The Unexpected Benefits of Embracing Telehealth as a Speech Therapist

Melissa Pouncey
Speech therspist doing telehealth video chat with child client.
Speech therspist doing telehealth video chat with child client.

I was called into my field by OK! magazine. It sounds like an impossible statement, but the first time I realized I had found the right job for me, I was sitting on the floor of a home, delivering speech therapy services to a family, pointing out pictures in a magazine with a child. The only print media in the house to work on early reading skills were OK! magazines, but this kid loved them — probably because his mama, a hard-working single mom, loved them and he idolized her. We sat together for our entire hour session looking at magazines while his mom sat talking with my clinical supervisor, getting maybe her only hour that week to have a real, adult conversation. And I looked around and realized — I’m supposed to be here.

I was a theater major turned speech-language pathology major in a master’s program and not sure where I fit. Doing some autism research and looking for something a little different, I happened into a clinical placement that took me into Early Intervention — a nationwide program that serves children and their families aged 0-3 with a developmental delay diagnosis, or who may be at risk for a delay. Families get coaching to help them learn to teach their child in the way that helps them best from therapists, all in their home or daycare.

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As providers, we get to sit in the middle of a lot of real — power getting cut off, grandmother making her famous pancakes, families splitting up, the birth of baby pigs, and too many moments to count in between. We get invited into spaces that hold joy and sadness, and into some real opportunities to create daily routines that literally change lives. It was this natural environment space that made me realize — vulnerability and intimacy make this work. There’s a humility to setting aside everything you think you know as a professional and asking instead “What do we need to work on today?” that I found incredibly compelling.

Don’t misread me — this isn’t a total inspiration piece. There are incredible challenges out there, and those challenges don’t sit down and wait for you to be ready. I learned about the challenges that first day, first solo home visit, when I knocked on a door and it opened to reveal… a completely naked woman. It was a total mistake on my part in getting the wrong address and a prompt door slammed-in-the-face. Or maybe that first time someone asked me an incredibly personal and hard question about their child’s future, and I felt completely inadequate in answering it.

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Not all moments are story-worthy. Families who have a child that isn’t verbally communicating can face challenges and need partners on their journey that aren’t afraid to sit with them in those very real moments, even the hardest ones. I learned over the years that sometimes just being there, not trying to fix anything or have all the answers, really is the best way to help.

As I’m writing this COVID-19 is spreading through our country. Families are quarantined and we all are separated from all those routines that make life what it is. Since those early career days of Early Intervention, I’m gone on to a more clinical role. I’m largely specialized, seeing mostly nonverbal individuals and connecting them with communication technology, and working with young children with autism and their families. And while the job that I have (had) is beautiful too, and has given me so many opportunities, the past two weeks have made me realize that those real, everyday moments — those are where the real magic happens.

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COVID-19 has had the unusual effect of teaching me an entirely new practice of speech therapy: telehealth. And to tell you the real truth, I’m a very reluctant convert. Telehealth, or meeting with families via live video, has been floating around in our clinic, led by our board of directors and CEO for some time, and I’ve been avoiding it. Like actually leaving rooms when it’s mentioned. I’m not a TV watcher, and as someone who severely limits screen time for my own kids, I couldn’t imagine how being a disembodied face on a computer screen could allow therapy to be in homes.

There’s something intangible about the way I do therapy — it’s a “be in the moment” kind of practice, for me at least. And until now, I’ve always said teletherapy could never work. Besides, I thought, why would we ever need it? And yet, here we are: surrounded by a global pandemic that keeps us from gathering, from physically connecting. Apparently, there are people with better imaginations than mine.

I spent almost an hour last week taking a walking tour of a Birmingham neighborhood, held in the sticky hands of a 2-year-old and led around by his older sister, who would exclaim at every porch “don’t go any closer, they might have the virus” and instructing her brother to practice greeting each neighbor by name. (Greeting and being able to say your neighbor’s names is pretty high on the important communication skills we all need.) I was the coach in her ear, telling her how to split up hard, complicated names into sounds her brother could produce. Talk about real-world practice.

I’m a crier, like leaking eyes at anything even remotely sentimental, and let me tell you — I was barely able to see where we were going on our walk. It’s probably a good thing I wasn’t actually there in person. But for being one of my first telehealth visits, this experience gave me chills. How wild, to be sitting next to the sunny windows in my bedroom and be connected and treating and truly walking alongside a family I loved.

I also connected with a family who had experienced COVID-19 and had been locked down for 10 days, alone in their house with their young child with autism. Before COVID, we had just gotten a communication device for him, and his skills using it were truly emerging. He’s nonverbal and struggles with regulating his sensory system. He thrives on routine and may or may not understand why everything has suddenly ground to complete halt.

His family is amazing and inspires me endlessly, but the first several moments on this call looked incredibly challenging. And on the other end, I was sweating. How were we going to pull this off? But something in me, maybe remembering those first moments with OK! magazine, made me ask, “What’s making him really happy right now?” And we went from there with me as the coach in this precious family’s ears — getting him seated, getting a rhythm of predictable rewards, getting him to work and request using his device — even seeing him comment “like” and “love” on it. Cue the tears again.

There have been other, more regular moments. More moments where my job just felt like my job: reminding parents that they can do this, educating parents on how to promote speech, teaching parents how to model communication on a device, helping parents as they work on new foods — all as a disembodied face on tablets, phones and desktops. I’ve spent several funny meditative moments imagining my face sitting on someone’s counter, and it’s hilarious to me that this works. But incredibly, it does.

I’m invited in — into the hard, into the weird, into the impossible. And I’m bringing with me the real and the regular. Development doesn’t stop for a global pandemic. Kids are still growing and changing and needing the ability to communicate. Families still want to learn, still want hope. And we’re here for it.

I’m not quite sure how to end this, because it hasn’t ended. I’m writing from the middle, maybe even still the beginning of the story. For the foreseeable future, all I am is a disembodied face. But maybe that’s OK. I can’t help but wonder what life, what therapy will look like post-COVID. Will teletherapy be as magical when it’s not a “have to?” I’m not sure. But I know that being present, perched on someone’s counter as they brush their child’s teeth or being held in the sticky hands of a child as we take a walk has some real lessons for how we can connect. In this time and for all of time, the most important tool we have is our presence with one another.

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