Telehealth: A Road Less Traveled

Nature is my happy place. During a recent morning walk, I was struck by the image of the empty path stretched out in front of me.  I was not sure what was waiting for me around the bend – perhaps some horses grazing wanting to greet me or another walker trying to get out of the house and reconnect with nature. But on this morning, in this time of uncertainty, the image took on a different meaning. When will my team be able to resume sessions with children and their families? Thankfully, telehealth has become the answer. Here are some of the things we have learned at Locus on this road less traveled:

  • We have been able to more fully implement an evidence-based coaching model of care as parents are now actively trying strategies with their child and in turn feeling more valued and successful.
  • It has been easier to accommodate family schedules and observe daily routines such as mealtime or bedtime as they are naturally occurring, which has been invaluable to my team in regards to problem-solving and offering solutions.
  • Surprisingly, there have been few if any technical issues that have interrupted or delayed our service delivery and my team has found creative, fun ways to engage and interact with the children via video.
  • Families parenting children who are medically fragile have consistently requested that all sessions moving forward be held remotely while other families have expressed an interest in a hybrid approach where some sessions are in-person and others are remote. We hope for the opportunity in the future to honor their requests.
  • We have been able to answer referral requests that are in rural or remote areas of North Carolina and typically out of our radius. One parent who lives in the northern corner of our state recently expressed gratitude as her son who has autism has not been able to receive the occupational therapy services he desperately needs for over 18 months. I foresee, if telehealth continues, that my company will be able to serve remote locations and underserved populations.

 

Adapting to Uncertainty

Our world has changed a lot in these past few months with most of us now required to practice social distancing, gather with friends and family virtually, and restrict our engagement in valued activities and hobbies. Who knew that the simple act of shopping or going out to dinner was such a valued activity in our lives? As occupational therapists, the people who we serve are more familiar with this sense of disruption than most. An injury, illness, or chronic condition has interrupted their “status quo” and they are forced to seek our help in creating new ways to engage in daily activities and routines. Perhaps it is time for us to follow our own advice!

  • Plan: Critical routines have been disrupted and new ones must be developed. Identify what routines you value most. What activities have traditionally been familiar or comforting? Write them down and find ways to adapt those routines and activities to meet new demands or limitations. Establish a new daily routine that includes time outdoors or exercising.
  • Pace: While the temptation may be to binge-watch a new Netflix series for hours, in the long haul you will become under-occupied, stressed, bored and unhappy. Intentionally engage in a wide variety of different activities during the day, seeking “occupational balance”.
  • Pause: Give yourself permission to slow down. Breathe. Be kind to yourself and look for joy. Ask for help when you need to, offer help when you can.

A Valentines Hug

Valentine’s day is a time to stop and take stock of all the people in your lives that you care about and this post is intended to give a great big (deep pressure) hug to the mom’s and dad’s on my caseload.  I am continuously inspired by your dedication to learning more about “that sensory processing stuff” and giving some of my unusual suggestions a try!   I know that at times you may feel like we should light incense and hum but you humor me anyway and I have to say the results have been impressive.  Here are a few of my recent sensory success stories which include the universal love language of deep pressure…..

  • For the first time EVER one darling two year old slept through the night after making some easy changes to their evening bedtime routine and giving her a weighted blanket to sleep with.
  • Another family has been using the Wilbarger brushing protocol diligently and have noticed less aggression and fewer tantrums (he also offers to brush them which is way cute!)
  • One creative family took some snack bags filled with sand to Build a Bear and asked them to create an extra heavy stuffed animal for their child who craves deep pressure – they were happy to help and it has been a hit with their daughter!
  • Wearing a back pack weighed down with sensory goodies and favorite toys has helped one little friend tolerate going out to eat with his family
  • Creating a cozy spot with weighted blankets, pillows and a small sleeping bag has proven to be the perfect place for one of my friends to calm and self-regulate towards the end of their day when they are most likely to tantrum (and their parents are busy preparing dinner)
  • A lap buddy (made from their dad’s athletic sock filled with beans) has enabled one little boy to sit with his preschool class and participate during circle time

New Year, New Approach!

According to the NY Times, four out of five people who make New Year’s resolutions will eventually break them. In fact, a third won’t even make it to the end of January (which is EXACTLY why I don’t bother!).  Even when we subconsciously resolve to get back into shape or be more organized those small promises to ourselves usually do not last.  What if you switched things up this year and made a promise to the families and children on your caseload?  How about ‘resolving’ to be more family centered in your approach during your home visits?

Becoming family centered does not necessarily come easily and old clinical habits are difficult to break despite mounting evidence that it results in the best possible outcomes for families and young children.  So what barriers are there to changing how you do your job?  One big barrier is a real lack of mentorship and support.  Within the field of early intervention therapists tend to work in isolation with rare opportunities to network with other early interventionists and professional peers.  Opportunity to share with each other what does and does not work with families, frustrations encountered when trying to include parents in your sessions, or even challenges leaving that well stocked toy bag in the trunk of your car is in my view critical. In order to successfully implement family centered care we need to intentionally seek out one another.  Spend time during lunch breaks to talk about your sessions.  Carve out time to network with each other either in person or electronically.  Share wonderful resources or creative ways you used a household item with a friend. You could even reply to this blog J

2014 is officially your chance to ‘resolve’ to put into practice what the evidence tells us works best for our families. Be that 1 person out of 5 that DOES keep your resolution and support the early intervention community along the way!

Being family centered is not as easy as it sounds!

Talking about implementing a family centered approach during your home visits sounds on paper fairly simple.  However, as Vicky has found out, it is not as easy as it sounds.  Here is an email she sent to me recently…….

“It is not easy to switch the strategy and get more mothers involve.  I talked with a mom about using her own materials, but the truth is other therapists walk in with their own materials. Even when I do bring in new toys many times the child still does not interact even with new material and only wants hugs from mom. Mom is so frustrated at this point that she pushes her child toward me to see if I can do something.”

Vicky brings up some valid issues.  It can be confusing to be the only clinician on a child’s team who arrives to the home empty handed.  This also raises a level of frustration for the child and the parent, as Vicky found out. Can you think of any possible solutions?  Here are a few:

  • Communicate! Start and end every session with a quick conversation about family centered care and why you do the sessions the way you do.
  • Touch base with other members of the IFSP team and discuss your approach versus theirs. Offer to let them observe part of your session.
  • The proof is in the pudding – actually getting better results is what parents and caregivers are most interested in.  Find out what routine or activity in their day presents the most challenges.  If you can make that moment run more smoothly you will have just gained a new best friend!
  • Shift from skill focused to routine focused while explaining the math behind it – expanding learning opportunities throughout the week versus just the one hour you are in the home.
  • This mommy was frustrated and that is where I would start the conversation – “seems like your daughter is fairly clingy to you, at least while I am here.  Does that happen during other times?  Would you like for her to be more independent?  Let’s problem solve that together – I might have some ideas!”. 

Those are just a few ideas from me.  Do any of you have other suggestions or have faced similar situations? Reply to this blog and give Vicky some support!