Adventures in Online Occupational Therapy by Alison Durocher

**** Editors Note- Alison Durocher is a featured contributor to Texhoma Teacher and a
Professional Occupational Therapist with experience working with people in person and online.
Texhoma Teacher appreciates her contributions to the blog as they provide a different perspective.
Her articles are being published under this username until I can figure out how to move it
directly to a username of her own. This article will be updated when that change occurs. ****

My career as an Occupational Therapist has been one of constant transition. The nature of my spouse’s work means that we relocate about every 2 years. This translates to many, many different positions for me. I have worked in hospitals with multi-disciplinary teams, in schools and in homes. I have worked in urban settings and rural settings, from the largest city in Canada to a town of 15,000, three-and-a-half hours from civilization. I have worked where there are almost 100 OTs to where there are 4. Recently, I even volunteered in India for several months to experience occupational therapy outside of North America. As you can imagine, starting over every time becomes exhausting after a while. So, when I saw an opportunity to provide Occupational Therapy services online, I figured I needed to check it out! Occupational therapy services online… How does that work, you say? Well, I had no idea either! And so this year I began my adventure! As with any job, there are aspects I love and aspects that are very frustrating. So here’s my summary of ‘the good, the bad, and the ugly’!

The Good
As an online therapist, I get to work from anywhere! As long as I have a good Internet connection, I can work. It allows me to maintain the same caseload of schools, no matter where in the world I am living or traveling.

It allows for consistent service to rural and remote areas that might not otherwise have regular access to speech and occupational therapy services. As long as the school has a decent computer and a DSL connection, we can make it work! Some students respond very well to having their therapist on the computer. For students with autism spectrum disorder (ASD), we know that they often respond better to an image on a screen, than to a person in the same room.

Online therapy also allows me to easily show videos, play interactive games, and record parts of sessions to show parents and teachers later.

The Bad (The less good?)
As I am not physically present in the school, it is more challenging to develop rapport and relationships with the students and staff. I also must rely on school staff to print out worksheets and assessments and have materials ready for my sessions. This is more work for the staff than if I was there in person. Of course, some creative teachers have given me access to their networked printers, which allows me to print materials from my house to their printers! Very cool stuff!

Because I cannot provide hand-over-hand support, I have to rely on the aides (eHelpers) to provide additional support and modeling. This is an exercise in ‘brain gymnastics’ for me. I have never had to talk someone through assisting a child with fine motor tasks, without being able to model directly with the child. While my directions seem very clear to me, apparently they can be open for interpretation! If nothing else, OTs are experts in task analysis, so sometimes I just have to take a step back and start from the beginning, this time explaining it differently.

The Ugly
Online therapy or telepractice, relies on technology. It’s great when it works, but it’s frustrating when it doesn’t. Sometimes connections are slow, or the child moves out of the view of the webcam, or the webcam freezes, or the headset stops working, or my favorite… There is an Internet outage in my city or theirs! Of course, many of these technical issues can be resolved and you become more proficient at troubleshooting as time goes on. But that doesn’t mean that you won’t sometimes be rolling out theraputty with the child and have to ask the eHelper to describe what the child is doing, because their video is frozen.


Final Thoughts
Overall, I would still rather be practicing in person, but when that is not possible online therapy is a good alternative. Ideally, I would teleport myself to all of the locations on my caseload, but technology isn’t quite there yet… and I don’t really want to find out what a teleportation glitch looks like! When everything is working smoothly and I have an attentive eHelper, it doesn’t feel that different than practicing in person. When the teacher steps out of the room for a minute and the child decides to hide under the desk… that’s when we have to get creative! It’s an adventure for sure, but a rewarding one. As technology improves, it’s an option that will only get better and better. Having seen firsthand the lack of service available to some remote and rural communities, I am very hopeful that online therapy becomes a more popular option.


So, what do you think? Do you want to come on the adventure with me?

A Reflection on Chapter 3...

Fialka, J. M., Mikus, K. C., & Feldman, A. K. (2012). Parents and Professionals Partnering for Children with Disabilities: A Dance that Matters. Corwin, A SAGE Publications Company.

