Telehealth for Individuals With Developmental Disabilities During COVID-19

Aspects of telehealth and remote learning are blending together for occupational therapists providing services for students living with developmental disabilities during the coronavirus pandemic.

The forced transition to virtual education for many school systems has also led to many services for people with disabilities being provided via telehealth systems. The U.S. Department of Education encourages flexibility in educating students with disabilities in this unique situation and has provided a question-and-answer document about IDEA and Section 504 during COVID-19.

Working in a North Carolina charter school for middle and high school students, Julianna O’Parks, OT, describes some of the challenges and unexpected benefits this situation has revealed. She works with middle and high school students who may be diagnosed with autism spectrum disorder, traumatic brain injury, or other intellectual and developmental disabilities (IDD).

Overcoming Technical Difficulties

Some of the first hurdles O’Parks and her students encountered in moving to OT telehealth sessions were technology challenges. Students already used Chromebooks in schools, so access to technology was luckily not an issue. Because the infrastructure was in place and students already knew how to use computers, she notes, the school was “able to be more dynamic and provide telehealth services and virtual school within a week.”

The transition wasn’t flawless, however. Because the use of Zoom meetings was skyrocketing in the area and the servers providing connections were in high demand, she and her students frequently encountered interruptions in sound and video connections. Students who need OT services, O’Parks says, tend to need support with processing and sequencing, so the outages added a layer of difficulty.

O’Parks and her students also had to work through the logistics of sending assignment files back and forth over email, using webcams for observation of activities, and uploading and downloading image files. Before long, she found that practice helped her communication with students go more smoothly.

In this situation, an OT has to be more creative and innovative. Some students have printers; some don’t. The therapist might have students and parents look for resources at home for the OT exercises that align with the students’ individualized education programs (IEPs). For example, the student may have putty or other manipulative tools for hand exercises.

A particular difficulty has been working with lower functioning students using cameras. Because they are not meeting face to face, O’Parks misses being able to see their body language. She may ask parents for feedback in that area. For some students, the parents have to be involved every step of the way.

Providing Choices, Boosting Motivation

An ongoing challenge has been student motivation. “It’s interesting to see which students are trying to do as little as possible,” O’Parks notes. “Some care and try really hard. Some of them don’t.”

To foster engagement, experts note the importance of providing choices when educating students with disabilities. As the Relias course Choice Making for People With Intellectual and Developmental Disabilities notes, “People who have disabilities are just like everyone else—they want to make choices and be in control of their own lives as much as possible.” By giving students with disabilities choices in the topics or tools of their activities, OTs can empower their clients and support them in becoming leaders in their own lives.

As the Relias course asserts, “Empowering another person is the act of providing the appropriate support and education so the person can safely and successfully make choices in their life.”

With the current reliance on telehealth, school OTs who are coaching their clients remotely during activities can provide choices to students to foster better engagement and collaboration.

To encourage students, O’Parks works to find activities that have a connection to their interests. Many of the young people lack shoulder, arm, and hand strength. To develop those areas, they may work on typing, posture, hand dexterity, and strengthening exercises. For some students, becoming strong is a personal point of pride. Gaming is a popular topic for assignments as well.

“I try to keep it relevant and meaningful for them,” O’Parks says. “Occupational therapy is all about being engaged. The fundamentals are solid, and I try to tailor it to their interests.”

For handwriting or drawing assignments, O’Parks and her students have had to adapt to using the camera to show their exercises. The student might hold a pencil in a tripod grasp in front of the camera, do finger extensions, or pencil manipulations. They might email writing assignments to her or hold them up in front of their cameras, depending on each student’s abilities.

Finding New Ways to Support Students Living With IDD

Many organizations are providing online resources for supporting students with disabilities during COVID-19. For example, the Frank Porter Graham Child Development Institute outlines seven strategies for supporting children with autism during the pandemic:

• Support understanding.
• Offer opportunities for expression.
• Prioritize coping and calming skills.
• Maintain routines.
• Build new routines.
• Foster connections (from a distance).
• Be aware of changing behaviors.

As a result of COVID-19 precautions, many parents are home with their students and available to provide support. This benefits OT services because parents can see their child’s school activities in action. “I do a lot of education with the parents about what I’m looking for and why I’m looking for it,” O’Parks says. Those experiences put parents in a better position to support their children’s activities and promote practice at home.

Previously, the parent might have wondered why their child was working on spinning a pencil, but the parent would forget to ask about it at an IEP meeting. By seeing the OT work with their child, they understand much more. “They see these other components of what goes into their child’s academic world,” O’Parks notes. “The parent is more invested. They now know how to ask the right questions to support the child’s learning at home.”

From an OT perspective, the open communication with parents provides welcome support.

Another benefit stems from a drawback. Because the server will crash at times, O’Parks says, “failure is going to happen.” When things go wrong, she has the incentive to try something new, and that provides a great lesson for her students.

For students who have difficulty dealing with disruptions to routine, especially children on the autism spectrum, it is helpful for them to recognize that things in life and out in the world don’t always go according to plan, O’Parks notes. The repercussions from COVID-19 have given students valuable practice with being flexible. She notes that the many pandemic-related disruptions still require support from parents, teachers, and OTs by acknowledging the stress involved and making a plan to deal with inevitable breaks in routine.

O’Parks shares her mantra when activities go off track: “We do our best and try again tomorrow.”