It’s been over three months since we closed our doors due to the COVID-19 pandemic.  Just like the majority of the global community, when 2020 first began, we had no idea the world would look the way it does now.  For those of you who may have wondered about the what, the how, and the why, we thought we’d use this blog to share our experience of transitioning to teletherapy, and do so from our perspective as the directorship of TALK.

First we’d like to go back to Winter of 2020.  In early February, the novel Coronavirus was slowly starting to take up more and more airtime and we were listening and following the news.  During one of our director meetings that second week in February, Sarah proposed the idea that we might need to prepare to close the clinic.  She was quite serious, but Alexia and Mari looked at each other and back at her incredulously and with a certain degree of dismissive humor.  We continued on with our meeting and it was business as usual.  Like the rest of the world, we had no idea what was coming.

By early March, the news was becoming more alarming and the situation seemed to be getting increasingly serious.  There seemed to be reason to worry.  During our first meeting of the month on March 3rd, we began to discuss how we would protect our clients, our staff, our families, and ourselves.  Still operating under the assumption that we simply needed to make the clinic as safe and sanitary as possible, we spent the next few days creating and revising office safety protocols, writing a general letter to clients detailing these changes and extra precautions, notified our staff of the upcoming changes, began ordering supplies like disinfectant wipes and hand sanitizer, and prepared for a potential uptick in cancellations, among other things.

The next week brought more worrisome news and we began to learn about early community responses and government recommendations in response to the growing pandemic.  We called an emergency Sunday night meeting of the directors.  Alexia had previously mentioned the potential need to look into telepractice platforms and it seemed like it was now time to seriously consider this option.  We spent the bulk of the meeting that night, revising and strengthening our in-office sanitization protocols, coming up with various scenarios in the event we might need to close, and delegated researching telepractice companies.  With our leadership team’s assistance, we were able to research several teletherapy options and selected the platform that we believed would best suit our needs.  We then informed our staff that in preparation for the unknown, we needed to prepare to make the switch from in-person therapy to virtual therapy.

That week, we began informing our clients that teletherapy was going to be an option in the near future.  We signed up for a multi-day live training course presented by Melissa Jakubowitz, an experienced speech-language pathologist with years of teletherapy expertise.  We spent the weekend creating internal tracking documents for which families had decided to switch their sessions to teletherapy, who had decided to pause and/or cancel services, and with whom we had not yet made contact.  We drafted consent forms, wrote a new letter to families, and transferred all our clients into our new teletherapy system in addition to our main EMR scheduling and billing system to make sure we were ready.  While we knew it would be extra work to be operating off of two systems simultaneously, we couldn’t see another way, so that is what we did and continue to do.   The entire staff, including our office manager Jill, and the directors, spent the weekend training on our new teletherapy platform (TheraPlatform), watching a myriad of video tutorials on all the features, and doing practice sessions on each other and any willing partners and family members.

The next week started off fairly normally, with all the new in-office safety procedures in place.  It was Monday, March 16th mid-day, when the news broke of the mandatory shelter-in-place ordinance, which was set to begin immediately.  This is when our staff took things to a whole new level.  Knowing that they would not be able to run most sessions without the necessary materials, visuals, templates, and resources, they immediately began copying, scanning, and uploading everything they could think of to the virtual platform.  It was a herculean team effort.  In the meantime, we had our IT support grant secure, remote access to each of the therapists in order to allow them to work from home.  The atmosphere in the clinic that day felt akin to nothing we had experienced before.  Our staff had limited time to gather everything they needed and didn’t know when we’d be back.  We spent that night and into the wee hours of the next morning entering each client’s schedule into our new teletherapy system.  We had a debate as to how long we should recur these sessions - initially deciding on two weeks thinking that this was all temporary, but then elected to be safe and recur them through July, while laughing at ourselves at how overly cautious we were being, as this would all be over by then.  As they say, hindsight is 20/20.

The following night, we began the three-day training course to educate and prepare ourselves with the tools we would need for this transition.  It could not have come at a more needed time.  Our therapists joined us in these nightly training sessions to learn about the efficacy and research behind telepractice and speech-language therapy, the technological and equipment requirements, privacy and HIPAA parameters, and clinically how to run sessions.  They banded together and began sharing various teletherapy resources and materials, as well as questions and concerns with how it would all work.  It was a significant amount of extra time and effort for all and through this, it became even more apparent how much each member of the team cares about their clients and wanted to make this a successful transition for each one.  Even though everyone was stressed, anxious, and exhausted, we wanted to make this happen the best way we knew how.  Everyone worked together to come up with new systems of tracking and sharing data, new assessment protocols, worked through tech issues, numerous other issues, and demonstrated their flexibility, capability, and creativity.  Who could have predicted that March 16th would be our last day in office?  But even more astounding, is the fact that we were doing sessions in the clinic on Monday and doing sessions via teletherapy on Tuesday, all due to the massive amount of time, energy, and teamwork of this amazing team.  We could not be more proud or more grateful.

