As the pandemic restrictions look set to continue for quite some time, many therapists and education professionals will be planning how to deliver their services safely and, in many circumstances, remotely in the longer term this year.
Sensory Integration Education (SIE) surveyed therapists and education professionals last autumn on how they coped during the first lockdown period in 2020* with delivering therapy and support to individuals with sensory integration and sensory processing difficulties. This is the advice those therapists and professionals offered should the strictest pandemic restrictions return:
Advice on Working Remotely and Using Communications Technology
“In [online] large team meetings, I have found it helps to establish a chair and communication rules.”
“Attend-Anywhere is useful virtual appointment system”
“Use a headset and microphone.”
“Microsoft teams has been so helpful. Telephone consults have been useful for families who don't want to say certain things in front of their children.”
“Have a properly set up work space with everything you need to hand.”
“Google classrooms and Your Therapy Source resources”
“We are going to be using Microsoft Live to deliver our school sensory workshop presentation. This appears to work really well.”
“Sharing information is key as we find we all need support to continue to find ways to meet the children and family needs. Take time to use clinical reasoning and Covid pandemic guidelines as it is reassuring for practitioners that you’re doing the right thing.”
“Making sure to take breaks and finish on time if home working and also having some kind of transition period at the end of the day to separate work from home life.”
“I have joined some groups of other therapists and this has been useful for sharing information.”
“When using new technology to consult with clients, have a practise session with colleagues first.”
“Have used Attend Anywhere video consultations successfully alongside sending worksheets to do dome work on interception & draw up sensory management plans.”
Advice on Remotely Delivering Therapy or Client/Student Contact
“Video calls may work better than you expect with some clients. It’s a chance to be creative, eg, modelling activities at a distance or assessing by video.”
“Don’t be afraid to try Telehealth. Sometimes getting to see the child at home in a non invasive way is hugely beneficial.”
“The client should be encouraged to make sure that they have enough data available on their plans to carry out teletherapy. Always go on mute when listening it helps video quality.”
“Use your OT skills to find books, resources that support doing 'tele-therapy' activities effectively, in the home for children with SPD, and other neurological challenges.”
“Wrote a social story for each individual patient. The social story was left with the patient for other [in-situ] staff to read if required.”
“Lego. It has been amazing how inventive you can be using Lego as your medium.”
“We have made use of a lot more video modelling - particularly with Covid-related skills such as how to put on a mask; how to wash hands; being screened with a thermometer etc. This definitely eased learners' anxiety around returning to school as they could practise at home first.”
“We run a Sensory Processing workshop for parents and used to do this is small groups of parents/carers - this has been suspended since lockdown but we have just run our first online workshop which was very successful and enables us to see more parents at the same time - so probably the way forward for the future.”
“Found that parent education sessions are easier to run virtually. More parents/carers can attend as they don’t have to travel and can participate without having video on if they choose to.”
“Secure a budget to provide therapy parcels to young people for their use at home, during session or otherwise. Open communication through an online forum with families, as people seemed happier to talk via a private forum or messenger than over the phone or video.”
“The CanPlan app supports [clients’] sequencing activities.”
“I used a website called wheelofnames.com which made online gross motor activities a lot more interactive as children were able to spin the wheel.”
“One-on-one communication and frequent check in calls with families go a long way in building relationships during turbulent times.”
“Practice use of video call technology with a friend to get used to it before trying to use it professionally. Give guidance to those receiving video call input about room layout and ability to see the child especially - limited camera view, supply a list of equipment for them to have available and keep it simple, so every day play items.”
“I created a support group for parents at no charge to help them problem solve the day to day which offered a lifeline and helped them to see the benefits of OT; I created a few different webinars for therapists on the best practices for providing ASI through telehealth, and lastly leaned on my professional groups for support in managing policies and procedures related to COVID-19.”
“There are social stories regarding Covid, virtual clinics and face to face clinic visits with PPE that I have created. There was virtual guidance for families which has proven useful. Zoom app has been most beneficial for meetings, training and interventions. Laptops had better video quality than webcams. Youtube has a wealth of videos to describe green screens and compacting videos for sending via email. Video your assessments/instructions for sessions in advance so these can be shown via share screen if you have limited room. Make a resource file of visuals that you can easily pull from to make visual schedules for zoom.”
“With regard to practice, understanding parents’ autonomic nervous system response and focusing on regulation for them so they can in turn be supported in regulating their child using a wide toolbox of strategies.”
“Have resources available on video calls to model as much as possible rather than purely verbal/written instructions.”
“I offered a free first Zoom therapy session to ensure that the set up at home, engagement of child and support of parent during the session were all appropriate for a regular session to then take place following this.”
Adapting Face-to-Face Sessions
“ASI therapy can still be delivered safely - using floor runner plastic covering as an alternative to furry swing covers has enabled cleaning.”
“Use all the PPE and be confident in its use. Learn how to use it properly and be diligent with cleaning and disinfecting.”
Managing Mental and Emotional Wellbeing
“Take it day by day, share your difficulties with others as you might be surprised how many people are in the same situation as you, give yourself time to make mistakes and have days when you feel 'lower'. During periods of reduced work, use it to follow a lecture or carry out CPD. Join forums and fb pages and blogs.”
“Patience. Regular breaks. Self care. Acknowledgement in the team of the exhaustion related to technology use.”
“connect with as much of the virtual learning opportunities that you can as there are more than ever now which is fabulous.”
