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Welcome to the show notes for Episode 90 of the OT Schoolhouse Podcast.
During the pandemic, teletherapy found its foothold as the world shut down and continues to now reopen. However, despite schools and businesses reopening, this is just the beginning of the story for occupational therapy and the doors that have opened in the world of teletherapy.
In today’s episode, we are talking with Occupational Therapist, Tasha Holmes, and Speech Pathologist, Kristin Martinez, from PresenceLearning. PresenceLearning is one of the largest providers of teletherapy services and in this episode, we are going to learn how they adapted during the pandemic and where they see teletherapy headed as the world continues to become more emerged in technology.
Join us and we explore the future of teletherapy with Kristin Martinez, M.A., CCC-SLP & Tasha Holmes, MOT, OTR/L
Links to Show References:
Learn more about Presence Learning at https://www.presencelearning.com
Transcript
SUMMARY KEYWORDS
students, tasha, support, services, telehealth, ot, therapists, therapy, kids, kristin, platform, ots, activities, piece, pandemic, working, people, helping, learning, slp
Amazing Narrator
Hello and welcome to the OT Schoolhouse podcast, your source for school-based occupational therapy tips, interviews, and professional development. Now to get the conversation started, here is your host Jayson Davies, class is officially in session.
Jayson Davies
Hello, everyone, and welcome to this week's episode of the OT schoolhouse podcast. Thank you so much for being here today. My name is Jayson Davies, and I'm here with you every other week, if not every week, sometimes to discuss occupational therapy in the schools. So today, we are here to discuss how teletherapy has evolved over the past few years, especially with the pandemic in the past two years, everything has changed. I think just about everyone listening right now has experienced telehealth or teletherapy in the past two years, and I cannot believe we're coming up on that two-year, March 13 date if I remember right when things started to shut down. But aside from looking at the past, we're also going to look into the future a little bit and how teletherapy is going to move forward, how it fits into occupational therapy right now, and also moving forward into the future. In fact, one of my favorite questions you're going to hear in a little bit is how the world is changing. You know, Facebook changed its name to Meta this past few months. And well, I just can't wait to see what teletherapy brings within the next few years, it's gonna take a little while to advance that much. But it's going to get crazy where we go. So to get some of these insights I'm excited to have occupational therapist, Tasha Holmes and speech and language pathologist, Kristin Martinez joins us for this episode. Tasha and Kristen are both employed at a company called Presence Learning where they do provide occupational therapy online teletherapy, as well as speech, and a few other services. Kristin and Tasha are not practicing for presence learning at this moment. But they do support other occupational therapists who do practice through teletherapy. And so they are going to have several insights as to what therapists have difficulties with and how they are helping them get past those difficulties and get past some of those, those mind thoughts that might be limiting their ability to progress. They're also going to share with us a little bit about the presence learning platform that they use, which is different from zoom or Google meet, and it allows them to do more things and be more interactive with the clients that they serve. So now that there is a light at the end of the tunnel with a pandemic, hopefully, I know Omicron is kind of poking its head out. But hopefully, we can get beyond that. We do want to see how teletherapy is going to continue to move forward. So please help me in welcoming Tasha and Kristin to the OT Schoolhouse podcast. I hope you enjoy this interview. Hello, and welcome to the podcast. Thank you so much, Tasha, thank you so much, Kristin for being here today. I want to let you all kind of get started and just talk about your role at presencelearning and kind of where you fit into the therapy world. And so I'll actually go ahead and start with Kristin, let us know a little bit about yourself.
Kristin Martinez
Okay. Thanks, Jayson, thanks so much for having us today. So I'm Kristin Martinez, I am an SLP by trade. And so I have been an SLP now for over 20 years, which feels a bit shocking. But here we are. So I was an on-site, school-based therapist and in private practice here in my local area for about 13 years before starting with presence learning in 2013. So I first started in teletherapy, not knowing any single another person who was doing teletherapy I knew nothing about it. But I was at a point where I was taking a leave of absence from my district physician needed some more time to support some family needs for a bit. And presence learning reached out to me because they were needing therapists in Colorado. So I thought, Okay, I'll try it. And about a month in just realized how much I loved it. It was a really great fit for me. And so I made the permanent transition. So I was a provider who provided teletherapy services, therapy evaluations, you know, it's really supporting all the full scope of work for SLPs for a couple of years, and then came over as an employee for the company and spent a few years managing the clinical side of accounts working really closely with school districts supporting our providers. And then the last couple of years, I've been clinical director for SLP and OT services. Right that's, that's my, my, my journey.
Jayson Davies
So that means all the OTs and SLPs. They kind of get to work with you a little bit to hone their teletherapy skills.
Kristin Martinez
So my role now is not as much day-to-day direct. You know, we've been lucky enough to have quite a bit of growth in our company. And so we have whole teams of clinical account managers who really support day to day needs for our therapists and Tasha and I, well, we do engage with providers, we also do a lot to support resources and bringing in programs and, you know, some of the high-level clinical pieces in order to, you know, expand what we're doing is a teletherapy company and to expand what is available to our therapist, but I'll let Tasha speak a bit more to her role and how she engages with our services and therapists.
Jayson Davies
Yeah, absolutely. So Tasha, yeah, go ahead, introduce yourself a little bit and share your role within presence learning.
