Therapy and clinical supervision

I work with the adult neurogenic population in a private clinic in Jerusalem. From the onset of the pandemic, very few patients were able to come into the office for fear of Contracting the virus as they are in the high risk group.
Almost immediately approximately 90% of our work became online over resume. We were able to do one-on-one sessions with patients with various neurogenic speech language and swallowing disorders including various types of aphasia, various types of dysarthria and apraxia, voice disorders, mild cognitive executive function issues, swallowing disorders. Where possible we preferred to do the initial evaluation in person but follow-up therapy was almost exclusively performed online. We found very few
exceptions to the rule that therapy was completely transferable to an online format. The exceptions included technical ones such as families who did not have any internet or any computer or smartphone. And also patients with global aphasia or with more moderate to severe executive function disorders.
The demand was quite high for teletherapy and patients were very satisfied with the sessions. Many of them reported that this was an even easier format then traveling and taking the time to get to the office and spending money on gas and finding parking. Also with the patient's consent we were able to record sessions and then send them to the patient afterwards for their own review and practice. Additionally with the patient's consent we were able to share these recorded sessions with family members who lived in different homes who wanted to be trained or wanted to be kept updated on their loved ones progress.
In terms of the cost of service, we charged exactly what we charge for an in-office session and much less than we charge for a session in the patient's home. When we were using Zoom, it was able to be in the patient's home at the cost of a clinic session and that was very agreeable to everyone, a surprising advantage for them. During those live sessions of Zoom we were able to add in other family members and Friends no matter where they lived or what timezone they were in that was a significant advantage over meeting live.
I really have been enjoying using the share screen option as well as the chat box in order to have therapy be extremely Interactive and also have access to everything on my laptop during sessions.
In terms of clinical supervision of students, I was able to have groups of students participate in the same session with the patient's consent. The primary therapist kept their video on audio Anne and the other students in the group were video off and muted. During many sessions we had students join in so that there was the ability to practice a group discussion and pragmatic speech tasks such as turn-taking and topic maintenance.
In short, I can say that doing therapy online has been extremely effective for the patients and has many advantages over in-person therapy. I do not feel that there was any clinician patient Rapport that was missing or damaged from the medium of Zoom. There were also so many unexpected advantages such as protecting the privacy of patients who would normally wait in a waiting room for their session when they may prefer to protect their privacy and not have people know that they have a motor neuron disease or that they are seeking the treatment of a therapist. I am very wholeheartedly in favor of advancing teletherapy in this country. In conclusion I will tell the terrible story of someone who suffered because they were not able to take advantage of teletherapy. A man in his thirties, father of 11, suffered a massive stroke and had aphasia and apraxia and was not able to benefit from therapy at all during the first few months of the pandemic because he had no access to a computer or Internet and his kupat cholim would not approve teletherapy. The stop Gap solution that I was able to provide for him was free therapy from a student who lived nearby to his home but that was not ideal as it was without one-on-one supervision. Once we were able to resume face-to-face sessions, there was a tremendous waiting list of patients who needed to be seen that took around two and a half months to catch up with and patients suffered during that waiting period as well.

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