Reimagining Therapy with Teletherapy

May 26, 2022
7:00 – 9:00 p.m. ET
Presented and Sponsored by Ambiki

When we are discussing teletherapy, we often start to consider the things we feel we lose by not being in person with our patient or student. But what about all the things we are gaining? In this Live Chat, learn more and ask questions about some of the amazing therapeutic benefits we can only offer our clients through teletherapy, as well as practical applications for apraxia, gender affirming voice, stuttering, and ADD/ADHD.

After this chat, participants will learn how to

• Utilize teletherapy exclusive treatment strategies
• Use practical applications for stuttering, apraxia, gender affirming voice, and ADD/ADHD over teletherapy

Panelists:

• Bailey Morgan, MA, CCC-SLP Ambiki
• Virginia Ingram, MS, CCC-SLP Ambiki
• Ian Quillen, MS, CCC-SLP Ambiki/Sidekick Therapy Partners
• Alexis (Lexie) Gregory, MA, CCC-SLP Sidekick Therapy Partners

This free event is open to all ASHA members and non-members. It is not offered for PDHs, CMHs, or ASHA CEUs.

Following is the transcript from this text-based event (no audio or video). Images uploaded during the live chat are no longer available.

Jennifer Fatemi, ASHA Moderator

Welcome everyone! We will be getting started shortly.

Before we begin taking questions, I would like to make a few administrative comments.

• Please keep in mind that this is a web chat and, therefore, there is no audio or video (Not a zoom meeting)
• Questions are typically posted one at a time, in the order they are received.
• Upon formulating a response, panelists will post answers to your questions. Should you wish to ask a follow-up question to a previously posted question, please submit it as a new question rather than adding it to the comments box.
• To ensure we get to as many questions as possible, we ask that you please begin typing them in now.

Please give a big Thank You to sponsor Ambiki Therapy. Simplified. | Ambiki

Ok, it's officially time to start. Our panelists this evening are

Ian Quillen, M.S., CCC-SLP has been a speech therapist for 3 years and started doing teletherapy during his clinical fellowship. He specializes in treating clients who stutter and consulting with therapists who treat these clients. Ian works in a clinical technology support role at Sidekick Therapy Partners, where he collaborates with developers and clinicians to identify issues and develop solutions with the technology used to deliver therapy.

Virginia Ingram, M.S CCC-SLP is a digital strategist and SLP who helps those with communication needs interact with those most important to them. With a 20+ year stint at agencies and start-ups, she has focused her career on technology-sparked solutions for business and life while transitioning her digital strategy work into both a clinical and strategic position. Clinically, Virginia specializes in delivering therapy to individuals with gender dysphoria and those who are Deaf or hard of hearing (particularly those who have recently received hearing aids or a cochlear implant). She has a keen interest in teletherapy and improving the digital literacy of all patients.

Alexis “Lexie” Gregory, M.A. CCC-SLP is a licensed speech-language pathologist working with the pediatric population since 2016. She currently works for a private practice, Sidekick Therapy Partners, in Knoxville, TN in both a clinic and school setting. She has been involved in teletherapy since the COVID pandemic began in 2020 and has experience working with a new teletherapy platform called Ambiki. She enjoys working with children with apraxia and is recognized by Apraxia Kids as a therapist that has shown an understanding of and experience in treating children with apraxia of speech. In addition, she is trained in PROMPT, PROMPTS for Restructuring Oral Muscular Phonetic Targets, which is a multidimensional approach to speech production disorders.

Bailey Morgan, M.A., CCC-SLP is a licensed SLP with experience working with teenagers and young adults with ADD, ADHD, and ASD. After working on the NYC frontlines during the pandemic, Bailey saw firsthand a heavy reliance on technology to keep therapy services accessible and to keep families in contact with their loved ones. She now spends 100% of her time dedicated to making technology accessible, intuitive, and easy to use for both clinicians and their clients. Bailey is an advocate for teletherapy and the access to services it provides for children who don’t have an in-person therapist available to them.

Thank you. I will now begin posting the questions.

Question 1: Submitted by Kevin Dias

Which types of disorders are able to be treated through teletherapy and which don't work as well (compared to in-person)?

Bailey Morgan, M.A., CCC-SLP

Many if not most disorders can be treated over teletherapy, apraxia, fluency disorders, expressive and receptive language disorders. Feeding therapy for example may be more difficult, but primarily because you may need a facilitator/parent/aide there with them. You would also be surprised when working with children how they are drawn to computer screens (and screens in general).

