As a therapist working in telepractice, the question I get asked most is, “how does that work?” There are many considerations to account for to make sessions successful. From video conferencing platforms, therapy preparation, and determining appropriate clients. Offering excellent telepractice services can be possible with the right tools. Here are few valuable resources to have the best experience.
1. Reliable Videoconferencing
There are a lot of options out there when it comes to videoconferencing platforms. When choosing the appropriate platform, consider the following:
- Easy to start and join – The session needs to be easy to access. Unnecessary steps to start and the join the session take away from quality treatment time.
- Video resolution and audio quality – It’s important to be able to able to see and hear from both the client and therapist perspectives. Be sure to consider the client’s WIFI and/or cellular internet capabilities when using a videoconferencing platform. Peer-to-peer video conferencing is faster and offers security options.
- Collaborative tools – During a session it is very helpful to have screen sharing capabilities, annotation, the ability to have multiple audiences, and desktop control support. This makes virtual sessions more functional. For example, screen sharing can be used to share videos, assessments, worksheets, etc.
- HIPPA compliant – No matter which platform you choose, it needs to be HIPPA (Health Insurance Portability and Accountability Act) compliant. Some considerations may include whether the platform has BAA, end-to-end encryption, and safeguards in place. Examples include Zoom, VSee, and GoToMeeting.
- Chat features – The chat feature allows for instant message-like conversation during a session. This is helpful when assisting with troubleshooting, commenting in a group meeting, etc.
- Audio and video controls – The ability to ask the client to start/stop their video and/or audio is another feature that can be helpful. There may be times where it is difficult to connect to audio. In these cases, the “start audio” function is a great option to keep the therapy session on track and avoid wasting time troubleshooting.
2. Mobile and Functional Therapy environment
- Phone/Tablet based – Virtual therapy can be performed almost anywhere. Therefore, it is important to consider the type of device being used. Depending on the type of therapy session (i.e., physical therapy vs. speech therapy), it might be better to use a tablet with a stand or phone rather than a computer.
- Cellular data plan – As mentioned earlier, virtual therapy allows for therapy to occur from anywhere. However, make sure the client has access to cellular data if not connected to WIFI. If cellular data is available, make sure there is a stable connection.
- Device mounts/equipment – Having a device or mount that allows for hands-free participation provides a great experience. Specifically, when performing physical tasks.
- As Wireless headphones – Headphones are beneficial to reduce environmental noise/distractions, increase mobility, and increase privacy.
- Remote site requirements – Prior to performing a session, be aware of the site requirements. For example, if performing therapy in the community, ensure the site is safe and approves the therapy session.
- Licensure – Law requires the clinician be licensed in the state the client is receiving therapy.
3. Appropriate clients
Community based level of care
It might be difficult to make the decision on what patients makes sense when determining the appropriate referral for telepractice. As a therapist serving patients via telepractice at an outpatient level, there are several considerations. First, the patient should be at a community-based level of care. They should be able access the community independently or with a reasonable amount of support. If a patient can attend an outpatient therapy clinic, they are likely suitable for telepractice.
Rural v. metropolitan location
Regardless of a patient’s location, there are many benefits to receiving teletherapy. If a patient lives in rural area, access to care may be limited or the closest clinic may be several hours away. Virtual therapy reduces time spent traveling to and from therapy clinics and frequency of in-person therapy visits. Telepractice also provides access to care where therapy and/or expertise may not be available.
It is important to determine the goals of the patient, family, and clinician when providing in person or virtual services. Being clear on the desired outcomes will help establish goals and carry out appropriate therapy tasks. It is also important to determine whether a multidisciplinary (PT, OT, ST, Psychology) or single discipline approach is most appropriate.
Preparation is key to a successful teletherapy session. It is critical to have plenty of treatment options available. Virtual therapy may offer less access to materials and hands on support. Therefore, the ability to be creative and adaptive are key. Having a variety of treatment options prepared will make a session more successful. Illness or recent injury, video connection issues, and external stress/anxiety all can contribute to participation. Therefore, it is important to be prepared with modified options.
Knowing the video platform you are using inside and out will also be key to preparing for a successful session. Technology issues are always possible, so it is important to be able to troubleshoot with the client if needed. It might be helpful to have the individual trial using the technology platform prior to a session.
5. Appropriate support
Making sure the patient has the right amount of support to access therapy sessions, carry out activities, and navigate technology is one of the most important tips for providing successful teletherapy. Physical and cognitive deficits, as well as being unfamiliar with technology impact access to technology. In these cases, it is important to arrange for environmental support.
Maximizing repetition of therapeutic tasks is highly important to an individual’s success. One of the biggest benefits to administering virtual sessions is the opportunity to train individuals and their supports so they can carry out therapy tasks. Evidence has shown providing therapy through real-life tasks in someone’s own environment is the best way to learn and make progress. Family members, friends, and caregivers play an active role in helping an individual make progress. When a therapist is available in the home, this increases ongoing education and support to family and caregivers. This also assists in reducing caregiver stress which can lead to burn out.
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Parafiniuk, D. (2020, April 29). 5 Telepractice insights from an experienced practitioner. @ASHA. Retrieved September 14, 2021, from https://leader.pubs.asha.org/do/10.1044/2020-0429-telepractice-tips/full/.
Quinn, W. V., O’Brien, E., & Springan, G. (2018, May). Using telehealth to IMPROVE HOME-BASED care for older adults and family caregivers. https://www.aarp.org/content/dam/aarp/ppi/2018/05/using-telehealth-to-improve-home-based-care-for-older-adults-and-family-caregivers.pdf. Retrieved September 14, 2021, from https://www.aarp.org/content/dam/aarp/ppi/2018/05/using-telehealth-to-improve-home-based-care-for-older-adults-and-family-caregivers.pdf.
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