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Presence Spotlight for Clinicians: Elisabeth Balcom, M.A., CCC-SLP (Part 2)

Despite being discouraged by a professor from persisting in speech-language pathology in graduate school, SLP Elisabeth Balcom persevered in the career that was her passion. If you missed part 1 of this two-part Presence Spotlight, make sure to read it here. Here in part 2, Elisabeth talks about her transition to teletherapy, working with students with more severe needs, working with a primary support person, and conducting evaluations remotely.

How did you make the transition to teletherapy and how did you find your way to Presence?

I came to teletherapy right before the pandemic started. At first, I only did a little teletherapy. Now, I only do teletherapy. Almost exactly a year ago, my husband and I were in a terrible auto accident, and we had to be airlifted to the hospital—it was very, very serious. I was in a wheelchair for a long time. Because of that, I retired from my on-the-ground job, and I became a full-time employee. Even though I was already hooked in, it was really a blessing—it transitioned really well for me. I am now physically able to do everything I did before, but I love working from home.

Was there a learning curve for you as you transitioned to teletherapy? If so, can you describe the learning process as you adapted to this new service modality?

My own school used teletherapy when I was on the ground. It was before COVID so that’s a huge thing, because before COVID, teletherapy was something many schools used if they had no choice. It was like a last resort and was often considered a second class service. And I wasn’t sure about it. I thought it would be very different. I didn’t have high expectations. I thought it would still be better in person. I’ve since changed my mind.

My learning curve, though, was pretty quick. I’m a fast learner. I thought the platform was very user-friendly. I was excited about all the things I could use. All the materials I needed were in the platform, and I found that in most cases—probably close to 90% if not a little higher—I was just as effective. I could see the change happening with the kids. I could see that we could connect. I watched the training videos and learned to navigate the platform. I practiced with another therapist first in the Room and that helped for sure. I felt comfortable by the time I had my 2nd “live” day with students. I think the platform has always been quite user-friendly. It didn’t take me long to get going.

How would you address any questions or concerns about being able to successfully address particular goal areas (e.g., apraxia of speech), or students with more severe needs, via teletherapy?

Only in one case I decided that I could not serve a student, and that was because she had extreme visual difficulty. She had nystagmus and she was using an AAC device that works with eye gaze because she couldn’t move her hands so she had to have tactile input. I tried to work with her and her assistant and I couldn’t be effective. Other than that, it’s case by case. But ultimately the proof is in the student’s progress. It’s always important to get a rapport with the student, whether you’re in person or not. Once you create that rapport with the student and, for example, they work on apraxia of speech, it’s a lot of repetition. You make repetition fun, whether you are in person or on the computer.

It really has to do with keeping their attention and with having a good person on the ground. Sometimes you have to redirect because you have a child who is fidgety. I’ve had that when I was in person. I’ve had to stand by the door because they tried to escape all the time. So the amount of work that we get is equal to the amount of work that the assistant on-site and the teletherapist put into it.

On the ground, people don’t always see you. You can hide some wasted time in therapy. You can’t hide wasted time on the computer, because your PSP is right there. So really, you’re under a lot more of a microscope when you’re a teletherapist. If there isn’t any improvement, you need to readjust no matter how you are providing therapy. We’ve got to look at success over time.

What has your experience been completing evaluations via the Presence platform? How would you address any hesitation providers or schools might have about this evaluation modality?

I have not experienced an AAC evaluation, I can’t address that and I don’t know that I would even feel adequate. But beyond that, I can do everything. You use your experience and testing for a triennial. Many of my evaluations are informal. I ask teachers, I ask my PSP. I have her send me an email about her observations. I ask her specific questions about the times that she walks the students to me, and how they respond when I am not there and I use that. As far as formal evaluations, I’ve never had them glitch or have a problem. I can score them right there. I can give students a break when they need it just like in-person.

Describe how you work with the Primary Support Person to support your students during therapy sessions, particularly those with more significant needs?

As soon as I get my support people or PSPs, I try to create a rapport with them. I ask them why they’re doing this and what their history is. I thank them for agreeing to work with me and tell them that we’re going to do this together. I make it a partnership as much as possible, because that is the truth. It is a partnership. I exchange my personal cell phone with them so we can text because you can’t just do email. I get the bell schedule and any limitations for scheduling from them. Then, I try to make sure that the times work with their schedule. It’s a team effort coming up with the schedule, even though I drive it, and am in charge. You get what you put into the relationship.

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