36. Keeping Kids Engaged Over Telehealth

Introduction To The Beyond Words Speech Pathology Podcast

So how can we keep your child engaged over telehealth? Welcome to Beyond Words by Pop Family. I’m Heidi Mum and speech pathologist. And today I’m joined by another one of our speech pathologists here at Pop to tackle this big question.

Not only is Lucy our clinical lead for engagement in Telehealth, she’s also a master’s qualified registered play therapist, a certified practicing counsellor with the Psychotherapy and Counselling Federation of Australia and a qualified yoga instructor.

If that wasn’t enough, Lucy is also passionate about continuing her contribution to the field through education and research. Her current research interests include teleplay therapy and rural mental health. I’m excited for you to hear our conversation on getting the best engagement over telehealth. So speech therapy, let’s jump right in.

Redefining Child Engagement As Collaboration In Telehealth

I want to explore what therapy would look like without engagement. So if we don’t have engagement in therapy and I mean, actually maybe first let’s explore the term engagement because I think we need to get that out of the way.

Yeah, I love that. Yeah, I think, more and more as I sit with that term engagement, I feel that I don’t want to use it anymore because I think we have this idea, idea of what engagement is. It’s a very simple thing, but it isn’t that simple. And so I think when we can kind of shift some of the wording around, it can allow us to be, open to having a new experience of what that might be about. So I think engagement is all about collaboration and feeling a connection.

I love that because engagement makes a parent or makes me as a therapist feel like. And I have explained this and I’ve actually taught this. Right. So I love continuous learning and I love unlearning things and learning new things. And so this is a concept that I’ve really come with you on.

When I first heard you say this a few weeks ago when we were talking about it, I’ve said to countless speech therapists, like when they say to me, oh, like how are you ever going to engage someone online? And I say go and watch an episode of Play School. Yeah. Which everyone actually all telehealth therapists, maybe you should go and do that because you can learn a lot from Play School.

Moving Beyond Entertainment In Online Speech Therapy

But the error there is that, that’s so one sided. It’s like you’re here to entertain. You are like the clown, like doing the performance. And the thing is that that’s certainly not all of what I did, but that was one of the ways that I could Explain that we can engage children online because there are really effective ways to do that.

But also, not every therapist is Play School. Right. They’re not an actor and a singer and dancer. And, and I feel pretty comfortable in that zone. But some people don’t exactly. Your term moving over to collaboration really changes that narrative.

And the way that I as a therapist see, see that expectation on both sides because as soon as you change the terminology to collaboration, it means that there’s two or more people involved, not just performing like a therapy monkey. Yeah. And we don’t, we don’t want a therapy monkey because we know, you know, every child and family is so different as well. So. Yeah.

Research Supporting Telehealth And Virtual Therapeutic Relationships

And I think, I mean the play school metaphor works really well when we think about that connection piece as well for the children because we see kids get really connected to those Play School actors. They’re amazing and they are doing the entertainment part, which might be different to therapy, but they can form that really strong warm relationship with someone that they actually they haven’t met in person. Most of the time. We think about wiggles or anything like that as good example of a one sided type of engagement.

Yeah, yeah. But also through the technology and through the screen they can still form that warm relationship. And I think that’s something as well that comes into the conversation when we’re talking about online speech that therapy is that we actually know from the research that therapists and, and parents often underestimate what the therapeutic relationship can be. The connection can be.

But actually we know we have lots of, lots of research when we’ve compared what is the relationship in a face to face service with what is the relationship in an online service. And we know that it is actually comparable which is really interesting. And I think that is important for us to think about. It is possible and it doesn’t just necessarily have to look like a child sitting down and being still and watching a therapy monkey entertain them.

No, it’s that strong relationship. And I mean I’m so glad that the research says it because And this is a silver lining of COVID really that so much research was then snap done into telehealth because of the lockdown. So there is one silver lining of COVID But I just know it like I have been doing telehealth for a decade and I have built a few of my kids. I’ve been, I, I saw them for seven years before I went on maternity leave, my second maternity leave and I… seeing children every week or fortnight for that period of time.