Tasha Holmes
Sure, so I am Tasha Holmes, I am an Occupational Therapist, I've been an OT for almost 18 years. I've done pretty much at all hospitals, nursing homes, home health, pediatrics, geriatrics, the ages in between. So I've, you know, had a pretty well-rounded career, my husband used to be active duty in the Marine Corps prior to retiring. And so with the moving around, I've done traveling therapy as well. But you know, once we got married, and we started a family, it became a little bit tricky to keep moving and continue with my career, you know, I loved being able to work somewhere, but then you're there, you're invested, and then it's time to go. And so when I, you know, found out about presence learning, it was an excellent fit for me. At this point, I've worked with presence learning in three different states. And I've been able to, you know, just that continuity of having a place where I can, you know, hone my skills, learn something new, but continue to do that have that work-life balance, is the reason why this has been the longest company that I've been with, in my 18 years as an OT, like Kristin, I started out as a provider, so you know, doing evaluations and assessments, working with families and schools. I did that for about six years. And then this past year, in October of 2020, I became an employee. And so as Kristin was stating, we do have account managers that are licensed therapists, and they work directly with the districts and make sure that the day-to-day needs are met via the providers. I did that for a year along with another position where I was able to support providers directly through office hours and workshops. And now my position has changed a little bit more. I'm a Clinical Quality and Resource Manager. That's my official title. But I'm also the subject matter expert for OT, for telehealth at the company. And I think that's a really important role. Something that really sets you to know, us apart is that not only do I get to help support providers, but I also helped to give input as to how things are being shaped on the OT end to support providers. So that way, they're delivering the highest level most ethical services that they can provide for their students.
Jayson Davies
That's amazing. And I must admit, you know, it's not very often that I get to sit down and have a call with either an OT or speech granted, we have both today that have gone into a role of leadership, it's very hard within the schools, even outside and other settings, clinical practices, and, and in a hospital, for OTs and speech therapists to get into a leadership role. It just doesn't happen, especially in the schools, you know, we don't have a credential in most states. And so we're not even able to, but I just want to congratulate both of you for being in a role where you have had that opportunity to really grow as a leader. So that's, that's really awesome.
Kristin Martinez
Yeah, thank you. Yeah, it is really exciting. And it is one of the other pieces that really drew me, kept me with presence learning once I learned about the company, and is that I did see opportunities where I could still be involved with what I loved as a speech-language pathologist, but also work as a mentor and as a coach and working with other, you know, people who are from completely different disciplines than myself outside of education outside of, you know, a clinical world. But really, all of that works to shape services for students. So it has been a really great opportunity.
Jayson Davies
Yeah, that's just awesome. All right. So I want to, Tasha I have a question for you. Obviously, as an occupational therapist, we always have some difficulty explaining our role as an OT, no one knows what we do. I think even fewer people know what we do when it comes to teletherapy. And so I want to ask you if you're at a party or at a gathering, whatever it might be, and someone asks you, what do you do as an occupational therapist for presence learning? How do you respond to that?
Tasha Holmes
So I like to explain first because you do always have to start with that OTPs and I explained to them, occupation is everything that you do in your life from the time you wake up in the morning until the time you go to bed at night. So if you're having a problem with doing any of those activities, then OTs are there to assist and we assist based on what is limiting you from being able to complete those activities, so then I narrow it down to telehealth for pediatrics, we're looking at what does it look like for the day in the life for the student and so everything that that student needs to do from the time that they arrive at school until it's time for them to go home, we're taking a look at those different activities, and those activities that are keeping them from being able to participate in their academic program. We're addressing those needs, you know, within our huge scope of expertise. And that usually helps people a little bit better because they're like, Oh, well, so then kids, right, and they cut and they socialize, and they do all of these different activities and like, exactly. And then in the telehealth realm, not only are we looking at those particular activities, we're adding in the technological piece of helping the students access the help that they need. So whereas maybe they can access an OT on-site, that can help address their needs. That may not be the case for their particular district, for their particular medical situation, or their particular needs. And so telehealth helps to marry that access to be able to complete your academic program by addressing those deficits.
Jayson Davies
Definitely. And I love how you tie it in that technology piece. Obviously, we're sitting here at the end of 2021, which has been a crazy time for many schools, basically every school across the entire world. And so that leads kind of into the very next question that I wanted to ask you about is how things have changed or maybe not changed. I don't know, at presencelearning over the past two years since the pandemic started. And I don't know maybe Kristin, you want to share a little bit about how presence learning has adapted over the last few years?
Kristin Martinez
Sure, absolutely. So, you know, of course, as a teletherapy company, we were founded in 2009. So we were around and providing remote services long before, you know, there was a pandemic, clearly. So we felt fortunate that we were in a position to provide help to be able to share expertise, share services because everybody was having to turn to teletherapy. During that time, of course, and, you know, and not because they wanted to not because they made a choice in their careers or for their students where they said, Oh, I'm going to consider this, get training and become a teletherapist, where, you know, that's how Tasha and I joined we, you know, it was our choice. It was we wanted to learn, we had resources, we had time, all of those pieces that didn't exist, you know, in March of 2020. So, of course, we were available to provide direct services, we do contract we have about over 1500 therapists in our network SLPs OTs, school psychologists, mental, licensed clinical social workers. So we could help with direct services. But what districts most needed just helped. They had the staff, in many cases already, they had their on-site, OTs SLPs. But they had just never done teletherapy before. And so of course, there were options out there, and just in terms of a piece of technology. But there were very few training supports or platforms that were actually designed for this. So the biggest thing that changed for us as a company, the entire time, since we started, we had had our own platform, our platform was designed by our product and engineering team over the past decade and specifically designed for therapy. So it's not based on zoom. It's not based in you know, another platform, it was built from the ground up. And everything included in the platform is designed to provide therapy services, either SLP OT or another, another discipline. So we realized that this was really an opportunity for us to help in another way was to make our platform available. So that was a significant pivot for us as a company is we did make our platform available to school districts to private clinicians, who wanted something better. And we also provided training on the platform. And that's something we've continued to do and continue to expand on. So it's actually called our therapy Essentials program. So that's another way that individuals, you know, university programs, clinics, school districts, if they are needing, you know, a really strong platform in order to provide therapy services, and are also looking for the tech support piece, which we also integrate and also training. We've made that available. So that was absolutely a new, a new piece for us and something that we are continuing to support.
Jayson Davies
Absolutely. Wow. I didn't realize that you had made that available. So I think I might ask us a little bit later. But how is that program different from Zoom or Google meet?