Lexie Gregory

I don't think it is necessarily based on types of disorders that wouldn't work well, but instead the type of client. I think it's always good to at least try a few times with a client to see how they do with teletherapy. Sometimes they surprise you and respond really well to a teletherapy platform. Sometimes it is more difficult if they are younger or have a hard time with attention span and you have to get creative to keep their attention and may need more help from a caregiver to keep them engaged.

Virginia Ingram, MS CCC-SLP

When the pandemic first started and I started using teletherapy, I was surprised at how easy it was for most our patients to start using teletherapy. I had a patient with Autism that I did not think would do well (prior to trying it) but once we started it quickly became the preferred method of treatment. He loved technology and suddenly I was now on his favorite device.

Question 2: Submitted by Julie K.

What are some examples of effective reinforcement activities that you use with school aged children when doing teletherapy?

Ian Quillen

I've found that using games and looking up images or videos on a topic students are interested in have been effective reinforcement activities. For older students (e.g. middle school, high school), I've found verbal reinforcement while the student has been engaging in a therapy activities works well.

Lexie Gregory

I like to use websites they are familiar with in school. A lot of school aged children I work with have experience with abcya.com and can tell me exactly what game they like to play. They also have holiday activities which are fun to switch it up when a new holiday comes up. I also like to use games/activities where they can be more interactive vs. watching me play the game for them. This website allows them to create stuff by telling you what they want and then you just follow their lead. I also like to use YouTube videos and let them watch a little bit at a time in between activities. Tic-tac-toe is always an easy go to as well. There is a game on funbrain.com called Turtle Wax I have been using a lot lately that the kids always request. Lastly, I rely heavily on boom cards because they have a lot of game boards or interactive activities paired with what they are working on in therapy.

Virginia Ingram, MS CCC-SLP

I had a 2-year-old who really enjoyed teletherapy. She loved the 'reactions' I would give her to keep her engaged. These bubbles make noise and attract the child's attention.

Bailey Morgan, M.A., CCC-SLP

Kiki's Word Guess is a game I use in teletherapy- I use this to choose a target word or sound, and then the child can guess

Question 3: Submitted by Sara J.

How should I engage the parent (if at all)? In my normal in-person sessions we don't have the parent there. How have you handled this with teletherapy?

Virginia Ingram, MS CCC-SLP

The beauty of teletherapy is parents are often able to participate in the session (and they often aren't able to participate in an in-person session). The parents then do a better job of carryover because they see how a therapist targets goals through play. Having them watch you is better than you reporting on what happened after the fact.

Lexie Gregory

I think engaging the parent in sessions is extremely beneficial and I love getting to interact with more parents! I work in on office setting where I have a lot of younger children and I encourage the parents to come in so they can see what I am doing in therapy and use the strategies at home. Seeing more parents in the home helps me to give them some strategies to work on at home with whatever their child is working on. If it's an older kid I sometimes have the parent come in at the end and explain what we did and ask if they have an email address I can send a homework sheet home with them and just explain how to cue them or what to listen for as an error that they can help correct. As for younger kids or kids that may need a caregiver sitting next to them in the session I use them to help keep the child's attention, but also if they are younger and doing play based therapy and they are just not attending to the screen too much I have them get their child's toys out and coach them on how to engage with the child to get more language. In addition, working with apraxia I get a lot of very unintelligible children and I use the parent to help me figure out what they want when they are asking for something and maybe pointing at the screen where I can't see it so they don't get frustrated.

Bailey Morgan, M.A., CCC-SLP

In my experience, with teletherapy it's easier to involve parents (which is one of the reasons why I love it) because the parents can be there with the child at home during the session, or pop in and out during the session, or just join you for the end to go over what happened in therapy that day (as opposed to during the school day when parents aren't present). With teletherapy, if you are working off of a specific resource or online game, it's also easier to show the parent what types of materials you are using, progress their child is making, and then you can even email them other materials for outside of therapy sessions. It's also been my experience that even if I can't get a parent to participate in the session, I do tend to have less 'rushed' parents (think of like in a clinic or picking their child up from school at the end of the day) and they will give me a bit more of their time to go over what they can work on at home.

