Teletherapy Tips for SLPs

We are going to be talking all about teletherapy tips for SLPs in this episode! I cover all things teletherapy with special guest, Stacey Pfaff. Tune in below to learn about teletherapy FAQs, tech troubleshooting, behavior management, work-life balance, and much more. Additionally, this extra special episode is part of the SLP Connect Podconference. So, be sure to listen to the very end where you can hear all of the details about how you can earn CEUs by listening to this podcast!

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Full Transcript of Podcast: Teletherapy Tips for SLPs

Episode 70: Teletherapy Tips for SLPs

Jessica Cassity: You're listening to the Speech Space Podcast, a podcast full of tips and resources for SLPs. I'm your host, Jessica Cassity, and this is Episode 70. Hey, there everybody! Welcome to the show. This is going to be a little bit different than usual because this is being recorded as part of the SLP Connect POD Conference. And today we are going to be talking all about teletherapy. So make sure that you stay on until the end, so you can hear all of the details about how you can earn CEUs by listening to this episode. This is just a temporary thing where you can earn CEUs. So make sure that you listen at the end for the details to see if you're eligible to earn CEUs by listening. Before we get started, I wanted to take a moment to introduce myself and let you know a little bit about my guest who will be joining us on the show today to talk about teletherapy. If this is your first time tuning into the podcast, my name is Jessica, and I received my Bachelor's Degree in Communication Sciences & Disorders from the University of Pittsburgh. And I graduated from Northeastern University with a Master's in Speech-Language Pathology. I've worked with both the pediatric and adult populations. I've also worked in private practice, schools, skilled nursing, and hospital settings as well. I am the owner of The Digital SLP membership site, which contains a library of engaging digital resources that are teletherapy platform-friendly. And I'm also the host and creator of the Speech Space Podcast. In terms of any financial disclaimers, I just did want to say that I am the owner of The Digital SLP membership site, and I do receive a salary from my sales on that site. I also receive a percentage of any sales that are made in my Teachers Pay Teachers store, and I do not have any non-financial relationships related to the content of this course to disclose. So let me go ahead and tell you a little bit about Stacey. Stacey Pfaff has been a speech-language pathologist for 15 years. She spent 10 years working as a school-based SLP, working in early intervention and with students in K-12th grade. Stacey's in her fourth year working as a full-time teletherapist for a virtual academy. And she is the author over at My Teletherapy Room where she shares her teletherapy journeys, speech materials she creates, and tips and tricks for anyone looking to move into teletherapy. In terms of financial disclosures, Stacey is not being reimbursed for participating in this interview. However, she does receive royalties for any products of hers that are purchased in her TpT store. All right. So let's go ahead and bring Stacey on the show and get started. Hey Stacey, thank you so much for coming on the show today.

Stacey Pfaff: Thanks for having me. I'm excited to be here.

Jessica Cassity: Yeah, I'm very excited. I know teletherapy is kind of a hot topic right now.

Stacey Pfaff:  It sure is.

Jessica Cassity: Yeah. Yeah. So I'm excited to talk all about it and I would love it if you could just give a little bit of background about you and your experience with teletherapy.

Stacey Pfaff: Yeah, absolutely. So I am on my fourth year of teletherapy. I have worked full-time just with a company that provides virtual services and teletherapy services to students who are homeschooled or come to school in a virtual academy. During that time, I have just really fell in love with the service delivery model. And from there, I started the blog over at My Teletherapy Room and also started creating some no print therapy materials that you can use in your sessions and your teletherapy sessions. And just continue to collaborate with speech pathologists all around the world who share the same passion of speech therapy in a virtual setting.

Jessica Cassity: That's awesome. Now I'd like to talk a little bit about how things have been changing in the world of teletherapy, because I know this is kind of something that, you know, you chose to do. You said you kind of fell in love with the model, but I know that's not the case for a lot of people right now.

Stacey Pfaff: No. It's interesting because I think about speech therapy and clinical practices and they haven't changed, but certainly the service delivery models and how we implement our clinical practices to our students have really changed in the past six months. Teletherapy has been, like you said, been around for a very long time as a speech therapy treatment model, but a lot of people really didn't hear about it. They maybe had certain myths in and perceptions about teletherapy, but now with the current changes in our society and how we need to reach our students and our clients, I think that teletherapy is in the spotlight. I also feel that, it's really my hope that, the more people use teletherapy as a service delivery model, as it's described really by ASHA and recognized as abut means to connect with your clients, that we're going to still continue to see the shift and focus on teletherapy and how it can really enhance our clinical practices and reach students from all over the world or in, really any particular situation. It might be a situation within your school district that you have all-traditional in-person speech therapy services, but there might be one student that would really benefit from teletherapy because they're at home and it's just going to be considered more often.

Jessica Cassity: Yeah, exactly.

Stacey Pfaff: I think it's been stressful for speech pathologists who really were pushed into teletherapy without any prior training or education and just were expected to have a very high caseload and jump right into the technology piece. It can be really overwhelming, but hopefully they've seen a lot of gains with their students and definitely worked through those challenges, too.

Jessica Cassity: Yeah, exactly. And I think you're right. I mean, I think in some capacity, teletherapy is probably here to stay for the long run. I mean, what do you, what else do you see in the future of teletherapy? What do you see happening?

Stacey Pfaff: Well, I think that, I really think school districts are going to use it as a means to reach their students, especially maybe if they kind of throw away the snow days in the winter times, they might. I've heard a lot of school districts kind of talking about moving to e-learning rather than having make-up days for missed classes just for snow days or inclement weather days where you can still get your students IEP minutes on particular situations, such as that. I feel that clinics have really, if you're in the private practice world, are really kind of taking grasp of teletherapy for clients who maybe want that extra services in addition to school-based therapy. So it's not just for kids who are in the education field, but it's also for private practice therapist, who want to expand on their business and also provide another service to families that really, really need it or are interested in and just being able to get those services in their home without having to leave.