Like I, I now miss them. I get updates from their mothers on how they’re going. I check in with their, their now therapists, to make sure that I actually can’t let go. Like I, I, I call them my boys. So they are they really are like such a deep part of me and we built that connection online. So yeah, it’s really nice to see evidence coming out to prove what I have felt.

Yeah, that’s so beautiful. And that shows the two way movement. Like when we think about engagement it feels very one way, like the child is engaged. But you’re describing something that is two way. You’re feeling the connection, they’re feeling the connection. And it’s helped you to have this long term relationship that’s changed kind of both you and them.

The Essential Role Of Caregivers In Paediatric Telehealth

A beautiful long term relationship. And then let’s also not forget that that relationship is if we’re talking about a child, which we are today, there’s generally a relationship with a parent or a mother figure as well.

And I mean yeah, I think about those two long term clients of mine. I have built such strong lasting relationships with those parents and can, what does the research say about that or what does it say about the parents relationship with the therapist? Is that important as well?

Yeah, it’s really important. It’s so important that the parent can feel like they are able to steer the ship and they have a really strong co pilot, co ship steerer. What’s the word? Captain. Captain’s the word. A co captain with them helping to steer the ship.

So we know that it is really important like for, for the therapist and the parent to intentionally build a relationship as well. And, and for the parents to also feel that they can come and be vulnerable and share about you know, something hard that’s happened in the week or something that they, you know, thought that they were supposed to get done but they didn’t have time to get it done.

Or they can share the reasons behind that really honestly and feel that they can just be their full selves, bring their full human being, their full child, their full family into this therapeutic space. And that’s where we get this really deep and long term change.

Implementing Family Centered Care In Online Therapy Sessions

I’ve spoken to a few of our other supervisors at Pop about this and I’ve spoken to engagement researchers about this actually outside of you of course. And I, I just have a theory and I think that the parents that choose to sign up to telehealth have inbuilt vulnerability.

So they, they are already signing up for us to be in their homes generally and, and for us to, for them to take on a lot greater load. So I say to people, you know, we don’t have drop and go mums. I’ve worked in an in person clinic where the mum or dad or drop and go parents. We, where the mum and dad would drop the kid off and then go and do the groceries and then come back and pick them up.

That was a decade ago. I don’t even know what the laws are like now, but if you’re allowed to do that. But I know that the laws have recently changed, but that was just the norm in an in person clinic. Or the parent would sit outside in the waiting room or the parent would sit in the room across the room reading a book or maybe on their phone or doing some work.

So that relationship. And I actually felt that when I worked in the in person clinic it was a lot harder to have that collaboration than on the telehealth model. Because telehealth forces it. The parent has to be there to set up the computer to say, come on, sit down, let’s go, Ms. Heidi’s ready or Lucy’s ready to go.

And so I just, I just have this theory that those parents have already signed up to a bit more when they start with us. And, and so I feel like you’re a little one just a half step further towards collaboration when you start off with telehealth. But that’s a theory that’s improving.

Yeah, no, I think what you’re saying is validated in the research as well. That we call it family centered care. We, we work in a way that is really encompassing the whole family and needs the buy-in with the family. But actually research we know about, speech pathology overall is that family centered care is like what we want all the time. Face to face practice. That’s what we’re working towards. But in telehealth we start with that already. So we’re already set up for more success. I, I feel so. Yeah, that’s such a, such a great reflection.

It’s also one of the main reasons why we rebranded to Pop a family actually. Yeah. Because we want that family. We, we want your family to be involved. We want. And whether that’s. If you’re an adult and you’re in care, we want the family, the core people around you, your hypothetical family, if you’re a child at school, those main carers are what we are, you know, the main people in your life.

We really focus on the support people as well as the child or person that we are working with because we know that now. I have a way better word. We know that collaboration equals success, essentially.

