, and it's all sensory processing, self regulation. Well, then maybe you're going to use a different subset of tools, but that's why those structured observations and that records review are so important. So now, after you've done those those observations, and you've talked to the parents, you've got to decide which tools you're going to use, and this is, I think, where we're getting most hung up right now as a profession on trying to figure out how to complete these telehealth evaluations, we need to know what assessments can and cannot be used over telehealth in a way that will create a defendable report. So let's start off by talking about some of the easy ones, like the sensory profile and the sensory processing measure SPM. These are both questionnaires that can be completed by the adult at home or potentially maybe also by the teacher from last year, last school year, or if you feel comfortable and you think. That the teacher that currently has the student knows enough about the student they can fill one out as well. I would highly recommend that if you are one that does not typically send home, a home questionnaire for the SPM or the sensory profile, I would start doing that, especially if that is their main educational area where they're learning, we need to know what is going on in the home. And what's great about these specific questionnaires is that you can either a mail them home, or B, have your district hopefully step up and get the electronic versions of it, and they can be emailed to the parents and completed, so that can still be done relatively easily. One common questionnaire I know many of you out there use that you probably won't be able to use is probably the SFA, and that is because you're going to have very few people that can fill out the school function assessment accurately based upon current ability levels for the student, the student is simply not there to be able to observe and see how independent they are on campus, and so that one may just simply not be able to be used. And it's unfortunate, but luckily, we have other assessment tools that we still can use. So what is the next type of assessment that we might be able to use? The next step up from there, I think, is some of our visual testing that we might do, such as portions of the VMI or the ravma or the dtvp, that is all visual. And I know what you're saying. You know, if you're doing anything through the computer, it is no longer standardized, and I understand that, and we're going to talk about that in just a second, about what to add into our report in order to kind of accommodate for that a little bit, but at the same time, we need to get some sort of data. And yes, those assessments were not standardized in a teletherapy assessment or a teletherapy model. And trust me, I went back and I looked and I tried to find some tools that we can actually use that were standardized via teletherapy, and they're just not there. But that's not stopping practitioners from still providing evaluations through a teletherapy model. I'm thinking right now in my head of the VMI, the Rama, where the student just has to point to a stimulus that matches the stimulus above. I don't see why that is not something that we could do if we were to mail that protocol home a few days before jump on with them and have them do it in front of us, and we can still score it real time, just like we would. Similarly, I think we could do the same thing when it comes to some portions of the test of handwriting skills, or the bot too, where the student does have to use a red pencil to do certain activities or to copy shapes, or the etch, where the student is asked to copy the alphabet and or, sorry, not copy, but write the alphabet and copy sentences. I think that these are skills that we could see through the computer, and I understand that they will be slightly different, and they may not be quite standardized, but can you explain in your report the skills that you saw and determine whether or not you feel those would be accurate or inaccurate skills? Do you think that the environment of the classroom would have interfered with the student's ability to complete those skills? Do you feel that if the student was with you in front of you, that they would have performed any differently? Or do you feel that these are actually skills that you're seeing on the computer that you would see if the student was right there in front of you, as they might be during an in person evaluation. As I say this, I know you're thinking it. I'm thinking it. There's also some evaluations, or some evaluation tools, at least, that we likely will not be able to use, such as maybe the Peabody. That's a tricky one. There's a lot of tools that are needed, and they're very specific tools. The blocks have to be the right size, you have to have the string, you gotta have the scissors, you gotta have the templates that may be a little bit more tricky to actually pull off. Likewise, the M fun, which I really like, that might be a little bit more tricky too, because there are several pieces that you have to provide. There's the snack time part of it, which might be a little tricky, even if you do have the tools here and there. I'm not sure the whole social interaction part might work the same live as it would via a teletherapy model. So that is a little tricky aspect to it, but there are several assessment tools that I do believe that we could use the bot as far as the manual dexterity part. Yeah, you might not be able to do that part, but you can probably still do the fine motor precision and integration part. So there are areas that you can do and there are areas that you can't do. I would definitely take this on a case. Case basis, I would be a little picky in in choosing where and when and what assessment tools you're going to use. Be careful in that, but you can do this, and many districts are struggling, and they're just flat out scared of doing evaluations because they don't think that they'll be able to