What Is Telehealth Occupational Therapy?
In simple terms, telehealth occupational therapy is occupational therapy online via video conferencing software or other means of telecommunication, e.g. phone.
American Occupational Therapy Associations defines telehealth occupational therapy as “the application of telecommunication and information technologies for the delivery of rehabilitation services” (American Occupational Therapy Association [AOTA], 2013, p. S69).
What Services Might Be Provided During Telehealth Occupational Therapy (online occupational therapy)?
• Parent education and couching
• Developmental skills for young children, such as grip, feeding, etc.
• Hand Therapy
• Visual Therapy
• Sensory Integration
• Life skills
• Social Skills
• Mental Health
• Training on ACC
• Training on home modification
• Training on injury prevention at work
Basic Equipment and Technology for Conducting Telehealth Occupational Therapy
• Computer or mobile device
• Web camera (built in or external)
• Headset with attached microphone (analog or USB) might be considered to eliminate echo
• High-speed internet connection with at least 3Mbps/sec upload and download and Ping:25 (test it here: https://www.speedtest.net/ )
• Document camera for presenting physical stimuli might be considered
• HIPAA compliant video conferencing, e.g. TheraPlatform
HIPAA Compliant Video Conferencing Platform (software) for Telehealth Occupational Therapy
Telehealth occupational therapy must be conducted over secure and HIPAA compliant video conferencing platform to protect patient’s health information (PHI) covered under HIPAA.
General video conferencing platforms such as Skype or What’s Up are not HIPAA compliant and pose risks for breach of privacy and confidentiality.
Occupational therapists interested in teletherapy, should consider video conferencing platform/software that:
• meets physical, administrative and technical regulations of HIPAA and HITECH
• includes user authentication, encryption at rest and transition, audit controls, etc.
• signs Business Associate Agreement (BAA)
TheraPlatform is one of the video conferencing platforms that meets HIPAA regulations and signs BAA with therapists or health care providers.
What Features Should Telehealth Video Conferencing Platform Include for Telehealth Occupational Therapy?
Video conferencing software should include features that allow occupational therapists to meet their unique needs and to deliver dynamic and engaging online occupational therapy.
Depending on what specific services occupational therapists provide online, they might need a bit more comprehensive video conferencing platform, that in addition to video conferencing offers some teaching tools.
TheraPlatform for example, was developed specifically for therapists and in addition to video conferencing capabilities, includes teaching tools such as:
• interactive on both ends whiteboard, which can be utilized by occupational therapists for explaining concepts, or therapeutic exercises such as writing, visual scanning, etc.
• video library, allowing occupational therapists to organize their favorite YouTube videos and then watch them with clients during live online session
• resource library, allowing occupational therapists to organize and upload their own resources such as worksheets and handouts and present these during live online session
• two-way screen sharing feature that allows occupational therapists to screen share their desktop, program or online website. Two-way screen sharing allows both OTs and their clients to manipulate their mouse on both ends. This allows OTs for example to pull up their favorite online games, which can be played by their clients on their end.
• Built-in and interactive on both ends apps (available in Pro Plus plan).
• Built-in games, e.g. puzzle game, basketball game, matching game, etc. (available in Pro Plus Plan)
Candidacy for Telehealth Occupational Therapy (online occupational therapy)
Not every single client or patient will benefit from telehealth occupational therapy and OTs should develop their screening protocol or questionnaire that would help them determine if a client or patient is an appropriate candidate for online occupational therapy.
Questions to Ask When Considering A Client or Patient For Telehealth Occupational Therapy Might Include:
• Is a client/patient able to sustain attention for reasonable time?
• Does a client/patient have any visual impairments and how severe?
• Does a client/patient have any hearing impairment and how severe?
• Does a client/patient have any cognitive deficits and how severe?
• Does a client/patient feel comfortable with technology?
• Does a client/patient have a good support system (e.g. family, a caregiver) at home?
• Does a client/patient have any sensory issues and how severe?
• Does a client/patient have any behavioral issues and how severe?
• Does a client/patient have limited fine motor skills?
Knowing client’s strengths and weakness will help OTs to determine if one can benefit from telehealth occupational therapy and what accommodations can be made. Just like in a clinic or office settings, OTs providing online therapy, can address certain behaviors and challenges and take appropriate steps to help clients participate and benefit from online therapy. For example, if a client is having a hard time sustaining attention, OT can take short breaks during online sessions or frequently switch activities to keep a client more engaged.
Environment and An Office for Telehealth Occupational Therapy
Environment and an office for telehealth occupational therapy is very important not only for privacy reasons but also for quality of online therapy.
OTs should consider:
• Location of an office
• Light of an office
• Appearance of the wall
• Organization of physical materials and stimuli
Use of Facilitators or E-helpers For Telehealth Occupational Therapy
In some cases, OTs providing online occupational therapy might need help from facilitators aka e-helpers. Facilitator is an individual who can assist OT during online session and is physically present next to a client or patient.
Facilitators can help with:
• Setting up client/patient for online session
• Troubleshooting as needed
• Assisting with therapeutic exercises and tasks
• Physically helping OT to teach certain skills by demonstrating or guiding
• Modifying client’s environment, e.g. positioning a lamp in a different location or adjusting a chair, etc.
• Controlling challenging behaviors
• Escorting students to classrooms
• Communicating with teachers about changes in schedule, etc.
Informed Consent Form for Telehealth Occupational Therapy
AOTA advises that OTs should provide their clients with an informed consent form prior to conducting occupational therapy online. Clients should also be informed about:
• Differences between telehealth occupational therapy and traditional therapy
• Benefits and risks of telehealth occupational therapy
• Descriptions of the equipment and technology involved
Currently, OTs providing telehealth occupational therapy must be licensed in the state of their client’s residency.
Reimbursement of Telehealth Occupational Therapy
• Currently (2019) Medicare does not provide reimbursement for occupational therapy services provided using telehealth technology. This most likely will change in the future and therefore OTs should be checking on Medicare coverage of telehealth periodically.
• Medicaid reimbursement practices vary on a state-by-state basis
• Private health insurance might cover telehealth occupational therapy
• Best practice is to contact above payers via phone to verify if they cover telehealth services