Kristin Martinez
Yeah, so good question. And there's I could go on for quite a while about what are some of the highlights thankful. Essentially, you know, as I said, I mean, those are amazing platforms, we're using one right now, as a business tool as a way to connect with each other, I think we were all using those platforms just to stay connected with family and friends, and, you know, business meetings. But there's a lot of if you're trying to provide therapy services, you're having to also bring in other resources, you're having to layer in, you know, the screen-sharing and trying to show another screen at the same time. And, you know, there's just, it's not built for therapy, they're just they just aren't, that wasn't the primary purpose. Our platform was, it was built for therapy. So everything is integrated. For instance, we partner with publishers to have integrated assessments in our platform. And so as an SLP, for instance, you know, I'm not if I'm administering something like the self, I'm not having to take my visual stimulus and hold it up to the camera for the student to see, it's built-in, I can integrate a second camera, which Tasha can speak to very important for OT services. Again, it's really just, it's a one-stop-shop. As a therapist, everything is there. I don't have to we have an activities library. I can upload my own activities to the library. It's interactive. There are built-in reward systems. So it's just, it's engaging and fun for kids. You know, we work in early intervention all the way through transition age, so really a pretty broad range of age levels. So it's just it is a meaningful and intentional tool for therapists.
Jayson Davies
Very cool.
Kristin Martinez
Yeah. And Tasha, I'll let you add anything else you want. I was going to the OT side.
Jayson Davies
Well, Tasha, let me ask you a question. You can answer a little bit of that, too. But, you know, Kristin just mentioned some of the technology sides, but she did mention you kind of talking about potentially having that second camera. So in addition to talking a little bit about the platform, also talk a little bit about some of the tools that are very helpful for teletherapists.
Tasha Holmes
Absolutely. And I would say that the second camera really does make a difference. I, you know, at the time, when the pandemic hit my two kids were home and, you know, everybody was trying to make there, you know, work their way around it. And so my kids, you know, they've seen me do therapy through the platform. So to them, that's what teletherapy was, or, you know, just doing their schooling online. And I realized that when I'm in the presence learning platform, and I have my second camera, and I'm just hitting a button to turn the second camera on, that frees up my brain for so many other things. Then when I was trying to set my kids up, like, let me get you set up, you know, this is my thing. And I'm like, Alright, I need a hack to figure out how to set up a second camera, so your teacher can see your hands. And you know, and there was a lot of thinking involved. And you know, and I'm sure that you can attest to this, Jayson, you know, burnout is really high as a therapist. And so the extra brainpower that you're taking to figure out hacks, or workarounds, really takes its toll on you throughout the day. And so I found with using the presence learning platform, I'm able to use tools to demonstrate things on the screen. So we have whiteboard tools, where you know, you can demonstrate letter formation, but I can easily pop out a YouTube video at the same time while watching the second camera, seeing what my students actually write on their desktop. But I can run a camera second camera too. So if you have two people in the room, you can be running four cameras, they can watch me I can watch them but I can simultaneously have a letter formation video on the screen or a drawing video on the screen. Or if I have a student who's working on typing, I can place an activity on the screen, have them open up a chatbox, have them angle the camera towards, their keyboard, I can see their finger placement also while seeing what they're typing. I can flip to we have something called team right where it's a collaborative typing activity. Have my students practice typing there, you can also save documents. So for those kiddos, one of the big things that people are always concerned about behaviors are kids who have sensory needs. The platform allows for that too where I'm not trying to bring in other things where okay, I know the student needs a timer. We have widgets, you can pull out a time or I can pull out pictures for a visual schedule that mimics what the student may have in the classroom. I can pull out you know paper special paper that maybe my students working on and they can write on the screen but also right on their desk and I can see what they're doing. So those features really help with you know, providing OT services, being able to I always told my kids that when you're small in the corner and we have something else larger on the screen. You are a TV star but I can make you a movie star by having you know put you on the big screen and so I can put them on the big screen their movie star I can see really well what's going on on their desk. If they get that movie star status and they're looking at themselves they can their door I can hide their pictures so that way, they're not distracted. And I can still see what's on their desk, they're focusing a little bit better. So all of those tools really helped with supporting services. But they also helped me as a clinician, because I'm not in the back of my head. Okay, how am I going to do this, I just do it seamlessly. So this on screen, I can do all of these different things. I'm not trying to figure out how I'm going to piece something together, which allows me to be more creative during my sessions.
Jayson Davies
I think that's spot on. Because it does take a lot of brainpower just to figure out how to share screen and whatnot. I remember I'm pretty technologically savvy. And so I was helping my AP teacher, I was helping my speech therapists, I was helping everyone learn how to use Zoom. And we were actually in the process of going through my first A-Z school-based OT course, with, I had about 30 therapists. And we were going through how to be a school-based OT all the ins and outs of evaluations and treatment. And when the pandemic hit, we were about four weeks into using zoom as our platform for that course. And so everyone that was in my course, like, oh, I already know how to use zoom a little bit. They're feeling so much better. But it's still a huge learning curve. One thing that you kind of mentioned in there was that you are able to hide the student's video from their screen. Is that true?
Tasha Holmes
Absolutely. So being able to hide the camera works for those kiddos who were either distracted by seeing themselves because it's a one-way camera, they just see a silhouette, or for those kiddos, you do have kids who they don't want to see themselves on screen, it's very jarring for them. And so to be able to hide that and allow them to work without feeling like they're being displayed really goes a long way for helping build that therapeutic rapport because then they trust you, they know that you're not forcing them into something that they're not comfortable with. And you can focus on what you're doing this session.