Jessica Cassity: Yeah. Yeah, it opens a lot of doors and new possibilities.

Stacey Pfaff: Yeah, absolutely.

Jessica Cassity: Yeah. Let's move on to talking about tech a little bit. And I know we kind of touched on some of those SLPs who are maybe kind of thrown into this teletherapy game, not necessarily wanting to do it. So let's just start with some basics for those who might just be starting off with some minimum kind of tech requirements and internet speed and equipment and things like that.

Stacey Pfaff: Yeah. And I love that you say basic because when you think about teletherapy, you can get started with just a few tools, little basic tools and equipment, you know, and then you can also have a huge major set up in your office with all the gadgets and whatnot. But so starting with the basics, you will need a really an updated computer, a really good, high-speed internet connection. And when I talk about internet connection, you want to be hardwired to the wall. And so that means you're going to take a cord from your computer all the way to your internet modem, and you're not going to be using Wi-Fi. So you're going to use, that connection is going to be right there. So you don't have to have any other interference with your internet connection, in terms of the TV, if you're streaming movies or anything, you're going to just have your computer connected to the wall. And you're going to want to do a speed test with your internet connection as well. And you can go to speedtest.net and the company that I work for, and what I tell a lot of people is that you're going to run the test and you're going to get an upload speed and a download speed. So for your download speed, it's going to be 4 Mbps. And for your upload speed, it's going to be 2 Mbps. So you're going to want to start there and make sure you're really running at a good, optimal speed to run a video conferencing platform.

Jessica Cassity: And those are the minimum requirements. Is that right?

Stacey Pfaff: Yeah.

Jessica Cassity: Minimum.

Stacey Pfaff: Yes, absolutely. Do not use hotspots on cell phones if you can at all. I mean, if you can avoid it. There are some situations where we have heard of this year that you're using hotspots and cell phones, but you're going to run into a lot of frustrations with it, just being able to run your conference with your students as well. So you're going, again, a computer, high-speed internet connection. You're going to need a webcam and you can just use the one that's internally on your computer. Most updated new computers are going to have a webcam right internally. Otherwise you can also have an external webcam that you can plug into a USB port and just use it externally. So you are going to need a headset. Headsets are not required, but suggested. And here's why I highly recommend using a headset. It's going to one, filter out any background noise and allow your students to really focus on either the sounds that you're saying or any language vocabulary that you're presenting to them. It just blocks everything out. It amplifies your voice and your sound so that it just, they can hear you a lot easier and a little bit better. And I think it just has a greater impact on progress with my students. And I say that because whatever you're communicating is just delivered right into your auditory canal. And I feel just so strongly that when they hear those sounds, if you're working on articulation, that it really amplifies it and gives them a little bit more feedback when you're working with them in a session. And I just really, for attention, I think, and they also, this could be, it's kind of a behavior management tool. They love wearing their headsets. They think they're very cool. We get to wear these cool headsets. If your students, have your students wear them too. They just think it's cool. So they're more likely to attend and participate if they get to wear their headset.

Jessica Cassity: Perfect. Now you mentioned the computer and you said an updated computer. Can you elaborate on that a little bit? I know. I feel like I've read, it would be from teletherapy company, a requirement. I read that it has to be new within the past five years or something like that. Do you have a suggested recommendation for how updated a computer should be?

Stacey Pfaff: Yeah. You know, you wouldn't think that it would really matter if you have an updated computer, but I know I've had families who we just really struggled with tech issues and the minute they bought a brand new computer, everything was resolved. And so, I don't really have a specific as far as how old a computer is, but I would say definitely knowing how quickly computers change and technology change and how compatible things can be with the newer technology. I would, I would definitely say three years, if not, I need five years probably at the maximum type of a timeline. And you can really tell if your computer is starting to run slow. If you open up your web browser, or if you open up a Word document, it just seems like it's taken a little bit longer to open up. It's probably time for a new computer as well.

Jessica Cassity: Okay, great. That makes a lot of sense. What are some common tech issues that might come up during a session? And do you have any recommendations for how to avoid them or solve those problems?

Stacey Pfaff: Yeah, the most common one is that you can't hear each other. I get that frequently where you just can't hear each other. So you're going to always want to make sure that they have their audio settings set on their computer to what it needs to be within the whatever platform that they're using, make sure they know how to unmute themselves. A lot of times when you enter into your video conferencing platform you're going to be muted automatically. And so just makes sure that your clients know how to control the sound and unmuting in your platform. If they're using a headset, sometimes if you, certain platforms can be kind of tricky with when you plug your headset in and get that started with the audio. So make sure you plug the headsets in prior to initiating your session and opening up your platform. A lot of times your audio will run pretty smoothly then. So audio is one, again, video can be an issue as well, but making sure kind of the same thing as your audio, making sure you have all the video settings set up in your computer, making sure they actually have a video camera in their computer or their external webcam connected. And then the tech issues with audio and video can run and kind of be correlated with your internet connection. So running and making sure you have all those things mapped out prior to getting started will kind of eliminate a lot of those things.

Jessica Cassity: Okay, great. Now I know that I'm sure you get a lot of frequently asked questions about teletherapy. So I'm going to kind of go through a few of them that I know are asked a lot and then I'd love it if you could just chime in with any extras that you get as well. One that I get a lot is about Chromebooks. So yea or nay for teletherapy?

Stacey Pfaff: I would say nay. What happens with Chromebooks is that the only thing you can pretty much do is video conference and share the screens. So students will not be able to interact. They won't be able to control the mouse, click on things. For some reason it's just, even with specific platforms, you get a lot of connectivity issues as well. It's really glitchy when I use, when students use Chromebooks. So I would try to avoid using them. I know that Chromebooks are frequently used in a lot of settings, but I would just be an advocate for your students and your services, and just let them know that they're not compatible with a lot of platforms and that it will really inhibit participation in your sessions with your students.

Jessica Cassity: Yeah, absolutely. What about listeners who do not have a lot of interactive materials, teletherapy-friendly resources, how can they use what they have already or what they have right now in teletherapy?