Yeah, absolutely. We better change your role description. Yes, I really think we do. Oh, goodness.

Building Emotional And Physical Safety In Virtual Environments

I know so, and I mean we can take that even a step further in terms of why, like, why do we want the families involved? Because so if we’re talking about just the therapist and the child when, when we’re meeting a child in this therapeutic space, we are starting our relationship.

So we’re, we’re setting out on this really intentional journey, session after session, purposefully spending time to connecting to get to know this little person and bring their world into our space, to help them to feel really, really emotionally, relationally, physically safe in our sessions.

But they also have a family that they have known for their entire life and have a pre existing relationship with. So they’re not starting from ground zero. So having that caregiver that they have a, strong connection with that can be present is just like a superpower in therapy. Especially if that caregiver can work collaboratively with us as if kind of their, they’re our hands in the physical space, they can support the child in their emotional world and we can have this trust that as a therapist, you know, I know all sorts of things about speech pathology land and that clinical kind of side of stuff.

But this caregiver knows this child intimately and so that’s their role. They know what that child needs. To be supported, to feel safe, to feel emotionally grounded and to be able to reach their potential in that session. And I know the clinical stuff of how to tweak it to help us to reach our goals. So we have to work together.

Absolutely. We have to work together. And it’s so vital to us at Pop that we have actually refused partnerships in the past like where other businesses and even non for profits have asked us to service their clients if they’ve had, you know, staff shortages or whatnot, where, if they haven’t allowed us to speak to the parent. We have actually, we, we, we have said no to partnering with that service or to providing a service because we just did not feel like we would be able to.

I just, I just don’t want to meet a child and do an assessment if I’ve never spoken to a caregiver, a parent, or even a teacher, a teacher at minimum. And, and so, yeah, we’ve said no to that because there was just absolutely no chance of us providing Family centered care. And I was like, well, we could take your money for this service, but then we would be giving such a poor level of service because it’s just a requirement. It’s just a requirement to do a good job.

Measuring Progress And Value In Private Speech Therapy

And sometimes from a parent’s perspective, now I’m going to sit in the parent’s seat. This can be so frustrating. And this is. So we need to send this episode to parents who are, frustrated by the fact that they need to pay money for their therapist to make friends with their child, essentially.

And that feels annoying because what you want is progress and you want value for money as a parent. And I’ve had a parent, I think I’ve told you this story where early in my career I had a parent walk into a session and I, I was advocating for a double, a second session a week because of the severity of the speech sound errors and what we thought the diagnosis was.

And this father said to me, what’s my return on investment going to be? And I went like, what do you mean? I’m working on a brain here. I don’t know what your return on investment’s going to be, but I have never, ever, ever made that mist again where I wasn’t prepared for that kind of question because that father was going, you’re asking me to double the money that I’m giving you. What am I going to get back? And that’s a fair question.

At the very beginning of a therapeutic relationship, therapy can feel like it’s all fun and games. And that’s where I want to, that’s where I’m coming from here, where the therapist is having to break down those barriers with that child. And you know what, if you’re meeting my three year old, it’s going to take you five minutes. Yeah. She has two extroverts for parents. And connection is her core, like motivation in life. All she wants to do, be around other people.

So that’s easy. That, and then, and then that’s easy for the parent. You could for the therapist as well. We can move on to the next thing from there. But we also could meet a child who is so, so far away from that that it’s going to take us little tiny chips each session. And you can’t just come straight in and start drilling something when that child hasn’t, you know, you haven’t been able to meet in the middle.

And you haven’t built that relationship yet. You can’t collaborate with someone. All that’s happening is then you’re going to be forcing the therapy down their neck and nothing’s going to work. That’s a real waste of money.

So, depending on what the child or person or family coming to therapy is like, depends on how fast that collaborative relationship is built and then, then we start to see success. So yes, we really can’t get, I guess from a parent’s perspective, value for money unless we have or build or put resources and money into building that relationship first and And sometimes we’ve got to chip away over a longer period of time just depending on what that child is like. Because like you said, they need to feel safe in order to have success in therapy.

