ROUGH EDITED COPY
2017 EHDI Annual Meeting
Topical Session 2
Hanover F
TELEINTERVENTION: STRATEGIES FOR EFFECTIVE SESSIONS
2:00p.m.
February27, 2017
CART SERVICES PROVIDED BY:
ALTERNATIVE COMMUNICATION SERVICES, LLC
PO BOX 278
LOMBARD, IL 60148
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This is being provided in a rough-draft format. Communication Access Realtime Translation (CART) is provided in order to facilitate communication accessibility and may not be a totally verbatim record of the proceedings.
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> KAILIE ASAM: Thank you, everyone, for coming. My name is Kailie Asam. I'm going to go ahead and get started. All right.
There's some handouts on your tables. There's some up here. You're happy to get them beforehand or after, whatever is easier for you. So today we'll be talking about strategies for Early Interventionists to utilize when providing services through a teleintervention platform. The goal of this session is for you to acquire functional and concrete strategies that you will be able to use and will lead you into effective sessions. My hope is that you will come away with strategies that can be applied to both your teleintervention and your inperson sessions.
This talk will focus on providing Early Intervention, or EI, services for children with hearing loss in the birth to 3 population and their families. Traditionally Early Interventionists provided services in the home and usually spend about one hour with the family. However, there are a variety of barriers to that inperson service model.
Barriers to inperson sessions can include a lack of qualified Early Interventionists in rural areas as well as reaching the families in those rural areas, a greater number of missed appointments due to minor illnesses or inclement weather. Time constraints due to travel and a tendency for Early Interventionists to fall back on a therapy model in which they teach the child directly rather than coaching the parents. Many of us know that these barriers exist. This is what led to the development of teleintervention.
But what we need to know how is how to ensure successful teleintervention sessions. So what is teleintervention? Tele is the Greek root word for distant or remote which lends itself well to the name of a service delivery model that has developed due to advancements in technology. It's revolutionized the ways in which professionals are able to communicate with their clients. The term used to describe the service model depends on the field in which it's being used, so in the medical field, it's often referred to as telemedicine, while occupational and physical therapists refer to it as teletherapy, and general practitioners, telehealth.
The American SpeechLanguage Hearing Association refers to speechlanguage pathologists and audiologists utilizing twoway video conferencing as telepractice. And in the field of Deaf Education, it's been referred to as virtual home visits, or live video visits. So where did the term "teleintervention" come from?
Teleintervention was coined by the Sound Beginnings program at Utah State University. They stated that teleintervention, a specific model of Early Intervention provided through telepractice provides familycentered services to infants, toddlers, and young children with hearing loss, and allows the provider to model strategies and coach parents in the use of language facilitation techniques.
Because teleintervention utilizes twoway video conferencing technology, it's able to overcome many of the barriers of the traditional inperson service model. It brings qualified practitioners straight to the family's home regardless of their location, which diminishes the issue of accessing rurally located families.
There are fewer missed appointments, reduced travel time, and less fallback on a therapy model since the provider is not physically in the home.
Now that you know where teleintervention comes from and why it was developed, let's take a look at what a typical teleintervention session looks like. In this video you'll see that the mom expresses doubt in her ability to work with her child in a bubbleblowing activity. However, keep an eye on the many learned strategies she employs, such as building anticipation, using wait time, including big sister in the activity, and pairing language with actions, among others.
So now that you've seen a glimpse of what a teleintervention session looks like, in which the mom was using many learned strategies and the child was fully engaged in the activity, let's take a moment to consider what led up to that successful interaction.
Prior to beginning teleintervention sessions with a family, it's important to discuss functional strategies that will ensure a successful session. Some considerations to discuss with the family can include lighting. It's important that the family chooses a space in their home where there's minimal outside light which can cause a glare on the screen, and decrease your ability to observe the parent and child interaction.
Encouraging the family to cover windows and turn on overhead lights will aid in creating an optimal environment for teleintervention sessions.
Decreasing possible distractions prior to a session is an important consideration. I ask families to plan ahead by silencing cell phones, turning off TVs, radios, or other auditoryvisual distractions. I ask them to test their child's devices beforehand, and ensure their video conferencing technology is plugged in, fully charged, and their internet connection is working.