Stacey Pfaff: Oh, yeah, that's a great question. So a lot of people who do start teletherapy have a very limited digital toolbox. So different ways that you can use those resources and you have to be respectful to any, you know, rules and laws, but you can use a document camera and kind of position your camera over the materials you have in person. So let's say it's a worksheet, or even it's a little game, you know, you can use those materials live by just putting it in front of a camera or on your document camera and having the students, you know, just elicit any responses you're trying to get with your students with using a document camera. Other things you can do is using the resources that the families have in their homes. And we all know that especially if you're working in early intervention, that you don't want to go to the home with all your, with a big therapy bag full of materials, you want to show the parents how they can use the things in their natural environments to facilitate communication, whatever goals you're working on. So talk to the parents prior to your sessions and get an idea of what really motivates their children in their natural environments, in their home environments, and bring those tools to your sessions and kind of do some parent coaching and have them kind of facilitate the session and be part of it using those materials.

Jessica Cassity: Yeah, that's a great idea. So for anyone who is listening, who maybe has not heard of a document camera, can you explain a little bit about what that is?

Stacey Pfaff: Yeah. It's just a camera that is not your webcam, but if when you think of it, it's like a projector onto your computer. So you'll have it outside or connected to your computer and it will cast an image onto your screen. So it's like a kind of projector that cast onto your computer.

Jessica Cassity: Yeah. Like one of those overhead projectors that they used to use that would project onto the, yeah, I'm dating myself.

Stacey Pfaff: I know, right. A lot of people will use that for assessments as well. And if we want to talk about assessments in a little bit, we can kind of elaborate on that, but it's really a great resource to have.

Jessica Cassity: Okay, sure. Another one that I get a lot, I'm sure you do as well, is what is the best way, well, actually, here's what I get a lot of is can you screen share in XYZ program or can you provide remote access and XYZ teletherapy platform? So my big overall question is what is the best way for someone to get acquainted with their specific teletherapy platform? Because the reality is that the answer is going to be different for, well, all of them you can screen share, but for remote access and for other features, it's going to be different for every teletherapy platform. So if something just because you do teletherapy doesn't mean that you're the expert on every platform. So where would you direct listeners to go to find and learn more and to get acquainted with their teletherapy platform?

Stacey Pfaff: Yeah, that's an awesome question. And I do hear that quite frequently. I would just suggest, let's say you're using Zoom or Teams. I would just go to their website and they should have like a tutorial section or an area that will show you exactly how to use all the features of their platform. That's usually the best way. Another great, and right now there's a lot of videos and tutorials out on YouTube, specifically for teletherapy, specifically for platforms and how to use them. So you can even do a YouTube search to see if you can find your answers, but most often start with the platform that you're using their website or their tech support section. And there, you should be able to find that resource really easily.

Jessica Cassity: Yeah. Because a lot of tech support has the chat now, the live chats, so you can really easily access them and just ask them any questions that you need the answers to, you know, that's their job is to get you familiar with your new platform.

Stacey Pfaff: And also just take a minute with your colleagues and play with it. You know, you'd be surprised how much you can learn by just taking just a few minutes to click on a few buttons. And you're like, oh, it worked, there we go. I figured it out on my own. So don't be afraid just to go exploring the platforms and seeing what they have to offer. I've had some new speech therapists come to me and show me tricks about different platforms that I never knew about. You know? So that's been fun, too.

Jessica Cassity: Yeah.

Stacey Pfaff: Creativity in this world.

Jessica Cassity: Yeah, yeah. And you're right. I mean, I think it can be intimidating, but just kind of jumping in sometimes and playing around with it is the best way through trial and error to really get it all figured out.

Stacey Pfaff: Yeah, absolutely.

Jessica Cassity: So what are some other FAQs that you get?

Stacey Pfaff: Well, I'm glad that you brought up the platform because that is a common question really about what type of platform to use for teletherapy. So I will maybe talk about that a little bit. I can't really recommend a specific platform. There are so many different ones out there. The most important thing is that it's really, user-friendly. Some platforms require you and won't let you use resources other than what's in that platform. And I sometimes feel that personally might be a little limiting because there are a huge plethora of resources out there, whether it's websites or different people who create them. But I really like to have access to whatever I want to use personally, in my sessions, rather than being limited to the ones that are like right in that platform. And then just making sure that you can, you have a whiteboard in the platform, you have the capacity to screen share and designate mouse control to your students and screen share and good video and audio qualities. So, and of course, making sure it's a HIPAA or FERPA compliant platform, which you're going to need to go through your districts or the private practice that you're working with, whatever, you know, the entity you're working through. So that'd be my biggest, you know, things to give you about platforms, but just take your time researching them. There are some amazing ones out there.

Jessica Cassity: Now you touched on remote access. So say someone is using a platform or they're using something that maybe wasn't designed to be a teletherapy platform, but they're in a pinch right now and they can't give remote access. What advice would you give to someone under those circumstances?

Stacey Pfaff: It's another great question. I get that as frequently as well. I am completely okay if my students don't always have the remote access to the mouse. Sometimes I prefer to do all the clicking and to do all of the typing on the whiteboard. It gives my students more opportunity to communicate and work on some of those skills that we're working on. The mouse can be a distraction sometimes in sessions. So it's not going to make or break your teletherapy sessions if they do not have mouse control and actually it can be really beneficial if you can just have a few sessions without giving them access.

Jessica Cassity: Yeah. Yeah. That makes a lot of sense. I think some kids could probably get pretty carried away with remote access.

Stacey Pfaff: Yeah. They can go a little click happy and so sometimes I have to take it back anyways. Well, I am in control, you can have it now, but in about two minutes I might take it right back. So, but it also works great for awards. You know, they get really excited if they haven't had control of the mouse and then the last four or five minutes I can give, designate that back then it works really well too.

Jessica Cassity: Now what age do you find is appropriate to start giving a remote access? Just because in terms of, you know, developmentally with mouse control.