    Getting behind in work, is always a challenge especially when your 5 month old is the reason.  My son has been under the weather for the last several days, and is just now getting back to feeling better.  That of course has put me behind in my classes. (Sorry Dr. Balderaz, I am trying the best I can.)  So as we begin to explore Chapter 3 of the reading, I am reminded about how parents, work and have lives outside of meetings.  I am also reminded that everyone needs to be a little more understanding on the roadblocks and obstacles we face in our everyday lives. 

    Being a parent for only 5 months, I have had to learn a great deal about young children.  Being a teacher has helped some, but a baptism by fire is the best description.  I really think that this experience has helped me understand a little more of what parents go through, especially when they want to help their child. 

    Chapter 3, provides a number of suggestions for both parents and professionals to help build a team that is able to provide the needed supports the child requires.  What this chapter provides is a set of guidelines each side should have when they are coming together with others to work on the issues the child and family face.   While many of these guidelines seem to be common sense, I have found that many times when people are scared, unsure, nervous, that a simple reminder of some of the guidelines are helpful to help keep the focus on the problem and the task.  It is also a good way for both parents and professionals to seek a common ground.  

    The first part of Chapter 3, deals with the guidelines that parents need when dealing with professionals, and the second part of Chapter 3 deals with the guidelines Professionals need when dealing with parents.   One important aspect of the relationship roles, is that I expect Professionals to be more understanding of the needs of parents than they seem to be portrayed.  What I mean by that statement is, that as a Teacher, I do a lot more "Dancing" than the parents do, with a variety of different partners.  I think that a seasoned teacher should be setting the example for other less experienced teachers.  For me, I was very fortunate that when I entered in to Special Education, I had a great group of ladies who were willing to help me as I got started and continue to this day to be a resource that I can draw upon. 

   (Page 97) Reflections, "As I review this list the three that caught my attention are"

1. Communicate
2. Read Carefully
3. Learn

The 3 guidelines I chose, are the ones, that I want the parents of my students to focus on.  I really think that each one of these components can help build a better relationship with the team as a whole and will also, prevent some uncomfortable meetings.   

     I would like to take take this one step further.  While each of those three elements I think are important, they are not the only elements that a parent should focus on.   I would encourage my parents to also to make documentation a habit.   I also would like parents to really ask questions about how to document. I would also like them to seek out information about what is going on with their child from some reputable sources.   I would also like to see parents show up to some of the workshops that the district puts on to help educate parents.  I want to see my parents more than once a year at an IEP meeting and I want to talk to them more than when there is a problem.  

(Page 100) How does the reframing of "in denial" impact your thinking about what families might experience?"

   I agree that the words "in denial" are poorly chosen.  I think the book is correct to point out that in disagreement is a better term to be used.  As I write this blog, I think of my former teachers, and their views of me when I was young student labeled as "Learning Disabled" well before I was diagnosed with Aspergers in college.  I also think of what my parents must have thought about what those professionals said and thought about my abilities.   I think that no one ever expected me to be an over achiever.  I certainly never had the grades my younger brother did.  To include college grades.  When I reflect on what I have accomplished in education and life I have shattered a lot of views of my abilities.  However it took a great deal of work on my part.   I think what both sides need to consider is what are realistic goals.  Early childhood intervention is a good thing.  I also think that we need to be setting goals that provide rigor and are challenging, but not impossible.   I also think that we need to also start to address transition early on.  I know that IDEA mandates that we address secondary transition by 16, however I am of the opinion that if you are waiting that long, you are not doing anyone any favors.  I think secondary transition should begin with the first IEP.   I also think that as the book states, that many of the goals should include input from the student.  As a student matures, and gets older, they should be not only informed of what is going on with their education, but they need to be team members who have a say in their outcome.  They are the one who are going to deal with the disability for the rest of their life, we need to be teaching them now how to make others "dance" with them.  

(page 103) "Name two other strategies you can use to promote partnerships."

