By Emily Hanlon
In the Australia’s current climate and in the midst of COVID-19, it is expected that many families are choosing the self-isolate and not attend allied health appointments in person. In some counties, forced isolation periods have already been implemented, and many children are unable to access their regular services. As such, I have been inundated with requests for ideas on how to implement psychology services via tele-health platforms.
Around two years ago I moved interstate. At the time, three of my clients wanted to continue seeing me via tele-health platforms, so I do have some experience (albeit minimal) in this field. My first piece of advice is, when discussing tele-health services with clients/families, set some ground rules. Ensure the client will be home during the scheduled call, ensure that that you have strict late cancellation policies in place, just as you would in the clinic, and ensure that your client has a private and quiet space to partake in the session. The last thing you want when you call your client, is that they are at the shops, in the car, at their cousin’s house, or with their siblings. I would also recommend that you talk to families about stopping any gaming/electronics 10-15 minutes prior to the session so that the child doesn’t feel as though they are being punished by having to put the iPad down. I would also recommend, with any client, that you set a timer to ensure that your client sticks to the same time restraints that you would have in a clinic setting.
So, this blog will discuss what I suggest for clients who I deem inappropriate for tele-health services, adult clients, child clients, and non-client-related activity. Please note these are my strategies and ideas and everyone is different. Please also note that every client is different, and all strategies should be modified accordingly.
1. Clients deemed inappropriate for tele-health services.
Before I get into strategies, I want to make it clear that I have personally gone through my client list and determined which clients it would be appropriate to see via tele-services, and which would not be. I have deemed clients inappropriate based on a number of factors: their attention span, the strategies I use in clinic (i.e., if we spend 90% of the session on the floor, this may not be useful), the age of the client, the level of disability the client has, whether the client has a hearing impairment, and whether the client has appropriate access to the internet.
I have spoken to the families of the clients who I don’t feel it would be appropriate to engage in this type of therapy, and we are in mutual agreement to put things on hold, should we go into isolation. So, this would be my first suggestion. There are a lot of children who I work with (given my field of working on developmental psychology) that would not benefit at all from tele-health.
So, what can you do for these clients until isolation ends? I suggest talking to families and seeing whether alternative things may be possible. Does the family have a school meeting coming up that they need letters/reports for? Do they have an NDIS review meeting looming that they need a report for? This may be the perfect time to use their allocated session time to generate these reports. That way, the session is not going to waste. Another alternative is to have the session via tele-health with the parents/caregivers and working with them to teach and help implement parenting/home-based strategies.
2. Adults and CBT
It may feel awkward to begin with but address the elephant in the room. Talk to your client about the change of environment and how they feel about it. Discuss the whether they are anxious about the change in routine, and always check in with them at the end to determine whether they found the session helpful.
For adults engaging in therapy for anxiety/mood-related concerns, you may be using techniques such as Cognitive Behavioural Therapy (CBT). In most cases, psychologists and clients can continue to do the same therapeutic activities online just as they had previously done in the clinic. Methods such as CBT can easily be modified and implemented via tele-health platforms.
Face to face communication is still present very much as it is in the clinic. Both client and psychologist can see one another’s faces, facial expressions and hear one another’s tone of voice with its various intonations and expressions. I think the biggest difference in this regard would be pre-preparing the session by emailing or mailing your client some worksheets that you may want to go through with them together.
You can also offer clients engaging in CBT a journal or workbook to complete during the week, that you can check in with during sessions. Keep in mind that if your client is in isolation, they do have more time on their hands which may increase their anxiety/depression, so giving them homework tasks may be really beneficial. An example of a workbook to provide to adolescents, is my CBT journal (https://www.theplayfulpsychologist.com/product-page/cbt-journal).
