Telehealth Best Practices: Kristin Martinez of PresenceLearning On How To Best Care For Your Clients When They Are Not Physically In Front Of You

Research the best tele-therapy platform for your needs — While tele-therapy is not a different kind of therapy, effective tele-therapy does rely on the successful transition of your in-person therapy skills to an online modality. That said, finding the best tele-therapy platform for the kind of services you are providing is crucial. Speak to other therapists who have used each platform, request a demo, and be thoughtful about how each tool and feature might make your work not only more effective, but easier!

One of the consequences of the pandemic is the dramatic growth of Telehealth and Telemedicine. But how can doctors and providers best care for their patients when they are not physically in front of them? What do doctors wish patients knew in order to make sure they are getting the best results even though they are not actually in the office? How can Telehealth approximate and even improve upon the healthcare that traditional doctors’ visits can provide?

In this interview series, called “Telehealth Best Practices; How To Best Care For Your Patients When They Are Not Physically In Front Of You” we are talking to successful Doctors, Dentists, Psychotherapists, Counselors, and other medical and wellness professionals who share lessons and stories from their experience about the best practices in Telehealth. As a part of this series, I had the pleasure of interviewing Kristin Martinez.

Kristin Martinez received her M.A. in Speech, Language and Hearing Sciences from the University of Colorado at Boulder, and has been a speech-language pathologist for 19 years. Kristin provided speech-language therapy to children in her local school district and in private practice before starting as a tele-therapist with PresenceLearning in 2013. Kristin has managed school-based tele-therapy services and has presented on the topic of tele-therapy nationwide, and currently serves as the Clinical Director, SLP & OT, for PresenceLearning.

Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?

Of course, and thank you so much for your interest! I am a speech-language pathologist by training, and I provided in-person school-based and private practice speech-language services for 13 years prior to becoming a tele-therapist with PresenceLearning in 2012. What I thought was going to be an interim position as a tele-therapist turned into a new career path as I very quickly fell in love with providing speech-language therapy services online. After two years of providing full-time school-based tele-therapy services, I transitioned to a clinical manager position for PresenceLearning in 2015, and I have served as Clinical Director since 2019.

Can you share the most interesting story that happened to you since you began your career?

In my work with PresenceLearning over the past seven years, I have had the opportunity to work with students, school districts, and special educators across the country, so I have many wonderful stories. However, one of my favorite stories is from my first year providing tele-therapy services. One of my initial concerns about moving from in-person to online therapy was that I would not be able to connect with my students in the same way. I live in Colorado, and one of the states I cross-licensed into was Oregon, and I worked with students in a small Oregon district for about two years. That first year, one of my students was a kindergartener with severe apraxia of speech, and he made tremendous progress over the course of the school year. Toward the end of my first year working with this boy, he insisted his mother invite me to his birthday party! Of course I had to politely decline (he didn’t quite understand that I lived 1,500 miles away!), but his invitation was one tangible sign that I was still building meaningful connections to my students and their families, even from a distance.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

“Do things for people not because of who they are or what they do in return, but because of who you are” by Harold S Kushner is one of my favorites. This is a relatively recent quote, so not one I grew up on, but when I read it years ago, I felt it epitomized the compassion, personal integrity, and work ethic with which my parents approached all people and situations. It also speaks to a value I am continually working to integrate into my life and work. I have always been drawn to people whose time is spent centered around helping others who may not be in a position to help themselves, and whose work is often thankless in the traditional sense. I do believe the values represented in this quote have impacted my career path as I count educators and special educators as a largely giving and compassionate group whose good work often goes unnoticed, and I am most fulfilled when I feel my work is truly useful to others, regardless of the thanks or accolades.

None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?

I have been fortunate to have many people, particularly women (starting with my grandmothers and mother), who acted as tremendous models of how to live with compassion and integrity. However, in the context of my work, I will take this opportunity to share my gratitude toward one of my colleagues, Teri Becker. Teri was my first clinical manager at PresenceLearning six years ago, and I admired her ability to lead a team by example: being smart and decisive while never straying from her core as a clinician and compassionate human being. I don’t believe effective leaders have to forego integrity or kindness, and Teri embodies this standard.

Ok wonderful. Let’s now shift to the main focus of our interview. The pandemic has changed so many things about the way we behave. One of them of course, is how clinicians treat their clients. Many clinicians have started treating their clients remotely. Telehealth can of course be very different than working with a client that is in front of you. This provides great opportunity because it allows more people access to clinical professionals, but it can also create unique challenges. To begin, can you articulate for our readers a few of the main benefits of having a client in front of you?