Jayson Davies
That's awesome. I can think of two specific cases where this would have come in handy because I had one kid who would be fixated on his view. And so he had figured out, I mean, just like most kids better technology than the adults. And anytime the mom tried to hide his video anyway, on Zoom, he knew how to get it back. And he would just stare at his own video, it was just like he was just looking at a book and he didn't want to move didn't want to do anything except stare at his own video, I had another student who didn't want to see my video at all. And so as long as my video was up, they weren't going to do anything. So that's great that the platform allows you to be very versatile, like that. Awesome. All right. So we're talking a lot here. And I want to make sure we get through everything. So we might have to go through some rapid-fire stuff. But if you had to think of one thing that therapists struggle the most with when it comes to moving from traditional in-person therapy to teletherapy, could you each give me that one big struggle that you see most therapists having? Kristin, do you want to go ahead and start?
Kristin Martinez
Sure. So I think one of the biggest pieces, at least for SLPs is, you know, for some I hear a lot from SLPs that they say they're very hands-on that they want to, you know, they're doing articulation, you know, and they want to be able to do tactile stimulation, or, you know, how do you do prompt therapy? Like, how do you do these things, if you can't be physically in the same space? You know, and there's a lot of related questions to that. How do you you know, possibly work with preschoolers or, you know, a lot of those things? So I, you know, first of all, I think it's really important for people to understand that teletherapy is not a new kind of therapy, you are taking your skills, your experience, and translating those skills to a different modality. So what we help with and help therapists learn and develop is how to just translate those skills. And so you're still addressing the single areas, you're not modifying goals for teletherapy, you're not taking goals off and saying, Nope, we just can't do that. You are learning how to still address those goals in an effective benefactor, efficacious way. So sometimes that means, you know, it can sometimes shift your technique potentially. But more often than not, you are engaging with, of course, the tools in the platform, sometimes leveraging that in person support. And so in presence learning, we call that person a primary support person, especially when you're working with kids, there needs to be an adult in the room. As you know, a staff member does not need to be a trained clinician in any way. But somebody who can you know, at the I think of it as a spectrum on one that spectrum, you have just line of sight supervision for kids who are very independent, they engage on the computer all day long, just somebody in the room in case something comes up a tech issue they can help with really quickly all the way over to our students who, you know, they might require one on one support throughout their school day to Access General Education. That same level of support is required if they're working in teletherapy. So really, that's one of the most efficient pieces we do when we come on with schools is to help them understand that so they have appropriate staffing to support that piece. So understanding as an SLP that, you know, yes, you might need to sometimes, of course, you're it's coaching, they are not providing they're not deciding on therapy, they are doing what you asked them to do. So there may be some facilitation, there may be somebody who is helping to support AAC devices or some of that tactile cueing as an SLP. But it can all be done. And so it really is, we really love to work with new teletherapists, to help them understand that and kind of, it's a little bit of a shift, I think, in thinking about your therapy services. But once you realize that, yes, you still can provide that full scope of service and address all goal areas. That's pretty powerful, and really, I think empowers therapists to realize that they are adding, they're adding tools to their toolkit, as opposed to just doing something completely different.
Jayson Davies
Absolutely. And that coaching was a big new thing, because all of a sudden, we went from working with a student, one on one with no one else in the room, especially for those who you know, we're working in the school districts, and all of a sudden, now we're working one on one, but we have a teacher or sorry, not a teacher, oftentimes, it was a parent, or a Big Brother or Big Sister.
Kristin Martinez
Right.
Jayson Davies
And they had to be our what was the term you use primary
Kristin Martinez
primary support person? That's our lingo. Yeah, yeah.
Jayson Davies
And so they were our support person, and you had to learn to trust each other and really learn to communicate well. And so, yeah, if you know, what I while you're on that, it's required that a district has a primary support person with the student at all times with presence learning, or how does that work?
Kristin Martinez
Well, I mean, I would, if I, if I were the school district side, I mean, I would think that anytime a student is engaging with another adult online, that there should be a staff member in the room, I think it's just common sense, safety, all of those pieces. Yeah. But, you know, if we're talking about high school students, if we're talking about that makes sense. You know, kids were very independent. They don't necessarily need somebody who's right there. But we still recommend it, we still think you know, we, at that age, we're actually sometimes the support person is more just to make sure the high schoolers make it to the therapy session from their classroom, and they didn't get lost somewhere in the way. So it's more about attendance at that age. But it's just we want to always make sure we are setting expectations with schools and helping them to understand that, you know, and I tend to use the analogy of the level of support, students need to engage and be successful in general education. So that's a pretty familiar concept for anybody working in special education is, you know, if a student is having to engage in a computer activity, which of course happens throughout students' day, what kind of support do they need? Surely, you know, there's a level of support already being provided for these students to some degree. And so giving them that framework can help and, you know, there's a lot of different ways it can look, we talk about different ways to set it up. Sometimes it's in you know, a few computers in the back of a resource room and maybe a paraprofessional can support both activities, or, you know, we've had SLP assistants or occupational therapy assistants do kind of dual roles is maybe running small groups, but also maybe supporting a couple of students. It just depends on the need of the student. But it is absolutely important, it's just a really important piece to making sure you're discussing and thinking through so that therapy services are successful for students.
Jayson Davies
Great, thanks. And Tasha then what do you see OT struggling with when they transition from an in-person type of role to more than a teletherapy role?