3. Engaging Children in Tele-Health Services
If you have deemed it appropriate to engage in tele-health services with a child, my personal opinion is to keep it simple. Once you start to try and introduce things like split screens, you are simply adding additional things that they can be distracted by. Like I had previously said, ensure the child is in a quiet space in the house where they are relatively distraction free. Kids will want to show you their pet cat, the inside of their fridge, and every aspect of their room. I would suggest a place like a study, parents’ room, or dining room. Also be aware that kids may need breaks, just as they do in the clinic. Schedule these breaks in but set a timer. One last piece of ‘prep’ advice: send the parents all links/worksheets you will use with kids in session a few hours prior to the sessions. Encourage parents to have the links open on the computer and have the worksheets printed where possible.
a) I would start the first session by talking about why you are having to engage in this type of therapy. They may be anxious about, or just have questions about COVID-19, do you may actually spend your first session discussing this. My Virus Social Story (https://www.theplayfulpsychologist.com/product-page/social-story-everybody-is-talking-about-a-virus) is a great way to start this conversation. You can print it out and read it to them via camera, or even send it to the parents via email prior to the session so that they can read through it with you.
b) Use a white board or piece of paper to show your client what you will be discussing/doing in the session and cross it out as you go so that they can predict what is happening. Keep in mind, you have probably pulled the child away from their siblings and games to engage in this session, so a visual schedule is more useful than ever during video calls.
c) Social Skills Training. There are actually quite a few activities you can do with children via video calls. You can engage in social skills training simply by practicing back and forth reciprocal conversations, create games around reading body language/facial expressions, or even practice turn taking via games such as Hangman. A lot of the conversation-based social skills you may be working on in session, can also be done via video call. This would also be a great time to watch Youtube videos together and asking kids to comment on the body language or social mistakes that the characters are making. You will need to pre-prepare for this by finding the videos, sending them to mum, and having your questions ready, but it would be worth it!
d) Emotional regulation. Like with social skills, you could work on emotional regulation skills via Youtube videos. This is actually something I do in session in the clinic anyway, so the prep time wouldn’t be lengthy for me personally. You could also read a book via video call and stop to discuss the characters feelings and the reasons behind those feelings. Again, a lot of the work you do in session could probably be done via video, you just need to get creative. I’ve used flash cards before (https://www.theplayfulpsychologist.com/product-page/abc-coping-cards) and it has worked quite well. I also find myself using worksheets more frequently via tele-health services, as it’s a practical way to get some good work done when you’re not there in person. An example is my Emotion Worksheet Pack, which can be emailed to the family prior to the session (https://www.theplayfulpsychologist.com/product-page/the-emotion-worksheet-pack). You could even create emotion posters or self-esteem posters by asking the parents to provide the children with glue, scissors, and some old magazines/newspapers. The only limit to what you can do, is your own imagination!!
e) Life Skills. You may want to take this opportunity to work on life skills. Instead of having one, 1-hour session each week, you may have two, 30-minute sessions each week. This way, you can discuss small goals, create a plan on how to achieve them and then give your client a few days to achieve the goal. You can then spend the second 30-minute session of the week discussing how it went and setting more goals. Life skill goals can be set for adults and for kids and can include anything. Life skill goals I have worked on in the past could be as simple as learning to turn the shower on and off independently, to learning how to make a sandwich, to learning how to get dressed in the morning. Spend some time talking with the family figuring out what they want their goals, to be because while everyone is stuck inside, it really is the best time to work on them!! You can then use prep time to create visual schedules or social stories for the family, if need be.
4. Non-client related activity: What can you do as a psychologist?
If you find yourself having a lot more time than usual while stuck in isolation, there are so many things you can be doing to better yourself as a psychologist once this is all over! Firstly, you can get into resource creation, or get into laminating/preparing resources that you have bought but haven’t had the time to prepare! You could create session plans for your clients based on their goals or listen to psychology-related podcasts for new therapy ideas. There is a blog post on podcasts coming in a few weeks, so stay tuned!! But perhaps the most beneficial thing you can do, is enrol in an only professional development course. We all have to engage in a certain number of professional development hours every year anyway, so what better time to get your hours done! It also means that later in the year you don’t have to take time off work to do this and can instead get back to your clients and your usual routine.
Websites where I buy/purchase/download a lot of my worksheets:
- Psychtools
- Therapist aide
- Hub for helpers
- Wholehearted school counselling
- And obviously, my own website www.theplayfulpsychologist.com
For more information on tele-health sessions, this is a good read: https://www.apa.org/monitor/2017/02/online-therapy
