Long before a global pandemic forced most people to pivot to video conferencing for everything from meetings to happy hours, Clarke had been using this technology to offer their services virtually. Clarke’s teleservices offerings began in 2013, providing Listening and Spoken Language (LSL) services to families with children who are deaf or hard of hearing from birth to age three.
“We were trailblazers in this area,” says Nell Rosenberg, MEd, MS, CCC-SLP, LSLS Cert. AVT, Clarke’s national director of teleservices. “We had nearly a decade to refine our program before everyone else was forced to do so.”
Clarke’s tVisit® Teleservices Program has recently expanded so children through high school (and their families and educators) can benefit from the service. It also allows Clarke staff to reach more families. “There is a critical dearth of teachers of the deaf (TODs) and LSL providers,” says Nell. “A lot of providers were spending the bulk of their day in the car. They couldn’t serve as many students just due to the logistics involved. With tVisit, we can serve more children.”
Clarke started to expand the program to older children before Covid, using it to fill gaps in service. “What we found is that older children, especially in the mainstream, did just as well with remote services as the younger children did.” [See sidebar for more on the program’s effectiveness.] Now, Clarke has some providers who only conduct virtual tVisits and some who only work in schools, while most provide a mix of remote and in-person support. tVisits can be used for any kind of service, including IEP/504 meetings, educator consultations, in-services and more.
How do tVisits work?
Like many Clarke services, tVisits are based on a caregiver-coaching model. “The goal is for the Clarke provider to be the coach and the caregiver to provide the actual intervention. I’m the expert on therapy; the parent is the expert on the child,” explains Nell. Exactly what that looks like varies a bit depending on the child’s age, personality and needs.
Infants to age three: At this stage, the provider prefers that the child does not engage with the screen at all — they should be focused on the caregiver. “I might even turn off my video so they can’t see me, and I speak directly to the caregiver,” says Nell.
The content of these sessions often differs from those with older children. “We might talk about the child’s hearing loss, their equipment and assessments and then decide on goals to work on,” she continues. Next, the provider will work with the caregiver so they can continue working on those goals for the rest of the week.
“Then we work with the parents or caregivers. So often parents ask, ‘How am I going to do this?’ but that’s my job as the provider,” says Nell. “What happens in the 30-60 minutes I’m with you doesn’t matter as much as the other 23 hours you spend with your child. My goal is for the parent or caregiver to be able to do my job just as well.”
Ages three to six: At this age, children can engage more with the provider but still need a caregiver to supervise. “You can’t park a four-year-old in front of a screen and expect progress,” says Nell. “We’re still doing coaching sessions, but it could be with a parent or caregiver, or it might be an educator who facilitates if the service is provided in a mainstream school.”
For children this age, some may be able to do a screen-sharing activity, while others may not. The content of sessions is highly individualized for each child. Nell notes that this is also the age range when children who are deaf or hard of hearing start to use “direct connection,” or streaming the teacher or parent’s voice directly to their hearing aid or cochlear implant.
Kindergarten through fourth grade: For these students in mainstream settings, a teacher will still typically be involved, but that phases out as the children get older and are more able to engage directly with the provider. Nell notes that if the child’s needs call for it, tVisits can still offer coaching for the family and/or educators, but that it’s more likely to happen apart from the student’s session.
Fifth grade through high school: These tVisits follow a direct service model and look very similar to an in-person pull-out session. “Instead of working with a TOD in the resource room, the students work with them via the computer,” Nell explains.
In these sessions, the student typically uses direct connection, and the content will focus on their IEP (Individualized Educational Plan) goals, self-advocacy and how to troubleshoot equipment issues. “We can also provide pre- and post-teaching, vocabulary and articulation work and aural rehab if needed,” she continues. “As they approach high school graduation we shift more to self-advocacy goals.”
As with the early education students, these sessions can also be used for outreach with educators. Nell notes that some students have used tVisits to do a virtual in-service to explain topics to their teachers, such as how their hearing technology works and what listening fatigue looks like.
To schedule a free consultation, call 855.203.7085 or email email@example.com. For more information, watch Clarke’s webinar on tVisits here or read our blog post on the customizability of tVisits here.
Busting Myths about tVisits
Families and educators are sometimes skeptical of the idea of providing services remotely to children with hearing loss. But Clarke’s history in this area has proven those fears to be unfounded. Here are some of the most common misconceptions.
Myth: It’s technologically complicated/families need to buy or provide lots of expensive equipment.
Fact: As long as the family or mainstream school has high-speed internet access and a device with audio/video, tVisits will work. Technical issues are rare since most families and educators these days have the technical savvy to log into a remote meeting platform.
Myth: Teleservices don’t work as well as in-person services.
Fact: “We’ve been collecting data, especially on children in early childhood, for over a decade and the data proves teleservices work,” says Nell. She notes that students who receive tVisits and those who receive in-person services have comparable scores on their assessments. And more than 90% of families surveyed said teleservices were either effective or very effective.
Myth: Teleservices are expensive.
Fact: Not necessarily. tVisits do charge a fee for service, but some or all of those fees may be covered by the family’s school district, early intervention program or even health insurance. Clarke also offers need-based financial aid for families. “Our goal is for family finances not to impact access,” Nell says.
Clarke tries to keep costs down in other ways. For example, Clarke discourages families from buying so-called “speech therapy” toys. “You can use whatever is in your home – it doesn’t even have to be toys,” says Nell.
Myth: My child won’t form a connection with a therapist/teacher they only see online.
Fact: Experience has shown that providers and their students are absolutely able to develop a good bond. “When we survey our tVisit families, 100% said they were able to build an effective or very effective relationship with the provider,” Nell notes.
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