Tasha Holmes
I agree with Kristin, it's the hands-on and a lot of times, it's hands-on in terms of sensory processing for the students because they're used to helping facilitate those different activities for students to be able to attend to, you know, whatever fine motor tasks they may be doing for OT. And I always like to say, you know, the kids that are running away from the computer, were probably the kids that were going to be running around the room when you were on site. And so we don't have that expectation that in order to receive services, you have to be in a chair, in front of the computer sitting at the desk, the whole entire session. Because it's not realistic, we wouldn't do that. If we were on site, we would allow the student to move we would incorporate movement activities. And so that's where you know, your activity analysis comes into play. What skills are we actually working on? Okay, so now let me be creative and figure out how we're going to work on it. So for example, when I was working in virtual schools, and I would have students seen at home, we would plug the laptop up to the television, the student would watch me on the television, I would watch them from the laptop, and we would do our sessions that way because that way if the students pacing or the students running around, there's something about things being on time Television that really draws the kids attention. Or maybe the first couple of sessions, we position a laptop or the computer in a certain area. And then I have them walk, you know, to the left to the right into the back of the room, we put a marker and I can say, Okay, I'm still in a visual shot of the student, while there, you know, between those socks or something like that. And then we do our sessions that way. And so that's where you just become creative. And you have to figure those things out. But I think, initially, that's a really hard thing to wrap your head around a student who's going to run around, they're not, you know, they need that sensory input. You know, just thinking about the fact that, well, hey, put the laptop on the floor, have them in prone prop under the desk, they can feel like they're in a cave, you know, so they're getting the different type of sensory input that they need. I've had kids where they're runners, so I'm like, hey, if we put them in prone prop, every single time they stand up to run, they're giving themselves proprioceptive input. And so that's what we do. They're in prone prop, they get up to run, they're pushing through, run away, wheelbarrow, walk them back, we're back in that position again, so that way, you know, you can use your environment to help with those therapy services.
Jayson Davies
Awesome. It sounds like you've really had to kind of accommodate for some of those difficult situations that we all find ourselves whether or not we're in person, or in teletherapy, we all have to figure out how how to manage those experiences. I want to follow up on that a little bit. What do you tell either potentially new therapists or even districts who are concerned with, hey, you know, we have some tough kids, and I don't know if teletherapy is really going to be right for all of our kids? What do you tell them? Or maybe you've been in a situation where you've had a therapist come to you and say, hey, you know what, I think this kid, just teletherapy isn't going to work? What do you kind of walk me through what that might look like, or what accommodations you might make?
Tasha Holmes
And I have to say, that's usually exactly what they say, Hey, we have some, that's almost verbatim what they say. And so that's one of those things where, you know, I'm completely honest, teletherapy is not going to work for every student, however, you can't, you know, you don't really know if teletherapy is going to work unless you try it. Because some of those students that you would think are oh, this is just not going to work for them. You know, just something about being on the computer really resonates with them, they thrive, they do a wonderful job. And then you have may have some kids where you're like, Oh, I would have thought this would have been perfect for them. And those are the students that you find that okay, this probably was not the best fit. And so I always like to suggest that people would just give it a try. And that's when you talk about okay, well, this is Plan A, we're going to try this, you know, these few times, we're going to set up a plan. And then we have a plan B if it looks like it's not working. And that's where it comes into play, having those supports that are really going to help you with your sessions. So if you're trying to piecemeal and put things together and try to figure out, okay, how am I going to make this work, it makes it much more difficult than having those resources already there. And those resources, I mean, by your choice and platform, if you do have a choice for what platform you use for therapy services, the location of your therapy services, so you know, maybe the student will be better in a smaller room because they like to run around, versus a larger room where now they've runoff. And it takes us so long to get back to the computer, you know, things that are less distracting. And so whereas if we were on-site, we would look around the room, and we would decide, is this a good area? Is this not a good area? Same thing you're going to do during teletherapy services? I've had it where I've had my primary support person, give me a tour before we even start services? Can you turn the laptop around? Can you take your external camera and show me what you have on your shelves? What's in the room? And that way I can know, you know, are there any hazards there? If the students you know, runoff? What things can I use in that environment that's going to support that student? Does that student need to be pushed in? Should that student be pulled out? How does your WiFi hold up outside all of those different things? And so you really have to take a good look at your environment and your resources to determine if it's really going to support that student. So it's going to be more than just, you know, do well with grandma over FaceTime that you know, that's not going to be the determining factor of whether they're going to do well with OT and telehealth services.
Jayson Davies
Yeah, every kid's unique and you don't know until you try. So definitely. Now you mentioned a term in their push out versus push-in type of services. As a teletherapy therapy provider, are you able to do some of those push-in services? I know when I think of teletherapy I do typically think of that student who is going to leave the classroom sit in another room with the PSP the helper and sit in front of a computer. But is it possible to do some of those push-in types of services through teletherapy?
Tasha Holmes
Absolutely. And it's another one of those things that we've teletherapy it does take a little bit of planning But the way I reconcile that is, when I was on-site, it usually took some planning as to where we actually going to do these services because you don't have a room. Whereas for pushing services for teletherapy, you're thinking about how are we going to do this? Is this going to be best where I have my primary support person, and they have the headphones on? And I'm coaching them, and they're, you know, pointing as to where those students should put there, you know, letters on the line? Would it work better for the student to have the headphones on and I'm giving direct instructions to the student? Would it work better for me to be on a laptop and do some observation first, and figure out okay, this is the classroom flow. I've done things where I've contacted the teacher beforehand, which is what you would do on-site. Hey, what's your lesson plan for next week? Because I'd like to come into the classroom to work. Oh, that's great. You guys are working that, you know, on that writing activity? Now, is this going to be individual is this going to be a small group are you going to do it in a large group. And so finding out those different types of things, so that way, you can plan accordingly for your session. Other kids, sometimes other students think it's so cool when you get to be in the group with the person on camera, and you know, you just have that your student in the visual shot, you're giving those directions, and you know, that students still interacting with their group. So really just figuring out what the plan needs to be for providing those services, and certainly pushing services, observations in classrooms, consultation for the classroom, co-teaching with the teacher. Very, I mean, it's all very appropriate.
Jayson Davies
Yeah, well, I gotta admit, you just open my eyes, like, the first thing you said was, you know, having either the PSP or the student wearing headphones in the classroom. I was like, that fixes so many problems that some therapists have when pushing in physically to a classroom, because the therapist wants to say something, but doesn't in fear that it's going to be distracting, or whatever the case might be. But if the student has headphones on or the helper has the headphones on, then the rest of the classroom doesn't hear you. And they can silently make the little corrections. So that's awesome. I never thought about that. Great idea. All right. Now, when I browse through the Presence Learning website a little bit, I do see some articles about research. And you know, whenever we have new models forming, and let's be honest, technology has evolved so much over the past, say 20 years, but really, it's been closer to 30 years now that we've really had the internet at least available, what research is out there that has kind of led to teletherapy really being an established model of therapy.
