Since the beginning of the global pandemic, there has been a major shift into telehealth, including telemedicine (appointments with doctors over technology) and virtual therapy sessions (appointments with other health professionals over technology). Although there has been a dramatic increase of health professionals using telehealth to deliver therapy, telehealth is definitely not something that is new. In fact, telehealth has been used by health professionals for many years prior to the global pandemic.
Telehealth therapy has been proven to be as effective in helping children and families reach their goals, with some even outlining better results compared to traditional methods. The research articles have also focused on the special needs population study populations have also focused on children with special needs including Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD).
Depending on your child and family’s needs, occupational therapy services via telehealth may or may not work. This article aims to highlight the pros and cons of telehealth vs traditional face-to-face therapy, and who telehealth works best for.
What is Telehealth?
Telehealth is “the delivery and facilitation of health and health-related services including medical care, provider and patient education, health information services, and self-care via telecommunications and digital communication technologies” (NEJM Catalyst, 2018).
Telehealth aims to monitor and improve health and can be provided using the internet, mainly through video calling and phone calls. However, with the advancements in technology, telehealth is also expanding to the use of sensors and monitors, wearables, mobile applications and secure messaging systems.
What services can be provided via telehealth?
A range of healthcare services can be provided via telehealth. One of the most common forms of telemedicine or telehealth is video conferencing or “teleconsultation,” in which a patient interacts remotely with a health professional in order to receive remote diagnosis and treatment. This means, you could:
Have a real-time telehealth session with your
- General Practitioner
- Occupational Therapist
- Psychologist and
- Speech Pathologist.
Store and forward telehealth: Where clinical information is collected and sent for an expert review (e.g. radiology, dematology imaging)
Remote patient monitoring: Where heart rates, blood pressure and activity level data can be shared with their health teams. Commonly used remote patient monitoring systems are fall detection and alarm systems.
There has been increasing use of mHealth which uses smartphones and wearables to help improve health goals. These are applications to help improve healthy habits and lifestyles.
Telehealth Occupational Therapy
Telehealth Occupational Therapy services have been used for many years, even before the global pandemic. However, since the Novel Coronovirus, there has been a dramatic increase in the use of telehealth to deliver occupational therapy services across the world.
Occupational Therapy practitioners work with a range of individuals with various goals. Some areas we have worked on in telehealth Occupational Therapy include:
- Handwriting skills
- Fine and gross motor development
- Emotional Regulation skills
- Fussy and picky eaters
- Self-care skills like dressing, eating and feeding (using coaching strategies as mentioned below)
How can Telehealth be used with Children?
As mentioned above, there are many types of telehealth. However, for the rest of the article, we will be focused on real-time telehealth services.
Telehealth can be used with children in multiple ways. For example:
- If they are feeling unwell, they can see the family doctor via phone call or video conferencing. The doctor can then write a prescription for the child, based on their illness.
- A Paediatrician or specialist may use telehealth to do assessments and consultations with the child and caregivers.
- The child may have ongoing therapy sessions with their Psychologist, Speech Pathologist or Occupational Therapist to help them achieve their goals.
- Telehealth may be used by health professionals to consult on ongoing treatment options and provide education to parents and teachers so they can better support their child at home and in school.
Can you do Occupational Therapy Telehealth with Kids?
Depending on your child’s age and needs, telehealth can look different for each child. Both Occupational Therapists and Occupational Therapy Assistants (OTAs) can provide occupational therapy sessions online. However, Occupational Therapy Assistants are overseen by the Occupational Therapist.
Below, we have a look at three different age ranges and how Occupational Therapy sessions via telehealth may look like for these children.
How do Preschoolers use Telehealth?
At ReadyKids, we have provided Occupational Therapy services to toddlers and preschoolers via telehealth. Generally, in these sessions, we require significant support from the caregivers on the other side of the telehealth session. We often use a coaching method in providing education to the caregiver.
Occupational Therapy telehealth sessions may also include the therapist demonstrating how to play a certain activity with the child while the parent does it on the other end of the telehealth session.
Telehealth Occupational Therapy with School-aged Children
These children have been brought up with technology since they were born, so they are quite intuitive to use a tablet or iPad.
Even with school-aged children, during Occupational Therapy telehealth services, we encourage parents to be present during the therapy session. Depending on the age of the child, parents may or may not need to be actively participating in the session.
Some parents may want to participate in the activity together with the child. While other parents may want to sit and listen to the therapist and child interaction.
Occupational Therapists may use a range of tools to encourage children to actively participate and keep them engage in the therapy session. They may use:
- Interactive whiteboard
- Regular movement breaks
- Screensharing activities
Occupational Therapy Services for Teenagers
Many teenagers have grown up with technology for most of their lives, including using them at home and school. So it may not feel like much of a big deal to them during telehealth sessions.
