There is a tremendous amount of excellent advice published about effective use of Telehealth for BCBAs. I don’t intend to cover that here as there are many great resources to turn to for those looking for advice. Today, I’m interested in discussing some reasons why Telehealth might actually be an improvement over traditional in-person therapy in some cases.
Many BCBA’s I talk to are absolutely astonished by how amazingly well Telehealth services have gone in some cases. As my friend Alan teaches, when you are surprised, that means that there is something that you didn’t understand about reality. I think it is worth taking the time to think this through. Why is it that I (and many other BCBAs) did not expect Telehealth services to go well, yet in some cases things have gone better than we could have imagined?
Probably, many predicted that Telehealth services would not go well because of the obvious limitations of things you can’t do on-line. Things like the BCBA can’t model during training, the short attention span of some children, and difficulty getting a complete picture of what’s happening online. Let me emphasize that those are valid concerns in many cases, and that in-person services are essential much of the time. In some situations, modifications can be made to make Telehealth reasonably effective.
Given all the issues above, I never would have suspected that Telehealth might actually be a tremendous upgrade in the quality of the services. But it can be, particularly when the primary service being delivered is training. This might happen for a few reasons:
- Increased Frequency and Duration of Services:
Often, if I’m doing training for a parent or therapist, I might only see that person once per week, or even every other week. But online, it is no problem to schedule sessions several times per week, or even every day. If I’m providing training, and I have to drive to the client’s home or school, I’m going to want to stay awhile to make it worth the time. I’m not likely to drive 45 minutes to an hour to do a 45-minute session. But in a short session online, we can often accomplish a tremendous amount. In summary, if I have three hours per week to work with a client, I’ll get much more done four 45-minute sessions than in one 3-hour session. - A Common Training Error Can No Longer Occur:
Trainers often do too much of the work for the trainees. Those of us who do this type of work usually love to work with the children, and don’t like to give that up. But trainers have to take care not to take up too much of the training time having people “observe.” Sure, observations can be helpful, but too much observation can waste precious training time. With telehealth, the trainer can’t take over. - More Responsibility for Trainees:The trainee has to be really motivated to make training successful. If I’m doing training, I’ll probably be responsible for preparing training materials, supplies, and everything we will need to successfully teach the child. But online, that situation is reversed. It is the parent or therapist that has to make sure all the supplies are ready to go. I believe this advance preparation significantly helps trainees learn more.
- No Modeling:
One of the major problems with working online is that unless you have great video models of exactly what you want the parent to do, modeling is generally impractical. One potential upside to this, though, is that the parent or therapist can’t just mimic exactly what you are doing. He or she has to really understand what to do and when to do it. I strongly suspect that this problem may actually make the skills more likely to generalize to similar situations.
For me, the lesson is clear. There are many situations where online Telehealth goes beyond just being practical or nearly as effective as in-person services. There are a few situations where it can actually offer a significant amount of Poogi compared to in-person services.