Tasha Holmes
I will say on the OT end, we're a bit behind what this research for speech therapists like Kristin speaks to that. But what I will say is that you know, our occupational therapy practice framework has been updated to include telehealth, you know, the AOTA does have a position paper where they support telehealth. And if you look at some of the more recent journal research articles, if you go into the AJOT, and you're looking at ones from I'd say maybe from like the past even like three or four years, it's discussing the effectiveness of using the telehealth service delivery model for different populations. There's for autism, there's, you know, several other different occupation-based coaching services for you know, students or children or even adults. And so I think that as telehealth continues to evolve, our research will, you know, start to bridge that gap. But as you know, telehealth is, you know, evolving so much faster than research. And even with research, there's always that lag between the day the research has been completed, when it's published when someone reads it when someone implements it. And then by that time, you know, it's you're already kind of behind the ball in terms of that. But everything that exists at this point, does support telehealth as a viable service delivery model on its own, not something to be used. Well, it's the next best thing. If you can't do on-site services. It's viable, it's viable and comparable to providing services on site.
Jayson Davies
Yeah,
Kristin Martinez
yeah, I echo Tasha's note on that, you know, there is more research on the speech side, I think, you know, teletherapy services started first, first, really on the medical front and then with speech and OT and little psychology and mental health. So there's been this, you know, order of things. There is growing research, it tends to be I would say, I don't know of one just Silver Bullet study that says, absolutely no matter what student you're working with teletherapy is effective, you know, that that's just not realistic. Anyway, there are studies that are, you know, specific to this goal area students with This disability this age group, I, you know, I know your audience is generally OTs, probably. So I won't get into too many details on this side. But I will say there are some really interesting studies that support the effectiveness with some populations of students that really potentially the opposite of what many might think in terms of effectiveness. So for instance, in early intervention, there's some good research that shows that teletherapy can be highly effective in early intervention services, and also with populations of students who are on the more severe end of the spectrum. And with both sides, part of the reason for that is that, you know, when you're thinking about early intervention, of course, the most important piece is the caregivers, you know, that coaching model. And so oftentimes, I think people have had the experience of doing in-home early intervention services, where you come in as a therapist to, you know, your hour, and sometimes that becomes the parents moment to go catch up on laundry, or which they desperately need to do it, all these pieces, and then you do the five-minute catch up at the end of the session. teletherapy, they can't do that when you're working with 14 months old, they need to be present the entire time. And so they're learning they are really learning from you as the therapist, how to support their child, the rest of the week, until you're back working with them again, the same is true for students who you know, for instance, are nonverbal. With AAC devices, the most powerful thing that you can do is to really train that person who supports them throughout their day, because you're as the SLP, you're in and out, and you might get 15 minutes, 30 minutes with them once a week. So the power of that through teletherapy is really amplified, I think, as opposed to sometimes in-person services where you don't always get that person who's really with you through the whole session and learning. So there's no, I'm hoping, I think we're always looking for anything positive may be to come out of the pandemic, I'm hopeful that there will be much more funding toward research in the area of teletherapy. Because of course, it really is impacting all of us and children across, you know, all kinds of areas of support. So I really look forward to seeing the future of research.
Jayson Davies
Absolutely. And I, I'm not in research, I don't know the answers, but I'm sure that there were some studies that went digital, and they're probably already has been some funding that has gone into it. And people couldn't research in person. So maybe they decided to do their research on Zoom or on another platform. And I think Tasha, you acknowledge, you know, it does take time, they say there's a 17-year gap between the research and things getting into practice. And you know, that's not the time it takes for a research study to be published. But still, it does take time from when the data is collected, to going through all the analysis, the writing, and to publish date. And so some of those research that might have happened in 2020 2021, we might not get to actually see it until 2024, potentially, because it does take that time to do all the analysis and write up so yeah, that's great. I'm really looking forward to it. Kristin, you mentioned both of you actually mentioned the coaching model. And that's the one research article that I'm most familiar with, I think it was coaching with children with ASD, I believe. And yeah, they did find success. And that primary piece was really coaching the parents. And that moves us from a position of one to one therapy to one to two in a week, because we're now talking to both the student and the primary care provider, which agree with everything you say, Kristin, because now that primary care provider is going to be using those strategies that we give them every hour of every day, not just for one hour of therapy. So 100% agree, and hopefully, we do see more research that comes out backing that up. That'd be great. All right. So one talk about teletherapy. Going forward, we kind of talked about some research, and we talked a little bit about what we're hoping to see but I want to get your take on where you see teletherapy going. Obviously, the internet is changing. We have Facebook changing their name to Meta because they believe in the meta-universe. We have Nike going to start selling shoes that are digital for characters and video games. How do you see all of this virtual reality augmented reality potentially changing teletherapy as we move into the future? I don't know who wants to take this one first?