Question 4: Submitted by Siena Roberts

What are some of the tools you are using now to treat clients during teletherapy sessions that you might not have used before COVID?

Ian Quillen

When I work with clients who stutter, especially older students, therapy sessions often involve discussing concepts, ideas, and experiences related to stuttering: for example, the stuttering iceberg, thoughts & feelings clients may have about stuttering, facts & education around stuttering, and different techniques a client might choose to use. I've found using a whiteboard to facilitate these discussions to be very helpful in teletherapy sessions. During in person sessions before the pandemic, I might have needed several different sheets of paper to talk about these concepts with students. With teletherapy I can use the whiteboard to write down phrases and draw pictures to illustrate ideas like the iceberg of stuttering, and then erase the whiteboard when we move on to the next topic.

Lexie Gregory

I use more digital resources and websites. I really have enjoyed and used a lot of boom cards in teletherapy that I now carry that over into my in person sessions because they have great activities that target specific goals I am working on. I can also get kids to engage more with shared book reading by using it on a screen vs. sitting down and looking at a book. You can get more animation with it to grab their attention. Youtube has some shared book readings and they like watching the pages turn and I also use the website Epic which uses books kids read in school.

Question 5: Submitted by Olivia H

What are some tips for engaging younger, early intervention clients on teletherapy?

Ian Quillen

I would say don't be afraid to take advantage of whatever materials are available where the client is! I've had successful early intervention sessions where we would use the toys and materials the family had at their house to engage the client. It helps that the materials are something the client is already familiar with. I've gotten a lot of mileage eliciting language with a client by having them ask for more bubbles from their parent, for example.

Lexie Gregory

This one was challenging for me to learn initially! I would suggest having a TON of toys handy where you can constantly switch it up because they have a shorter attention span. I would also educate the parents and have them have some of their own toys they can play with and encourage the parent to use a Milieu Therapy Approach where they use communication temptations to encourage language. I have found videos and songs to be helpful too. Again, I can't say enough about boom cards and finding activities where they can build something, feed something, find something hiding, pictures along with a song, etc. and again Youtube where you can pause videos and have them communicate when they want more of it or use it as a reinforcement. Last, but not least, be SUPER animated and make it fun :)

Virginia Ingram, MS CCC-SLP

I still use books and manipulatives in teletherapy just like when seeing a patient in person. I will find videos of someone reading a book a patient has at their house and then we will practice "book skills" and follow along (looking at the cover and reading the title, turning the pages at the appropriate time, etc.,). I'll be modeling the appropriate behavior along with them. For manipulatives, many patients have farm or community helper toys so I will design a session around the toys they have. I also love to do songs with this age group and get the parents to join in!

With teletherapy, you often have built-in toys that help to facilitate engagement. I mentioned 'reactions' earlier. Littles LOVE them. We also use whiteboards with different materials and let the patients scribble on them.

Bailey Morgan, M.A., CCC-SLP

Virginia mentioned this already in an earlier question - but 'Reactions' (which is a feature of Ambiki's teletherapy platform) are a LIFESAVER with some of the younger children. They are essentially visuals with sounds that pop up on the screen. Once I find the one my client loves - I use that the entire session for redirection, reinforcement, a celebration etc.

Question 6: Submitted by Josephine L.

How does using group therapy benefit? Do you find that some clients work better in group settings?

Lexie Gregory

I think group therapy is really helpful for carryover of sounds. I have some kids who do really well in conversation on their sound working with me, but the minute they start talking fast with a friend it falls apart. Also, I think if you can have the kids teach the others it helps them learn more too! If I have multiple kids working on the same sound I have them describe how they make the sound to maybe have it click more for another kid or just to raise self-awareness of what their mouth is doing to make the right sound. In addition, social skills especially for autistic children. It helps to generate more real life scenarios rather than "how would you respond if..." I have one kid working on asking appropriate questions so I have him ask the others about their weekends, etc. and teach him how to ask appropriate questions to facilitate a conversation.

Virginia Ingram, MS CCC-SLP

With group therapy, patients get the opportunity to learn from each other. In the chat we have talked a lot about teletherapy with early intervention or school-aged children, but you can do group teletherapy with any age.

For instance, a teletherapy group session works great for patients who are participating in gender-affirming voice therapy. You can role play phone conversations and have participants turn off their cameras to see if others in the group would gender the caller correctly on a phone call.

