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This post wraps up April with continued celebration of Occupational Therapy with a Spotlight interview with Tasha Holmes, an OT who practices in schools via telehealth. She has been an Occupational Therapist for 14 years and has worked with children and adults in a variety of settings, including home health, skilled nursing facilities and now school telehealth. I was curious to discover from Tasha how telehealth could work to provide school services and understand the nuts and bolts of it.

Tasha, first off, why did you choose to become an Occupational Therapist (OT)?

I worked at a mental health institute between my sophomore and junior years in college. Some of my time there was spent with an Occupational Therapist on vocational skills. I also did research with a focus on Sociology. I was headed into a career in mental health until I fell in love with Occupational Therapy and went to school.

Who is your professional “hero” or role model?

Dr. Sandy Dunbar, she had a great demeanor. Dr. Dunbar treated me as a peer. She peaked my interest in pediatric practice. I appreciated how she approached each person. Dr. Dunbar was loving but firm. She was absolutely full of knowledge. I could just sit and listen to her talk and learn all day…

Barbara Klornblaugh is another OT I admire who I met through the American Occupational Therapy Association. Barbara is a tremendous speaker! She is also remarkably patient, a great mom, a natural leader, amazing person…I could go on…Barbara Klornblaugh is a well-rounded woman; professional, loving and simply excellent!

What drew you to telehealth?

We also call telehealth, on-line OT. I learned about it from my OT program. It seemed a new avenue for OT, something outside the box. I was just generally interested in it. Then after having my children I was looking to improve my work/life balance. On-line OT was a perfect fit! It happily combined my hobby interest in technology with OT and also brought better balance in my life. We are a military family and on-line OT diminishes the frustration that can come from short-term work stints. It allows me to invest into my work despite the frequent moves required of a military family.

How did you prepare or change practice for Telehealth?

First, I did my research, I investigated what was required and some of the efficacy. The change from in person to on line activities is quite a jump; there is nothing like doing it! I benefit from lots of reflection afterwards and collecting effective practices and activities. This is now my third school year providing on-line OT. Now I feel competent and I work to add more options over time as well as variety to my interventions. I also have found that verbalizing goes a long way, just talking things though. I also spend time thinking of how to improve the assistant or paraprofessional on the other end. How I can better held him/her to be my hands? I try to talk out and explain what I would do as descriptively as possible.

Did you practice previously in the school?

I practiced school-based OT in Virginia for 3 years. I loved my students, I did not love the heavy caseloads and burnout was high. To sum it up, I loved some but not all of school practice: 8 schools and 60 students, too much lost treatment time, nowhere to treat or inadequate space, lost time driving. I am glad to still practice in school with more time with student versus trying to get the student and right place. With on-line OT, shifting to another student is easier and more efficient. I also find treating the students virtually, especially with students at home, my interaction with parent(s) is greater. I have improved rapport and communication, because they are right there and sometimes assisting. Since I am virtual, we have to arrange a designated time and I think it motivates parents to ‘catch’ me.

So, how does on-line OT work?

I am assisted by a trained adult, the parent or school staff on site. CURRENTLY, there are no qualifications to assist with on-line interventions but I anticipate that may change. Most often schools designate specific staff which really improves consistency for the student as experience and training compound over time.

I email the OT plan with the scheduled day and time, all the materials s/he will need to gather and access for the session along with notes about VC Letter on line (a program I use) or whatever specific computer activities are in the plan for today. I do all I can to eliminate any guess work. If it is the same paraprofessional, over time s/he will anticipate other needs or how the environment should be configured from my emailed description. Collaboration improves with longevity and consistency with the same staff person. I encourage the on-site staff to ask questions, I rely on them!

How long until the on-site staff person is competent?

That really depends on the person, most often it is within one or two weeks. Having the on-site staff improves carry over. It really helps if the same staff are providing all the on-line interventions, then the staff can apply information from other disciplines during on-line OT and throughout the school day.

Compare telehealth and face-to-face services? What can you do with telehealth that you could not do when you were in school?

Positives: I find the tech is very motivating for my students. It is more cool than strange. I have many things right at my fingertips instead of having to remember to bring them or run and get them from my car! Adjusting to ‘plan B’ is easier, transitioning seem more natural- this might be because I have to have everything planned out thoroughly in advance. One of the most positive aspects is that on-line OT connects me to many students that may not be able to get services or access through a traditional school setting.

Obstacles: Adults don’t seem as comfortable with on-line interventions initially. There is a learning curve. The on-line provider MUST be an effective communicator. I know this is true for any therapist, especially a school-based therapist, but the on-line forum requires clarity. You cannot make any assumptions. You must be concise, and hone your verbal cues for the on-site staff and the student. Verbal communication controls your ‘remote hands’. One more thing, on-line OT demands more advanced, specific preparation, because you need to communicate your intended interventions, how to carry them out and have all things required on location.