Kristin Martinez
Well, I will I will start and I'll let Tasha speak to it. Yeah, I think I think there's no going back. I think we know though, those who may have thought that this was a fad of some sort. I think we've pretty much dispelled that. And yes, the need is there. And also because when it's done when teletherapy has done well with fidelity, it is effective. And students, our students, adults, you know, are getting the services that they need, you know, teletherapy was born because of out of a need for access and equity, and that is still a significant problem across our country, in the world. But, you know, our focus as a company is in the United States, k 12 services. And there are significant differences in the services students are receiving depending on their geography, and that just shouldn't be. So that is the initial reason. That's why we are passionate about teletherapy, Tasha, and me because we have the opportunity to affect that and to reach students. So, fortunately, the technology is just getting better. I did you mentioned virtual reality, we did a brief partnership, kind of a pilot with a VR company that's doing some awesome stuff with kids with autism. So I think there's going to just be incredible things on that front, integrating virtual reality for some students. And, you know, I think that it's just going to be a hybrid approach, there will always be a place for, you know, in-person services. But there also needs to be an equal place for teletherapy support. And the more you know, we have some really incredible school partners, special education directors who are just incredibly innovative, they have been pushing teletherapy, and the integration to solve so many problems, you know, anywhere from again, students who were underserved because of where they lived, all the way over to just the time that their staff is spending driving, you know, in some of these rural areas, driving hours and hours each week, just trying to reach to students who might be in, you know, one building. So there are so many areas where, again, if we are using the knowledge we have accessing the experience of those of us who've been now doing this for a number of years, it's just going to expand and we're going to see, you know, I think the the the implementation being just standard, where it's not, you know, people ask me a lot, well, this is just for rural schools, right, or this is just for now, we're everywhere, we are in very large districts where they just they don't have enough staff to cover, they can never keep enough people on staff, rural areas, suburban, charter schools, private schools, virtual schools. So the need is just well established. So I think it is, you know, Tasha, and I get to be part of a company that is looking to be innovative, and really on the cutting edge of what we can provide to support students and in reality everyone who can benefit from teletherapy.
Jayson Davies
Absolutely. And Tasha, do you want to add anything to that about where you see teletherapy going?
Tasha Holmes
Sure, I think that not only will teletherapy, because right now we're looking at using teletherapy, for skill acquisition, and for rehabilitation, I think that it will be used more for wellness, there seems to be a very big mental shift, where people are realizing that wellness is a thing. And we need to be preventative versus reactive. So I think that that's really teletherapy is going to assist with that. I think teletherapy will be a specialty, think it will not just because it is a service modality, but it is also a specialty and I think that it will be more recognized as a specialty, versus just one of the other tools that we pull out of our tool bag. But more importantly, the sociologist in me is very excited about what this is going to do. I feel like for the world because if you think about it, telehealth is connecting people who might not other I mean, these are people who don't live in your community, these are people you probably wouldn't have run into at the grocery store, people you would have never had a reason to interact with. And so you know, it's really, um, transcending cultural boundaries, racial boundaries, religious boundaries, a lot of different things where I think that certainly in this, you know, time and age, we need those things. And then I also really think that in terms of just our profession, I think it's really going to help with the OT profession. You know, we do get pigeonholed a lot for the handwriting teachers, or we're the people who help people get dressed. But I think that you know, OT and mental health, I think that people are going to really realize that not only are we qualified for mental health, but we can deliver those things to telehealth services. And I think that as the world shifts more into technology, for us, as OTs, we're really going to be the ones where we're saying, hey, telehealth is excellent. But let me connect some of these dots for you. These are the things that you're missing because you're using technology for these different, you know, activities. And this is how we can bridge the gap. And we can also bridge this gap by using telehealth. And so I think that that kind of ironic line of thinking will really help our profession because we know those components skills that you need in order to be successful in other occupations. Whereas you know, tech Knology is replacing the acquisition of some of those components skills. But we can certainly use telehealth to help with that skill acquisition and to bridge those skill gaps. So I'm very excited for that about what it's going to do, you know, for our profession as well.
Jayson Davies
Yeah, I agree, I think there's going to be a lot of great news coming out of the teletherapy. side, and a lot of like, we talked about earlier research. Alright, I want to ask you a question. I don't know, one of you, I probably only need an answer from one of you. But there is a shift right now, as you know, I think both speech therapy and I know OT, you have to be licensed right now in the state that you are living in, as well as the state that the client is in. Now, I know, there's some change on that front. And I don't know exactly how speech pathology works. But Tasha, what do you know about that? And what updates are there? Do you know those?
Tasha Holmes
Yes, so during the pandemic, there were several different states or even just, you know, DC, which is not a state, which maybe will be you know, and sometime in the future, where they became a little bit more lacks in terms of being licensed in that particular state in order to provide services. And that was temporary due to the pandemic. However, you know, speech is also trying to, you know, pass their compact license legislature, as well as what we are trying to do for OTs, which will help people to get services faster. And so with having to have licenses for where you are located, and also where you're providing services, that legislation with the compact licenses certainly will make it easier and will propel further propel telehealth, you know, forward, there are also states that do recognize so you know, you have the military clause in some states where if you are a military spouse, or you are in the military, you can have your licenses expedited. So that way you're able to practice in another particular state, and you know, myself who was a military wife, that is definitely going those laws there to looking at those they assist, but they don't necessarily help if you're in transition between two different states. So certainly the legislature being supported by practitioners is really what's going to help us, you know, for both professions overall, but specifically telehealth.
Jayson Davies
Yeah. And it sounds like an OTs is making decent progress on that. I feel like a few states have already jumped on to the compact and only need to find out more, nine out of 10,
Tasha Holmes
nine out of 10. And ironically, DC has not signed on, so I'm an hour. So like I always thought I'm like, I need to just drive to there, you know, DC OT meeting and say, hey, look, I'm supporting you being a state. Let's, you know, let's get this in there. So you know, if there's anybody in your listeners who are, you know, in the DC chapter of T, like, let's get this question. Maryland's on board, Virginia's on board, so we have both, you know, bordering the bordering states.
Jayson Davies
Awesome. Alright. So before we wrap up today, we have two more questions, I think. And the first one is a really light-hearted fun one, I would like you each to share one big success story that you've had with teletherapy with a kid that you've had, maybe it's even a provider that you had a success story with or a parent, but I'd love for you each to share a success story that you have that that's a good memory for you.
