Though I have over 10 years of experience delivering services via telepractice, most of my telepractice experience has been with children ages 5 and up. I have in-person experience with kids between the ages of 1 and 4, but I will admit that it was a bit of an adjustment for me to work with this age group via telepractice. I had to go back to the basics and put things into perspective. I knew that I already had the knowledge and skills to serve these toddlers and their families. I just had to start with that foundation and then figure out how to incorporate the technology as the method of service delivery.
The typical early intervention model is home-based and includes a lot, if not 100% parent coaching. When working with preschoolers, however, they may be in a school setting, in which case you are working closer with teachers and aides than parents. With the widespread use of telepractice in the past month, SLPs are finding that their service delivery model has had a major shift. I know that transitioning your toddler caseload to telepractice can seem like a daunting task, but I advise you to do as I did--go back to the basics, and start with what you know. Ask yourself, “What would I do with this child if we were in person?” Then, ask “What technology do I need to be able to deliver equivalent services?”
In this blog post, I’m going to provide you with a template for planning telepractice sessions with toddlers that balances direct intervention with parent coaching. You may choose to do 50/50, 80/20, or any combination that you choose. It will primarily depend on three factors:
- What the child’s needs are,
- What level of family involvement you have, and
- What technology you and your clients have access to.
You absolutely should not let technology be a barrier to providing services that are equivalent to the quality of in-person services. If you need help to get more comfortable with the technology, you can check out my Technology in Telepractice course. But for now, let’s take a look at how you can structure your sessions.
When working with little ones via telepractice, you need to have a lot planned to keep their attention. No matter how long (or short) the session is, be sure to do your due diligence to plan several activities and ensure that parents/caregivers are also adequately prepared. I've developed a format to provide some structure for my toddlers that includes about 50% parent coaching. I use a different theme for each session, which is consistent throughout all of my direct intervention materials. I then have the parent or child select the toys that they will use during the parent coaching.
Here’s the format:
- Read a book
- Watch a video
- Use a toy/app/website to elicit language
- Parent coaching
Now let’s look at each one in a little more detail.
Read a book. I select a book to read that is related to the theme for that session. Depending on the technology and books that you have available, you can do shared book reading in a variety of ways.
- Paper books held up to the webcam or placed under a document camera on your desk (Tip: I have an instructional video for how to use your phone/ipad as a document camera in my Technology in Telepractice course.)
- Digital books screen shared from a website or mobile device
- YouTube videos of book readings
Watch a video. There is no shortage of videos for this age group. Just type "Old Macdonald Had a Farm" into a Google search, and you'll see at least 10 different options (just on the first page). I like to stick to videos from Little Baby Bum and Cocomelon (aka, ABC Kids TV). Tip: if you are using Zoom as your videoconferencing platform, you will just need to check the box to "Share my computer sound" when sharing your screen. This allows the clients to hear the sound from your video even while you’re wearing your headset. For other videoconferencing platforms, you would just unplug your headset so the sound can play through your computer speakers.
Use a toy to elicit language. You can share your screen with digital materials or use traditional toys (e.g., think Mr. Potato Head, farm animals, or toy cars). This is where you will set the stage for the parent coaching that will come next.
Parent coaching. While I incorporate parent coaching and discussion throughout the session, I dedicate time at the end of the session to coach the parent through the same skills that I just modeled with my toy/activity. This allows the child to use their own favorite toys in their natural environment. Since it’s at the end of the session, the parent and child can then continue playing even after we’ve logged off.
Finally, I’d like to leave you with a few tips that should help keep the attention of your youngest clients.
- Keep it short. I only do 30-minute telepractice sessions with this age group. If you are required to do longer sessions, just build in more time for parent coaching.
- Keep it fun. Think about how lively and energetic you are when working with this age group in person...and multiply that by 10! You want to go above and beyond to engage the child, which may require you to be a little more animated than usual. If the child seems to be losing interest, you can always take a break to play a short video, sing a song, or play Simon Says. The “Wheels on the Bus” is usually my go-to for quick movement breaks. “Head, Shoulders, Knees and Toes” is also a good one for getting the whole body moving.
- Follow the child’s lead. If the child is having a rough day (e.g., They were crying before the session started or the parent had to drag them to the computer), you want to start with something highly motivating. You know that toy that you were saving to use later in the session- start with that instead!
I hope you’ve found these tips to be helpful as you plan your sessions with your toddlers (and even preschoolers). I have developed an online course that has 15 themed lesson plans that include all of the books and activities planned out for you. Click here to enroll in our TODDLERS IN TELEPRACTICE course. It is on sale through May 31st. As always, feel free to email me at [email protected] if you have any questions related to telepractice or private practice that I may be able to help you with.