Welcome to Therapy Connect Conversations. Today, we’re joined by Sue Cameron and Simone Dudley, the owners of Therapy Connect. We’re going to address a question that comes up all the time in relation to therapy via telehealth, and that is how we allow young children to access the great many benefits of telehealth therapy. It may come as a surprise that therapy is far more accessible and possible than first perceived. 

Q. What age range can children participate in their therapy via telehealth?

Sue Cameron: Children of any age can participate in telehealth. Anyone who would be able to participate in therapy at their home or in the clinic can participate in telehealth. People often have the misconception that a child would need to be able to sit at the computer for a whole session and engage with the therapist, but that’s not actually the case at all. We identify a person to be the helper for the child. It’s usually the parent, but it can be another important person in the child’s life, like a child carer or a relative or a teacher’s aide, for instance.

We help that person to become the therapist for the child and we coach them during the session. We have a capacity-building model where we teach the parents so that they can integrate the activities they learn in sessions into a child’s everyday routines and activities. We know that it’s really important that children get therapy when they’re very young, especially so for children with disabilities. It is really important that those children are identified and that they start therapy very early. Waiting on a waiting list is not a great idea. So telehealth is a really great solution for families who can’t get easy access to services in the area where they live.

Q. What types of therapies work well for young children via telehealth?

Simone Dudley:  At Therapy Connect, we have a full range of allied health. We have speech pathology, occupational therapy, psychology, physiotherapy, and dietetics. Our approach is to start with what it is that the family really wants to achieve, and what their therapy goals are. Really common goals for families with young children are play. Working on play skills, such as turn-taking, how to play effectively, winning, losing, sharing etc. Those are really common areas to work on with children.

Supporting communication and the development of communication skills is really essential. Many families also want to develop their child’s motor skills so that their child can be able to engage with ball activities or ride a bike. Social skills are really important. Learning how to understand their own emotions and how to read emotions in other people, thinking about other people’s thoughts to be able to take part in conversations and experiences, like birthday parties and family gatherings.

Of course managing daily routines, such as mealtimes, toileting, sleep routines of young children is often a really high priority for families. And then I would add that supporting challenging behaviours. Working with families on understanding what sits behind the behaviour and how best to support behaviour.  These are the common areas that Therapy Connect team are working on with families of young children. 

You can nearly do everything that you would do in a clinic to support these goals online via tele practice.

It depends on the skill of the practitioner and their ability to work with a family, understand their priorities, set goals, conduct an assessment, and work out then how to adapt an intervention approach online. It can all be done via telehealth

Q. For a family, particularly in a regional area, it’s a relief to know that you don’t have to travel to a big capital city every two weeks for therapy, that all of the typical therapies can be delivered where they are. Would that be fair to say?

Simone Dudley: I think one of the other great benefits is, that if families are traveling long distances, all of a sudden that travel time can be converted to something else. So it might be converted into having another session next week instead of then waiting another month until you can sort of muster the energy or the time to be able to travel again.

Q. Can you think of a family who was really struggling, say, with sleep time or meal times with children with disabilities and how a program through telehealth made a difference in that particular family’s life? Can you just tell us a quick anecdote?

Simone Dudley: I think an example that sort of comes to mind is a family living in remote Queensland, where one of the therapy goals was meal times. The occupational therapist worked with the dietician. We were able to not only just have one therapist, but we could have two therapists with the family at the one time understanding the full mealtime context, which then meant that we could select some specific strategies and then monitor much more closely than you would have in a face to face setting. You’re meeting a family in their own kitchen. So you’re not taking a family out of their home and in a clinic somewhere. You’re able to talk and practice strategies and even model using the family’s own environment and their own food supplies, for example.

Q. When you’ve got a child in the therapy session, how do you keep them engaged?

Sue Cameron: If we have the child in a clinic, usually we’d know what sort of toys and games and activities they might like and have things ready to entice them to the table to interact in a therapy session. But we don’t have a cupboard full of toys at the far end. So we would talk to the family who knows very well about their child’s interests and the things that they like to do and we would ask them to collect some of those activities and bring them to the session.

We might ask the family to put their toys and activities into a box and have the lid on the box and have it just out of the child’s reach so that the child builds some anticipation about the next exciting activity that’s going to come out of the box. We would limit the activities to a fairly short time, depending on the child’s ability to concentrate. So the family might bring the toys in a bag and we could have a mystery bag of games. If it was a physio session, we might put the toys onto the coffee table so that we could encourage the child to standing and reaching and that sort of thing.

Or often a speech pathologist might want to have the child contained perhaps in their high chair or at a seat at the table for part of the time during the session. So we use our screen to share games with the family. That’s often very engaging for children if you’ve got exciting games on the screen. We can give the parents the remote control of the game so that they can control it from their end. That way they get a bit more … They’re more the important person in that game or activity.

Q. This must carry a sense of relief for parents, that one of the biggest things you would do for them is tell them what to do and how to do it. Isn’t it? That they’re going, “This is my first encounter with a two, three, or four-year-old with a disability. I don’t actually know what to do.” You see thousands of children those ages.

Sue Cameron: Yes, I think that we see our role as being a bit like a personal trainer to help the parents to incorporate these activities. Often, they know and they’re doing the right things, but if they have at the front of their mind the most important things, then they’re going to be much more able to be the child’s therapist, I guess.

Q. Coming back to that point you raised at the start about the parent and child or carer and child in therapy together is really that group family coaching advantage of telehealth over, say, traditional therapy where mum or dad might not be in the room or might be slightly less engaged. Would you agree?

Sue Cameron: Exactly. It’s just so important to have the family on board because it’s the family that’s going to make a difference. It’s not your one session a week with the speech therapist that’s going to make all the difference. It’s going to be what the family does the rest of the week is very important.

