Teletherapy: What to Do the First Week of School

Starting back to school with students is a few weeks away but my nerves are flaring.  I have a new assignment at a new school with new kids and a new staff. As a teletherapist, I have experienced periodic, if not frequent, reassignments. I don't know my caseload yet but I'm itching to prepare. In the past, I have started off the year with get-to-know-you activities, reviewing speech room rules, and collecting baseline data. The first round of progress reports come quickly and I like to be prepared. I am still tinkering with ice breaker activities but I did decide to put a new twist on my typically boring speech room rules review. I made a video of myself on webcam, in Zoom, demonstrating less than stellar etiquette for the students to critique. My goal is to have the students observe my behaviors, discuss my behaviors, and generate a short list of speech room rules. I uploaded the video to You Tube, set the permissions to unlisted, then copied the link to SafeTube to get rid of the advertisements. I made a very basic slide show in Power Point with a link to my video, then saved it as a PDF. I use Adobe Acrobat Reader for my PDF's. This tool allows me to click on the video link, which will open in a new window, then annotate the slides if the students have more ideas or comments. I also plan on creating a Google Document for each group where I can write down student thinking and post the rules list. That way I have a running record of session activities, homework assignments, and a way to review rules as needed. Now I have an activity I'm hoping to be able to use with the majority of my students and their families. 

Teletherapy: Summer Speech Homework Using Shared Folder in Drive

One effective way to share summer speech activities with families is to use a shared folder in Drive. Parents will need to have a Google account to access the documents. With that in mind, NEVER include any Protected Health Information (PHI) about your students anywhere in the documents or in the folder, even if students need a link to access the folder.

Steps for Making a Homework Folder in Drive

1.       To create your folder, go into your Drive.

2.       Then left click NEW, then left click FOLDER. You will see a box called New Folder. Name your folder then select CREATE.

3.       Once created, it will show up as folder in your Drive. Double click on the folder and a large circle that says, DROP FILES HERE, will appear.

4.       You can upload PDF’s and Documents into the folder. Within the folder, you can create sub folders for specific areas such as articulation of language activities.

5.       To create sub-folders within the Homework Folder, right click in the empty folder and a box with options will appear. Select NEW FOLDER and name it to create the sub-folder. The great thing about using the folder is that you can add to it at any time. Many parents may not have a printer or want to print out worksheets. Uploading colorful NO PRINT activities, as long as you have Terms of Use permission, can be an effective solution for families on the go. If parents have Drive as an app on their phone or tablet, they will be able to access full color activities on their devices.

6.       To share the folder with families, you will need to right click on the folder name. You can do this a couple of ways. You can right click on the folder as it appears with your other folders in Drive or if you have already opened the folder, click on the drop down arrow next to the name of the folder. Right click on SHARE. Click on CHANGE.

7.       You will see a drop down next to ANYONE WITH THE LINK can view. Copy the link to share with your families.

8.       You can also right click on the folder and select GET SHAREABLE LINK. If link share is OFF, slide the button right so it turns green then the link will be copied to your clipboard and you can paste it into an email or document.

9.       Below is a link for an editable calendar that can be used to created customized calendars that can be saved as PDF’s and added to a shared activities folder in your Drive. The second link is for a NO Print Calendar that is also editable in Google Slides and can be uploaded into a shared folder.

Teletherapy: Support for Speech Therapy Home Practice

Providing home practice or home support for students with speech and language challenges is often considered part of providing high quality speech therapy services. My personal view of home practice or “speech homework” has varied over the course of my almost 30 years in the profession. I will admit that providing meaningful home practice has not been my strength. When I worked in the schools, some parents wanted daily homework and summer packets. Of those parents, there were always a few that completed the activities. Sometimes I worried that parents would end up reinforcing poor speech productions or that not completing the homework would result in a privilege being taken away. Towards the end of my time in brick-and-mortar schools, I stressed reading, sketchbooks, gardening, card and board games, cooking, crafts, play, photo albums, scrap booking, 4-H, participation in camps and group sports—activities that encouraged the need for oral communication and interaction. I encouraged parents to “name and notice” what their child was doing and tried to stress that parents can model correct productions rather than focusing on correcting their own child’s speech. That said, not one method of home practice is appropriate for all families. Some families are comfortable with activity suggestions and others want printable worksheets or specific word lists. My most recent hybrid approach to providing parents access to home practice activities is to use a shared folder in Google Drive as well as creating a website using Google Sites with an embedded Google Calendar.

Teletherapy Materials: Making Board Games in Power Point

This process is for making your own materials for personal use ONLY—not for making materials to sell! Click below for a FREEBIE game board with movable pieces!