1. Refrain from using Jargon.
2. Strive to learn about the parents as a person.

I think that we as professionals use Jargon to often with parents as we use it all the time with our peers and co-workers.  I think in many cases that can lead to a sense of making parents feel uneducated, and intimidates them.  I think that parents also are afraid to ask for explanations.   I think that when we prepare ourselves for meetings, we should be working from an outline of how to make the meeting progress.  (This is what I do in any meeting)  When I use an outline, I look at it like a script that I have things planned out, and it helps me avoid talking over the head of everyone in the meeting.   I also think that too many times, we as professionals don't try to learn about the parents.  I think the nature of being an overworked teacher with so many students on our case load makes this worse.  I also think that in some ways, parents also don't want to run into us either.  In the high school setting where I teach, I have very few parents come in for open  house, or parent teacher conferences.  Those parents that do come in, are the ones I have the best relationship with and are the ones, I really don't need to see.  I think that when we have IEP meeting, we need to set around some time to talk about something other than the meeting.  I think that will also help set the stage for a good open conversation and I think it will help put everyone at a more relaxed mood.

(Page 106)  "What strikes you as important to remember when meetings are beginning?"

I think all the suggestions in the book are good ideas, but I will admit I won't use all of them.  I will tailor my meetings to the dynamics of the group, and the relationship I have with the parents.   If I were to pick one of the suggestions as being the one I would concentrate on the most, it would be to create an environment that is welcoming to the parents and their child.  I think that will do more to set a good tone for the meeting than anything else.   I think that this is best done, with my approach of using an outline of the meeting. (This is also good, so I don't forget anything during the meeting if we get a bit side tracked.)  

(Page 108) "One thing I want to remember about beginning and ending meetings is."

From the reading it would be to encourage parents to follow up with any questions concerns after the meeting.   One thing I did not see in the book that I think should be is for professionals to be respectful of the time parents spend in meetings.  We are paid to be at the meetings they are not.  In many cases, parents have to take off work, to attend meetings.  That is why, when we plan meetings, we need to be accommodating to parents schedule, but we also need to make sure that all of the people who need to be at the meeting are at the meeting. 

AUTHORS NOTE TO READERS:
The posts in this series are for credit in my Masters Program at the University of Texas of the Permian Basin.

A Reflection on Reading, Chapter 2

Fialka, J. M., Mikus, K. C., & Feldman, A. K. (2012). Parents and Professionals Partnering for Children with Disabilities: A Dance that Matters. Corwin, A SAGE Publications Company.

      Continuing in my series on Children with Disabilities: A Dance that Matters,  I am going to reflect on Chapter 2.  While chapter 1 one offers a look at a dance and how people interact, Chapter 2 is like a play.  I get the sense the author wants the reader to see each interaction between the parents and the professional as independent scenes of an ongoing production.

  Reading through Chapter 2, I begin to see that each side shares a lot of the same concerns and apprehensions.  Each trying to hide from the other what is going on, as to avoid showing fear or weakness.  From the parents perspective, they not only have to put on a brave face for the professional but also their child whom they have a deep amount of concerns for. This adds a great deal of stress from the self-doubt that the parents have because of the lack understanding and inability to help their child without going to a professional.   For the professional, the brave face is to reinforce to outsiders that they are knowledgeable in the area.  The professional also has a great deal of fear, because they want to be sensitive to the needs of the family but this is after all an awkward time for them.    The ideas portion after each scene is great as it really puts into perspective what is going on.  In many ways, these are really rules or guidelines that should be in place but not really taught.  I would venture to say, that one of the downfalls of our society being so digital today, is that we are losing our abilities to interact with each other on a personal basis.  We are losing our understanding of how to communicate our needs and build that personal relationship with a service provider.   Below are my reflections to the two case studies presented in Chapter 2.

My Reflection on Sam. "As you read the Story of Sam, What feelings did you experience? What do you hope to remember and use as you build a partnership?"
     I think one of the issues that we face as professionals in education is that when we address parents in the role of parents we take time to digest and review the data we collect before we discuss what that data with the parents.   This is something that parents can find very frustrating.  I can understand why.  If we take our child to the Dr. because of medical issue, we start working on a treatment immediately.  If our child gets a surgery, we wait for the Dr. to come out and talk to us about that surgery and how it went. Something is done immediately.  We aren't left to wait and wonder the results.  I think that the challenge here for many is between physical issues that we can see, and neurological issues we cannot.  What I hope to remember is how to open up a dialogue with parents that treats them as a partner in their son's education.