Also in Ambiki's teletherapy, there is an 'Observer Mode.' Observer mode allows a therapist to invite invisible observers. Because the observer is invisible the patients are not as likely to be self-conscious. This allows observers to view the patient with a more natural presentation.

Question 7: Submitted by Josephine L.

Are there resources you would recommend using during teletherapy session when working with preschool clients who stutter?

Ian Quillen

The Stuttering Foundation has some helpful resources for educating parents of preschoolers who stutter: https://www.stutteringhelp.org/content/parents-pre-schoolers. An important aspect of intervention for preschool-aged children who stutter is educating the families/caregivers on how they can respond in helpful ways when their children stutter. For example, reducing time pressures for communicating, pausing when a child finishes speaking before responding, verbally praising when the child communicates and finishes what they're saying.

Bailey Morgan, M.A., CCC-SLP

This is a great tool also for stuttering to help measure progress over time. You can ask, "How easy is talking this week, from 1-5? 1 means "It's really hard to talk" and 5 means "It's super easy to talk." Progress is measured by the numbers going up. You can also use faces that the client can draw instead of numbers! https://ambiki.com/activity-lists/stuttering-self-report-rating-scales-ceafab47-c739-4bda-94b6-d01a1748cc23 

Question 8: Submitted by Karen S.

For children who are hyperactive or easily excited how do you keep them interested in the teletherapy session?

Lexie Gregory

This one is difficult too I find it takes a lot of energy! I would say have a lot of activities to be able to switch to something new if they get bored quickly or don't like the activity. The more you can create the novelty of an activity the better I find their attention span. I download a bunch of boom cards and have them choose and when I lose their attention I can quickly back out and have them select another activity. If that doesn't work I might switch to a song or video for a break. I think movement breaks are helpful too! You can choose songs that encourage movement for them to get out of their chair for a minute and I just create a timer for their break. I had one kid who even had a mini trampoline at home and in between activities he would go jump and I would count 10 jumps and he would come back and do some more work. I think the best advice is to keep activities short with a lot of reinforcement and switch activities to constantly keep it new!

Bailey Morgan, M.A., CCC-SLP

I use a lot of different stimuli (so I move through a lot of different resources and games during the session) and try to keep as much structure as I can during the session as well by using things like visual schedules and timers. Break times are super important as well. If you have a teletherapy platform that you can screenshare with, I will usually show a video intermittently as well between tasks.

Question 9: Submitted by Jlendenholt

What are some of your go-to resources for AAC users via teletherapy?

Lexie Gregory

There are a lot of boom cards that use core board words and corresponding pictures for the activity. For example, you might be teaching the word "put" and in the corner it has the symbol for them to match and use on their device to communicate during the activity.http:// https://wow.boomlearning.com/play/A9oJJ7RbWzDeijiEh/teacher 

Question 10: Submitted by Jlendenholt

What would you say is your most used technology feature?

Ian Quillen

I've used the click beacon a lot when doing receptive language activities. The click beacon allows me to see where clients are touching the screen when they're doing activities, without me giving them access or control to my screen which could create issues with maintaining HIPAA. I've also used the click beacon when working with a client on phonology to target perceiving the differences between two sounds during a minimal pairs activity.

Bailey Morgan, M.A., CCC-SLP

I would say the most used features of Ambiki teletherapy are the Reactions (which are audio/visuals that you can select to pop up on your client's screen for reinforcement, rewards, or just for fun) and also the built-in Visual Schedule, since that structure over teletherapy is extra important, and it's hard to have a paper visual schedule visible to your client over teletherapy. You can keep the visual schedule up for the entirety of the session which makes redirection and transitions much easier. I also just want to give a nod to our built-in resource library which lets you pull up a PDF/resource right into the session, and then the child can draw/stamp/type on the resource directly. It adds an interactive component that our users have told me they just don't get when screensharing a PDF.

Virginia Ingram, MS CCC-SLP

I like using the 'chat correction' feature with older students who are working on language goals. Chatting with them helps you evaluate their written language -- and correct their mistakes. Homophones, misspellings, grammar mistakes, really anything can be corrected and reviewed with the patient in the teletherapy chat.

Lexie Gregory

I use the white board in my sessions a lot too. Kids often request it to just draw or play tic-tac-toe and it allows them to choose different symbols they can play with! I also use it as another cueing tool to show kids with apraxia the different sounds or words they have to combine. For example, I had a kid working on the word "my," so I used the white board to draw an 'm' and then a symbol of an eyeball to help emphasize to him to use the word "eye" to create the word "my" and it clicked better for him with that representation!

