Telehealth Occupational Therapy is growing! Learn what you need to get started with telehealth occupational therapy (teletherapy): technology, license, documents, HIPAA compliant video platform, client’s candidacy and more.
What Is Telehealth Occupational Therapy?
Telehealth in occupational therapy is a method of live online service delivery through video software, by phone, or by other means of electronic communication.
The American Occupational Therapy Association defines telehealth occupational therapy as “the application of evaluative, consultative, preventative and therapeutic services delivered through telecommunication and informational technologies” (American Occupational Therapy Association [AOTA], 2013, p. S69). Amidst the COVID-19 pandemic and rising caseloads for many practitioners, a telehealth method of service delivery has been gaining popularity for a variety of populations.
What Services Might Be Provided During Telehealth Occupational Therapy (online occupational therapy)?
• Parent education and coaching- Parent education opens up an opportunity for the therapist to model successful intervention strategies, provide ideas for carryover, and problem-solve as a team.
• Meeting of developmental milestones- This may include physical milestones like rolling over, or social milestones such as turn-taking.
• Visual-motor skills- Intervention to improve a client’s visual-motor skills may include interactive activities such on an embedded whiteboard, or by using physical household objects.
• Hand therapy- In telehealth, hand therapy may include education regarding scar massage, exercise compliance, functional activity participation and more.
• Life skills- This service can be highly beneficial to clients when provided through telehealth. Does your client have a goal that they will create a simple meal? Coordinate so that you can support them in the context of their daily routine.
• Mental health- Telehealth provides a great opportunity to create routines, work on executive functioning skills, and develop healthy habits with your client in the context of their own life.
• Interdisciplinary consultation- Take advantage of reduced commute time by collaborating with professionals on your client’s team.
What are the Benefits of Using Telehealth in Occupational Therapy?
See more clients- Telehealth eliminates the need for travel for both the practitioner and the client. This can significantly reduce client absences and ‘no-shows.’
Provide services to those who may not have access- According to the Census Bureau 23% of the American population lives in rural areas. Worldwide, this number is even greater. This can limit access to in-person services for a significant number of people. Some families or individuals may also be balancing a variety of services. Allowing an opportunity for therapy to take place at home may provide an opportunity for more family involvement
Increase collaboration for better outcomes- The opportunity to engage with a client through telehealth allows for more opportunity to target outcomes that are meaningful to the client and/or caregivers. Problem solve in real-time and provide ideas for carryover.
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) is an option to limit audio feedback
• High-speed internet connection with at least 3Mbps/sec upload and download and Ping:25 -test it here: https://www.speedtest.net/
• Document camera: Optional for presenting physical stimuli
• HIPAA compliant video conferencing platform, 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 in order to protect patients’ personal health information (PHI). This is mandated by 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 Telehealth Occupational Therapy Should Consider a 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.
• Provides a Business Associate Agreement (BAA)
• Is user-friendly for clients
• Provides supplemental features such as an interactive whiteboard and screen sharing designed for use by occupational therapists
TheraPlatform is a video conferencing platform that meets HIPAA regulations, allows therapists to sign a BAA, and has a variety of interactive features for intervention.
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.
TheraPlatform for example, was developed specifically for therapists and in addition to video conferencing capabilities, includes teaching tools such as:
• Interactive whiteboard that can be used on both the therapist and client end. This feature can be utilized by occupational therapists for explaining concepts, or therapeutic exercises such as writing, visual scanning, etc.
• A video library that allows occupational therapists to organize their favorite YouTube videos and then watch them with clients during live online session. This is excellent for clients who benefit from visual cues and/or demonstrations.
• A resource library that allows 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 an 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 online 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 all clients will fully benefit from telehealth occupational therapy and OTs should develop a 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 able to sustain attention for reasonable time?
• Does a client have any visual impairments and how severe?
• Does a client have any hearing impairment and how severe?
• Does a client have any cognitive deficits and how severe?
• Does a client feel comfortable with technology?
• Does a client have a support system (e.g. family, a caregiver) at home?
• Does a client have any sensory issues and how severe?
• Does a client have any behavioral issues and how severe?
• Does a client have limited fine motor skills?
Knowing a client’s strengths and weakness will help OTs to determine if an individual 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 a client for their 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 for telehealth 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 (2021) Medicare provides temporary reimbursement for certain occupational therapy services provided using telehealth technology. Therapists are advocating to make this a permanent change 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 may cover telehealth occupational therapy
• Best practice is to contact above payers via phone to verify if they cover telehealth services
How to get started with Telehealth Occupational therapy?
We’ve published Ultimate Teletherapy E-book that covers all you need to know to get started in telehealth occupational therapy. This telehealth book contains 10 chapters loaded with information and resources and it was written for therapists by therapists. You can get a free copy of the book here.