As an Occupational Therapist, I have provided teletherapy, in-home therapy, and in-clinic therapy.  Based on my experience, I would rank them from least effective to most effective in the following order:  teletherapy, at-home therapy, and in-clinic therapy.  I encourage parent participation, and parents are invited into the sessions.  Our clinic provides an optimal environment for hands-on engagement with minimal distractions, which leads to increased participation and better progression towards age-appropriate skills. I view the seven points as drawbacks to teletherapy and home-based therapy. 

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1.  Pediatric OT is best provided in a neutral, structured and controlled environment utilizing fun and engaging activities to keep children focused on therapeutic tasks.  While OT can be helpful in the home for elderly patients and those who need assistance in the home, children who require OT often need therapy to improve certain abilities required throughout their daily lives at school, daycare, in social settings, as well as home.  Children need to be slightly nudged outside their comfort zones in all areas of growth.  Much of the equipment utilized by clinic-based therapists can't be transported to and from people's homes.  Preparing one's home for an effective therapy session also cuts into the time of therapy, further reducing the efficiency of the session.  Parents can't be expected to pay full rates for what essentially becomes an hour of glorified play time.  I provide simple home-based activities for parents to utilize between therapy sessions, but these home-based programs are designed to supplement in-clinic therapy. 

 

2.  Occupational Therapy is a hands-on profession, especially with children who have special needs - those needing OT the most.  Medical professionals are supposed to ensure any form of telehealth allows for the same standard of care as in-person treatment.  Most research on teletherapy has been done in the field of mental health and other medical fields that use telehealth for things such as medicine management.  It is nearly impossible to maintain the same standard of care for OT, especially when TLC Occupational Therapy has extremely high standards with our in-clinic therapy.  If a therapist claims teletherapy for children with special needs, is just as effective as hands-on therapy, that therapist's hands-on approach must either be flawed or inefficient, if it can be equally replicated remotely via the hands of parents. 

 

3.  Parents cannot be expected to become therapists.  One hour of coaching parents during a session, is inefficient, and any concentrated treatment is significantly reduced.  Would anyone ever hire a plumber via Zoom?  Would a Zoom-guided haircut be as efficient and result in a similar outcome as a trained beautician?  Most parents want the best care for their children, which is absolutely done in a professional clinic with trained and experienced professionals who provide hands-on therapy utilizing specialized equipment.

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4.  Therapists should always provide parents with home programs for children to complete between therapy sessions.  The therapy sessions should NOT morph into the home programs.  These home programs should be supplemental activities to in-clinic therapy.  If parents can be trained in OT, why hire a trained therapist and pay in-clinic rates for what could essentially become an hour of paid play time? 

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5.  Children already have more than enough screen time, especially with distance learning.  Many children with special needs require socialization in a controlled manner, rather than impersonal interaction from behind a screen. 

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6.  Therapists must resist the urges of personal convenience.  Most writings on teletherapy in this field, are slanted towards the benefits of the therapist, although it is understandable people have become used to working from home.  Parents must consider the motivation for anyone pushing for teletherapy, considering some therapists struggle to handle the challenges with children who have special needs.  While teletherapy puts the responsibility and control of the session at the hands of the parents, it should instead be the role of highly trained therapists to increase the effectiveness of the sessions. 

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7.  Insurance companies will slowly wean people off teletherapy for OT, as they should, as they are only paying for a temporary work-around to the most effective means of treatment.  If parents do most of the work via a teletherapy session, it is unconscionable to consider charging the same rate as in-clinic care, unless a client specifically requests it for some reason. 

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