WHAT SERVES US… NOT AT ALL?
School tele-therapy in the time of COVID: the four factors.
We are failing the Four Factors for tele-therapy.
You probably don’t know the Four Factors. I made them up.
You see, before COVID, back during face-to-face therapy in the school, I observed that the children who progressed the most quickly toward their theraputic goals in speech, occupational, and physical therapy seemed to always have these three factors present.
-An engaged face to face caregiver who will implement the therapy plan and exercises multiple times per week (parent, teacher, home health nurse, PCA)
-An environment in which the therapy plan can BE exercised (school OT room, home)
-A child who is willing to engage with the therapist and the therapy plan (not refusing, screaming, biting, kicking)
Why?
It seems as if, from our N of 1, and our lived experience, we have a new set of FOUR equal factors that create the highest chance of progress toward the therapeutic goals.
-An engaged face to face caregiver who will implement the therapy plan and exercises multiple times per week (parent)
-An environment in which the therapy plan can BE exercised both during a therapy session and later in the week (at home, stable internet access, enough room in the room, the right equipment at home, etc)
-A child who is willing to engage with the therapist via the screen
-A parent who can engage with a therapist via the screen (doesn’t have work meetings, other children to watch, can be home, the child isn’t at a child care center, the parent speaks English…)
And if we are unable to meet these four factors, with all of our advantages… who is doing well?
We get multiple messages every week like the one at the top of this entry from the school. They are directed to Oldest Child and his parents (the Dread Parents Evans). This is one. Sometimes there are others– we haven’t seen Oldest Child in a long time. Can you remind Oldest Child to go to group? Please fill out this survey. Occupational therapy is the first Friday of the month.
Every week, I send polite messages back: I’m sorry. I’m usually still at work at that time, and I am not able to be at home to remind Oldest Child to go to the conversation group for speech therapy. My husband is sorry; he was in a meeting and couldn’t remind Oldest Child. Oldest Child said he couldn’t get to the meeting, the link didn’t work. Oldest Child said he went, but didn’t go, and the other Dread Parent Evans wasn’t able to check. Oldest Child said nobody reminded him at 2 minutes to 1 pm. Can you call him if I leave his cell phone with him? No? Can you text him? He is ignoring my texts. Can his advisor remind him during advisory? Can the SLP remind him? Can his 1 pm teacher remind him, since Oldest Child is doing distance learning?
It is March. Oldest Child has been to this weekly group five times this year, and we say we are invested in his success and attendance.
And honestly? When it comes to teletherapy services like these? We are the lucky ones.
We are a family with two adult parents who are involved and stable internet.
We are a family with the ability to do distance learning at home: my husband is able to work from home part of the time, keeping an eye on his own work and an eye on what Oldest Child is attempting to learn in the 18-21 year old transition program. I am able to be at home part of the time as well, listening from the hallway as Oldest Child learns about independent living skills on a Chromebook borrowed from the school district while repetitively rubbing a blanket on his face for the sensory input.
We are not attempting to do, say, physical therapy in a living room too cramped for large muscle movement during Minnesota winter weather (today, the high was 28 degrees), or find ways to feed Oldest Child’s sensory regulation needs with swinging or bouncing while still indoors in a one bedroom apartment.
We speak English as a first language.
And we know— WE KNOW— that school rehab minutes, direct and indirect, are one of the Crown Jewels of the educational system’s special education offerings. Our schools provide speech therapy, occupational therapy, even physical therapy to children, teens, and young adults who otherwise might get nothing at all.
So I grind my teeth a little every week, sending that polite reply. Because we— because I, especially— know that it takes doing the work, participating in the therapies, engaging with the therapist, having the therapist modify the plan, having a therapist that knows your child or teen or young adult well enough to modify the plan of treatment in ways that will benefit your child— to make progress.
The question is– what am I making all of that mean?
Am I tying my success as a parent to Oldest Child’s ability to attend speech therapy and make progress with tele-therapy during a pandemic? Because when I tie my success to what I think should be happening, I spend all of my time living in frustration and overwhelm.
Instead, noticing that of course he isn’t able to do these things. That of course this system isn’t working well– school therapy was never designed for this sort of situation. That my brain is going to offer frustration and overwhelm, but ultimately, I get to decide if sitting in that feeling is what moves me forward in supporting Oldest Child and strengthening my relationship with him.
How do I want to show up for Oldest Child?
Do I want to try a different strategy?
Do I want to campaign for face to face services to restart through the transition program?
What do I want to do? Because that? That is the factor that I control.
Today, at 1 pm, I stood behind oldest child as he checked in with his advisor. “Hey,” I said. “This is The Dread Parent Evans, checking in. Did Oldest Child go to 1 pm conversation group this week?”
A pause, and then: “I didn’t know he had it. I did ask, and he said he didn’t.”
Oldest Child didn’t look at me.
Down the hall, I could hear my husband, in a meeting. “He does,” I said, rubbing my forehead. “Every week. I’m wondering if there is a better way to make this work?”
