Telehealth has drastically changed the way many therapists are practicing in these past six months. (Six months! Can you believe that?) I haven’t personally tried my hand at it because I was let go from my job when COVID closed schools and clinics in March. I am always eager to hear my former coworkers talk about their experiences navigating the unchartered waters of telehealth. I’ve also admired the creativity, ambition and flexibility as I see resources, tips and tricks that therapists new to telehealth have discovered and shared.
Adapting to Telehealth Like Champs
I may be biased, but therapists are incredible people. While the adaptability, creativity, goal setting and executing that many bring to the field has made providing telehealth services possible, I have to believe many are grieving the loss of in person therapy. I’m getting married and moving abroad in a month or so, so it didn’t feel like the right timing for me to get a new job. However, I have thought about how I hope to get an OT job when I move. I’ve had to tell myself that I might have to be open to telehealth if that is what my option ends up being, and that makes me so sad.
But, alas, accept the current state of society we must. My goal in covering this topic is to encourage people doing telehealth that what you’re doing can make a difference! I know I’ve heard many people say, “It’s not really effective.” I can certainly imagine that, if the parents aren’t involved. There are often factors we can’t control. However, there are always things that are within our power to change.
How to Provide Effective Telehealth OT Services
I’m hoping this article review serves as encouragement that doing the hard work to shift our thinking even more from “I’m the therapist and I’ll make the change,” to “We’re working as a team and my collaborating with the caregivers will help this child to continue to succeed,” is worth it. You will also find some specifics and direction of elements that the investigators in this study used in order to promote successful parent coaching.
Journal The American Journal of Occupational Therapy (SNIP score 1.121)
Article Title Occupation-Based Coaching by Means of Telehealth for Families of Young Children with Autism Spectrum Disorder
Authors Lauren M. Little, Ellen Pope, Anna Wallisch, Winnie Dunn
- 1A Systematic review of homogeneous RCTs
- 1B Well-designed individual RCT
- 2A Systematic review of cohort studies
- 2B Individual prospective cohort study, low quality RCT, ecological studies; and two-group, non-randomized studies
- 3A Systematic review of case control studies
- 3B Individual retrospective case-control studies; one-group, non-randomized pre-post test study; cohort studies
- 4 Case series (and low-quality cohort and case control study)
- 5 Expert opinion without explicit critical appraisal
Methods
The study investigators recruited children in underserved and rural areas through early intervention and early childhood programs. Investigators included children with an Autism Spectrum Disorder who were 0-6 years old. Seventeen families completed the intervention.
Intervention
Occupational therapists completed 12 weeks of coaching sessions through Zoom. Therapists used the coaching model to empower families to understand and grow confident in the knowledge they have in regards to their child. The therapists ask questions to promote reflection, guide families to realize what knowledge they already have and use, as well as to guide families in developing and implementing strategies to assist their children in meeting goals the family set.
OT’s used the first session to complete a routine-based questionnaire as a means to gather information on the family’s daily routines and context of their daily activities. The family then came up with goals for the OT sessions. Investigators used the following measures to gather relevant data for the intervention.
- Demographic Form-Family
- Sensory Profile-Second Edition
- Social Responsiveness Scale-Second Edition
- Parenting Sense of Competence Scale
- Assessment of Preschool Children’s Participation
- Canadian Occupational Performance Measure-Second Edition
Study authors also used Goal Attainment Scaling to work with parents in establishing goals. This is a documentation method that uses established, sensitive levels of change for a targeted goal to demonstrate progress in that area.
Findings
Authors compared the mean scores of each measure from pre and post intervention to determine the effects of intervention.
Parent Efficacy as a Result of Telehealth Coaching
Post-intervention scores for the Parenting Sense of Competence Scale (PSOC) demonstrated a significant increase in parents’ feelings of efficacy. This indicates that parents felt more equipped and able to manage the situations they encounter as a parent. Parents did not report increased levels of satisfaction. Satisfaction included the degree to which a parent reports their role as a parent is comfortable and rewarding (Little, Pope, Wallisch, & Dunn, 2018, p. 4)
Child Participation as a Result of Telehealth Coaching
The authors measured child participation with the Assessment of Preschool Children’s Participation (APCP), GAS goals and COPM-2. The frequency with which children participated in activities and the diversity of the activities in which children engaged significantly increased per the APCP. There was also a significant increase in parents engaging in more play activities with their children as well as trying a wider variety of activities to develop their child’s skills (Little, Pope, Wallisch, & Dunn, 2018, p. 5).
Children’s increased participation in activities was significant per data from the COPM-2. Parents’ satisfaction with intervention goals increased significantly, and children made significant gains in their GAS goals.
Things to Consider
The study authors mention that only parent report measures were used to gauge effectiveness of the intervention. They suggested that the addition of objective measures of behavior or performance may enhance understanding of coaching on child performance outcomes. They also mentioned that the use of a control group may be helpful to further understand the effectiveness of telehealth vs. other modes of service or no intervention. Finally, the need for a larger sample size was mentioned.
Experiences of Parents of Children with ASD to Guide Telehealth Intervention for Others
While the current study included only parents of children with ASD, I think this information serves as a good guide for coaching a wide variety of parents. A factor that is relevant to me is that these families lived in rural or underserved areas. There may be cultural differences for families with whom we are working who are receiving telehealth services due primarily to COVID. Most notably, I think of families in suburban or urban areas that may fill their schedules more than what I often see as a slower pace of life in rural areas. However, the fact that families were able to effectively use technology to participate at a distance and make significant measurable change is encouraging.
How is your experience with telehealth going?
Have you had to switch to providing telehealth this past year? What tools and resources are you finding helpful?
References
Little, L. M., Pope, E., Wallisch, A., & Dunn, W. (2018). Occupation-Based Coaching by Means of Telehealth for Families of Young Children With Autism Spectrum Disorder. American Journal of Occupational Therapy, 72(2). doi:10.5014/ajot.2018.024786