Stacey Pfaff: You know, I don't have a specific age. It really depends on each student. I've had some young students who were kindergarten, pre-kindergarten, who did amazing on, they had touchscreen computer actually. And so in that situation, if I gave them mouse control, they just touched the screen and they did amazing with it and it was really effective and kept them engaged. And then I even have some older students who might be a little bit more involved motorically and have a hard time manipulating them all. So I think you really just need to see and make those clinical judgments individually and what you'll catch on very quickly, what works well for each student and what doesn't.

Jessica Cassity: Yeah. And I would imagine everyone's kind of developing at their own pace and some kids probably have more exposure to the computer than others.

Stacey Pfaff: Yeah. Yeah.

Jessica Cassity: Okay. What about any other FAQs that you get that we didn't touch on?

Stacey Pfaff: Well, we can talk a little bit about assessments and evaluations.

Jessica Cassity: Okay, sure.

Stacey Pfaff: There's a few ways to do speech and language evaluations. So first of all, there are no tests that have been standardized for teletherapy, but it doesn't mean that they're not effective. You can still use those standardized assessment scores, as well as your clinical judgment to make sound recommendations for whether or not they would meet eligibility criteria or that they would really need speech and language services. So what a lot of teletherapy companies will do, they'll get a subscription or an account with Q-global and on Q-global they have all virtual assessments. So very popular ones on Q-global would be the self, there's the Goldman-Fristoe where you just pull up that assessment virtually, screen share, and then you can administer the test right on your computer. You have your paper protocol with you. You can also scope record your answers on the website rather than using a paper protocol. But particular company that I work with, we most tend to use the paper ones right now. And then you just really complete your assessment in that manner. Now, if you have other assessment tools that you want to use, that you'd have the hard copy, then that's where the document camera is going to come in. You can put the document camera on the stimulus book and proceed with the test answers. You really, really want to make sure that your internet connection is optimal and you're not having any glitches during the assessment, of course. So you're going to really want to use good, make sure you have good internet connection so that you're having a valid test results.

Jessica Cassity: So is there anything else that you wanted to say about assessments before we move on?

Stacey Pfaff: I don't think so. That's just the gist of it. It can be done effectively and with getting quality data. So don't be afraid of doing assessments via teletherapy. It's very effective.

Jessica Cassity: Awesome. So let's talk about behavior management a little bit. I know you have lots of suggestions and tips and tricks, and I'm sure that everyone listening is dying to hear what you have to say.

Stacey Pfaff: Yes, behavior management is like one of my favorite things to work on, especially with just younger kids. It's like just fun. So from the start you can really control the environment of your teletherapy session. So make sure they're in a quiet space in a chair at a really sturdy table. So do not have them sitting on the couch or sitting in the bed or on the floor. You know, you really want them to be in an environment that's conducive to learning. So you're going to see that a lot with teletherapy. If the students are at home, they will try to get away with, you know, not being in a good space. And that's going to set you up for failure right away. If you don't establish that as expectations with the parents prior to your sessions and be firm with it. Make sure you have really good rules in place. So no snacks, no siblings, you know, no TV on in the background. Those are all distractions, especially for those kids who do have some behavioral goals on their plan of care or their IEPs. You really want to make sure you nip that in the bud right away and make sure you have really strict rules about that. Once you have the environment set up and your environmental expectations clear, and they're still kind of having some difficulty attending, I have some tools that I use, so you can pull up a virtual timer. There's some Google Chrome extensions, or there is a website that just has a variety of virtual timers. Some, a bomb goes off at the end of the time or different whatever's motivating to them. You can kind of find one. And so I'll set a timer where we have to work for a certain amount of time, of course, and then you can go on a game or take a break. I've had parents sit with the students and they have their phone with them. And so this particular student was motivated by car videos. So we would work for three minutes. Timer would go off. Then it was break time. They watched a portion of the video, mom put it away, and then we're back to work. So when we did that, it was really effective because the parent was sitting right next to the student with the reward. And I was setting my expectations of what our work time was. Other things that I have, I've used some virtual token boards. And basically it's just a boom card lesson that they earn virtual stickers with. They type in what they're working for, and when they are, whether it's one sticker or five stickers or ten, when they're done with that, they get to get the reward that they choose. I also have used some virtual visual schedules, or you can also have the parent if they're really good about having a visual schedule at home. And they have pictures that work well for them, have the parents set up the visual schedule for them prior to the session, and we'll go through it together. You can just, a little bit of parent collaboration on that piece can really make a difference in your time with your students.

Jessica Cassity: How often do you find that parents are really ready for teletherapy sessions? I know you mentioned kind of some environmental modifications. I mean, what percentage of the time do you feel like they're really coming to these sessions ready and prepared on day one where they really, you know, know or, you know, is it usually kind of, you know, for the next few sessions, you're doing a little bit of education here and there to get them on the same page.

Stacey Pfaff: You know, I kind of think it's 50-50. I get a handful of kids and parents who come and they really are intuitive on what, you know, they need to do to be successful in their therapy sessions. And then I get another handful of families who do need a lot of coaching, and they might need coaching all year round long, and lots of reminders and lots of text messages asking them to just remember the expectations and, and reminders of, you know, what makes my session show progress on your student's IEP or plan of care is, you know, he needs to be successful with me. So sometimes it just takes a little bit more coaching.

Jessica Cassity: Yeah. Now I know you also had mentioned a parent sitting with that one particular student. Do you generally recommend that the parent is there?

Stacey Pfaff: Especially for younger kids, I always recommend that the parents sit with the student. That can sometimes take coaching too. A lot of times, parents like to have their students independent, but I try to really pull them into the session most of the time. Now, for older students they prefer to work with me one-on-one so as they get older, I think that's fair for them to work with me independently, as long as I'm seeing progress and I'm seeing really good attention and engagement. And then I'll just kind of check in with families either in or via web mail or emails or at the end of the sessions.