They absolutely do. It’s foundational. Yeah.

Sustaining Long Term Connection In Online Clinical Practice

And I would argue that the same idea that I think in speech pathology school we learn that at the start we have to work to build the relationship. And that’s our first step. Build the relationship. Okay, tick done. Let’s now go on to our work. Our real stuff. But I think that is what I just said. That is, that’s what you said.

But I think we sometimes think of it in that way because that’s what we’re taught. But I think that’s something talking kind of about unlearning or shifting our thinking. I think that’s something that we can unlearn, a little bit. That this collaboration, this relationship building is something that needs to happen intentionally 100% of the time that we’re with this young person.

It’s not just the first session. It’s not just the first five minutes of each session. It’s not just on the days that it’s hard. It’s. I think we have this real privilege in our work to be able to connect with little people and to be thinking at all times. How can we build their self esteem?

How can we allow them to communicate their voice, to share their voice broadly with the world? And we can do that in the way that we interact with them by, by giving them that opportunity to amplify their voice, to have a say, to bring their interests into the space. And all the while we can be targeting whatever we’re working on. We could be targeting these speech sounds in whatever activity. We can work flexibly.

You know, this is making me think. Lucy. One of my core weaknesses is like, I just assume just continuously throughout my life I’ve just had to unlearn my Assumptions that just people are like me. Oh, that is like the human experience. That’s so hard. I just am so socially driven and so driven to connect. Like, it’s just my.

I used to wonder why I could do telehealth. I, I found it and I learned this, I guess because I had to. It felt like tearing myself apart to try and teach someone else how to do telehealth when no one knew how to do it. So this is what I had to teach. And it’s so funny that, like, I still don’t have the words for it because I.

And you’ve just, you’ve just explained it beautifully. I never stop putting effort into that connection. And I just assume that, other therapists never stop as well. Right. But what you’ve made me and, and what I’ve seen and I’ve employed a lot of therapists is that, no, it’s not the top of mind for everybody. I’m just making the assumption, which is wrong of me, especially as a clinical leader, to assume that this is just the number one important thing for everyone else. Like it is for me.

And it’s something that I, I find baffling because without it, I’ve. I honestly just feel like it’s a superpower in therapy. If, if you can, if you, if your session is just going awry, stuff it. Let’s do something fun. We need to get back to that connection safe zone.

And I know that I explained to you when we were planning, like, what we were going to talk about, I explained how I had a child in therapy who used to cry almost every session because of what we were doing and how I am reflecting now on the type of therapy that we were doing and the type of drilling that we were doing. And I would avert and we would, you know, we would reconnect again.

Maintaining Engagement During Long Term Speech Therapy

But at the same time, I put in place at, at Pop. Structures. Because what I found with super long term therapy is that even though rapport building and connection is top of mind, for me, when you see someone super long term, it can drop off. That’s what I felt in myself. I felt like if I saw you super long term, we could re.

Change our goals, but then we get, we’d get there and I would be motivated to be like, okay, I want you to hit this today. Or like, we’re going to do this today. And then I wouldn’t always be present to meet them exactly where they were on that day. So then that’s how we have those term progress summaries to feel like, all right, we’ve got to review everything at least once a term if we’ve got someone.

But because I found that I was making those errors. And it’s interesting to reflect and unlearn. And I am not so clinical now, but I wonder, I’m, I’m wondering now what I would do with that same child. I would definitely do it differently.

Yeah. That’s such a great reflection. Yeah. And I think the reflection prompts action as well. Like having these discussions. And I guess that’s probably my role at Pop is relationship, relation and relationship, like making sure it is front of mind for everybody.

And just helping it to be a little bit more explicit and tension. I think because that’s what I’m hearing from you, there needs to be intention on the connection in every single session. Rather than as therapists we can get ourselves. And I am driven for results. Like, I just wanna, I wanna get those results. I wanna see them.

