Today I’m excited to share an interview with Emily from DotCom Therapy™, an SLP teletherapy practice. Emily is one of the co-founders of DotCom Therapy™, so I’m thrilled that I was able to pick her brain about telepractice.
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Can you tell me about DotCom Therapy™ and how it began?
Myself and co-founder of DotCom Therapy™ Rachel Robinson love telling our Founder’s Story, if you will! We actually met in graduate school at Missouri State University where we were research partners. While analyzing data for Learning by Design’s SPELL-link’s program, who we are now partnered with for service delivery, Rachel and I became fast friends. We are as different as the day is long, but that’s what makes DotCom Therapy incredibly unique.
After graduate school, I began working in rural southern Missouri across four counties where I was spending upwards of 3-4 hours in my car on any given day to travel between school sites and work with students. In this model, I was supervising teachers who were providing therapy due to the extreme shortage of certified SLPs. Rachel was working in a neuro outpatient clinic with long waiting lists for patients to be seen. Waitlists as long as 4 months for acute rehabilitation post stroke. Us #slpeeps know that these scenarios are simply not ideal or benefitting of anyone involved, patient or therapist.
That said, we knew there was this huge problem that existed with lack of access and limited supply of certified providers, and we wanted to make an impact! We knew technology could be the solution. In the meantime, I serendipitously received an inquiry from a friend of a friend to work with their child overseas. They had limited access to therapy resources and were struggling to help their daughter be more easily understood as she entered school. I had heard about teletherapy and decided to give it a whirl. The rest is history. Rachel and I started delivering teletherapy services and knew this was our path. We began working with students living in rural villages in Alaska between our on-site visits (check out our bush-plane travels on Instagram!), and the model proved to be highly effective. From there, we bootstrapped a company from the ground up with a mission of making therapy available to everyone, everywhere. It was and continues to be the hardest, most rewarding career path we never imaged would be included in our journey as SLPs and friends, but we wouldn’t have it any other way. Today, we are providing teletherapy services to children all the way from Alaska to North Carolina, everywhere in-between, as well as internationally.
What kind of licensure is required for SLPs hoping to practice teletherapy?
Essentially, each state has different licensure requirements. There’s a really helpful guide on ASHA’s website that can point you in the right direction. Best practice for our organization is licensure in the state where the therapist resides as well as licensure in the state where the client resides.
Where are most of your clients located?
While we imagined when when DotCom Therapy was first created that we would serve mostly children in rural areas, we have been very surprised. There is a shortage of SLPs all across the US, not just in rural areas, but urban areas too! We also see that we are not only able to fill gaps in on-site provider coverage but able to offer specialized services seamlessly to support on-site staff (multilingual treatment, AAC evaluation, etc.)
What kind of speech disorders do you see in your practice?
Everything. Because we are not limited to location when employing our therapists, we are able to work with professionals throughout the country who are deeply experienced in certain specific areas of evaluation and treatment. As mentioned above, we just launched a program in partnership with SPELL-Links that gives individuals around the US and other countries access to this highly specialized reading and spelling intervention. Telepractice is bridging the gap for people to receive the best services possible no matter where they live. Conversely, what an advantage as a clinician! Within our organization we prioritize clinician specialty with their caseload, so this means that therapists are generally being afforded more opportunities to work with specific populations of clients.
What does a typical session look like?
Just like an on-site session. In all reality, when Rachel and I started providing teletherapy services and then expanded into training certified therapists within our organization, we knew that in order for paralleled results to be achieved, we needed to get creative in service delivery, and technology allows us to do just that! Teletherapy sessions are not a one-size-fits-all or at least they shouldn’t be. We must assess the strengths and weaknesses of the client and determine how they can best be served with a creative approach to treatment. Yes, some sessions are very straightforward with the clients attending to the clinician through the video conferencing platform and screen sharing activities are completed to achieve therapy targets. The creative part of telepractice is that most sessions, especially when working with children, do not always follow that same format. Sometimes, our therapists utilize push-in or play-based approaches and even enlist the help of a therapy facilitator to manipulate on-site activities. One of my favorite things about teletherapy is the challenge of creating environments that mirror traditional on-site therapy activities. Keep in mind, technology allows us to work with clients in diverse environments and offer support less intrusively, so in many cases it can be a preferred method of delivery. My initial wavering perspective of this somewhat-unknown form of service delivery was radically changed when I actually became a teletherapist. Teletherapy can be a powerful way to connect with clients when it is executed successfully.