“One of my colleagues made us all a little notebook for positivity and she put little comments and quotes on random pages and we had to fill it with positive things. Looking back on it is great to see the positive things that happened through this challenging time and a reminder that there are good things still happening around us.”
“Take a day at a time and try not to be too ambitious . We have made sure that we have a therapy team video call every week to make sure we keep in touch and share ideas . Look after the welfare of everyone and share positivity.”
“Be honest with yourself about how you feel about what you’re doing and the effects it may have on family. It makes it so much easier (if not actually easy to sit with) to help it move on than trying to pretend it’s all okay when it’s not. Then it’s also easier to take responsibility for your own safety and put relevant guidelines in place. I had to learn that I was responsible for me and in my case needed to do more than employers suggested.”
“Keep connected to the natural world as much as you can to bring a sense of calm to your world.”
“Stay calm and remember you can only do your best.”
Upsides to the Changes Brought About by the Pandemic
Therapists and education professionals also discussed a wide range of surprising upsides to the changes brought about by the pandemic. The two most common reasons cited (11% each) were the reductions in travel time and increased parent engagement in the therapy process. Several (5%) of respondents reported benefits to using video calls to observe the child in his or her home environment uninfluenced by the physical presence of the therapist.
Other responses included having more time to spend on activities, such as continuing professional development, service planning and making resources, and being able to reach a geographically wider range of clients. A few responses noted that clients or pupils appeared to be faring better at home during lockdown than in the “sensory overwhelming” environment of school.
“More emphasis on parents carrying out home programmes e.g. for bimanual therapy. Discussions via videolink with parents and child - can be more relaxed as they haven't had to travel - especially for those on the Social Communication Pathway.”
“From now on I will always include having parents video their children doing their everyday activities and sending me those clips to contribute to assessment.”
“The families have been able to spend good time with their children and also have observed them doing a lot of activities which previously they thought would be difficult for them.”
“Yes.. getting to know families on a more personal level, being able to see what is going on in the home, providing tele-therapy, virtual OT services brings us closer to parents, families, clients in terms of understanding their challenges in the home, and surprisingly finding there are 'alternative' home strategies that are effective in reaching similar OT goals.”
“We have moved our assessment to an online platform, so that we can share learning more easily with parents. For the families who have been able to access this, it’s created really positive conversations and sharing of learning through photos and videos!”
Do You See Your Work as Being Permanently Changed by the Pandemic and, if so, How?
Eighty-five per cent of therapists and professionals who responded to the SIE survey believed that their work was permanently changed now, with only 10% believing that it wasn’t, and 5% unsure.
Out of the respondents who forecasted areas of permanent change:
- 47% thought that their practice would continue to offer virtual sessions with students, clients or families: some would offer a blend of in-person and virtual sessions, with others only offering a virtual service at least initially.
- 24% predicted that the majority of staff meetings would be conducted online
- 24% also predicted that an element of homeworking would now be a permanent feature of their work life.
- 12% believed that increased hygiene practices were permanent introductions with some even citing that they could not see them ever again using difficult to clean items of equipment.
“This has pushed me into developing telehealth and I can see the benefit of incorporating telehealth alongside face to face provision of services in the future.”
“Yes, there will be more demand to complete assessments, meetings and supervision remotely. Permanent loss of work space as now we have to work from home and use this as base and go to client home/school/settings from home. All equipment/resources therefore will need to be transportable in car and be able to comply with infection control guidelines which are unlikely to be changed.”
“No. I think we will be able to work in the same way as we did before the pandemic. Eventually.”
“In some ways I do hope so as working from home for me has 1) saved me money as normally I have an hour’s commute each way and 2) it has been better for my well being - I am less worn out. I still have one day in the office (out of 3 as I work part-time) and I feel that this is really important to have contact with colleagues and I'd be happy to just have one day a week working from home going forwards.”
“Yes - I think that the workshop will continue to be an online workshop rather than face to face. We are also likely to continue with the first appointment offered for a child with sensory issues being a telephone appointment to gather information and to offer initial advice”
“No, I think the in-person work supporting pupils with autism and special educational needs is so important. Only pupils who had extremely hands-on and confident parents really benefited from ‘remote learning.’”
“For some telehealth will remain useful. We cover a large geographic area. Parent training will probably continue online.”
“Yes, I have more of an awareness and emphasis on relationships with parents. I have a regular online/telephone drop in with both parents and staff which has improved communication and offering strategies to those ‘difficult to reach’ families.”
“Yes, in some ways. Shared materials, co-treatments, and social touch will likely be changed for the long term. The emphasis on exercise, nature, and play will also be highlighted as extremely important in our lives.”
It is clear that there is a big task ahead in resuming therapy and support for individuals and families but also in establishing better-planned working practices and conditions for the health and education professionals that are safe, effective and sustainable in the longer term. The impact on training and continuing professional development, particularly where access to clinical experience is reduced and the ability to work directly alongside colleagues is limited, will require innovative, flexible solutions. Find out more about SIE’s online training courses here.
The full report includes areas for further consideration particularly how therapists maintain their CPD, clinical hours and training during pandemic conditions. Access it here: Sensory Challenges During a Pandemic: Providing and Accessing Therapy.
Sensory Integration Education is a not-for-profit organisation providing world-class, transformational learning and a community of practice in the area of sensory integration since 1994.
*Between 5 October and 15 November 2020, SIE hosted two surveys - respondents comprised: 231 health and education professionals working with people with sensory challenges; 31 people with sensory challenges or their parents or carers. The majority of respondents were UK and Ireland based.