defend them in court. And if that's the case, if there's specific cases, or even if your district is just going that route where they want to bring everyone in for an evaluation, well then you can still bring them in person to complete one or two evaluations, or all of your evaluations, whatever you feel is necessary, of course, when I say bringing them in, I do mean with the proper protections in place, the barriers in place that are needed so that everyone, both you and the student and everyone else at the school, are in a safe and well, also efficient in a way place. You know, we don't want anyone getting sick, but we also want to get these students the services. And the only way to get them the services, if it's an initial is to do that evaluation. And I think districts are going to understand that if they are holding off on evaluations, be it because they don't think a teletherapy evaluation is defendable. Well, they're going to start to realize, I think, in the future, that they should have gotten that evaluation done, because you're going to have parents asking for comp services for all those missed sessions when their student would have qualified for services. And so we really need to somehow get these evaluations done. Whatever can happen online. Let's do it online, and if we need to bring a student in, let's try and do it in the safest way possible before we move on to potentially writing up the report. I want to say one thing about sending those assessments home, be sure that you are including in the packet or in the email to the parent that you don't want them to open that package until it is time to complete the evaluation with you. Basically let them know that do not open this until you are on the video call with me and I instruct you to open it that way, you can at least say in your report that the child did not have exposure to the therapy tool prior to you assessing the student with that tool, which is important because we I mean, with every assessment tool, the student is not supposed to be playing with it right before they are about to be assessed using the tool, right? So make sure you let the parents know not to open it and let their student play with it all right? So that brings us to the final part of the evaluation, and that is writing up your report so that you can give your report at an IEP. And I've already kind of alluded a little bit to this, but when it comes to writing up your report, you want to write it up just as you would if the student was in your room for that standardized evaluation and how it went, just like you would write up how the child participated and how the child interacted with you during that evaluation, and how they were engaged or not engaged, you want to do the same thing in relationship to the student's engagement participation when on the computer. And then go a little bit further, add in your thoughts on whether or not you felt that the student scores still reflect their ability level, and whether or not you feel that these scores are actually comparable to what the student might have achieved if they were sitting right there at your table. You want to make sure that this is all in your evaluation, because, again, if this does, for whatever reason, end up in court, you want to be able to say that you are comfortable with your evaluation and the results that came about from your evaluation. And if you feel that those scores are sufficient, you can score them and you can put them in your report, but I would just make sure that you clarify that this was done technically in an unstandardized way, because they were administered over a telehealth platform. And you know, there's nothing right now that you can potentially do to change that, because your district is asking you to do your evaluations over a telehealth platform. And you know what that is, something that when that day comes, it may need to be addressed. But again, like I said a little while ago, I think the parent and well, I mean, everyone involved is going to be just more satisfied that at least the evaluation is done and that now their student is getting services, albeit via a teletherapy model, probably, but that evaluation was taken care of. It was done in a way that allows you and the parent and everyone to feel comfortable that it was done in a way that was. Uh, really inclusive, and that everything was was thought of, versus not doing the evaluation because we're scared of having an evaluation, and then the student not getting services because of that. So just make sure that in your report you're adding those details in there. So I'm going to wrap up this evaluation section of the podcast really quickly with a quick disclaimer, as much as I hate them, that make sure everything that I'm saying you are running through your district just to make sure that everyone's on the same page. The last thing you want to do is have everyone else bringing students in for an evaluation, and you are providing an evaluation over a telehealth model, everyone should be on the same page, so be sure to do whatever your district is having or asking you to do. All right, so let's really quickly dive into some ethics as far as providing teletherapy services. And I want to share with you what is called the 10 E's. Now I came across these 10 E's in my research review, or literature review, if you want to call it that, as I was preparing for this podcast. And this comes from an article titled tele rehabilitation services, a successful paradigm for occupational therapy clinical services. This article was published actually just earlier this year, and it is in response to providing teletherapy services in this current climate with the pandemic going on. And so it wasn't so much a research article in the traditional sense, where they're actually going through and trying to see what works and what doesn't. It was more of a systematic review, and one of the things that they reviewed was the 10 ES. And so I'm gonna go ahead and read off these 10 