Teletherapy - Advantages Unique to the Delivery Model

As a practitioner you are well aware that there are some invaluable aspects of an in-person session that could never be replaced in a virtual world - such as that high-five after a correct answer. Since the advent of Internet video calling, teletherapy has typically been analyzed through the lens of how it compares to in-person therapy, as in, what is missing? What is lost when moving from an in-person session to a teletherapy session?

Today I'd like to explore the other side of the equation. Not what is missing, but what is gained? Are there elements of teletherapy that are impossible or impracticable in an in-person session? Are there unique aspects of teletherapy which are only made possible because of its delivery model?

The following are areas wherein I think teletherapy's unique characteristics unlock new benefits to patients and therapists.

1) The parent(s) can be involved

In April we surveyed our therapists about teletherapy and the fact that the parents were involved was one of the most cited benefits of teletherapy. As Sidekick's therapists typically see kids in a school setting, it is rare that the parent is involved during the in-person session. When we started doing teletherapy in March that all changed. This is what our therapists had to say on the matter when asked about the benefits of teletherapy:

1. "Plus, parents/families are directly involved in the therapy (yay!)."
2. "Teaching parents strategies to use during the session, especially increasing wait time to allow for processing! But, also very beneficial for parents to see in therapy and practice later in their homes."
3. "More parent involvement and modeling for parents."
4. "LOVE the interaction with the parents!!! We're getting to know each other, and I'm involving them much more in therapy this way. Often texting/emailing things to target at home, interacting about progress, etc..."
5. "Getting to know parents/more communication with parents."
6. "The parents also get to see what we do, which is very helpful if they're practicing their speech at home."
7. "More parent involvement."
8. "Parents are able to see what we are working on."
9. "It allows for the parents to be more involved with the child's therapy."
10. "I am able to talk to the parents and get them involved."
11. "I think that the biggest benefit for early intervention is it naturally requires parent involvement. In person I can model and guide parents to participate during sessions however with teletherapy the parent MUST participate in a hands on manner for attentions. It has been really great to see parents so involved and gives me the opportunity to encourage their natural feedback and teach techniques with their hands on participation. I feel like this gives great benefits to at home carry over."
12. "The parent gets to see the session and see what we are working on."
13. "Parents are able to see what their children do in therapy and are hopefully able to do some similar things to continue the learning at home."
14. "Flexibility for both clients and SLP. Having parents close at hand (vs school) to update/express concerns/accomplishments/help with generalization of skills."
15. "It has been great to get to know the families more! I think the parents appreciate seeing what we are working on and I think the kids have loved seeing a familiar face during this stressful, confusing time."

2) Complete confidentiality

An in-person session loses some aspects of confidentiality. If you go to a clinic, you could be seen in the waiting room. If your child receives services at school, they may get pulled out in the middle of a class. With teletherapy, your child can be seen by a therapist without ever leaving the house. This is beneficial to the patient on two levels:

1. The patient doesn't have to worry about any stigma that may come tied to knowing they receive therapy (no waiting rooms, no being pulled from class)
2. The patient won't see other people. We have seen cases where kids may unfairly compare themselves to others in the waiting room, especially older kids ("why are there only babies here, I'm not a baby").

Teletherapy eliminates these added stressors. No one sees you and you don't need to see others.

3) The patient can attend the session in a more comfortable setting

As one of our therapists said, "I love that I can see my clients in their natural environment. I can see where communication breakdowns are occurring while clients are at home, and use the resources already at their disposal to functionally solve problems that my families are encountering in real time." We've found our patients love to show the therapist items in their room or house (pets, toys, etc.). In this type of setting the therapist is able to provide better generalization. Therapists have also found that some children, especially those with autism, may find it easier to open up in the "virtual" setting. These patients like computers so the session is meeting them at a place they are already most comfortable.

4) The ability to record detailed notes and save rich multimedia without breaking the flow of the session

Therapists often need to focus on pragmatic language skills. As such, they also need to model the behaviour they want to see. If a therapist is constantly checking a computer screen or typing during an in-person session it can be a distraction and in some cases be a poor model of non-verbal communication. On the other hand, teletherapy presents a unique delivery model. The therapist can record patient audio, type notes, and capture whiteboard screenshots while still giving the patient their complete attention.

5) Third-party proof of session if you were ever audited for a claim

If you do an in-person session at a patient's home or school it is often a requirement (or at least a best practice) to get a signature as proof of service. A good teletherapy platform can provide an easy, automated audit trail of your sessions including timestamps and timelines.

6) Improvements in digital literacy

For older kids, our therapists have found that teletherapy has also been an opportunity for them to learn computer skills along with language skills. In addition to their speech goals, this gives them an opportunity to improve a skill set that is vitally important in today's world.

While there remain benefits to in-person therapy that will never be replaced or replicated in a virtual setting, there also exist unique aspects to the teletherapy delivery model which should be considered when thinking about patient outcomes.

- Kevin Dias