Jessica Cassity: Have you ever run into any particular students who have had behavioral issues that you weren't really able to tame down and teletherapy just wasn't a good fit?

Stacey Pfaff: I have not, but it doesn't mean that it doesn't exist. So how I would handle that situation would be, it just, one or two things could happen. It depends on your setting. So if you're working with an IEP team, you would need to meet with the IEP team and how the facility or the company that I work with handles that is that we would just have an IEP meeting. I would make a recommendation that the student may move to in-person services because his needs are not being met via teletherapy. And then we would provide that in-person therapist. But if it was, you know, private then you would probably set up, rather than your teletherapy sessions, you would probably move to more of the in-person model, whether you go to the home for services or the having them come in or depend on your service delivery model, but it's not uncommon. And it's okay. You know, it's okay to say teletherapy is not appropriate for your child. It is not appropriate for everyone. And that I think is what has kind of been my hiccup a little bit with, you know, how teletherapy was really just kind of pushed into all these situation environments is that it's not appropriate for everyone. And it's okay that it's not, you know, we know that in-person therapy has so much value for our students and for, you know, anybody who has speech and language needs or behavior needs that it's okay to say it's not appropriate.

Jessica Cassity: Yeah, exactly. And I think you're right. I think given, given the craziness of, you know, the switch, the quick switch to teletherapy, I do think there probably were a lot of scenarios where, you know, SLPs were attempting to treat students through teletherapy and maybe they weren't appropriate and, you know, and that can cause a lot of frustration on both ends for the parents, the student and, or actually all ends, I guess, parents, student and the SLP.

Stacey Pfaff: Yeah. And you know, another thing that I'd love to bring up is just when I was kind of visiting with people about getting, moving into speech therapy, without having any training and just kind of be pushing into it. Those SLPs had case loads that were 70 kids, you know, where my caseload as a teletherapist is 38 to maybe 43 and I'm, full-time, that's a substantial difference. So I always felt really bad because that's, you know, some speech therapists really didn't get a true taste of how teletherapy really is. And when it's delivered in, I guess in the typical way, you not get throwing into it where my week is very manageable with the number of kids that I have on my caseload. I group students individually and, or up to two kiddos, you know, so I can easily see that number of kids in a week and also have time for assessments, paperwork, and I'm done at a really reasonable time of the day. I'm not working hours into the night. So I just kind of want to throw that out there. So people who maybe have different perceptions of teletherapy based on their experience this year, just know that it's not, it's not typical to have 80 kids on your caseload or 70 and be expected to see them all as a teletherapist, you know.

Jessica Cassity: Right. Yeah. That's not the norm. Definitely. Okay. Let's talk a little bit about some free online resources. I have a couple, but I'll let you go ahead and start.

Stacey Pfaff: Yeah. There are lots and lots of resources online. And I think the first thing, when I became a teletherapist, I felt a little overwhelmed with knowing what resources I'm going to use in teletherapy, right? So I went to the internet and I started Googling things and there's lots of websites. So there's websites like abcya.com. There's website, I gotta think of...

Jessica Cassity: While you're thinking, I just want to say that we'll make sure that I link to all of these in the show notes. So if anyone's listening right now, you don't have to worry about writing down the links or listening for the links. I will put everything in the show notes, which you can access on thedigitalslp.com/podcast.

 Stacey Pfaff: Awesome. So like I was saying, there's a lot of free websites online, so there's abcya.com. There's PBS Kids. There's some great articulation ones. I think there's one called Speech Tutor. That one I think eventually you have to pay for but there's a free trial. But there's one called Speech is Fun. But just Google speech therapy articulation, and they'll bring up great word lists and just different activities and ideas for articulation therapy. There are wonderful matching websites. So there's matchthememory.com where you can create your own matching games and also put in your own articulation words or vocabulary words. So definitely explore the great world of the World Wide Web in looking for your free speech therapy materials. I also use Google Chrome extensions for my brain breaks. So there's Connect Four. I also use the Bitmoji app to pull up a Google drive, maybe something in Google drive or even on a website, and you can talk about some Bitmoji emotions and use it for social skills. So explore different Google Chrome extensions. There's one that's really great and it's called weava.com. And basically it's an online highlighter. So I would pull it up with websites such as ReadWorks or National Geographic Kids. And what they'll do is you can highlight a word and then you can create these little folders with that vocabulary word. So you can write a sentence with it. You can work on syntax, you can work on defining the word. You can work on articulation. That highlighter is amazing and its capacity in using with any website is truly amazing. You almost have to just play with it for a while to see its full implications, but I do have a blog post on it, over at myteletherapyroom.com, about using Google Chrome extensions in teletherapy. And I kind of described how it's used and I also posted a YouTube video for that Chrome extension.

Jessica Cassity: Awesome. For Weava specifically?

Stacey Pfaff: Yeah, I have for Weava specifically, there's a video tutorial on that. But other free ones, there's thousands. I don't know if you've heard of Boom Cards? So you can sign up for a free trial and do a search on Boom Cards. You'll find probably 50 free Boom Cards out there that you can just add right into your library. So hop on the Teachers Pay Teachers or The Boom Learning site and just do a search for free free resources, you know?

Jessica Cassity: Yeah. There's a lot of great stuff out there. Can you talk a little bit more about Bitmoji? I know, I feel like that's kind of a buzzword right now. Everyone's talking about it, but I'm sure there's some listeners who are like, what is Bitmoji? Like what is that?

Stacey Pfaff: You know, Bitmoji is like, you can create your own avatar, that looks just like you. It's amazing how they look just like you and a lot of people are creating Bitmoji classrooms. So it's just basically a Google classroom, or even a slide on Google that you can link to different websites, different activities. So if you just kind of go online and type in Bitmoji classrooms, they're so cute. They're the big hype right now for teachers and teletherapist just because of all the distance learning, teaching going on. There's a lot of use of it right now. So it's basically just creating your own avatar and we've got lots of different ones to go with it too.