1.      Open Power Point.

2.      Delete text boxes that automatically come up on a new slide.

3.      Click on Design tab at the top. Go all the way to the right and select Slide Size.

4.      Chose Standard Size for more of a square look or Widescreen for a more elongated look.

5.      Next, choose Format Background.

6.      To add some interest, I use backgrounds from Pexels or Pixabay. Choose Picture or texture fill then select Insert from Picture Source. I like to slide the transparency bar over to make the background a little more transparent.

7.      Then insert shapes to form your game path. Go to the Insert tab at the top and find shapes. Select the shape you like, such as a rectangle. Change the color to coordinate or stand out from your background. Select shape outline to add an outline. You can also choose the color and thickness of the outline. Once you have a shape you like, copy and paste several times and create a path from Start to Finish.

8.      If you want to align your path shapes more, use the align tools to get a look you like. To center your new path on your background, select all of the shapes, then move them together as a group.

9.      Write directions or words in the boxes. For example, you can write START, END, AHEAD 1, BACK 1, or specific words or directions in your pathway boxes. Once you create a path you like, you can use it over and over with different backgrounds and customize it with different target words or sentences. Another trick is to select the Shape, Go to Shape Fill, then select picture. You can add a picture from your own files or go to the image search and grab an image online. If you choose to add online images, DO NOT TRY TO SELL YOUR GAMEBOARD. THIS WOULD BE A COPY WRITE VIOLATION. If you are planning on making products to sell, that is a whole different ballgame!

10.  Once you have your power point slide the way you like it, save it and label it something like Power Point Game Slides. That way, whenever you need to make a new game, you have a template.

11.  Next, save it again as a PDF. I prefer to save my PDF’s in Adobe Acrobat Reader. This allows me to add stampsto my game board as movable game pieces.

FREEBIE PDF GAMEBOARD

Telepractice Materials: Learning to Make Your Own

Providing teletherapy comes with many challenges and many rewards. As I have stated before, telepractice is not for wimps. If you are a school SLP, you are already versed in clawing your way over walls and finding ways to solve seemingly impossible or unreasonable problems. Sad but true. School SLP’s are problem solvers. Wall climbers. Public relations specialists. Sometimes it feels like we have to fight our way to be able to work with our students. Again, sad but true. Teletherapy is a service provision model that exercises all of these skills. As you transition or begin to regularly include telepractice services as part of your new normal, you may end up falling in love with the experience. Or not. Either way, you will grow your expertise and push yourself in new ways. It can be especially exhausting at first—both mentally and physically. It took me a full three years to cross the Rubicon to arrive at a place where I consider myself a teletherapist. I am confident I will never return to face-to-face therapy.

Teletherapy: Feeling Comfortable is a Process

To my newbie teletherapy co-professionals--try to take a breath. Allow yourself to step back and synthesize what has been placed at your feet. What are you asking of yourself? What is your school district asking of you? Are these expectations reasonable? Could these expectations potentially violate your license?  I disclose that I worked as an SLP in brick-and-mortar schools for over 26 years and have been a telepractioner for 3 years. When I started in teletherapy, the learning curve was steep and fraught. That hasn’t changed. In the beginning, one big frustration was that I didn’t know what I didn’t know. I didn’t know what questions to ask or even how to put some of my questions into words. I also struggled with wanting to know it all RIGHT NOW and being so frustrated when my brain couldn’t seem to grasp, store, and use everything I was learning, RIGHT NOW. The best teletherapists I know are perpetual learners. Many are self-taught. Many started out with very few, if any, mentors. Teletherapists tend to be a generous group but there are limits. Learning is doing. In other words, as you have your first few sessions, you may have new questions and the space in your brain that holds the unknown stuff about teletherapy will get smaller. It takes time. I swear I kept a big waste basket by my computer during my first of couple telepractice sessions because I was sure I would throw up. Scared. To. Death. Now my waste basket is filled with energy bar wrappers and popcorn kernels. I promise it will get better and better and you will grow your identify as a teletherapist. Seek out smart mentors. Read. Keep a journal and reflect on what you are learning. Make lists of questions and seek your own answers. Listen to pod casts. Join SIG 18. Document your concerns. Document everything. Keep learning. Most importantly, push yourself to provide a high-quality service, know HIPAA laws, and do all you can to protect the private health information of your students.

Teletherapy: Do a book study!