What kind of therapy materials do you use during teletherapy? Can you share some of your favorites?
Some of my favorite activities are centered around what the client already has in their environment. I love working with preschool children and always prefer to use games, puzzles or activities to keep them engaged and excited. This involves close communication with the therapy facilitator before and during the sessions but it’s so much fun for the kids. Who doesn’t love engaging students in turn-taking activities or teaching correct placement for the /k/ phoneme during fun, play-based activities?! The therapist is visible on the technology, sometimes even on the smartboard, and is able to lead the sessions while keeping the students engaged. So many materials are available in digital format or within an app now, and I am crazy about Teachers Pay Teachers just like every other speech therapist out there.
How do you treat clients with pragmatic and social issues?
Again, in the same way that we would with on-site delivery. We can use a wide-angle lense to see larger groups of students. We can even be portable! If the video conferencing platform allows for mobility on the form of a tablet, how cool that we can “walk” with our clients and support them non-intrusively through different social scenarios- even with a bluetooth device in the client’s ear if needed. This helps to shape independence and carryover in real scenarios.
How are assessments completed?
Within our organization we train our therapist to utilize assessments available in digital formats and those only available in print version. We understand that not every evaluation tool is going to be accessible digitally and we take efforts to ensure that environmental considerations are met with the utmost respect, paralleled to on-site administration of assessments. Teletherapists must work closely with the therapy facilitator to communicate expectations and processes in advance so that fidelity of the assessment is maintained.
What kind of hours do you work?
Well as the co-founder of a growing company, I’m embarrassed to admit how many hours I work per week! What I’m focused on right now is maintaining a strong, mission-focused foundation as we expand. Rachel and I also advocate for this model by speaking to different organizations, so we do a lot of traveling. We are humbled and proud to represent our family of amazing DotCom Therapists™ and realize that they are the true champions of this company. Most of our team of therapists are full-time employees. We also have part-time rockstars too.
What’s the average caseload for a telepractitioner?
DotCom Therapists’ caseloads mimic those of on-site providers, but I would also say that because we are able to meet larger demands by providing as many therapists as possible to serve the needs of schools, our therapists might tend to have smaller caseloads.
Can CFs do teletherapy?
At DotCom Therapy they can! Of course, this is dependent upon state regulations and employer practices. We love giving new clinicians access to a wide variety of experiences, and teletherapy can definitely serve that purpose. Because we employ our therapists, we encourage added levels of supervision and support from mentors within our organization.
What telepractice trends do you predict in the next 10 years?
Here’s a quote from a presentation we gave to the American Council of Rural Special Education that continues to be our co-founders’ mantra, “The future of teletherapy affords individuals access to an ecosystem of certified speech-language pathologists. Furthermore, it supplements and supports on-site therapists to ensure that the highest quality of services are being offered with no view of teletherapy as a stopgap option but rather a positive, valuable experience for all.”
I anticipate that teletherapy will gain speed as people continue to embrace innovation. It starts with us as a profession. We are afforded the beautiful opportunity to leverage how those around us view teletherapy. It should never be a final option when there are no other choices. It is powerful and can connect certified clinicians from all over the country and the world. Who benefits? Therapists and clients. One of the many things I love about speech-language pathologists is that we are a collaborative body of professionals that continually seek added ways to help our clients improve. In that same spirit, we can embrace this model and advocate for best-practices to ensure the efficacy of service delivery.
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Thank you so much, Emily! I loved learning more about telepractice, because I think it’s a trend that will only continue to grow over the next few years. Check out Emily’s travels (so jealous) and work on Instagram at @dotcomtherapy. Happy Monday!
Nora Anne
has been her favorite so far!
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