Yeah. And also I think that the way that You know, if my, if I saw them, geez, I was good at that feedback. So that child would get. And I think that’s what you were talking about before. We can move over there to modeling and, and feedback so that as soon as a child has those wins, you see their face go, oh, did you see that? Like I just did that or I just said that, or did you see that word that I wrote or whatever it was?

Speech Pathology Modeling Techniques For Parents At Home
What’s the importance of modeling in all of this? And what is modeling? Okay. Yeah. What is modeling? Good question. Modeling is doing something without any expectation that the child’s going to do anything about that. They’re just gonna observe it.

Perfect definition. And so can you give me an example?

So that might be if a child has unclear speech, they have some speech sound errors. We as caregivers can support them by modeling or giving them the example of what clear speech sounds like. And so they’re hearing that version of that correct production. And their brain is. Without them even knowing it, their brain’s going, oh, okay, I got that sound now. Yep.

So for example, my daughter Goldie is two and she does stopping for everything. Everything is, so if she was saying bib, she will say did. Yeah, and goes, and put bib, put did on. Put did on. So us modelling towards her is bib, bib put bib on. And it seems so crazy, but then she would go, b did. B did.

And then even my 4 year old will just give her the biggest round of applause. It’s like, yay, you made the sound. But there’s no expectation that she will say bib. It’s more that we going, bib bib and giving her exposure to that correct sound. And I don’t even expect her to say bib like she’ll, she’ll say it eventually. She’ll just say it.

Yeah, we just trust. We. There needs to. Yeah. Be that trust that the child has everything within them to move towards that growth and healing and development, which we know they do. If we can just give them the right environment. And that’s our role. It’s not to be molding kids, it’s just to kind of help discover them and help to set them up in their environment for the best success.

Developing Trust And Vulnerability In Remote Health Services

So we’ve talked a lot about and I guess I’ve shared my own unlearnings from a therapist perspective of what that connection feels like. But from a parent’s perspective, what does it feel like to click with your therapist?

Yeah, absolutely. That’s really important. And I guess maybe. Can I step back a little bit before we were saying we have this assumption that parents come to telehealth with already a vulnerability and, you know, a big comfort of being on the camera and to feeling like they have the space to emotionally be vulnerable with somebody and open up into our home. That’s not actually. It’s not that comfortable for everybody. Right.

Like that is still. We have a lot of families that sign up and go, I’m going to give this a go because this is gonna, this is probably gonna be the best option for me, but it’s gonna feel a bit uncomfortable. And so families who don’t have any other option, right?

Yeah, absolutely. Yeah. And that is, yeah, that is a reality in our world, you know. So I think, yeah, being as a parent, I think kind of getting through that, the hurdle of acknowledging that you’re ready for help is something that’s really keen and key and seeing therapy as that opportunity to expand the village around the child and to build a wider support, network and give the child an extra person.

So when you feel really connected with your therapist, you should feel like you can really trust them, them and you can really trust them even when it’s hard, even when you have to bring up something challenging or you have to give, you know, you want to give some feedback about something not working, there has to be that sense of safety that they’re going to be able to hear you, they’re going to take on your ideas and it can be that, partnership and they’re going to encourage you to, kind of question things as well.

So I always, I think it is red flag if you’re With a therapist and you ask a question about something that even you might think is controversial or, you know, whatever topic and it is kind of shut down or you haven’t felt really heard by that.

I think it’s really important that you can bring whatever it is you need to bring to the space and feel that it can be on the table and it can be a part. If it’s a part of your family, then it’s a part of your child’s story and it’s going to be a part of that therapy process too.

Evidence Based Practice And Family Values In Speech Pathology

Exactly. I really, really like that your therapist, regardless of their background, culture, opinions, ideas. Right. Should respect yours. And vice versa, though, like, as a parent, or, you know, as a. As a client, we should also respect our therapist. Like, really, we’re just saying be a good human being. But at the same time, therapist’s job is to create space for that and to really listen and to know.