My Reflection on Rachel. "As you read the Story of Rachel, What feelings did you experience? What do you hope to remember and use as you build a partnership?"
 Unlike Sam, Rachel's parents are familiar with the school and the people working in it.  I think that you also have a situation here where the parents have dealt with issues of being parents before and are more seasoned to address the issues they are facing.   I feel for the parents in both the cases of Sam and Rachel, as it is heartbreaking for any parent to deal with these issues.  I think in this case, the parents are wanting to make sure that their daughter gets the best services in the least restrictive environment.  I also think that they want to protect her from the negative aspects of being labeled as being a special needs student, as that term holds a stigma that can stigmatize young people among their peers, and the peers of their siblings.   What I hope to remember from this case, is that we are not just dealing with the individual, but we need to address the concerns of the entire family.

AUTHORS NOTE TO READERS:
The posts in this series are for credit in my Masters Program at the University of Texas of the Permian Basin.

SPED Law.... Wrightslaw: Special Education law

Wright, P. W., & Wright, P. D. (2014). Wrightslaw: special education law. Hartfield, VA: Harbor House Law Press, Inc.

      I am not a Lawyer, and I am not giving any legal advice here.  I am simply tell you, the reader about information that is out there.  Several years ago, I had the opportunity to attend a workshop put on by the Oklahoma Disability Law Center, about Special Education law.  The workshop, which only lasted a day, taught me more about being an advocate than my previous years of being a teacher.  

     One of the the books, that I received at this workshop and was taught to use was the book pictured to the left.  One of the interesting things about this workshop is that they taught me how to use the book to find the answers, instead of spoon feeding me the answers to my questions.  The old adage of "Give a man a fish, you feed him for a day, teach a man to fish and you feed him for a lifetime" is the the approach that was taken.

      About 3 years later I again had the opportunity to attend the same workshop.  With my previous experience, I was more than excited about attending. ( I am the type of guy who can watch a movie, or read a book over and over again and still enjoy it as if it is the first time.)  What I found was the second time I attended the workshop, I learned so much more than the first time.  It was a great experience because, even though I had been introduced to the material, the refresher of what I knew, and my further experience allowed me to understand more of what was going on in the class. 

      Some of what I tell parents and fellow teachers is that you should seek out training such as the Wrights Law workshop.  It is a great tool to help you understand the rights of a Child in education.  Further, I also recommend that everyone get a copy of Peter Wright's book and the Updates. It is a book that is a great reference for parents, advocates, teachers and others.  More importunately, you need to be taking notes in the book about what you are looking up.  This will help you ask the right questions in meetings. 

     Peter Wright, also has a number of other books on the market that are there to help parents and professional provide the required services for children.  If you are able you should add them all to your library.  This may not be possible, so if I have have to recommend a single book for you to get it is this one. It has a number of resources in the back, as well as a fairly comprehensive glossary of terms. 

     As to the layout of this book, it is not like a novel.  It is more like a law book, because that is what it is.  You need to understand that the book is the Law, and as such, a lot of the good information is in the footnotes, and the commentary section.  This information doesn't appear in the law available online. 

     As always, I want to include a few links to give you some other places to go for information.

General

http://www.wrightslaw.com

https://www2.ed.gov/about/offices/list/osers/osep/index.html

https://sites.ed.gov/idea/

http://specialedlaw.blogs.com/

http://specialeducationlawblog.blogspot.com/

https://scholar.google.com/

http://www.scotusblog.com/

Oklahoma Specific

http://www.okdlc.org/

http://sde.ok.gov/sde/special-education

https://www.oscn.net

Texas Specific

https://www.disabilityrightstx.org/

http://tea.texas.gov/Academics/Special_Student_Populations/Special_Education/Special_Education/

CNMI Specific

http://www.nmpasi.org/

http://www.cnmipss.org