es, and then we'll go back and dive into a few of them just a little bit further. Okay. So here they are, one through 10. The first is efficiency, specifically decreasing cost. Again, I'm not sure how much that relates to right now, and occupational therapy in schools, because right now, we're just trying to survive. Districts are spending more money in places that they're not used to spending it in. The next one is enhancing quality of care. Number three, is evidence based practice. Number four, empowering consumers. Number five, encouraging new relationships. Number six, education. Seven, enabling information exchange. That one I really like. Number eight, extension. Number nine, ethics and equity and number 10, easy to use, entertaining and exciting opportunities. And these 10 e's are designed to be things that a we need to think about, but also when you are putting into place teletherapy these, these 10 E's should be things almost outputs of teletherapy. It should be less less expensive. It should be more empowering to our consumers. It should enable information exchange, and it should also be easy to use, entertaining and exciting for not only the clients, but also for ourselves. So that's the 10 ease. And while I did get it from this one article, and I'll cite the article on the show notes page@otschoolhouse.com forward slash episode 57 these 10 E's have actually been noted as far back as 2001 from an article in the Journal of Medical rehab. That's the earliest I can find them, but it's all over the internet. So like I said, there's a few key points of those ease that I really wanted to focus in on. The first was number three, evidence based practice. And I'm focusing in on that one because there is very little evidence when it comes to providing teletherapy practice. I mean, there's a handful of articles, several of them I have mentioned either in this podcast or episode 56 so you have those, but there isn't a lot. However, that doesn't mean that the evidence based practices from all the stuff that we covered in episodes one through 55 and all the articles that you know about and the Size Matters handwriting program which is evidence based, and all those other programs that have evidence behind them, just because you are providing those now in a teletherapy model doesn't mean that they're no longer effective. It just means that we are providing that evidence based practice in a different way. The next few es that I want to talk about are encouraging new relationships education and enabling information exchange, because I think these all go very much hand in hand. If this were a traditional, you know, professional development opportunity and we were all in the same room, this is where I would ask, how many of you are providing therapy through teletherapy model means, and the parent is right there next to their student, and probably 98% of you would raise your hand, right, hand up. Got it well these three E's, encouraging new relationships, education and enabling information exchange is exactly related to that. This is a new opportunity for us to better understand our parents, to better understand their needs and to better provide them with information. Help their student. This is something that many therapists, I think, are scared of, but also excited about, because we have parents watching our every move when we are providing a service to their student, but at the same time, it's exciting because we're probably getting more carry over than we ever had before, because there is someone there watching everything that we do and carrying that over after our session is over or after school is over, and so that's fantastic. Be sure you're taking advantage of this. Let the parent know what they can do and how they can continue to develop their students skills or their child's skills. The last set of ease that I want to talk about is ethics and equity, and that is a huge topic right now. Right equity? What is equity when it comes to students learning and being able to access school right now? Does every student on your caseload have access to a Chromebook? Does every student have access to an iPad? What do they have access to and what don't they have access to do? They have the ability to sit at a computer in front of you in a calm house that doesn't have kids running around in the background or adults fighting, or are they just there looking at a screen with no adult trying to figure out what they're supposed to be doing, because they aren't even sure what the teacher is trying to get them to do. You know, this is a huge factor, and we need to try and work with the parents, with the teachers, with whatever adult is available at the house, or big brother, to see if we can get that get that student the help that they need in the home. And the last part of it comes to ethics. And within ethics, there are so many topics, right? But what we're going to talk about here is licensure, client selection, confidentiality, personal and cultural attributes and provider competencies. And so let's start with licensure. Many of you, I think, already know this, but you have to be careful. Be careful when you're providing services to make sure that you are licensed in the state that you are in physically as well as the state that the student is in physically. You know they're working to change this with the licensure compact that a OT is working on, but currently, for most states, that's the case. You're supposed to be licensed in both the state that you're in, so maybe that's California and Texas, if that's where the student is, or wherever it might be. So if you know that your students vacationing, and you know because they don't have to be at school, the parent has now moved them to another state for a while, until school gets started back up, you need to relay this information to your boss, and you might need to even reach out to your department of education or your department of occupational therapy at the state level and find guidance. The