Jessica Cassity: Great. So I have a blog post about some freebies, Stacey, I believe yours is included in that one. So I'll make sure that I link to that in the show notes as well. Another one I was going to mention, I feel like the live cams at the zoos are really fun. It's not speech therapy specific, but you can get a lot of language, whenever you're showing those. Another one is called Tate Kids. It is a UK-based art site and it has some really cool stuff where you can compare the same, it's like a compare-contrast, where you're doing similarities and differences between two paintings. And then you can also create some your own artwork and there's lots of different activities and fun stuff on there, and it's all free.

Stacey Pfaff: I have to check that out. I haven't heard of that one.

Jessica Cassity: Yeah. Yeah. I'll send you the link. It's, it's fun. My kids like it.

Stacey Pfaff: There's also a lot of great YouTube resources out there. My recommendation is just to make sure you have a filter on there to filter out all the ads and there's Google Chrome extensions for that, or there's ViewPure, I think. But there are Ellen's Epic or Fail videos where you just kind of can work on predictions and, you know, story retell or predictions, yeah. Mostly are just, they're so funny. The kids will love them with that. And then there's SciShow Kids. I don't know if you've used that at all. That's another good one where it's just all science experiments and I can just get a lot of vocabulary and language from those videos, too.

Jessica Cassity: That's the one with the little mouse, right?

Stacey Pfaff: Yes.

Jessica Cassity: Squeaky. Squeaky, okay. Yeah, those are really good too. A good way to get a lot of, you know, science-based content in there as well while working on your speech needs.

Stacey Pfaff: Yeah, so good.

Jessica Cassity: Let's see. Any other free resources you can think of? I mean, I know there's tons. I think it's probably just Google free teletherapy resources for speech therapy, but we'll make sure to include this list of things that we've talked about here, but there are a lot of really great stuff out there.

Stacey Pfaff: Yes, there is.

Jessica Cassity: Yeah. Now let's talk a little bit about maintaining a work-life balance at home, if that's even possible right now, the way things are. I mean, I feel like these circumstances are different. So I guess maybe we can start off by talking about what the general recommendations would be for a, and I'm doing air quotes here, like a typical, like a regular teletherapist. Because it is a change if you're going from working in a school to being in a regular teletherapist. But then I guess we have an extra layer of challenge added on right now with people having their kids home and working from home and trying to kind of wear all the hats and do all the things. So maybe we can start off with kind of the traditional recommendations and then maybe these kinds of recommendations for these crazy times.

Stacey Pfaff: Yeah, absolutely. So if you're looking into teletherapy and you want to move into it as your primary position, like I did, I would recommend just kind of asking the people who are interviewing you about the culture in your workplace that you're interviewing with, because if you are very social and you're going to miss out on just having a lot of connections with colleagues and they don't have a lot of emphasis on building culture with that company, it might not work for you if that makes sense. There are lots of opportunities where I work for us to connect in Hangouts and in chats. And I feel like I'm in the office with a lot of my colleagues who to be constantly connecting with each other. So we've really formed a culture that is inviting and whenever we have new speech therapists come on, we know we, they make that into a special announcement and we instantly reach out to them. So really being intentional about working for a place that has inviting culture, and also just being able to connect intentionally with other SLPs in your department, or, you know, in the same school that you might be working for is going to be really important initially, just to kind of get that social connection rolling. Now in terms of just feeling like you're not sitting all day, like I can remember working in the public schools, I would easily get 10,000 steps, right. And my cousin who works from home her whole life, she's like, Oh my gosh, I cannot get over 2,500 steps. And I was like, how do you not get more than 2,500 steps in a day? Then I moved to teletherapy and I was like, today I am at 3,000 steps, because I haven't gotten on, I haven't been moving. So if you are not intentional about making space in your day to get moving, and you will only have about 2,500 to 3,000 steps in a day. I've seen it over and over again. So I just encourage you to either get up in the morning and go for a walk before you sit down to take your lunch break. Make sure you schedule a lunch break, whether you're a teletherapist or your regular speech therapist. I think we give up our lunch breaks way too much, right? So I want you to schedule a lunch break and get up from your desk or, you know, go running after work or for a walk. So just being so, so intentional about moving, because that has been a hard transition for me because I am very active. But you get busy and your day go by, it goes by, and then you're laying in bed to sleep, thinking oh I'm still up 2,000 steps. So just making space in your life for wellness is really important. Really. Those are the two most important things. It's just that culture and social, emotional connection with people and movement.

Jessica Cassity: Yeah. And what about those little, what are they, little like pedals that you put underneath your desk? Like, are those the things, should teletherapists be using those?

Stacey Pfaff: Definitely. Some people have gotten a standing desk. But if you did a standing desk, make sure it can just go up and down, whenever. Don't make it a permanent standing desk because I've heard people having their feet or their back hurt after standing all day. So if you can have that balance and then I do know several therapists who used the pedal bike underneath their desk. Make sure you have a tall enough desk for your knees to pedal. And then just, yeah that, my desk is lower so I don't have that, but I wish I did.

Jessica Cassity: Yeah. I'm kind of looking at mine like, hmm, I could possibly fit it under there. I also have a lot of equipment under my desk. My desk is not the cleanest of spaces.

Stacey Pfaff: We'll also bring a medicine ball into their office and sit on a medicine ball for part of the day to work on core, things like that.

Jessica Cassity: Oh yeah. Like one of those, oh, I wish I could bring it over. I am looking at one right now. I have one in my room. I do not use it. My children play on it. I should probably be using it to work in my core, like you just described. But yeah.

Stacey Pfaff: Yes, so just things like that and, you know, take a break and call your best friend or your sister, whoever you're closest with because you kind of get stuck in this isolation run if you let it, but it doesn't have to be like that. I'm really social. So I am constantly just reaching out to people at work or whomever to visit.

Jessica Cassity: Yeah. Yeah, no, I think that's really smart, especially if you're really social person and you thrive on that. You know, I'm sure it can feel very lonely to not have those connections to be working from home. Yeah.