Question 11: Submitted by Jessie N.

In what ways does teletherapy benefit over in person services?

Ian Quillen

Flexibility in scheduling is one advantage teletherapy has. In a school or clinic setting, it can be difficult to reschedule on short notice due to logistical constraints (e.g. rooms not being available at a different time). Communication with families about scheduling can make accommodating changes for teletherapy sessions straightforward, depending on a therapist's availability.

Lexie Gregory

As a therapist working with children with apraxia I think it is easier to get them to look at my face and draw attention to my mouth because they are looking at a screen vs. the entire room/toys during an in person session which is a very important component of working with apraxia.

Bailey Morgan, M.A., CCC-SLP

Teletherapy can also be a good opportunity to practice making phone calls and such for fluency client (or really any clients who are trying to build confidence in social situations). You can also change the climate where they are doing teletherapy (home, school, work, other environments) since we know that setting and stress can also impact speech and language.

Question 12: Submitted by Jessie N.

How do you handle patients who may want to give up on teletherapy sessions? What positive reinforcement techniques would you recommend?

Lexie Gregory

I think visual schedules and timers are really helpful here for them to see what they have to accomplish first or how much time is left in the session. Ambiki has a total time remaining component, but also the ability to set visual timers for different activities and the ability to create a visual schedule where you can show the kid after each activity that it is done and what is coming next.

Bailey Morgan, M.A., CCC-SLP

Sometimes I have clients in person as well who will want to give up or become frustrated during sessions. In the same way that I try to verbally encourage during in-person, I also try to do the same over teletherapy. The good thing about teletherapy is it can be quick and easy to turn teletherapy into a 'computer game' if you notice your child is starting to become distracted or not into what you are doing, and it can be a little easier to switch gears quickly with a new activity or resource (verses being in a classroom and not having anything else prepared in that moment).

Ambiki also has a 'reveal image' feature that you can use over teletherapy- I have a user who told me her client really loves Doritos. So, after they complete each activity, an image starts to reveal itself (the image being a bag of Doritos), and at the end of the session, Mom gives the child a bag of Doritos. I think identifying motivators as early as possible can be great ways from keeping the kids from giving up mid session.

Ian Quillen

In situations where the above approaches haven't worked, it may be helpful to level with the client and have an honest conversation about what the expectations are and what's needed to make something meaningful out of sessions. Something along the lines of, "We have 30 minutes each week where we have to work together. How can we make the most out of this time?"

Question 13: Submitted by Isabella T.

Any advice for treating gender dysphoria through teletherapy? Should these sessions always be individual or have you ever had experience with a group gender dysphoria session?

Virginia Ingram, MS CCC-SLP

I love teletherapy for patients who are working on gender-affirming voice therapy. Teletherapy typically makes it easier for these patients to work the therapy times into their workday. Teletherapy also allows you to create groups that are not tied to a geographic location. Teletherapy offers an unobtrusive way to record sessions which is helpful for monitoring progress over time.

I think a mix between individual and group therapy is best. Teletherapy group sessions can almost work like a support group allowing the patients to learn gender-affirming presentation techniques from each other (such as tips for dressing, mannerisms, and conversation style). Individual therapy allows the therapist to work closely with the client to address their specific goals.

Question 14: Submitted Olivia H.

How do you target literacy skills via teletherapy?

Lexie Gregory

A lot of the stimuli I use for speech sounds I try to have the written word below the picture or just the written word to encourage them to read the word they have to produce. I also use the website Epic which allows you to choose books based on their reading level.

Bailey Morgan, M.A., CCC-SLP

Ambiki also offers a Chat Correct feature which lets you automatically correct and annotate spelling, capitalization, punctuation, missing word errors that I use. So we are having fun writing in the chat (children love writing in chats!!) while also working on literacy skills (without them even realizing!!).

Question 15: Submitted by C. Roberts

How does working with parents of clients change through teletherapy? Can you share the difference between teletherapy and in person.