Q. What are some expert considerations or ways to approach a telehealth session with a young person that people may not consider?

Simone Dudley: So when you’re working with young people, it’s a different experience than an older person where an older person might be able to sit for an extended period of time at a table, for instance. Think about young people. What are young people doing? They’re quite often playing on the floor or running around or outside. So we need to think about how will the therapy session be designed to enable the goals that the therapist and the family have to be able to be achieved. Sometimes that might mean thinking about the environment that we’re going to use for therapy.

What room will we choose? Where will we have the resources that we might need placed? Are they going to be all over the floor or are we going to, as Sue said, sort of put some aside so that we can strategically select specific activities depending upon what goals we’re working on? So the environment and the space is really important. Sometimes we might be outside and that’s using family’s play equipment outside as well, particularly if we’re looking at motor skills or sensory skills.

So then this then leads us to the second consideration, which is what device is best to support this model of service delivery? Sometimes it might be a laptop. Other times it might, in fact, be an iPad because an iPad is more mobile. But consider where to position the iPad so that you can get the best view of the therapy space that you’re working in. That is really important.

Sometimes we can be really clever and think, well, if the therapist isn’t engaging directly with the young child, say if the therapist is coaching the family specifically in a play transaction, it might be best that the therapist is out of sight, out of mind and, in a way, speaking only to the caregiver or the play partner. Quite often, we might then use a Bluetooth headset and coach in that way. So you can say that careful design of the components of the telehealth model will all be very individual depending upon what the goal of the therapy is for each family and practitioner.

Q. What happens if some of our little people who … well, as grownups, we suffer from shiny, shiny, but the butterfly effect. You’re outside. You’re doing an external activity and they wander off. What’s some of the techniques do you use to bring the children back and focus on the session?

Simone Dudley: Well, I guess this is an interesting dilemma that we may have no matter where we are, whether we’re in clinic, in-person. Our strategy would always be to try and lead with a motivating, interesting activity that’s fun and engaging for the child. So we need to establish what they are really early on in the therapy experience. 

Q. Are there any scenarios with treatment and therapy that actually do only work in person? Tell us about any times where there are limitations around what telehealth can do.

Sue Cameron: Some people don’t really want to do telehealth. Some people have some barriers that they put up towards telehealth and they don’t think that it would work. A lot of our families say that they might have been a bit sceptical about it at the start, but once they got started with tele practice, they found that it did work much better than they had thought. But it is hard to overcome if they’re really anti-telehealth. So the people who come to us obviously have been able to overcome that barrier. They’ve been reassured by their conversations about telepractice before they get to a session.

Sometimes they can find that it’s a bit harder at the start than it would be because the responsibility is very much on the parent and helper to be the key person here. So sometimes I feel a bit embarrassed about that. Sometimes it takes a little bit of time until they develop some proficiency. The benefit of that is that they can use their skills that they’ve learned in their everyday lives with their child, even though it’s taken a little bit harder to get started. 

There’s some things that we can’t do. There’s some approaches that you might use as a speech pathologist that would involve touching a child’s face, for instance. There’s a program called PROMPT where you would have to touch the child’s face. So that wouldn’t be a type of strategy that we would use in telehealth. Sometimes if there’s physical disability, then there’s things that we can’t do, like fitting splints, fitting wheelchairs. So if there are any barriers, such as things that we find that we can’t do, then we would really try to enlist the support of a therapist who’s on the ground near the person. Sometimes families who live in the Outback might travel to a big city for a consultation sometime when they’re there visiting relatives and things like that. So we try and enlist the support of other people around and problem solve on a case-by-case basis really.

Q. It sounds like some of those physical things could be done in-person, but then topped up with telehealth ongoing for implementation, couldn’t it?

Sue Cameron: Absolutely. We always encourage families if they have access to in-person therapy as well, we’re very happy to work with other therapists in the same disciplines that we work in.

Q. For people who are new to Therapy Connect and have not heard of you before, to wrap us up, tell us a bit more about your company that both you and Sue run and then how can people get in touch with you and find out more?

Simone Dudley: Therapy Connect is a 100% dedicated telehealth allied health practice. We’ve been working and delivering telehealth supports since 2015. So that’s quite some time, certainly well before COVID. 

I’ve mentioned we have a full allied health team. Our team absolutely love working with very young children. That’s very rewarding in the early intervention space. I would add that we just know how important access is to allied health for this early childhood cohort and that not being able to access allied health can impact health outcomes down the track.

We really consider that telehealth is a fabulous option for those families that can’t access allied health therapy or remain on wait lists. We know that telehealth really enables this capacity-building model that’s certainly evidenced as best practice within this age cohort as well. If people would like to find out more, they could certainly reach us via our website, www.therapyconnect.com.au. We have an inquiry form or you could give us a call on 1-300-757-806.

Q. You are a very well-established and set-up and resourced organization. So your waiting lists are minimal, if not an issue at all, are they?

Sue Cameron: We’re very lucky … well, not just lucky, we have been able to recruit from all over Australia, so we haven’t got the same difficulties recruiting therapists that other companies do. We try to run without a waiting list. We try to recruit to the demand. Sometimes we have a short waiting period for some therapies, but usually there’s very minimal waiting periods. Once they have sent in a registration form, probably they’d be contacted the next day. If they’re quick to get the service agreement signed and so on, then they can be in therapy probably the week after. So yes, it’s a great way to do business.

Well, thank you both so much for your time and your insight today. Certainly, for anyone listening, I’m quite convinced they’re thinking now, “Well, look, any age of child can access and participate in telehealth.” I love your dedication to this sector and giving access to people wherever they are, rural, remote across Australia or big capital cities, that therapy is here to help everyone and you’re giving them that access. So thank you both Sue and Simone for your time today.