Updated: Mar 2, 2021
One of the best pieces of advice in graduate school I received was "While it's good to follow the child's lead, you should be the one in the director's chair." Like in-person therapy requires, part of being a director is Behavior Modification with Positive Supports and Reinforcement in Teletherapy. There are countless factors that have a role in a child's behavior on any given day. Thank goodness it's not our job to fulfill all of those daily needs, but we are in the perfect position with expert child development knowledge to help alleviate a parent's or learning coach's stress when a child's negative behaviors cause chaos, confusion, and delay.
Your first strategy should always start with being a personable collaborator with your parent or learning coach. They are your "hands" in teletherapy. With your frequent negative behavior flyers, they are often sitting close by and ready to take action when the refusals begin. Or, they may be busy with their three other children in a virtual school setting and simply don't have enough hands, arms, and legs to help out in your virtual speech sessions. Either way, collaborating with parents and learning coaches by identifying appropriate and inappropriate behaviors, discussing age appropriate behaviors, addressing parental priorities, developing a plan for potential problems, and discussing strategies to comfortably implement is so important. That first step is going to guide your selection of the following supports available to you in telepractice.
Consider each of these components for behavior modification in teletherapy and remember that your end goal is to replace misbehaviors with behaviors that are beneficial to learning. Keep in mind that the most effective strategies facilitate a positive change through instrinsic rewards (Kohn, 2001). That's all the more reason not to worry that you can't give the child a jelly bean from your candy jar at the end of the speech session. Find what breaks the cycle of misbehaviors for your students and model love + logic (Love and Logic, 2020).
Visual Schedules: A visual schedule not only outlines the structure of a teletherapy speech session, it sets expectation and helps a student plan which activities will need more of their focus and energy. This applies both in their home environment--knowing when to expect their virtual speech session--and within the speech session--knowing what activities need to be checked off.
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You may also want to check out the following digital visual schedules:
The Speech Serenade's Editable Digital Visual Schedules with Tokens Growing Bundle
KI Speech Therapy's Free Digital Visual Schedule for Distance Learning
Mrs. D's Corner Digital Visual Schedule Google Slides™
Nicole Allison's The Very Visual Digital Schedule
The Type B SLP's Virtual Speech Schedule for Distance Learning
Choice Dichotomy: I generally operate by two rules when offering a dichotomy of activities: 1) Never give a student a choice unless you really want him to have one. 2) If you offer a student a choice, be sure all options offered are okay with you and with the parent/learning coach. Sticking to these rules establishes trust between you and your student, then allows you to empower them with choice.
Reduce Task Difficulty: Initial inner refusal is completely natural when faced with a difficult task. We do it. Why shouldn't our students? Each student is different, as you know. Some prefer to get the hard task out of the way. Others start the session feeling defeated when confronted with the hard task first. If you have a student who follows the latter way of thinking and those thoughts manifest into negative behaviors, try switching up the order of your planned activities and reduce the task difficulty. You may find he or she is more willing to take a stab at the hard task after feeling a sense of accomplishment with an easier one.
Visual Supports (WBL listening): Part of replacing negative behaviors is modeling the positive behavior you want to see. This becomes a challenge on the other side of the screen when the behavior you want to see isn't completely visible, for instance, sitting upright in your chair facing the computer directly with feet firmly planted on the ground. That's why I created presentations to review and a Whole Body Listening hand out for parents and students to use as carryover. These are my go-tos for providing visual supports for expected behaviors in a speech session.
Sensory Supports: One difference between in-person and virtual speech sessions that took some getting used to was that I couldn't just bring my box of fidgets and sensory supports to the table. Collaborating with the parent or learning coach for sensory supports to have on hand is crucial in telepractice, and I would suggest having a conversation before the speech session. Adjustments may need to be made, of course, but I'd rather make adjustments than start out with a fidget or sensory support that is more of a hindrance than a help. Wouldn't you?
Flexible Seating: Though sitting at a therapy table in a chair is often the ideal expectation for brick-and-mortar schools, I've seen all kinds of flexible seating used in therapy sessions. Again, the different seating needs to be individualized based on level of benefit to learning. Laying on beds with pillows and covers has never worked out well in a teletherapy session. However, flexible seating such as a small trampoline or under a blanket on the floor can be extremely beneficial. You'd be amazed at what articulation and language a child can do while jumping. You'll be astounded at the focus you get out of a student when everything but the computer screen is invisible. Side story....I once had a student with severe Autism up in cahoots over a difficult task that started yelling throwing arms around and walked off. Guess what? I told her mom to take the computer and follow her around. The student was so caught off guard that the computer moved with her, that she ended up back in her seat!
Enticement: Enticement is one of the easiest things to implement in teletherapy. If you're using true no prints, the full color and interactive activities and games can be enticing by themselves. Additionally, digital materials that also incorporate movement out of their seat like my Early Language Concepts and Activities Boom Cards™, can help with students who are transitioning in their acceptance of learning through the virtual environment. But if you've got a child that doesn't seem interested in anything you have in your digital director's bag of tricks, throw it all out. After all, you're in their home. Let them bring their preferred toy to speech, you direct the show, and I guarantee you'll get language, articulation, social communication, fluency, or whatever you need out of them!
Red Herrings: You can always tell the moment right before fight or flight kicks in, right? But how do you prevent the reaction? Distraction. It doesn't always work, of course, but sometimes you might just a) throw up a random (but highly preferred) picture and saying, "Whoa! Look what I found!", b) start playing music or nature sounds through the computer to calm their minds, c) quickly shut off your video and play peekaboo, or even d) throw up a virtual background and play "where's the speech teacher?" Then, once you see the fight or flight recede, you're back on stage.
Timers: Timers can either be magical or a complete wrecking ball of anxiety. If they are the magic your student needs, here's a blog of 26 different digital timers that you might be able to use in teletherapy. My personal favorite is the "countDown." It's a completely customizable chrome extension that allows you to add multiple timers at once, rings or alarms, text/comments and labels, and different timers. It hangs out on your web browser bar while you are working with your student so they can keep track of their work and scheduled break with you.
Token Boards: Many digital resources created for a younger audience contain reinforcers within the activity, however, some students simply need a little extrinsic reinforcement or reward system in place that motivates. Check out the following token board resources if you need to add a few to your teletherapy sessions.
The Speech Serenade's Editable Digital Visual Schedules with Tokens Growing Bundle
My Teletherapy Room's Virtual Token Board Bundle Boom Cards™
Stacy Crouse's Teletherapy Brain Breaks
The Good People Project's Virtual Token Boards and Rewards Google Slides™
Teacher Erin Online's Digital Rewards Bundle for Google Slides™
Empathy: The reactions from students when you show them you understand speech is hard by communicating empathy are priceless. Y'all, speech sessions are hard for these children. Communication demands require a lot of thought, energy, and focus, as we know. These children who struggle often just don't have the words to say, "This is hard for me." They love it when we help them say those words and show our understanding.
Angela C. Hancock, MSP, CCC-SLP
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