I just go back to evidence based practice all the time. There’s three sections of evidence based practice. One is like the research that’s already been done. I say the research that’s already been done because there’s a hell of a lot of research that’s not been done.

One core section is the client’s values, like, who they are, what’s important to them. Because if you miss that whole piece of the puzzle, you are never going to connect with your client, or your parent. And when you have a child, you can’t say to the child, oh, what are your, like, cultural beliefs and family values? You know, the child might be four.

So you really learn what’s important to those fam. To that family through the connection with the parents. And, that brings it back to strengthening that. Strengthening that connection. Because really, if you’ve got a connection with that parent, it just supercharges you towards therapy success.

Because the parent’s going to say, oh, he doesn’t like the Grinch. Like, he finds it scary or whatever. Like that little thing where you go, oh, okay, I won’t bring the Grinch game again next week or whatever that is.

Whereas if parent wasn’t there, you just wouldn’t have that feedback. And what if you turn up with a Grinch game again next week and This child is like, oh, my God, the Grinch gives me nightmares. Yeah. Or the. Or the parent is there and thinks, oh, I don’t know, I don’t think I can give that feedback because the speech is expert and it’s not my role, but it is, it Is. Must be a good game. No. Yeah. No, no, no. If you don’t think it’s a good game, it doesn’t have to be a good game. Yeah, yeah, exactly.

So that’s really important. And as a parent, you would feel that’s a really good example. As a parent, you would feel comfortable to say or to say in the moment. Oh, let’s choose a different game, Ms. Heidi. Maybe not fun today. Or to send an email or a text or a phone call afterwards to be like, oh, hey, I don’t know if that went that well. We’ve, we’ve had a situation where he accidentally watched the Grinch movie and now he doesn’t like it.

Or I’m using this example because a friend of mine told me that their child accidentally saw the short version of the Grinch the other day and now they’re really scared about it. So these things happen when you’re watching ads on TV or whatever. So it just those little insights and that connection where you might have to say something or give that feedback, that’s really only going to strengthen your therapeutic connection and Get you further.

Empowering Parents Through Clinical Leadership And Education

Yes. Okay. So how do we build strong relationships? Does it have to be. I’m asking you questions now. Think about, like, think about a friend, a long term friend, a really close best friend that you’ve had for a long time. Has it been smooth sailing the whole time? Heidi? Molly?

No, it was not growing up with my best friends. Absolutely not. And I think what I’m coming back to every time we talk about this, because my career now really is heavily based in leadership. And I’m preparing, you know, my opening speech for our Pop Academy, which is in January, where we’ll address the whole team, we bring the whole thing together, and we do training and development and growth and personal growth is a, is a big part of what we do at Pop.

And that’s literally what we’re talking about today. Being open. Having the space to listen to someone means that you have to be open to growing and learning and, and holding space for someone is hard. That’s, that’s a lot of our job. We’ve got to be able to be big enough to hold space for someone even if we don’t like what they’re saying.

So the theme this year is empowerment in action. And really empowerment. Empowering someone else is leadership. Every single speech pathologist on this planet is a leader. And leadership is hard. You’ve got to, you know, do things that are hard to, to build that relationship and Empower someone else.

And I mean the analogy coming from the friends and building the friendship like leadership. I, I think it’s coming back to a term that we use in leadership which is having winning conversations and winning conversations, we call them winning conversations because it’s difficult, but everybody wins.

And those friendships, building friendships, like you have a blow up, like you disagree on something or someone says something mean or whatever. And depending on what age you are at the time, you then have to be able to repair and it’s that repair or, and it could be, depending whether it’s personal and you actually had an argument with your friend. You’re not likely to have an argument in a professional situation with your client. But you could have. I’m, I’m in a disagreement. Yeah. Yeah.