Lexie Gregory

I think it gives you more access to the parents especially if you work in the schools. A lot of times we don't interact with the parent with kids we see in the school, so teletherapy helps to be able to see and engage with the parent to introduce yourself, explain in more detail how their kid is doing in therapy and even encourage them to work on specific things at home. You notice better progress and carryover when you can get a caregiver on board to also work with the child at home, so I think the more you are able to explain and engage with them the more likely they are to work on things at home!

Ian Quillen

I think teletherapy can create a different dynamic in the relationship you have with the families you work with. In an outpatient or school setting, the setting you're working in can contribute to a more formal relationship. E.g. When the client goes to see you for a session, the outpatient clinic room or school therapy room establishes that they're there for therapy, and you're their therapist. With teletherapy, you're often seeing the clients wherever they're at--at home, in the car, or sometimes other locations. That difference in location can change or break down a more formal dynamic that can exist in other settings. That can lead to you gaining more insight about what your client's life is like when they're at home, or wherever they're joining the session from. You may gain insight into parts of a client's life or family environment that you might not otherwise know about if you saw them at school or a clinic.

The same goes for the client's parents as well. Teletherapy can facilitate more interaction with parents like Lexie said, and you also may learn more about what parents are going through by virtue of the interactions you have with them over teletherapy. That's something I noticed a lot during the 2020-2021 school year. I'd often hear about what families were struggling with or dealing with during the pandemic, just from talking to them at the end of sessions. Of course, it's important to maintain the professional boundaries you're most comfortable with as a therapist. At the same time, these interactions can affect your therapeutic relationship with the clients you serve and their families, and sometimes even strengthen it.

Question 16: Submitted by C. Diez

What are some of the biggest barriers with telepractice? What are some way to overcome these?

Virginia Ingram, MS CCC-SLP

Digital literacy is a barrier. Many patients and families do not feel comfortable attempting teletherapy because they don't think they have the skills to do it. If you can get them to try it at least once, they will see it is not as hard as they think it will be. People don't give themselves enough credit for the digital literacy skills they have! I had a co-worker who used to get her patients to do a mock session with her whenever she did a new evaluation so the parents would feel comfortable trying it on their own.
Lack of Wifi in rural areas can be a barrier. Don't get me started on how high-speed internet access should be available for everyone (ideally it would also be free!!). :)

Bailey Morgan, M.A., CCC-SLP

For me, having switched from in person with older populations to teletherapy with young children, my biggest fear/concern making that transition was being able to maintain control of my session while distanced. I think having different tools and small details to help you keep a wrangle on your session are really important and help you feel good going into the session like you're not walking into chaos where you don't know what's going to happen that day. For example, having a teletherapy platform that has a whiteboard you can lock/unlock, a quick way to turn off a child's camera/video in a group teletherapy session where the next thing you know you're in the bathroom with the child and their tablet, having things like timers and visual schedules that set the expectation - those are all things that help make teletherapy a little less intimidating for myself personally. For me, that was the barrier in itself that kept me from doing teletherapy for so long. I was so nervous!

Lexie Gregory

I think one of the biggest challenges I encounter is the internet/technology aspect. What I have found helpful is to understand the system and be able to troubleshoot with the parent on the phone and be able to explain how to log in and what different links/buttons mean. I think then the more they do it the more familiar they become and the easier it gets. I also sometimes have sessions where the kid is in the car and it makes it difficult to get a connection and for them to hear. I think giving the parent some guidelines for successful teletherapy ahead of times is helpful as well. Jennie Bjorem has free handouts which includes a checklist for parents before a session. https://www.bjoremspeech.com/collections/free-resources/products/teletherapy-checklist-for-parents 

Ian Quillen

One of the biggest challenges I've encountered is finding ways to redirect and engage clients when you're not physically in the room with them. For some clients I've seen, it can be more challenging to use techniques like structuring or manipulating the environment to reduce distractions. I've found that I've needed to adjust my expectations for sessions doing teletherapy. Sometimes I've had to learn to be flexible and be okay with a client needing multiple verbal redirects to participate, and using the tools I have at my disposal to keep them engaged with me.

Question 17: Submitted by Julianne P.

What are some common therapy activities that older students enjoy the most during teletherapy sessions?