From the perspective of a speech-language pathologist who was providing tele-therapy services to students long before the COVID-19 pandemic, experience has taught me there are few — if any — educational speech-language goal areas that cannot be effectively addressed via tele-therapy with the appropriate platform and supports in place. There are a few speech-language assessments for which there is not yet a digital version available, so being able to complete evaluations in-person is sometimes a benefit, depending on the specific assessments being administered. In addition, if a student requires support for feeding and swallowing, it is imperative that someone trained is physically present with the child to ensure techniques are being implemented safely.

On the flip side, can you articulate for our readers a few of the main challenges that arise when a client is not in the same space as the clinician?

In regard to school-based therapy services, the primary challenges are related to the lack of appropriate in-person supports, not the fact that the student and clinician are not in the same room. While many students are highly independent on the computer and in a tele-therapy setting, there are some students who, because of their age or because of physical, cognitive, or behavioral needs, will need a higher level of support from an adult in their physical space. This person works with the tele-therapist to provide any needed support, always under the direction of the tele-therapist. If a student with significant needs (e.g., a student who is non-verbal and cannot physically access a computer mouse) does not have the appropriate level of support from an adult, such as a paraprofessional in the school setting, tele-therapy can be an ineffective and therefore inappropriate service delivery model.

Fantastic. Here is the main question of our interview. Based on your experience, what can one do to address or redress each of those challenges? What are your “5 Things You Need To Know To Best Care For Your Clients When They Are Not Physically In Front Of You ? (Please share a story or example for each.)

1. Seek training/clinical support — Tele-therapy is not a different kind of therapy, but it is a different mode of service delivery, so reach out to those who have already made the transition! Set yourself up for success and learn from other clinicians who have successfully made the transition to tele-therapy services.
2. Set expectations and establish a communication plan — Whether providing tele-therapy services myself, or supporting other therapists who are providing tele-therapy services, I generally find that the “therapy” part of tele-therapy is not the most challenging piece — the most challenging part of tele-therapy is often working and communicating with remote school-based teams and families. Prior to starting therapy, take a little time to meet with those involved with your therapy services (e.g., IEP teams, parents, paraprofessionals) to introduce them to the therapy platform, give them an opportunity to ask questions, and establish an ongoing communication plan. For instance, some school-based tele-therapists like to hold weekly virtual office hours. Establishing a consistent time and method for communication can help to establish strong collaboration with your teammates.
3. Have a strong tech support plan — While we would all love to believe that tech issues never happen, the reality when utilizing any technology is that problems will happen occasionally. So, particularly when providing therapy services, it’s essential to have a tech plan in-place! PresenceLearning, for instance, has an experienced tech department that can be reached in real-time via chat during therapy sessions, so both the clinician and the student/school are supported and any interruptions to therapy are minimized. Whatever platform you are using, know what the tech resources are and the best way to leverage them during and between therapy sessions.
4. Ensure appropriate in-person support is in place — I may sound like a broken record, but this point is that important. This also ties back to reaching out for training and support from those in the field with tele-therapy experience: if you’ve done tele-therapy with children, you know the appropriate in-person support, based on the needs of the child, is an essential piece to effective tele-therapy services.
5. Research the best tele-therapy platform for your needs — While tele-therapy is not a different kind of therapy, effective tele-therapy does rely on the successful transition of your in-person therapy skills to an online modality. That said, finding the best tele-therapy platform for the kind of services you are providing is crucial. Speak to other therapists who have used each platform, request a demo, and be thoughtful about how each tool and feature might make your work not only more effective, but easier!

Can you share a few ways that Telehealth can create opportunities or benefits that traditional in-office visits cannot provide? Can you please share a story or give an example?

Tele-therapy is, at its core, about equity and access. When licensed and experienced clinicians are not proximal to those who need services, appropriately implemented tele-therapy allows high-quality services to still be available to anyone with access to basic technology. However, there are a few benefits that only a tele-therapy model can provide. First, tele-therapy can offer greater anonymity/privacy for the student or client. In a school setting, for instance, a child receiving speech-language therapy is not necessarily being “pulled-out” for services, but rather logging onto a computer just as students do all day long for various reasons. Some students (particularly those in later grades) prefer receiving therapy online simply due to the fact that they do not feel as stigmatized as when being pulled out of class for in-person therapy.