I spent 12 years as a literacy coach. Yes, I am an SLP. Believe me, I received some smug puzzled looks from teachers when I bounced into their classrooms as their coach for the year. My favorite reaction from a classroom teacher was always, “You’re just an SLP. How are you going to coach me?” Being an adept actress. I would often look at them apologetically and say, “I know. I am just an SLP. But I noticed your kids in line for lunch. Wow, you have some needy ones. I can definitely help you with your struggling students.” The needs of the kids became our common bond. I actually loved coaching. No IEP’s. No paperwork. No report cards. Just kids. Kids and lessons that promoted access to the curriculum for all students, but most especially the students who were having difficulty. I privately cried a lot my first couple of years as a coach, wondering what the heck I had done to myself. But during that intense decade, I fell in love with using books as tools for learning. I fell in love with revealing to children the writer inside themselves and that their words were powerful and important. Heady stuff. Seeing the learning candle lit was addictive. And so often it was a book, a piece of art, an illustration, or a poem that served as the catalyst. Since returning to speech therapy, and embarking on this journey in telepractice, I felt that pull to bring books into my therapy sessions in a meaningful way. I now use a document camera to read aloud with students while sharing the printed text. One of the books I am using this year with some of my middle and high school students is Maniac Magee by Jerry Spinelli. The chapters are short and packed with figurative language and great sentences, perfect for analysis and inferential thinking. I created a playlist in YouTube with videos of teachers reading chapters aloud and collected favorite quotes from the book on Goodreads. When I read aloud with students, I write my thinking on sticky notes and use these notes to model questioning, inferring, and synthesizing.  Another book I am using with some upper elementary and middle school students is The Miraculous Journey of Edward Tulane by Kate DiCamillo. I created a playlist in YouTube with video of the author and illustrator talking about the characters and clips from theatrical productions based on the book.  This text also contains short chapters, rich language, and engaging characters. 

Sticky note on text from The Miraculous Journey of
Edward Tulane by Kate DiCamillo using a document camera.

Teletherapy: Legally Protect Your Students and Yourself

Only a few more weeks (days) of summer vacation left! Time to get organized! One part of my telepractice that I need to get in order is making sure I am following HIPAA, FERPA, and HITECH rules and guidelines. Take the time to read and develop procedures for legally protecting your clients and yourself. 



What is HIPAA?

Health Insurance Portability and Accountability Act of 1996

Below is my current list of useful links specifically related to HIPAA.

HealthIT.gov

Official Website of The Office of the National Coordinator for Health Information Technology (ONC)

Texting and HIPAA

https://luxsci.com/blog/to-text-or-not-to-text-sending-text-messages-under-hipaa.html

Google Drive/G Suite and HIPAA compliance

https://telehealth.org/blog/which-cloud-storage-services-are-hipaa-compliant/

https://www.hhs.gov/hipaa/for-professionals/special-topics/cloud-computing/index.html

Document from US Dept of Commerce

The NIST Definition of Cloud Computing

BAA’s

https://www.hhs.gov/hipaa/for-professionals/covered-entities/sample-business-associate-agreement-provisions/index.html

What is FERPA?

Family Educational Rights and Privacy Act

https://www2.ed.gov/policy/gen/guid/fpco/ferpa/index.html

What is HITECH?

Health Information Technology for Economic and Clinical Health

https://wayback.archive-it.org/3926/20131018161347/http://www.hhs.gov/news/press/2009pres/10/20091030a.html

Sharing HIPAA fines and victims of security breaches with public

https://compliancy-group.com/will-new-laws-allow-patients-to-cash-in-on-hipaa-fines/

Teletherapy: Using Google Forms to Track Parent Contacts

I have no problem with the idea of keeping handwritten documentation. In fact, sometimes I think it is faster than using the computer. I suppose it depends on the system or the way you do it. Some telepractice platforms have powerful data collection capability built in or require data and information to be tracked with their own online system. The company I contract with uses Go To Meeting. It is the only platform I have ever used. All of my students that I currently work with, attend virtual academies and I provide one-on-one services. As part of my daily documentation for each student, I needed to find a fast and efficient way to track my contacts with parents and maintain an editable running record of those contacts organized on one page that could be uploaded to the school's secure database in the form of a PDF. I'm okay with Excel but have found Google Sheets and Forms easier. I decided to use a simple Google Form with drop downs that would populate a spread sheet for me and could be downloaded as a PDF. Below is a sample form and what the spreadsheet looks like with bogus information. 

The following is screenshot of what the information looks like in a spreadsheet format. If needed, the spreadsheet itself can be edited at any time. A nice feature of  Google Forms is that you can also see data presented in charts and graphs with a click.