next area, real quick to talk about is client selection. I just want to remind you, I know I talked about this in Episode 56 but be mindful of who you are recommending to your team as being the kids that need to come back to school as quick as possible. And you know, if it comes down to trying to figure out what kids can and what kids can't come back, by working with these students online, hopefully you have a good idea of what students really need to be back on campus and what students are just simply not benefiting from occupational therapy or distance learning in general, and a teletherapy or distance learning educational model, also under this larger ethics umbrella I have is HIPAA and FERPA, you should be well versed, or at least have a basic understanding, of what HIPAA is and What FERPA is in OT school. We all learn about HIPAA. We don't all learn about FERPA. FERPA is really the educational version of HIPAA, and it does apply to us, as does HIPAA, if we are billing electronically. And so just be mindful as you're providing your teletherapy services that you don't have this crossing between students and parents. I already mentioned the difficulties that I have had with Google meet and how I've had students come in when I'm still trying to finish up with the previous client, and how that can be a little bit of a mix. You know, our special education department has kind of said You are good so long as you're not like talking about the student's IEP these kids, they see each other on campus. Many of these parents already know each other, and I know that is still a thin line, but for the most part, I think it's kind of that Wayne, well, we're trying to do this in the best way possible, and we know that not everything's gonna be perfect. Just remember that if a parent is on the line with you as you're wrapping up a session, and maybe they bring up another student that is the time to let them know that you cannot talk about that other student with them. That student is not their business, and it is not your business to be talking about one student with another parent. And our second to last topic that I want to discuss is personal. And family attributes you are in this family's home when you're providing a teletherapy session, and we don't know how a person handles stress, we don't know how a family handles stress, and we don't know what situations that family is in. And we need to be mindful of that. We need to understand that a parent might not be able to be next to their student, 24/7, when they are on distance learning and with you during your session. Likewise, families may not have all the tools that you might ask them to have for your evaluation or your therapy session, so be mindful of that and help them if they need to ask your therapy team at the schools, if you guys can put something together, or just have alternatives that people can use. For instance, maybe people don't have a stapler. Well, what tools might they be able to have that can replace the stapler? And finally, the last thing that we need to keep in mind is our own provider competency, as well as the competency of all the people that we are working with. Be kind, be gentle. You don't know what everyone is going through, the stresses they are going to through, not just the family, but also the teachers and the other therapists. You also don't know what training they've had in the past, and maybe what training that you can provide them. And so anything that you are getting trained in in an online conference, or whatever it might be, make sure you're taking some time to bring it back and let your teachers know, and let the rest of your therapy team know, so that they can also use that to their advantage. One way to do that is share this podcast with them, not trying to plug that in, but it is something that you can do. Share that information that you're getting with your team, all right, and that is going to wrap up this two part series on telehealth and teletherapy. We have talked about so much over the past two episodes. First, we started off by talking about what a ot a and other guidance and states say about telehealth. Then we dove into what some teletherapy models look like, and how you can use those and and how you can provide the best practices to your students. We talked a little bit about research, both in the previous episode and just a little bit in this episode, and then in this episode, 57 we dove into evaluations, ethics and platforms and hardware. So I hope you really did learn a lot from these past two episodes. Please do check out ot schoolhouse.com forward slash episode 56 and ot schoolhouse.com forward slash episode 57 for the show notes from these two episodes. At both of those links, you will also be able to purchase the OT school house professional development that goes along with this. And what that is is basically you already got the knowledge. You already listened, but now you can take it a step further by earning a certificate of completion for the two hours that you listened to this episode and the previous episode. When you do purchase that professional development opportunity, you're going to receive two documents. The first is going to be a PDF that tells you how to take the short quiz to prove that you actually listen to these two episodes. And the second document you're going to get is the slides that go along with this presentation. So you will have the ability to basically quickly reference back to your slides and know exactly what we talked about in these two episodes. All right. And with that, I'm going to say goodbye, and I hope you all have a great start to your school year. 

 

Amazing Narrator   

Thank you for listening to the OT school house podcast. Now that you've listened to this episode, head on over to OT schoolhouse.com forward slash, PD, as in professional development to earn your continuing education certificate until next time class is dismissed. 



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