Lexie Gregory

I find that asking the kid what they want to do or what they are interested in is really helpful! Then I can find some specific activities or games based on their interests. I had an older kid that really enjoyed jeopardy and quizzes. You can create your own jeopardy game online with JeopardyLabs https://jeopardylabs.com/ or even find some that are already created for you based on topics. I know a lot of older school aged children are in to video games and Erik Raj does a create job create materials that incorporate video games for older children. I would suggest checking out some of his materials. https://erikxraj.com/

Ian Quillen

I like finding news articles about a topic the client is interested in and using those as a basis for therapy. Targeting speech sounds in reading or conversation for artic, comprehension or inference questions for language, practicing overcoming communication challenges and brainstorming solutions with stuttering, or perspective-taking and problem-solving for pragmatics, are all different activities I've tried with older students that have worked well in therapy.

Virginia Ingram, MS CCC-SLP

Emojis are cool and what they use to communicate with their friends. We want our students to be fluent in visual language; in some cases that may work better than written or spoken language. To use this technique, present a student with a string of 4-6 emojis and see what story they create. You can also get your students to talk about the multiple meanings different emojis have. I get my emojis (and meanings from Emojipedia.org).

Bailey Morgan, M.A., CCC-SLP

Kiki Creates has also been a hit with older kids! Kiki Creates lets you type in a prompt, topic, subject, or question - for example: 'Create a scary story with a rabbit' - and Kiki Creates will instantly create a story for you to use in your session. This is the story it created for the 'Create a scary story with a rabbit' prompt:

"Once upon a time there was a rabbit that was so scared of everything. It would always hide in its burrow when there was a storm outside or when it would hear a loud noise. One day, the rabbit's burrow was flooding and it didn't know what to do. The rabbit started to panic and then it saw a huge snake heading towards it. The rabbit was so scared that it ran towards the snake and it bit it. The snake died instantly."

Older kids have a lot of fun using this feature and typing different prompts in. And then you can use what it gives you for your session. It will even give you a response to "Why shouldn't I hide under the table"!

Question 18: Submitted by Guest

Are clients still making the same progress over teletherapy that they do in person?

Lexie Gregory

Yes! Even though the format is different I still find myself targeting the same goals and using similar stimuli just in a digital form instead of a paper based form. We had a therapist at our company work with an early intervention client solely via teletherapy and was able to discharge him for meeting his goals in a very short timeframe!

Question 19: Submitted by Guest

What are some ways that recording/screen capturing can be a helpful tool for therapy?

Bailey Morgan, M.A., CCC-SLP

Biofeedback has been proven to be a successful tool across the board for therapy. Screen recording (with permission obviously) allows the client to review their errors, adjust self-perception, view progress (like a before and after picture!)... it can also help parents or caregivers as well to review what is happening in therapy and improve carryover at home. Some clients may also have stronger visual skills than auditory skills where watching their movements is more beneficial to them (like for a motor speech client).

Lexie Gregory

Like Bailey mentioned I use recording a lot to help with self-awareness and self-correction of errors. I record the kids saying their sounds and have them tell me if they think it was good or not quite right and it helps increase their auditory perception and ability to identify when they said a sound incorrectly to be able to start correcting on their own.

Virginia Ingram, MS CCC-SLP

I start every voice-affirming session by recording the patient reading the Rainbow Passage. Over time, I can compare the recordings to see the progress they are making. When you are doing the session via teletherapy, the recording tends to be more natural because it is easier for the patient to forget they are being recorded.

Jennifer Fatemi, ASHA Moderator

I am afraid we are out of time. Perhaps the panelists have something they would like to say in closing?

Lexie Gregory

Don't be afraid to try teletherapy! It's a learning curve just like everything else we do in therapy, but it definitely has its benefits!

Virginia Ingram, MS CCC-SLP

This was so fun!! I am glad we got a chance to chat tonight! Thank you for joining us. You can follow me on Instagram if you want to continue the conversation. I love chatting.

Ian Quillen

I've really appreciated being able to connect with my clients during the pandemic via teletherapy. I think teletherapy has a place in service delivery that will continue to be important moving forward, to give clients access to services they might not have otherwise had.

Bailey Morgan, M.A., CCC-SLP

Like Lexie said, don't be afraid to try it out! Ambiki offers teletherapy demos where you can get on with a clinician and have a chance to go through different teletherapy applications for your specific clients. You can set up a demo here: Try out Ambiki teletherapy!

Jennifer Fatemi, ASHA Moderator

Thank you all so much for your great questions and comments and thank you, panelists, for your time and great information! This chat will be available immediately after it has ended from this page.

Thank you again to sponsor Ambiki.

Goodnight everyone!