In order for me to track all of my parent contacts, I will need a Google Form for each student. All of the forms would be stored in one folder in Google Drive. I also need a folder for the live spreadsheets. In actual use, since I have a second monitor, I can open Drive and select the students I have on my schedule for the day so they would appear as tabs. Once organized, the process of documenting using the forms will require a few more minutes of morning preparation time, plus I think I will initially keep paper forms in case I encounter glitches or it turns out to be a pain. What would really be cool is if I had an iPad or tablet and each form could be a "button" on a screen. That would make it easy peasy. Now I want an iPad. 

Telepractice: Start with Research!

I belong to three Facebook groups dedicated to telepractice: SLP Practice Collaboration, Telepractice for SLP's, Teletherapy Materials for Speech-Language Pathologists. I found the groups after purchasing teletherapy materials from Teacher Pay Teachers (TpT). One of the sellers I had purchased materials from was a moderator on one of the Facebook pages. From there, I found recommendations for two more useful pages. That came almost 3 years after my initial interest in teletherapy. I was still working for a school district at the time and was investigating telepractice as a way to continue my SLP career after retiring from my current position. Articles in ASHA Leader and the addition of a SIG for Telepractice attracted me. I began searching for jobs on Indeed and made a list of all of the states licenses that companies wanted and a list of telepractice agencies or companies. Frankly, I felt like I was trying to connect dots and collect clues to solve a mystery.  My research was aimed at determining if telepractice could be a viable source of income and if it could be a delivery model that could help me get back to my focus on making a difference for children and families rather than doing paperwork and bus duty. During the last year before I retired, I had become so beaten down that I wasn't sure I had anything to offer anyone. Once I started interviewing with telepractice companies, I found out I had plenty to offer. Experience. Lots of it. Decades of it. And after a year of telepractice, I can say I've used all 30 years of that experience. I have learned a ton and my list of things I want and need to learn expands daily. And that feels good to me. I am happiest when I am in charge of my own learning. When considering telepractice as a possible career, I recommend the 3 R's: Research, Reflect, Reach Out. Transitioning to telepractice requires that you start by doing your homework. Your own homework. Make a list of questions and start finding the answers.

Importance of Materials and Activities Used in Telepractice

Several weeks ago, I posted a 6-question survey on the Teletherapy Materials for Speech-Language Pathologists Facebook page. The purpose of the survey was to gather information from practicing teletherapists regarding their opinions about the role that motivating materials played in the success of sessions. By no means was this a scientific survey. But it helped shed light on my personal burning questions related to the amount of time I had been spending creating and adapting activities for use with my students in telepractice. I enjoyed making my own customized activities but also purchased many excellent appropriate materials on TpT specifically for telepractice or that could be easily adapted. I had tremendous respect for our TpT sellers and the amount of time, effort, and creativity they invested in making such activities available. My survey came from wondering if I was the only one spending tons of non-paid time planning and creating telepractice friendly activities. Was I missing something? Was there some magic website I wasn't aware of? Were some platforms easier to use? What was my problem? Given the results below, it appeared that having access to motivating appropriate activities and materials was important to many telepractioners. Having access to materials or a budget to purchase materials would be a significant plus for teletherapy companies looking to attract and keep therapists. Also, when interviewing, therapists should feel justified in asking about how a company provided access to materials to use with their platform.

Getting Started in Teletherapy

As I was listening to Episode 2: Expert Advice from Tracy Sippl  from Andee Szwabowski's podcast, I heard them discuss how often SLP's asked them to explain the way to get started in telepractice. I began thinking how powerful it was to hear details of Tracy's personal journey. Listening to individual stories helped me to wrap my head around teletherapy. When I heard the stories of others, I listened and looked for pieces of myself. Listening to personal experiences of practicing teletherapists often answered "nuts and bolts" questions and helped me to formulate new questions. I pondered how I could model their successes and learn from their struggles. I thought about how to synthesize what I knew with what I was learning. As a newbie teletherapist myself, with only one year of experience, I encourage telepractice-curious or just-signed-a-contract SLP's to listen to Andee's podcasts. Take notes, write down your questions, and reflect on them.

