How to Create the Best Experience for all When Doing a Pediatric Assessment Via Telehealth

Hi, my name is Janet Ottersberg and I have worked as an Occupational Therapist for over 30 years. I have had the pleasure to work with clients from neonates to 104 year olds and have worked in all settings that OT’s practice. I am so grateful for this career that has allowed me to be flexible and work according to my lifestyle needs at the time. As a single parent, this flexibility allowed me to be there for my child as much as possible and still have a flourishing career. All the shifting I learned to do as a single parent afforded me the experience to create the changes necessary to continue to work, despite a global pandemic. 

As this global pandemic drags on and on, many of us in the rehabilitation field have had to make accommodations to stay afloat in the field of Occupational Therapy. Some people have left the field, some have changed their practice to a hybrid model and for many of us that shift included moving to a telehealth model of treatment. I don’t know about you, but I have always enjoyed face to face interactions with my clients and this switch has not been easy. That being said, it has had its benefits and I am very grateful to have the flexibility to continue to serve my clients throughout this pandemic.

Even after working in the field for over 30 years, it is still challenging to assess pediatric clients, and assessing via telehealth brings a whole new set of challenges. Thank goodness for a growth mindset in this year of shifting and changing. I will share with you a few of the things that I have learned along the way in having a successful pediatric assessment via telehealth. 

#1-Communication-First and foremost, set up a meeting with just the parents. Send out a letter of introduction which includes the information on the platform you will be using for the telehealth meeting along with the instructions for downloading the app. Provide the link to the meeting, the date and time and another means of communicating with you so that if they are having technical difficulty they can contact you at the time of the meeting. Along with the information in the email send a calendar invite for the meeting. It is important to remember that even though we have all been using technology now for months there are still people that do not have the technology or experience with the telehealth platforms. On this initial email, include consent for telehealth, privacy policy and a history form for the parents to fill out, attendance policy, along with insurance information or payment policy.

• Letter of introduction
• Information on telehealth platform
• Meeting information
• Contact information
• New client information

#2-First meeting with the parents only- Parents today are overwhelmed and overworked. It is not easy for them to have a quiet moment without a kid around, however, even if you have 15 minutes with the parent you can obtain a lot of information about what the needs of the child are and how to move forward with the assessment. First, focus on what are the strengths of the child. When you give the parents a chance to shine a light on how great their child is, it can shift the energy for the entire process and it gives great information that you can leverage when treatment planning. Next, find out what the parent’s concerns are for their child and why they are seeking Occupational Therapy services. This can be a great opportunity to then explain what OT is and clarify what is beyond the scope of practice in OT. Next, I like to get a picture of the child’s day, from how they sleep at night to their daily routine, including meals and their circle of friends. The input from the parent is the most important information that you are going to receive and when they are feeling stretched between talking to you and chasing after kids they may forget vital information. Finally, review the medical history that you have received ahead of time, and if there are any missing pieces, especially vision and hearing screening ask the parents at this time. 

• Child’s strengths
• Parent concerns
• Daily habits
• Medical history
• Allergies

#3-Explain the assessment process and set up the follow up appointments for the assessment. Set up at least two different days to complete the assessment, keeping the appointments to 30-60 minutes depending on the age of the child. Review the attendance policy and how to contact you if they cannot make it for the appointment.

• Explain the assessment process
• Set up appointments 
• Attendance policy

#4-Prior to the first appointment with the child, determine which assessments that you will be using and get the assessment protocols to the parents by mail or electronically. As you are choosing protocols make sure that you are using protocols that have been approved for telehealth. There are many assessments that can be obtained online through WPS and Q-global. Email the parent any questionnaires and a list of supplies that will be needed for the assessment. Keep in mind that in some cases you may have to utilize whatever is available in the home and not expect that they will have everything that you recommend in the supply list.  Remind parents to have a favorite toy close by to use as a reward. Kids can be shy even over the camera and may need some prompting to participate.

• Determine assessment protocols
• Email parent questionnaires
• Email to parent reminder of times, link to meeting and list of supplies needed at time of assessment

#5-At the first appointment with the child- Take the time to introduce yourself and get to know the child. Ask them about their favorite toy, favorite food, etc. Allow them to show you their toys or take you to their room. Start off with an activity that feels like fun and then go from there. 

Parents are used to helping their child and may automatically jump in to help. You may need to remind parents to let the child complete the activity on their own. Parents are frequently more frustrated with the process than the child. So, a reminder to the child to take some deep breaths can be a helpful reminder to the parent as well. Remind the parent to move the camera to get the angle of the child sitting or standing and ask to zoom in to see how the child is using their fingers.

Make sure that you have the same supplies as the child so that you can demonstrate when needed.  Switch back and forth between sitting and standing activities in order to keep their attention throughout the session and follow the cues of the child. Sometimes it is just not working and you may need to reschedule for another time.  Relax! Kids can sense your tension even through the screen. Prepare for the meeting with a few deep breaths, some exercise or whatever helps you to feel grounded. 

One of my biggest takeaways from doing telehealth assessments is that it is absolutely vital to prepare ahead of time. It may seem like a lot of work but the end result is a much smoother time with the child. Whether this is your first time doing a telehealth assessment or you have done multiple, preparing for the assessment is always the most important step in the process. 

Janet has combined her many years of practice as an Occupational therapist and her experience as a life and wellness coach to create a unique offering to families with kids with Autism and ADHD as well as kids and adults with cancer. If you would like to find out more about how to work with her go to https://ottersbergcoaching.com/.  If you have questions you can contact her at [email protected].