Understanding the potential distractions will come with getting to know a family, and can continue to be addressed as both the Early Interventionist and the family become more comfortable utilizing twoway video conferencing technology.
Another consideration is internet speed. The broadband connection will affect the audio and video quality. Encourage families to disconnect other devices in the home, close out of programs other than the software being used for the session, and plug directly into an internet source rather than using Wifi or a cellular connection.
Some of these considerations can also affect privacy. It's important to discuss with a family that as the Early Interventionist you'll work to ensure the family's privacy by plugging your hardware directly into an internet source or utilizing passwordprotected Wifi, using HIPAA compliant software, and conducting sessions in a locked room where they cannot be seen or overheard.
However, it's vital that the family recognizes that upholding their privacy occurs on their end, as well. Educating the family on how to access a secure internet connection and to be aware of the environmental risks to privacy will help the families protect their sensitive information.
All of that being said, families must be educated on the inherent risks involved when utilizing twoway video conferences and Early Interventionists should always have families sign a privacy waiver prior to beginning sessions. Now that we've considered functional strategies for a teleintervention session let's look at 10 strategies that are unique to providing services via twoway video conferencing and consider how they can ensure successful sessions.
As the Early Interventionist it's important that we assess the family's home environment to gain insight into the family's wellbeing. During traditional inperson visits we may do this informally by scanning the environment, assessing the family's most basic needs, referring to Maslow's hierarchy of needs and gauging the family's emotional state. If it's clear the basic needs are not being met or they're experiencing emotional turmoil you likely are not going to jump into a discussion of audiology and assistive technology. Rather you'll likely discuss available resources and the stages of the grief cycle so what if you cannot observe this immediately?
Imagine how that could direct your parent education, and possibly affect your family provider relationship from day one. During a teleintervention session, your view is limited to the scope of the camera. This could make it difficult to assess the family's environment and their potential needs. Giving the family a presession questionnaire can help guide you in understanding their general needs.
Try asking openended questions, such as: How does your child like to play? If the family answers, "She loves books and blocks and her brand new baby doll," that's going to give you some information on the family's resources. However, if they respond, "Oh, my child prefers to watch TV, and they're always getting into things," you may want to dig a little deeper to better understand where they're coming from. A questionnaire can also help guide you on whether or not to supply the family with materials prior to beginning sessions.
Once you've begun teleintervention sessions with a family, something to consider is provider wait time. During inperson sessions how do you feel when you're allowing moments for silence? Most people are uncomfortable with silence. However, it's useful to realize the power of not talking.
You did it. Believe it or not, that was only 30 seconds. Now, consider how you felt in that moment. How many people wanted to talk to break the silence? Yeah, it's uncomfortable. Use that feeling to give families a voice. When you step back from sharing information, from commenting and coaching, you open a space in which the family is able to use their voice.
As Early Interventionists we know that parents know their child best and they're an integral part of the EI team. It's important that we embrace wait time, and give families that space to share their input. You never know what you might learn, how what you learn might direct your parent education, and most importantly, how it might strengthen your familyprovider relationship.
Further, during teleintervention sessions, it's important to embrace wait time not only for giving family a voice but to allow time for latency or a delay in transmission. Technology is not a perfect science and at times there can be delays so utilizing a few seconds of wait time before responding will help ensure that your session is running smoothly.
The next few tips for effective teleintervention sessions refer to modeling, listening and language strategies. For many years, Early Interventionists typically worked one on one with the child while the parents observed. When utilizing twoway video conferencing technology this is not an option. Luckily, research has shown benefits in utilizing a coaching model in which the Early Interventionist models strategy for the family, then passes the activity to the parents while observing and coaching their interaction with their child.
So what does this look like during an inperson session? When you do model strategies in person, do you plan the materials and the language that you'll use ahead of time? Do you plan the length of time you'll model a strategy before handing it over to the parents? Or how many times you'll model that strategy? Prior to modeling strategies in a teleintervention session, it's important to consider these questions, and then plan and practice for a few reasons.