Teletherapy: Office Design Part 1

I moved this month. The last time I moved, sixteen years ago, my son was in kindergarten and my daughter was in 5th grade. I was much younger then. One purpose of the move was to downsize.  Downsizing is supposed to mean getting rid of stuff and locating to a smaller house. My husband and I accomplished moving to a smaller house but failed at the getting rid of stuff part. We now have a basement that looks like a furniture consignment shop. Hopefully our kids will take most of it as they continue to pursue independence. Hopefully. Or not. I'll worry about that later. One of the best benefits of this move has been living close to my aging parents. My dad will be 89 this summer! I've already been able to pop by their house before heading to Kroger and they stop by with cookies and herbs and tomatoes from their garden and homemade wine. Nothing like the taste of a home grown tomato. And the wine. Sipping a glass of Malbec right now. Moving back to the town I grew up in was a foggy dream a few years ago. Now, as I click on my keyboard watching my office curtains billow in the breeze, I smile, maybe even get choked up feeling like I don't deserve what I have. Speaking of my office--I love my office. My office. Mine. Since retiring after 30 years of working as an SLP in brick-and-mortar schools, I work from home as a teletherapist. Did I mention that I love my office?

Fly swatter adds a nice touch, don't you think?

I transformed my old dining room table, plus two leaves, into my amazing desk. I have room for two monitors and ample space to use my document camera to share books and activities. I keep my printer on a cart that rolls under the table. I also have room to stow my paper shredder. The area behind the desk has short book shelves and filing cabinets. I wanted to keep the space that students would see behind my face while on the webcam as clear as possible. The window provides wonderful natural light.

Teletherapy: How to Create Game Stamps in Adobe Acrobat Reader Part 1

As a novice telepractioner, saving money is important. Learning how to utilize game boards I had already made to use in my former brick and mortar school in Adobe Acrobat Reader has been critical. Adobe Acrobat Reader is free and allows you to view and mark up PDF's. After downloading Acrobat Reader, the next step is creating or saving game boards as PDF's. When a game board PDF is opened in Acrobat Reader, you will see some tools on right side. Select the comment icon, which adds another tool bar at the top.

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Teletherapy: Using Board Games in Telepractice

Games. Sometimes when students are asked what they have been working on in speech, they respond with, “We play games.” With a cringe, SLP’s hope that the student and their family have a solid understanding of their speech goals. On the other side of the coin, games are motivating and productive speech and language therapy activities. I use a lot of games—all types of games with students.  But the one thing I have learned about games and therapy is that a game is only as good as the quality and quantity of student responses that it helps me to facilitate. When I use games, it is less about the game and more about how I am able to cue the student. In teletherapy, interactivity is a factor I am constantly attending to. As the SLP, I still need a level of control that allows me to respond to the student's speech and language output and how to further cue the student. For me, there is an interactivity “comfort zone”  when the child is engaged in a telepractice session.

Teletherapy: Using a Document Camera Part 3

In Using a Document Camera Part 1, the focus was on how to incorporate a document camera to share materials, typically used in face-to-face therapy, for telepractice sessions. In Using a Document Camera Part 2, the emphasis was on ways to use books to engage students. In Part 3 of this series, incorporating books is a continued theme.  Do any of your students have goals related to producing grammatically correct compound or complex sentences to describe characters and events, respond to questions, or compose questions? Using a document camera to engage the student in a virtual book pass is a low cost high-yield activity with the potential to address all of these goals and more. In brick and mortar schools, a book pass in a classroom might look like stacks or tubs of books placed among the students. The student can choose books from the tub, look them over, then decide if they want to add it to their "Books I Want to Read" list. After a few minutes the book is passed on to another student to examine. The most effective book passes I have participated in are followed with a class discussion about what books the kids found the most interesting and exciting or having the students share their lists and explain why they added particular books. 

Teletherapy: Using a Document Camera Part 2

Books. Books. More books. I love books—all kinds of books and when I started using a document camera to share my favorites, a huge weight was lifted from my nervous telepractionershoulders. Once again, I had the ability to share a book, using my voice, stopping when I thought it made sense, and thinking aloud to facilitate comprehension strategies in response to the child. And here is the amazing part, I had the ability to zoom in and zoom out on parts of illustrations, words, and sentences. That power to show parts while hiding others is a useful tool for facilitating inferential thinking, questioning, and synthesizing. Bring on the delicious wordless picture books! The wordless book used in the video clip below is The Red Book by Barbara Lehman.

Teletherapy: Using a Document Camera--Part 1

Thank you to Chelsea DiMarzio, one of my managers, for
encouraging me to try a document camera and giving me
new ideas for planning telepractice therapy sessions. 

Are you new to or considering using teletherapy to provide speech therapy services? Are you using a platform like Go To Meeting? If so, seriously consider purchasing a document camera. For me, it has been worth every penny. Before purchasing my Ipevo Ziggy HD Plus, I asked what other speech therapists were using on the Teletherapy Materials for Speech-Language Pathologists Facebook group. I searched for and purchased my document camera on Amazon and it arrived in less than a week. I followed the directions for downloading the software, played with it for about an hour, and was ready to use it for therapy the next day.