With the official switch to teletherapy, we were worried about the lack of connection and support, so we held all-staff meetings every day of the week, some during business hours, but most before and after clinic hours, to discuss issues, share knowledge, and remain connected.   Amongst the challenges, we also had some unexpected success stories.  There were clients who had opted out of trying teletherapy, who decided to give it a try after learning that we might be providing services this way for longer than planned.  There were clients for whom we thought teletherapy might be too difficult, but who have actually proved to do better than in clinic and are thriving.  Some families have even found that they prefer this mode of service delivery and have requested to continue even when we resume services in person!   At this point in late March, it seemed as though we had made the transition successfully, but as the situation began looking less and less temporary, we were then forced to think about how to sustain.

The month of April was spent with us applying for financial assistance in every form imaginable.  Like many other small businesses, we applied for the government Payroll Protection Plan (PPP) loan, several other types of government funding, private grants and awards, and began calling banks and lenders up and down the peninsula.  We had to start having the difficult discussions about potential pay cuts, furloughing, and laying off employees. After what we had just asked of them, this was the last thing we wanted to have to think about or discuss.  These weeks were tense, scary, and stressful in a way that we had not experienced before.  We set up meetings with our accountant and were in frequent communication with our attorney about options.  We also worked with the Women’s Business Center and received support and guidance from a wonderful advisor there, which turned out to be invaluable.  Just like everyone else, we were also adjusting personally to learning how to re-balance life at home with families, while simultaneously doing all the necessary things and more to keep the business going.  Between the three of us, with six children under the age of seven, losing childcare options, two spouses who are essential workers and were consistently gone 15+ hours a day, learning how to homeschool for the first time, and having aging parents move in, we were each overwhelmed, yet grateful to have each other for whatever support we could provide at any given time.

Early May brought the news we were waiting and hoping for.  We were notified that we had been approved for a PPP loan.  Because of this, we were able to continue to support our staff, which was the biggest and most immense relief.  We continued to follow the news about phased and partial re-openings.  We were and are committed to reopening in the best way we know how, which was to attempt to make sure that everyone had an option with which they felt comfortable and safe.  So we created surveys - one for our clients and one for our staff to determine what parameters would need to be in place for anyone to return to the clinic.  We expected a wide range of responses and we received as much.  Based on the results, we began to make plans, purchase equipment and supplies, and prepare for a potential partial office reopening.

While we decreased the amount of all staff meetings and leadership team meetings to once per week, we as directors have continued to increase our workload to continue to best serve our clients and team.  That often means meeting before and after hours and on weekends. This is something that is often necessary or expected, but also something that we are working to address. The same goes for our office manager, Jill, who has put her all into ensuring that the day-to-day operations run smoothly, which is no small task.  She goes above and beyond every day and her steady presence, dedication, and the extra support she provides has been invaluable.  Despite the trying times, we have had some moments of joy and things to celebrate as well - we’ve had virtual happy hours, a bridal shower, some staff appreciation surprises, birthdays and work anniversary celebrations, and a couple of upcoming (likely virtual) baby showers around the corner.  So life goes on in this, our “new normal”.

Now that we have been providing services through teletherapy for a couple of months, we have learned that teletherapy is HARD.  There is more prep work, more planning, a greater need for flexibility and creativity, among other challenges on the part of the therapists.  It is also hard for families and caregivers (our fabulous “E-helpers”!), to be present and engaged for every session on the other side of the screen.  BUT we have also learned how beneficial and wonderful it is to have increased parent participation and interaction, not just at the end of the sessions, but for the whole duration; having the opportunity to do more parent coaching, and seeing first hand how this promotes a greater understanding.  One thing that is paramount and something we often discuss is our clients’ social-emotional well-being.  This is no different than when we are in the clinic, but we recognize that there is now a new level of stress, change, and uncertainty (and “Zoom fatigue”!).  Children and humans in general are often described as “resilient” and we are aware of the truth in this, but we also want to give them the space to express their discomfort with what is going on around us right now.  Some therapists have reported this coming up in sessions, either through behaviors or in conversation, and we want to be able to support those needs as well.

June brought the partial reopening of our clinic.  We have one therapist working in the clinic, seeing a few clients who are comfortable being seen in the office and/or for whom teletherapy was not working, with all the new and necessary procedures and precautions.  All of our other therapists are still continuing to provide services via teletherapy and will hopefully be returning to the office slowly and at a time that fits their personal parameters for health and safety.

And here we are - it’s July.  We have all been adjusting and continuing to try to support each other, but as you know, this is not an easy time for anyone.  We truly miss seeing you and your faces in person.  We are now fortunate to have new clients who we have never even met in person and we are looking forward to that day.  If there is anything we can do, please reach out.  We are grateful beyond words for your continued support and are here for you.  We fully recognize that the fact that we are able to work and serve you is a privilege and would like to sincerely thank you for your trust and confidence in us to do so.  To our amazing team, we are truly inspired by your dedication and commitment to your families and our practice every day.  We will all get through this together, one day, one week, one month at a time. Thank you.