Stacey Pfaff: You wanted to touch on a little bit about those therapists who are working from home and teaching from home, their family and you know, that crazy situation that we're seeing everywhere right now, because we know that a lot of schools are doing distance learning and in-person are all distance learning. And so we still have to work and do our job. So my recommendation of course, first and foremost, is always to show grace to yourself. You know, this is such a unique situation and you need to give yourself some, cut yourself some slack and just know that you're doing the best you can and that's okay. So my other suggestion would just be to find that balance of when you can see students and when your kids can just have some quiet time or if you can arrange, you know, a balance with your husband, if he's working from home and teaching at the same time, just really do a block schedule where you can coordinate your personal time with your work time, the best you can. You know, I think that would be really helpful. And just knowing that if you're in a teletherapy session and the parents and your students hear your kids in the background, it's okay. I promise you when I first started teletherapy, I had some IEP meetings with some case managers, and their kids just popped into the meeting every once in a while. And then they went back and nobody fledged, nobody said a thing. It's okay if I hear your kiddos in the background or your child comes into your office and asks you a question in the middle of the session. It's a unique situation, a unique time. And honestly, your students probably would love to say hi to your kids. They would think it's very fun. So it's okay if that happens.

Jessica Cassity: Yeah. Now what about communication boundaries? Do you ever find that you want to check emails late at night or, you know, when you're working from home, I feel like the boundaries can get blurred a little bit. And I know you talked a bit about scheduling. How can you discourage yourself from, from kind of always being on?

Stacey Pfaff: Right. And that's something that I have to work really hard at because I could work all day and all night. But you just have to shut, first and foremost, turn your computer off. Shut the laptop, turn the computer off. Do not have your emails synced to your phone and shut your office door. You know, if it's open, if your computer is open, you're going to be easily enticed to log on and check emails and do work that can wait until tomorrow. So I think that's really important. Just set boundaries when your workday is over at 4:30 pm, you need to shut the door and just let it go.

Jessica Cassity: Yeah, now, do you ever find yourself needing to set boundaries with families? I don't know how you're available or how they contact you if it's just email or if they have your phone number.

Stacey Pfaff: It's mostly email and then we use Jive. We also use Google Voice last year, so they don't ever have my personal email. And then they do text me in the evening. It's very rare that they do try to reach out to me after-hours. If I do, it's something that they probably is urgent. Maybe their child's sick may won't be there tomorrow and whatnot. If I need to respond then I will, otherwise I'll just wait until the morning. But for the most part, parents are really, really good about respecting my work hours and whatnot.

Jessica Cassity: Okay, that's great. So let's talk about one thing that you wish that you had known before you started teletherapy.

Stacey Pfaff: Okay. So I think, some of it is just internal procedures. You know, I found out a few crazy time-savers like a year and a half after I started my teletherapy position. So my tip is connect with the veterans there and just ask lots of questions and ask about time-saving tips and different things like that to make sure you're really understanding the procedures and the protocols. So you're not doing double the amount of work that can easily happen when you're working by yourself at home. And I wish somebody would have told me earlier how amazing teletherapy really is. I can't even tell you how much it has changed my life and how much I love it. And it's just been such an amazing adventure and journey personally, for me. And, you know, I always say that teletherapy found me. I did not go looking for it. It just happened that I needed to step into teletherapy when my son was in preschool. So I have a little flexibility until I was going to go back into the public schools and work full-time. You know, which was my love was working in, has always been working in the schools, but I'm still at a school district, but in teletherapy and after I took my first position, I love the technology piece. I loved the collaboration with my parents and my families and other colleagues. I know colleagues across the country, now in the world, that are amazing. So I just wish somebody would have told me sooner how amazing and teletherapy can be for me. I would've started a lot sooner.

Jessica Cassity: Yeah. Yeah. Yeah, do you feel like the majority of the speech therapists that you hear from online or say when you're posting on Instagram about teletherapy, do you feel like the speech therapists who were kind of thrown into this have the same love for it? Or do you feel like it's kind of 50-50?

Stacey Pfaff: I think it's 50-50, honestly.

Jessica Cassity: So do I.

Stacey Pfaff: Yeah. I have, I mean that card spend a little hard for me to read. And even in some of the collaborative groups that I'm in online, it's been a journey for them and it's been hard. And so they have a little bit of a negative taste in their mouth about teletherapy, but I can respect that. I can really respect and understand why it's been a challenge, you know? So and it won't be like that for everyone. It was for me, but it just, it is, it's not something for everyone. So just like, you know, working in the hospital isn't for everyone or working in the skilled nursing facility, isn't for everyone. I think he just really, that's a joy being a speech pathologist, as you have all these options of environments and things you can do that you just got to find your passion and that right fit. For me, it just took me a little bit longer, but I also feel that all my time spent in the public schools for those 10 to 13 years prepared me for the journey that I'm on now. So I think that it all comes together when it's supposed to come together. But I would agree with you. It's not for everyone. It's been hard for a lot of people, but hopefully it will just make them stronger and appreciate the thing that they were in more when they go back.

Jessica Cassity: Yeah. Well, that's the good news about it is this is all temporary. So if you are doing it and it is something that you are not enjoying now, you get to go back to the way things were, hopefully someday soon. You know, nobody really knows when that is just yet, but that they will come and, and things will, you know, start to return back to normal. I mean, I do agree with what you said at the beginning of the show that I think there will be some shifts, like for things like snow days and other things like that where maybe you will see a little bit of teletherapy or distance learning worked in here and there. But you know, overall I think things will, that will shift back, you know, to in-person again.

Stacey Pfaff: Sure. For sure.

Jessica Cassity: We covered a lot. Say you had to choose three tips from today or even those that you didn't mention where you really get the most bang for your buck. Say you met somebody there. Like I have like three minutes, what are the three things you would tell them to help make their teletherapy journey easier?