Tasha Holmes
So I have this one student who was completely adorable when I first met her, she would bark at me. She's very poor. She was on the spectrum, very poor social skills, anxiety, very poor, fine motor skills, double vision, a lot of different things. And so fast forward to like three years later, and she's building like Lego firehouses, you know, without a model structure because her visual perceptual skills or visual-motor or fine motor is better. She told her grandmother Finally she liked to write, she started writing in a journal, she said, finally I can write about my life. And she's writing in her journal, she's writing on the line with correct spacing, it's legible. And she's not only gone from working at me through every session, to texting me on the weekend, hey, look what I did in karate. They're sending me pictures. They like knitted me socks and mailed to my house. And, you know, they lived you, you know, very far up in Washington. And at that point I was living in I was in North Carolina, but then I was also living in Oregon. And so that, you know, was a family I would have never run into and, you know, I had such a close bond with them. And it's, you know, they're texting me on, you know, the holidays and different things like that. And so that was a huge success story for me, to see her from the point of evaluation to the point of discharge and to see not only how well she was doing in school, but the fact that she had more confidence that she started to make friends outside the home and different things like that and that just so heartwarming to me.
Jayson Davies
That's awesome. It's always nice to have good stories that just make us feel better to get us through those tough days. So, Kristin, what about you?
Kristin Martinez
Yeah, so, you know, I would not have stayed the teletherapy. If I didn't feel that I was being effective I was able to address goals. So I, you know, I have lots of students I can think of where, you know, they just made great progress. And it was so exciting. But I have to say one of the first experiences I had that, again, kind of hooked me, was with a kindergartener, and again, I'm in Colorado, I was unlicensed, was licensed in Oregon. So I was working for school districts in Oregon. And I think my first my first concern, I think, starting in teletherapy, is that I would not have those connections with my students, I wouldn't have that same. Just we get to know each other, we feel, you know, because that's so much of that effectiveness is, of course, your skill as a clinician, but also just that buy-in, and then, you know, being motivated to work do work for you. So again, a kindergartener, he was pretty severely Praxis. And so it was, it was challenging, but you know, it was really wonderful working with him. But it really hit me that after working together for about three months, he invited me to his birthday party, which, you know, we had to talk about the fact that we were 1500 miles apart. But it was just, you know, I felt like, I can still, I can still have that peace, I'm still able to connect, even though there's this screen, but it really wasn't a divide. So that was just meaningful, not a clinical story. But just more about, I think the effectiveness and the ability to still connect with whoever you're working with. On the other side,
Jayson Davies
I completely will second that, because I did a short stint of teletherapy. And I completed it at the end of the school year, and I didn't come back at the beginning of the next school year. And part of the reason I didn't come back, was I had a whole new caseload. And I had built connections with some of those students. And I kind of missed some of the students that I was working with. And even though they were hundreds of miles away, I was only working with kids in California. But even though they're 100 miles away, like you still build that bond was not just not with just the kid, but with the family. And you really do build that bond. So I agree with you that that's very, it's very awesome that we're able to do that. And not even just do teletherapy. I mean, we can have conversations. I don't even know Tasha, you said you're an hour outside of DC. Kristin, I don't even know where you're calling in from.
Kristin Martinez
I'm in Colorado,
Jayson Davies
Colorado. Okay. But yeah, so it's just amazing that we can do this with technology. Well, I want to say thank you so much for coming on here. And I also want to ask Kristin, where can people go to either a learn more about potentially being a clinician for presidents learning, or even if they're thinking, hey, you know, what, my district might really need this, you know, we're struggling, and we're still doing teletherapy, or even, they're just doing great, but maybe they need a little more support? Where can they go to learn more?
Kristin Martinez
So the best place is just to go to our website presencelearning.com. And you can if, regardless of whether you're an individual therapist looking potentially for work, or if you're interested in a platform that you need to use, or if it's a district, yes, looking for services, all the links are there. So it's pretty easy to navigate the website. And, you know, you can request to speak with the recruiter, if you're interested in working with us, or talk with one of our, you know, sales representatives, if you're, you know, looking for services for a school district. And we do live demos, and you know, there's just a lot of great information. There's also just a ton of information on our website, there's a lot of videos that you can watch, you know, kind of services and activities. You know, there's a whole blog section that both Tasha and I have contributed to so lots of information, even just on the website itself.
Jayson Davies
Yeah, I think you guys even have some, like professional development type of videos, I don't know if you actually get professional development for watching them. But you have videos with specialists and whatnot, that really, that really share some great information. So be sure to check out presencelearning.com, the link will be in the show notes. So be sure to check that out and go over there if you're interested in learning more. Well, Tasha and Kristin, thank you so much for coming to the show. I really appreciate having you here. And we will definitely have to keep in touch about the future of teletherapy.
Tasha Holmes
Absolutely.
Kristin Martinez
All right. Thank you, Jayson. Great talking to you.
Jayson Davies
Take care. Bye-bye.
Tasha Holmes
All right, bye.
Kristin Martinez
Bye.
Jayson Davies
Oh, right. And that is going to wrap up our episode for today. Thank you so much to Kristin Martinez and Tasha Holmes for coming on and sharing all their knowledge and experiences with teletherapy and presencelearning.com Especially when they shared their biggest wins and their biggest, biggest success stories right there at the end. It's always nice to see how people can make a big change to go from traditional in-person therapy to a more I don't want to call it modern but a new way with teletherapy and as they call it a new model and potential Even a specialization in the future, how they made that transition and were able to succeed in that. I think they are spot on with using more of a coaching model potentially going forward. That is going to be a big game-changer when we are able to support especially the guardians and the parents and working with their child, big success stories whenever you're able to use that type of model in my opinion. Thank you everyone for listening. I hope this has been a great commute for you or a great workout, whatever you've been doing while listening to this episode, even if it is just cleaning the house. I hope you had a good time listening in and I'll see you next time on the OT Schoolhouse podcast. Take care. Bye.
Amazing Narrator
Thank you for listening to the OT Schoolhouse podcast. For more ways to help you and your students succeed right now, head on over to otschoolhouse.com Until next time, class is dismissed.
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