Some teenagers may prefer to have their telehealth OT session with just their Occupational Therapy practitioner, instead of having their parents around.
Depending on the goals of the child, providing Occupational Therapy sessions may look different for each teenager. For example, if the goal is to develop emotional regulation and/or social skills, then it may include
- Watching some videos and analysing them
- Role playing with the therapist of different social situations
- Problem solving common social scenarios
- Talk about how we feel in different scenarios
- Work out effective strategies to manage our emotions
What is Coaching?
Before we delve into the research study about the effectiveness of telehealth, let’s define a term called “coaching”. This is where the health professional and caregiver work together to problem solve situations.
Coaching, in particular for early intervention (up to 6 years old), has been highlighted as the best practice method (Adams & Tapia, 2013). This is as the Occupational Therapist uses coaching to build on the family’s knowledge and skill in supporting the child.
Is teletherapy as effective as face-to-face therapy?
One of the most common worries is whether telehealth therapy is as effective as face-to-face therapy.
Over the years, there is growing evidence supporting the use of teletherapy. Research studies have evaluated the feasibility and effectiveness of telehealth among different populations, including Cerebral Palsy (Reifenberg et al., 2017), Autism Spectrum Disorder (Little et al., 2018; Little et al. 2020) and at-risk youth (Gibbs et al., 2017).
These studies have looked at addressing a range of goals including:
- Child’s health and functional abilities (Gibbs et al., 2017)
- Toileting (Little et al., 2018)
- Family goals like social interaction, self-regulation, toilet training, eating, transitions between activities, sleeping, play, safety and bathing (Little et al. 2020)
- Motor impairment and participation in activities (Reifenberg et al., 2017)
Although parents preferred in-person therapy (especially before the global pandemic), there were high satisfaction rates with telehealth (Kronberg et al., 2021).
A recent article, whereby allied health practitioners provided coaching to families of young children, highlighted that there were no significant differences among the families when comparing those who had received in-person and telehealth services (Kronberg et al., 2021). In other study (Gibbs et al. 2017), the students improved in motor performance after 20 sessions via telehealth.
Little et al. (2018), a study on using coaching intervention for families of children with ASD, found that both parent efficacy and child participation increased after the 12-week study. Coaching allows parents to feel more confident in using strategies they have developed to help their children progress in their goals.
Pros of Telehealth Occupational Therapy
One major benefit of telehealth is time effectiveness. Instead of travel time, finding a park and waiting for your appointment in the waiting room, telehealth occupational therapy allows you to save so much time. There is no travel time. No need to rush to and from the appointment. No waiting rooms. This leads to the second benefit.
Your child comfortable in their own environment
For many children, a new environment can be daunting. Having the appointment via telehealth means that your child can be comfortable in their home environment, where ever that might be, either in their bedroom, lounge room or play room. This allows the therapist to see them in their natural self, rather than what your child is like in a new environment.
Use the resources that you have at home
When you go to an OT clinic, you often see occupational therapy practitioners using resources that you don’t have and you may feel inclined to purchase some of these resources. However, when you use telehealth, you can use all the resources that you have at home.
Interestingly, most Occupational Therapists are quite creative so they can work with a range of existing toys to help your child develop their skills. Telehealth may even help you save money in not needing to buy so many toys!
You can choose what time suits you best
Because you aren’t location specific, you can find Occupational Therapist who have availability at times that suit you best. This may be early in the morning or late at night when the kids at in bed.
Rural and remote areas
If you live in rural and remote areas, you know how challenging it can be to access certain services. Instead of dedicating time to go to the cities, telehealth means you can access quality services in a timely manner. This is a way more convenient way to access health services.
Cons of Telehealth Occupational Therapy
Require the use of good audio and video
Accessing telehealth can be pretty much impossible if you can’t hear and/or see your therapist. Thankfully, the development of technology has made it increasingly possible through the use of a smartphone, tablet or iPad.
Although the audio and video qualities have improved, it is still important to minimise the amount of background noise to ensure you can hear your occupational therapist.
Reliant on internet
Good audio and video quality are also dependent on your internet. Poor internet can hinder therapy sessions as it can cause frustration in constantly repeating yourself or trying to get the video working.
In Australia, the introduction of 5G has allowed an improvement of the internet in most households.
One common concern raised by parents is their child’s distractibility. Since COVID-19, there has been an increase in telehealth appointments as well as school via technology. This has increased children’s understanding of using technology to assess school and telehealth sessions.
Additionally, Paediatric Occupational Therapists often work with children with limited attention and generally have good strategies to keep them on task.
Who Should Consider Telehealth Sessions?