Stacey Pfaff: Yes. So I would always go back to the tech. You know, making sure you have your office set up, your technology set up so that you can have a successful teletherapy session. If you do not have that, you will get so frustrated and you won't be successful. The number, the next thing is stack that digital toolbox up because you want your speech therapy sessions to be successful and fun and engaging to your students. And that is what you will use everyday in your work is your digital toolbox. And then just really establish a good relationship with the families that you're serving. I have just strong feelings that you needed to connect with the caretakers and just be empathetic and understanding about what they're going through in whatever journey they're in. You know, it's hard to have a student who has needs with whether it's just an /R/ sound or whether it's really significant needs, be really empathetic and understanding and listen to what their goals are and really work on that rapport with your families that will really allow you to have a lot of progress with your students. And if you can build that trust within their family, they'll be there at every teletherapy session for you.

Jessica Cassity: Yeah, so what would you say to somebody who, I know I'm giving you a lot of hypotheticals here, but who really loves hands-on therapy and they feel really intimidated by technology. Because I know there's a lot of people where the shift has been very difficult because they are very into using hands-on, you know, as most of us are for in-person therapy, what would you say to them? Or how could they incorporate some of that into teletherapy?

Stacey Pfaff: Well, I think you can still use minute manipulatives in your teletherapy sessions, I see it done frequently. So I would just encourage them to use the manipulatives in their sessions. Like I said earlier in the show, whether it's you having them or the caretaker, having them, bring them in and use them in your session. Otherwise I just encourage them to think outside the box and, and try some of your digital activities and incorporate that into your sessions. They might be surprised that they actually will like it just as much as those manipulatives.

Jessica Cassity: Right. You'll find out. A little trial and error. And I think that's a lot of it is trial and error because, you know, some students are going to be motivated by somethings that'll work for them, and then maybe not for the next student. And you know, it is a lot of trial and error, not just for teletherapy in general, but just for students in general, you know, you never really know what's going to work until you try. And I feel like I can kind of, you know, go off on a tangent here about some of the digital stuff. But I think that, and I understand this, but I think that sometimes there can be a negative connotation with anything related to screen time. And I think there's good reason for that. And as a mother, I have, you know, very strong concerns about that. But I think that when we think about the quality of some of the resources that we use, and I think when we think about the level of interactivity with another human being, who's assisting us through the process where we're not just setting someone up with an iPad. I think that it defines tech a little bit differently whenever we do it that way. So I think that's something that's important to remember as well.

Stacey Pfaff: Yeah. Thank you for bringing that up because it is such an important comment to discuss and talk about is that it's not sitting, it's an interactive with another person facilitating learning, you know, it's a facilitated learning environment. And I think it's really important to remember that.

Jessica Cassity: Yeah, absolutely. Absolutely. Because I think it can be even scary and misleading to parents sometimes because there is so much negative information out there about screen time. And like I said, I'm not doubting that or disputing that. But I do think that the scenario, especially when you're getting therapeutic services, it's a different whole different scenario.

Stacey Pfaff: Absolutely.

Jessica Cassity: Yeah. It's challenging right now because there's so many different types of people doing teletherapy where, you know, I have podcasts for a while and we've talked about teletherapy before, but I think when we're talking about teletherapy now, it's just a totally different, a totally different journey. And actually, you know, I think you touched on this, but maybe we can elaborate a little bit. So for those who are on this teletherapy journey and not enjoying it, I know you mentioned kind of giving yourself some grace, you know, what else could we say to that, that SLP doing teletherapy and not enjoying it.

Stacey Pfaff: And I think there is a, you know, a good handful of that's that has happening with. I think you just got to fight hard to get through it and know that there is a end to it. I mean, it's not going to be that school districts are going to be doing this type of service delivery model indefinitely, you know, so if you can just work through it and lean on your other colleagues who are in the same boat and maybe even try to figure out a way that you can some enjoyment with it, just to kind of get you through, that would probably be helpful.

Jessica Cassity: Yeah. Yeah. And just modifying it to a way that would make it most comfortable for you, you know?

Stacey Pfaff: Right, right, exactly.

Jessica Cassity: Yeah. Absolutely. Absolutely. Okay. Well, if there's not anything else, I think we covered a lot of really great stuff and I so appreciate you coming on to share your expertise and I'm sure the listeners will really enjoy listening to all these tips.

Stacey Pfaff: Yeah. Thank you so much for having me. I could talk about teletherapy all day. It was so fun to share my experience and just my expertise in this area. And I am grateful for the invitation.

Jessica Cassity: Yeah. Thank you for coming on the show, Stacey.

Stacey Pfaff: You're welcome.

Speaker 3: Thank you for participating in SLP Connect. Remember that listening to this POD course does not automatically guarantee ASHA CEUs. If you want to earn ASHA CEUs for this conference, there was a small $25 administration fee to process and submit your paperwork. You can pay this administration fee and find more details at tasseltogether.com/slpconnect. Once your purchase is made, you will be able to access the course evaluation, quiz and earn your certificate. Please submit these materials by October 7th, 2020 at 8:00 PM Eastern Standard Time. SLP Connect would like to thank its sponsors for offering products, services, and discounts as giveaways to attendees at no charge. You can see a list of these sponsors and enter to win on the SLP Connect webpage. SLP Connect would also like to thank the presenter of this course who has provided her speaking services at no charge. Ready to fill your digital swag bag? You can enter to win a giveaway of your choice by taking a screenshot of this course and sharing it on social media. Use the #slpconnect2020 so we can find you. The winner will be announced by midnight, October 10th, 2020. Thanks for listening and we hope you enjoyed this second annual PodCon.

Jessica Cassity: Thank you so much for tuning into today's episode. I'm so grateful that Stacey was able to come on and join us and share all of her words of wisdom about teletherapy. If you would like to access the show notes. I know I had mentioned earlier that I will make sure to drop the links that were mentioned in today's episode, in the show notes. Then you can head on over to bit.ly/teletherapytipsforslps. I hope that you learned a lot today and thank you so much again for tuning in.

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