Second, tele-therapy allows other students or professionals to join therapy sessions as appropriate, regardless of physical location. For instance, I was providing tele-therapy services in a small school district one year and I had two students on my caseload who stuttered, but they attended different schools in the district. They were close in age, but had never met each other and neither knew anyone else who stuttered. Because sessions were taking place in an online environment, I was able to bring these two students together in group therapy sessions and each student benefitted from meeting the other and also from having the opportunity to practice fluency enhancing techniques with another student who stuttered, not just with the SLP!

Let’s zoom in a bit. Many tools have been developed to help facilitate Telehealth. In your personal experiences which tools have been most effective in helping to replicate the benefits of being together in the same space?

An effective tele-therapy platform that includes features built for the user’s purpose is essential in creating an experience equivalent to in-person services. PresenceLearning’s product and engineering teams have developed a proprietary therapy platform over the past 12 years and in doing so they have built tools and features that support clinical practices, not just a teleconferencing system. It is important for anyone delivering tele-therapy services to spend some time researching available platforms and asking questions about features that will support the therapy being provided. One example of a feature that supports clinical best practices is the ability to integrate a second camera on both the clinician’s and student’s side.

This feature becomes clinically important if there is anything in the student’s environment, such as the desktop or an augmentative communication device, the clinician would like to view without ever losing sight of the student’s face. This feature also supports the administration of some assessments. Second camera integration is just one of many thoughtful clinical features in the PresenceLearning platform, and spending some time up-front to research platforms and features will make the transition of conducting therapy in an in-person to an online environment much more effective.

If you could design the perfect Telehealth feature or system to help your clients, what would it be?

In my role as Clinical Director with PresenceLearning, I have the opportunity to share clinical “wish lists” with our product and engineering teams on a regular basis, and it’s been incredible to see them turn many of these wishes into a reality! All of us who provide tele-therapy services would love to remove all barriers to quality therapy services, so the “perfect” tele-therapy platform would support all accommodations needed to ensure every student, regardless of disability, can fully participate in all activities. Examples might include automatic integration of all augmentative and alternative communication (AAC) devices with any therapy platform, or eye gaze mouse control. I expect to see amazing technological developments in tele-therapy over the next several years!

Are there things that you wish clients knew in order to make sure they are getting the best results even though they are not actually in the office?

As my work is centered around working with children, from early childhood through high school, my wish is that the adults in the children’s lives, whether the children are logging in for therapy sessions from their homes or school settings, would understand the importance of in-person support during tele-therapy sessions.

Tele-therapy can be highly effective, often just as, if not more, effective as in-person services, when implemented correctly. This implementation, particularly when working with children, includes coordination between the treating clinician and the adult supporting the student in-person. Without this coordination and expectation setting of what each student will require in order to successfully engage in tele-therapy, the quality of services will be negatively impacted.

The technology is rapidly evolving and new tools like VR, AR, and Mixed Reality are being developed to help bring people together in a shared virtual space. Is there any technology coming down the pipeline that excites you?

PresenceLearning is running a limited pilot right now with an educational VR company that is focused specifically on supporting the pragmatic communication skills of children with autism. The VR technology, in conjunction with our therapy platform, allows therapists to guide students through engaging and clinically-targeted virtual reality social scenarios. I am very excited to see how innovative VR programs such as our pilot can be integrated into tele-therapy.

Is there a part of this future vision that concerns you? Can you explain?

In addition to our in-house research and development, PresenceLearning is also continually connecting with other innovators in the field for potential collaboration, so I wouldn’t place any limits on what might be on the horizon for us as a company and for our tele-therapy services and platform.

Ok wonderful. We are nearly done. Here is our last “meaty” question. You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

What a question! While the need, even just in the area of special education, can be overwhelming, based on what I have experienced my entire career in special education, I would love to inspire a movement to better fund excellent public education and, as a segment of that, special education services. Far too often educational decisions are made based on available funding, rather than on what is most needed for students, and funding is not equal between states or even between counties. As tele-therapists, we have a unique view into the variance of special education services nationwide, and while tele-therapy is an essential piece to bringing greater equity and access to all students, funding for education and special education continues to be a barrier.

How can our readers further follow your work online?

Some of my blog posts and webinar presentations can be found on the PresenceLearning website at www.presencelearning.com or I can be found on LinkedIn at https://www.linkedin.com/in/kristinpmartinez/.

Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.