Early Intervention Team Shifts to Telehealth Model During Pandemic

The therapists working at Grafton’s Infant and Toddler Connection of the Shenandoah Valley (ITC-SV) typically work face-to-face with clients during home visits. The program, which offers services for children ages birth to three who are not developing as expected, uses a parent-coaching model to help families develop their children’s skills and assess progress. Since the COVID-19 pandemic hit Virginia in March, the team at ITC-SV has had to find new ways to perform their job remotely.

We spoke with occupational therapist Jennifer Mantz and speech language pathologist Susan Anderson to see how their work has changed due to social distancing.

 

What were your jobs like before the pandemic?

Susan: Our jobs consisted almost entirely of home visits. Depending on the client, we typically visited a child anywhere from once per week to once per month, with each visit lasting about an hour.

Jennifer: During these visits, we start by asking how things have been going since the last session and address specific concerns. As an occupational therapist, a lot of my time is spent coaching parents by modeling behaviors and doing hands-on demonstrations with the children. For example, I may be working with a toddler on developing fine motor skills, sensory processing, or showing a parent how to transition their baby from a gastrointestinal feeding tube to oral feeding.

 

How have you adapted to provide services remotely?

Susan: We’ve started providing our services exclusively through video conferencing. The ITC-SV has always used a parent-coaching model, but switching to telehealth has forced us to focus even more on the parents. Now that we can’t be there, they are our hands. We’re talking them through it, and for the most part it goes really well. It’s just a little more challenging.

Jennifer: I’ve started asking the families to show me daily activities, like washing their hands or taking a walk. I can observe through the webcam, and then we can work with what I saw. I’ve been using that strategy a lot and it’s been very helpful.

 

Were parents initially resistant to the switch?

Jennifer: A lot of them didn’t understand how telehealth would work and couldn’t see it being effective. In the beginning, about half of my clients said they didn’t want to participate, but as the stay-at-home order kept getting extended participation has increased to 80%. Now I’m seeing about 32 kids through telehealth, and most families tell me it’s going better than they anticipated.

Susan: Convincing the parents was a pretty big challenge. They would say, “We try to FaceTime with grandma and grandpa and it doesn’t work.” I had six or seven families that said no, but we kept connecting with them to ask if they would give it a try. At some level, we also had to convince ourselves that this would work. We had never done telehealth like this before, and we were all thrown in the same boat. The truth is, it has really been working better than I thought it could.

 

Have you experienced any other challenges?

Jennifer: The technology has been a challenge for some clients, especially for those with a poor internet connection. One of my clients is a grandmother who doesn’t feel comfortable with video conferencing. In those cases, we invite families to send video clips and photos, so we can work with them over the phone.

Susan: If a client can’t connect with me online, I still check in by phone and send activities and information to help their child with speech and language skills. Even if they’re not participating in telehealth, we want them to know we’re thinking of them and still there to support them.

 

Have there been any unexpected benefits of switching to telehealth?

Susan: We used to spend at least 10 hours per week in the car, driving from client to client. Since we started working remotely, I’ve had more time to follow up with families about their treatment plans and provide additional resources. I feel more organized and prepared now that I’m not driving 120 miles per day.

Jennifer: Parents also seem more empowered than before, because they are forced to take the lead since we’re not physically there to show them. Some of the clients are even coming up with creative ideas on their own.

Susan: I agree. They are taking what we’re suggesting and really running with it. Most importantly, we haven’t seen any regression in the children’s skills. At the end of the day, I think the parents are happy to connect with us and still have our support. We’re so happy this is working and children are still able to get the services they need during this difficult time.