It is dependent on a range of factors. As a parent, you are the expert on your child and your family. Therefore, if you consider the advantages and disadvantages of telehealth sessions for your family, and your child’s condition and nature, you can determine whether telehealth sessions work for you or not?
Telehealth can be trickier for physical impairments, however, in saying this, the advancement of technology is improving this where evaluations and assessments conducted by a Occupational Therapist can be completed virtually too.
The suggestion is to talk to your Occupational Therapist. Be honest about your concerns and see if your OT thinks it is worth giving telehealth sessions a try with your child or not.
Quick Tips for Occupational Therapy Telehealth Services
Having experience providing occupational therapy services via telehealth, there are some tips for families to consider:
Whether it is in-person or telehealth services, it is important to remove distractions, especially if your child has trouble with focus. Consider things like background noise from the television and other people talking in the background. Find a quiet room in the house for your child to do the telehealth session.
Your Occupational Therapist may write a list of things to gather before the session (e.g. pencils, paper, glue, scissors etc.). Some might ask to print worksheets so your child can do the activity together over the internet. If they don’t provide a list of resources, you can ask your OT if there is anything you need to prepare.
Set Clear Expectations
Your Occupational Therapist is probably going to go through a set of rules or expectations for the therapy session. However, before they do this, as a parent, you can also set clear expectations to help prepare your child for the session. You can talk about how [name of therapist] is going to be playing some games/doing some work with you over the [device]. Clear expectations of using manners and being respectful are still important, even though it is not in-person.
Test the Technology
There are a variety of platforms that can be used for telehealth services. Before your first session, ask your health professional whether you can try the technology first and ensure it is working effectively in preparation for the first session with your child.
Use a Computer, Tablet or iPad
When possible, try to use a computer, tablet or iPad for the OT telehealth services. Phones can be tricky and difficult to use, especially due to the smaller screen size. A computer is a great tool especially if the child can become easily distracted.
However, the tablet and iPad are great interactive tools where the therapist can use digital visuals or interactive boards to help keep the child engaged.
Having a choice of using a specific device may not be possible. It is a good idea to talk to your occupational therapy practitioners about the type of device you have available so they can better plan the session.
Experience of the Therapist in using Telehealth
Although there are many experienced occupational therapists and occupational therapy assistants, they are not equally experienced in providing telehealth services.
Providing Occupational Therapy services via telehealth are a new concept for many OT clinics. When looking for a suitable occupational therapist it is important to consider the level of experience they have had with telehealth.
There are some private clinics that provide only telehealth OT services and therefore have experience in telehealth sessions.
If you have had a negative experience with telehealth, consider the health care professional providing the therapy. They may not be as experienced with telehealth. This is a new concept for many therapists. Maybe consider OT clinics that provide services primarily via telehealth.
Diferent Regulations Across the World
Depending on what part of the world you are in, there are different regulations around telehealth to maintain the safety and security of the patient and the therapist delivering the OT services.
As an Occupational Therapist in Australia, check out Occupational Therapy Australia and AHPRA for more guidance.
For Occupational Therapy practitioners in America, look up American Occupational Therapy Association.
Regardless of what happens with the global pandemic and social distancing, our technology is here to stay and to advance. Telehealth is something that will become even more popular and common in the coming years.
Providing Occupational Therapy services has been shown to be effective through the current research. As more children and therapists use this method, we will learn to improve it and its effectiveness.
Adams, R. C., & Tapia, C.; Council on Children With Disabilities. (2013). Early intervention, IDEA Part C services, and the medical home: Collaboration for best practice and best outcomes. Pediatrics, 132, e1073–e1088. https://doi.org/10.1542/peds.2013-2305
Gibbs, V., Benham, S., Abraham, J. and Mathew, J., 2017. Telerehabilitation and Virtual Gaming in a School-Based Setting for At-Risk Youth. The American Journal of Occupational Therapy, 71(4_Supplement_1), pp.7111515216p1-7111515216p1.
Little, L., Dunn, W., Pope, E. and Wallisch, A., 2016. Feasibility of a Telehealth Coaching Intervention for Families of Children With Autism. The American Journal of Occupational Therapy, 70(4_Supplement_1), pp.7011515244p1-7011515244p1.
Little, L. M., Pope, E., Wallisch, A., & Dunn, W. (2018). Occupation-based coaching by means of telehealth for families of young children with autism spectrum disorder. American Journal of Occupational Therapy, 72, 7202205020. https://doi.org/10.5014/ajot.2018.024786
Little, L., Wallisch, A., Dunn, W. and Tomchek, S., 2020. A Telehealth Intervention to Increase Toilet Training in Autism. The American Journal of Occupational Therapy, 74(4_Supplement_1), pp.7411520511p1-7411520511p1.
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