First, you need to ensure that the family has the materials necessary for the activity. Planning with the family and gaining their input on the materials they'd like to use for, say, a turntaking activity will aid you in being prepared to model the strategy correctly. When utilizing teleintervention, you also have to be aware of the frame of the camera that you're using. By observing yourself modeling a strategy prior to your session, you can ensure that you are staying within the frame of view.
Also, consider the lag time or latency you may experience. This will help you gauge the timing of your sessions, including how long you'll model a strategy, before handing it over to the family and the time you need to leave for observations, questions and reflection.
Now that you're prepared to model listening and language strategies, how will you ensure that you're conveying the "how" and the "why" to the family?
Be prepared to repeat and rephrase the information that you're giving the family. During an inperson session, when we observe a parentchild interaction and have suggestions for listening and language strategies, it's easy to take over and model that strategy or fall back on that therapy model again. Think about how often you hand that interaction back over to the parents. Did they learn through watching your successful interaction?
Not all families are visual learners so it's important that as Early Interventionists, we give the family information in a variety of ways including modeling but also being prepared to repeat and rephrase so that the family understands both the purpose and the goal of the activity.
To ensure you will successfully coach a parent on a listening and language strategy during a teleintervention session, try thinking through a few different ways to describe the activity to elicit the strategy you're working on prior to your session. You don't have the option of taking over and modeling through direct interaction with the child so it's important to make sure you've considered options for explaining to the family not only how to use the strategy, but also why the strategy's important, and how we know the interaction was successful. By giving the family clear and concise information in a variety of ways, you will ensure that the parentchild interaction is successful and it will set you up for meaningful reflection with the parents after the interaction.
So we've considered how to model a strategy, and how to set the parents up for success during a parentchild interaction but how do you, the Early Interventionist, successfully encourage and coach parents during their interaction? During inperson sessions, we often rely on modeling to coach, but as we've learned, not all parents are visual learners. Many families learn through handson experience. Inperson, it can be easier to read the situation and know when you need to model a strategy again, or what component the parent's missing so that you can coach as they interact with their child.
During a teleintervention session, it can be difficult to jump in due to the time lags and the fact that you're not there in person, and cannot model the strategy directly with the child. Try planning a key word with the family so that you don't need a long explanation, but from one word only, the parent can remember to use the strategy you're working on.
For example, imagine you're working on wait time, while reading a book. The parent points to the dog and says: Look, there's the doggie. Can you say doggie?
When the child doesn't respond, the parent begins to turn the page. Since you've already discussed with the parent that you will use the key word "wait," you don't need to go into an explanation in this moment. You simply say wait, and the parent pauses and gives their child a moment to focus on the dog. Maybe by giving the child that extra time to consider the picture of the dog and their parent's model they'll be encouraged to imitate the word.
As Early Interventionists we are experts in our field and we see a variety of children ranging from medically complicated to typically developing. When considering intervention plans, we use our informed observations and our knowledge of typical development to guide our practice and parent education. During inperson sessions, it's natural to be putting ticks on your mental checklist as you're watching the child play in their home environment. However, let's take a moment and consider how much weight we put on our own informed observations with how we move forward with intervention strategies. Now consider how much weight we put on parent input to inform how we move forward with intervention strategies.
When providing services via teleintervention, we must consider that our vantage point is not comparable to that of an inperson session, and therefore, it will affect our ability to rely on our own informed observations to guide our practice.
It's vital that we rely more on parent report. We must remember that parents truly are the experts on their child, and to be an effective Early Interventionist it's our job to balance parent input with provider knowledge.
A great strategy is to ask parents for more input on their child's actions, and not only when it's difficult for you to see, such as, did you push the button on that toy, or did he? But also to gain valuable information on child behavior and progress outside of your sessions.
While aiding you in becoming an effective parent educator, relying more on parent report will also help the parent become a meaningful observer of their child, and it will strengthen your familyprovider relationship. So speaking of a strong familyprovider relationship, let's consider ways in which you establish rapport with the families that you work with.
Personally, I know that I rely a lot on body language during May inperson interactions. Parents may know that I care for their family by the way I hold or engage their child in play. They'll get a feeling based on how I express my level of comfort in their home.