Cautions? Be clear on your motivation. It is still a job, a job that requires much patience with technology. You have to have a high tolerance for frustration, especially with the technology! You must take feedback from long distance, this can improve humility!! Be careful with your schedule. On-line OT does not allow dual tasking. Make certain any company you work for is compliant with confidentiality rules (networks, security, emails, phone calls). SeekFreaks note: all connections need to be encrypted and secure. Telehealth must comply with both HIPPA and FERPA regulations.

How do you integrate into the classroom?

I conduct observations of the classroom and other settings and interaction with teachers and other staff using an iPad with secure video feed.

Do you miss the interaction with other therapists?

I do miss face-to-face meetings and discussions. Oh, HUGS! I miss hugs and playing. I do miss some things from being on-site but I fill in with my family! It is a trade-off but I have discovered that relationships are better because our time together must be scheduled, it is deliberate and intentional.

Difference in collaboration?

Yes and no. The good collaborators are still good, the not-so-good collaborators are still not-so-good. However, somehow, on-line interactions are less intimidating. Most seem to like the lady who lives in the computer! In fact, collaborators seem even more responsive.

Please describe the typical day of a telehealth OT…

  • It starts the night before with sending emails to home-based and virtual students (parents need a bit more lead time for preparing everything)
  • Check my schedule for the day
  • Early that morning (8am-ish) send emails to learning coaches= all activities, descriptions, needed materials and other notes
  • Set-up materials for interventions
  • Provide supervision for PTAs between sessions, also any needed phone calls for the day, planned meetings/follow-up, ordering materials, needed emails
  • Most days I provide 10-11 sessions; on ‘light’ days, I provide around 5 or 6 sessions
  • Like in any practice, I document and do paper work throughout the day
  • Always, communicating with teachers, assistants, all instructional staff, parents and my students!

What is your setup like at home?

It is not that complicated, really. On my side, I need:

  • Laptop or desk top computer
  • Connect with Chrome or Firefox
  • Head phones are helpful but optional
  • Keyboard
  • I recommend a hard wire connection, technology can be fussy so why not one less complication? Any reliable, secure connection is fine
  • Not much space is needed. A closet space is sufficient!
  • Desk
  • Web camera
  • Blank background to avoid distractions and ensure focus is on activity

On the student side/On-site:

  • Desk top computer or laptop
  • Key board
  • Web camera, should be removable so the staff/assistant can move or adjust the camera to change focus or zoom in on hands, etc. as needed
  • Desk
  • Mouse
  • Reliable, secure internet connection

What area can telehealth improve on? If you can change something what would it be?

On-line OT is emerging and changing. I would like to have increased awareness, not fear or skepticism. If telehealth or on-line services are refused, that means no access for that child. I would love to improve professional understanding and education on telehealth.

If I could change something, I would love to have a greater evidence base for telehealth practice, especially some well done research to establish the effectiveness of telehealth. ASHA is currently the leader in this practice setting. I want more for OT! Not just anecdotal evidence but a higher level of research. Also, we need solid opportunities for professional development for telehealth in OT.

I want people to know anything can be done in on-line OT, IF you have the right supports in place!

How do you motivate your students?

The technology itself motivates, the tech tools and programs. I think my multi-media approach gets enthusiasm from my students instead of being limited by what you have with you.

What is the #1 lesson you have learned from your virtual practice?

It affirmed my affinity for technology; which, through my practice, has deepened from like into love! Practicing on-line spawned my interest in= “what is next?”. I am a much more effective communicator. I thought I was good before, but now I am really effective given I can only communicate by email, phone or verbal directions.

Virtual practice has renewed my love of OT after 14 years! I am learning again. I have new challenges about OT, technology and computer skills. I am excited to see where this is headed! What OT telehealth look like in another decade?

What steps should someone take if s/he is interested in OT telepractice?

I invite anyone to explore our Presence Learning website and get more information!! The AOTA has some great resources and an excellent position paper on Telehealth that I would recommend. You should review the licensure regulations and practice laws for your state. Clarity and competence with all the details can be critical when entering a new practice setting. Oh, there are some really good videos on the Presence Learning website you should watch!

Are there any other companies doing OT telehealth?

Tiny Eye

So, you have answered so many questions I had about telepractice. Thank you!! Is there anything you want to say before we finish?

After being an OT for 14 years, this job has no perceivable end. I can’t imagine doing anything else. I see myself doing this a LONG time, no end game. I am able to live anywhere and keep the same job. Thank you for your interest, I hope people check into on-line OT for themselves!!

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We are so pleased Tasha invested time with us to share her practice and insights with us! If you are interested in telehealth, follow up on some of the resources Tasha suggested. What does a SeekFreak enjoy more than a cutting edge practice to ruminate over?! Look for more spotlights to come…use the comment area here to give us suggestions for who we should interview or areas we need to spotlight. We hope this spotlight conversation has given you some food for thought…Happy OT Month!!

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Readers of this article also read:

3 Steps to a Strengths-based Practice

Late Summer Reading List for Seasoned School-based OTs, PTs & SLPs

2 Tests of Selective Motor Control – SCALE and SCUES

Review: Service Delivery Model for Children with DCD

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