Early Intervention and Telepractice



By: Janet L. Courtney, MS, CCC/SLP
Founder and CEO of Lighthouse Therapy LLC
Lighthouse-therapy.com

I am so excited to introduce my guest blogger, Janet Courtney.  She is the founder and CEO of Lighthouse Therapy LLC.  They are the newest online teletherapy company for schools.  Janet is a Speech-Language Pathologist of 25 years with the last 8 years spent servicing and assessing students PreK-12th grade via telepractice.   Her passion has always been helping students and professionals to become the best they can be through therapy, mentoring, and supporting those she serves. She currently lives in Michigan with her husband and three mostly grown children. Janet was working as a lead therapist for a telepractice company when we met a few years ago.  We have a mutual respect for each other's skills and abilities as therapists and leaders in the field of telepractice.  You can find Janet's blogs at https://www.lighthouse-therapy.com/blogcontact her at Lighthouse at contact@lighthouse-therapy.com or call 888-642-0994.
"My son is two and he isn’t talking yet, is that normal?"  "Our one-year-old doesn’t feed herself and has trouble holding a spoon, is that normal?"  A teenage mom with a 2-year-old and a 3-year-old is feeling overwhelmed and doesn’t know how to handle her children’s bad behavior.  All these scenarios are great examples of children who will benefit from Early Intervention.  The federal Individuals with Disabilities Education Act, Part C, (IDEA) covers services for children and families from Birth through age 3.  The Preschool Program of Part B covers children for ages 3 to 5 (Section 619).  These programs mandate special education services to be provided to families and their children with developmental delays or disabilities.

So, who is responsible for identifying these students?  Referrals for students can come from a variety of people and places.  Parents obviously are the first to notice difficulties that their children are having, but not all parents will recognize these delays in their own child.  Physicians, social workers, daycare providers, preschool teachers, relatives, and family friends may be the first to recognize developmental delays or disabilities in this population. By seeking out assistance for a child, parents and educators can get crucial services that a child and their family needs. These services will significantly impact a child’s development and future educational achievements. Critical physical, social, communication, and academic development occur in the first 5 years of a child’s life.   

When a child is referred for Early Intervention (EI) or Preschool services, many different professionals will be involved in developing an Individualized Family Service Plan (IFSP) until the child turns 3 and then the team will develop an Individualized Education Program (IEP).  The team may include a school psychologist, neurologist, speech-language pathologist (SLP), physical therapist (PT), occupational therapist (OT) or other professionals, depending on the areas of concern for the child.  The team, including the parents, will develop an IFSP or IEP that defines the areas of concern and the services that the family and child will receive.  An IFSP specifically includes the entire family; education and consultation are a key component in the IFSP.  Goals related to the child’s development are also an important part of this program.

Some parents and professionals wonder how telepractice can address these children’s needs in an online setting?  Will it even work?  If the therapist is not there, how can they get data to determine if a student will qualify?  These are all excellent questions that should be answered to address EI and Preschool services and telepractice services.  When a child is referred for EI or Preschool services, developmental assessments and parent/teacher questionnaires are crucial to get a caregiver and teacher’s perspective on where the child is functioning.  These questionnaires and interviews can be conducted via telephone or on the platform.  Many questionnaires are also sent via email.  Lighthouse Therapy’s platform allows for safe and confidential sharing of information through the security of our platform, thus decreasing the risk of exposure to Pertinent Health Information.

Therapy services are conducted via online video conferencing services.  These services can be performed in the child’s home with the caregivers/parents or in a preschool classroom in an individual or small group setting.  The clinician can coach parents on strategies and activities specifically designed to promote development in deficit areas.  The therapist can observe the caregiver/parents with the child to continually monitor progress and adjust strategies that are being recommended. In the preschool setting, a student support specialist or classroom assistant can assist the child to join the therapist in the session. The session is conducted via the platform with engaging and interactive activities.  The student may also perform tabletop activities and, using a second documentation camera or external camera, the therapist can observe the student’s activities and guide the student and assistant from there.  A wide-angle lens is great for group settings or observation of the student performing with peers or in a classroom activity.  At Lighthouse Therapy, our platform can easily adapt to all these environments and provide a dynamic and interactive experience for the students, parents, and other professionals engaged in assisting the student.

When coaching parents or caregivers, we as therapists must speak in layman’s terms.  It is important to give those most involved in the child’s education practical tips to enhance communication and learning opportunities.  Teach the parents how to use highlighting in their speech to emphasize the message or direction they are working on with the student.  Using repetition and modeling for the child by giving them the words they are missing or giving them the correct production of the words they are trying to communicate.  Another tip I always recommend to parents or primary caregivers is recording the child at the beginning of the year.  When they interact with the child daily, they will not notice the progress their child is making.  By going back 3-6 months later and listening to that recording again, it will be much easier for them to recognize and identify the gains their child has accomplished.

So how do I integrate these ideas into a successful teletherapy session?  With children this young, it is always a good idea to have at least 3 or more activities planned for a 30-minute session.  This will allow you to move from an activity that has lost their attention without losing the child’s attention completely.  Some examples of activities I have prepared would have a theme related to a holiday, a concept we are addressing, or favorite types of toys that the child responds to (i.e. trains, animals, princesses, etc.). With the topic or goal in mind, I include a song or YouTube video with lots of action to get the student excited and engaged at the beginning of the session.  I can stop and start the video and use annotation on the video.  This also lays the groundwork for what we are working on that day.  Then we do an activity with pictures, a story, or a book related to the child’s goals.  I incorporate the use of stamps and drawing to help the child interact with and talk about the pictures using highlighting and modeling for the student and as a demonstration for the parent.  Then we transition to a simple memory game or flashcards again giving praise and excitement about the activity.  If this is too difficult, I will use my documentation camera and have a time of show and tell.  This is a great way for the child to use his communication skills to tell me about something that they are excited about. For some of my ASD students, I make sure to include social greetings at the beginning of the session and goodbye before they can end the session.  When used consistently, my students become accustomed to these requirements and start to spontaneously produce them with minimal prompting and carryover.

It is important for the professionals to have access to developmental norms, so I have included a few links related to Developmental Norms for Speech and Language, Occupational Therapy Developmental Milestones, and the National Association of School Psychologists position statement on Early Intervention Services.  Many of you already have your favorites, but it is always nice to have other resources available.

These services are desperately needed in many areas of the country.  By engaging in the use of telepractitioners, these children will be given services that will be key to their future academic success.