Establishing Instructional Control via Teletherapy

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Using Technology During Your Sessions with Learners with Behavior Challenges

Instructional Control.  Not as bad as it sounds, I promise.  Truth is, in most cases we all want and need it.  When a speaker is standing in front of the room and the audience is quiet: control.  See…not as bad as it sounds.

But how about the therapist that needs it so that a skilled learning (acquisition or fluency) can take place and the therapist cannot use his or her hands?  By this, what if the behavior of noncompliance is present and the session is via teletherapy or over the web?  What is a well-meaning therapist to do?  You’d do the same, with some variation, as if the child is in front of you.  That is, if you take the perspective that instructional control is about presence or owning the room in such a way that yelling or holding become completely unnecessary because YOU, therapist, have the floor.

Today I worked with a student who is constantly told “NO” all day.  So by the time he has a another provider he is, at my husband would say, full of hearing the same admonishment. This particular student is classic in escape.  We’ve all met versions of him in size, color, gender, age….doesn’t want to do anything at anytime except what he’d like to do at the time.  So when he told me I was boring, I ignored him.  Recognizing that wasn’t enough for me to change. He then started doing other things with not so kind language and then plain moving away.  Could I have used a variety of reinforcers?  Of course, but for him the only effective reinforcer would be the escape.  And getting him back to task after a break would have prolonged his escape.  So here is what I did and it worked.

  1. Planned Ignoring of client’s off task language (including insults)
  2. Restatement of the Consequences when the behavior escalated to property damage (break something, your parents will pay for it).
  3. Reminder: Work First. Then Leave.  No work done.  We will sit until you are ready.  I have the next two hours free (too much language…but he needed to know I was in it for the long haul)

My voice: Firm

Client Responded to the Consequence and the Reminder.  He completed his work.  I congratulated him (even though he was still disgruntled).  I then had him survey the room and posed this question “Is the room in the same condition at the beginning of our session or messier?”.  His response: Messier.  My response: Clean up for two minutes then leave.

He complied.  I instructed the adults in the room, we were not looking for perfection but for compliance.

Here is the lesson:  Hearing NO or admonishment all day can ruin your mood BUT  it is no excuse to break, destroy, or not complete assigned tasks.  In teaching children resilience in learning and extending their ability to stay with it…we teach them communication (telling another you are annoyed or irritated) and we implement realistic situational consequences.

After cleaning for two minutes, I called him to the computer and reviewed: Come in the room. Sit Down. Get the work done. Leave.  He responded: Yes.  I then said “I’m proud of you for getting it down.  It’s over. Now go enjoy the rest of your day”.

My voice: Soft and pleasant

In the It’s Over part, we as providers teach them to understand how NOT to carry the feeling of anger.  The challenge for us is not to carry on in our case and school meetings about the student’s behavior.  (Don’t you know when you’ve been discussed and the discomfort you feel…now imagine being a child or teen).

Still looking for a well written behavior plan and some data collection…but hey, Rome was not built in a day and neither are adults.  Everybody’s learning 🙂

Let’s THRIVE!

~Landria, SLP Guru

 

Teletherapy

The American Speech Language Hearing Association (ASHA) defines teletherapy as  “the application of telecommunications technology to delivery of professional services at a distance by linking clinician to client, or clinician to clinician, for assessment, intervention, and/or consultation.”

I started using teletherapy when I was the Executive Director of SLC Therapy.   With this medium, our clients didn’t have to leave their homes, but can tune into their therapists and receive intervention via the web.  We used teletherapy with a select few clients over the last year with a range of diagnosis (ASD, speech delay, and language impairment) to develop a protocol, get creative about our reinforcers, and compare the progress of the same child seen in the clinic vs. teletherapy.  Our biggest question was: Did progress stop when the client changed from center based to teletherapy.

HERE ARE MY RESULTS:

1. When teletherapy was initiated, two of the four clients were on the road to dismissal of services due to progress. Those two clients were able to be dismissed earlier as the home practic component became more intensified.

2. Parents were our parents in a more meaningful way.  We even made video samples of prompting, homework samples, etc. so that generalization could skillfully be applied by parents.

3. Social communication therapy can be very cool via web therapy.  Both from the therapist perspective and the client perspective.

4. Our families were less stressed about getting to therapy!  This was huge, especially during the winter months, client illness, etc.  Our clients were ready for therapy and rescheduling was very easy.  We found that this therapy fit into the family schedule a bit easier.

5. Private schools were open to this option as it allowed for better teacher and para collaboration.

6. Providing ABA Therapy via teletherapy can be done.  Creating the programs, implementing, and using the parent as our partner has been wonderful.  It’s great to see a child who could not wave and say hello with fluency do it quite readily with us on the web and generalize it to his home environment.

7. It placed parents in a better position of power and partnership.

8. Clients still made progress, 30 minute sessions 2x per week for mild- mildly moderate impairments.  Mild: 1x per week with home program component.

9. Most families already had a webcam and skype account.  Our skype account (business account) is secure, and we were able to provide this using with no additional cost to our clients.  And now this is not the medium I utilize for teletherapy as there are many other options.

To begin in teletherapy as any other therapy, an assessment, evaluation, or consultation is conducted.  Treatment plans are still created.  In addition, we complete a mock session in which a client eligibility form is completed to determine if they are ready for teletherapy.

As I watched weather reports and hear of clinics closing, client’s not being seen due to weather and travel concerns, I smile because I know many would benefit from losing the hustle and bustle of getting to therapy and would say “yes” to WebTherapy or Teletherapy.

For more information about Teletherapy, visit:

American Telemedicine Association:  http://www.americantelemed.org/i4a/pages/index.cfm?pageid=1

American Speech Language Hearing Association Position Statement:   http://www.asha.org/practice/telepractice/

http://www.asha.org/Publications/leader/2006/060815/060815f.htm

http://www.asha.org/Publications/leader/2002/020611/f020611_2/

http://www.hrsa.gov/telehealth/publications.htm

Enjoy and Be Empowered!  (Maybe I will see you via teletherapy).

Landria Seals Green, M.A., CCC-SLP