And if you don’t any disagreements, then maybe that’s also like if I’m a parent. If you’re a parent, I want you to challenge your therapist. And if I’m a therapist, I want the parent to be, I want the parent to just be going, yes, Heidi, three bags full, like whatever you want. Like you’re the expert. Like no, I’m not, I’m not the expert on your child. And if you’re not going to challenge me, then we need to bring a little bit more challenge into that relationship. I want to hear your voice.

And that’s when I, that’s why I’m talking about empowerment. Because empowering someone sometimes means, especially if they’re not as free flowing with their challenge, for example, as I am, sometimes you need a little bit deeper to get that, to get that challenge. And sometimes as a therapist we need to really ask deeper questions.

And that’s why the tool that you have created essentially has a list. It’s, it’s a list of questions that are going to stimulate or stimulate that are going to hopefully start a winning conversation with your therapist and then build that relationship. Like, like, like you building a friendship or, or anything. Any strong connection is through, is through small wins. And it’s not going to be easy. No. Yeah.

Understanding The Rule Of Repair In Therapeutic Relationships

And it makes me think, I think there’s some parallels in the parent child relationship to. Every other relationship that we have. And we know as a, one of the original researchers, theorists around parent child relationships or attachment is the term that’s used in psychology is this concept of the good enough mother originally about the good enough parent.

Which is the idea is that in relationships we can’t be perfect 100% of the time. We’re gonna miss the mark. We’re gonna misread each other, we’re gonna say the wrong thing, we’re gonna, it’s not gonna go well. One, but that’s okay. What is important is the repair afterwards so that we’re able to make up. So we have this pattern of rupture, a break and then repair.

And if we’re able to do that for X amount of time, then we know that we can have a secure relationship. What do you think is that X amount of time? Like percentage wise? How. What percentage of time do you think we need?

Okay, I’m just answering this based on like my own experiences. For what amount of time? Oh, it would have to be long term. Like what I want it to be is like three to six months. But I just don’t know if it is. I, I because how many times do you have the chance to rupture in a three month period? Like probably it’s.

So let me reframe the question actually. So a percentage. So do you have to be able to repair 100% of the time? No. Do you have to repair 0% of the time? No. How. What amount of time percentage do you need to be able to repair to have a secure relationship with somebody?

Oh, it has to be high. It’s got to be. I’m struggling with my own personal values because I’m the person that wants to force you to repair like 100. A bit angry. So I, I aim to cool down on my, take my repairs slower in life. Maybe 70 or 80%.

Yeah, yeah. And it, it will vary for between people. But what we know from the research, to have a secure relationship, we need a repair 30% of the time. It’s so low. So it’s low, isn’t it?

So this idea of the good enough parents. So we, if we can repair 30% of the time, you just have to be good enough. You don’t have to be perfect. That we can have these secure relationships. We know that they use that in family law. My best friend, my best friend’s a family lawyer and they use the 30% of the time rule for secure attachment for children.

Like you only need to respond to your children 30% of the time to have secure attachment. That’s what she said to me, something from the legal world. And I was like, what? Right. Well that’s a good example of research for getting into the practical world, isn’t it? This same research that she has said, this was also us talking as mothers about you know, when you’re just at your limit. And as a mother, I just feel like, wow, 30%. The bar seems low. I feel like I’m achieving that.

Beautiful, great. That’s the goal. It’s just good enough, good enough. And maybe you’re an overachiever. Like I said, I’m like, obsessive. I need to repair that relationship. I won’t be able to sleep for a week unless I’ve repaired it. So probably not everybody was like me. They might want to avoid that. Wouldn’t keep them up at night. Maybe everyone has different experiences with it, but I think the.

The key part too is the repair is so important and that when you now coming back to the therapy space, you know, like, we have these challenging experiences sometimes in sessions. Speech can be really hard, especially for little ones. You know, hypothetically, you have a little one with a really severe speech sound disorder. Speech is hard for them. They’re used to people not understanding them. They, feel really scared to use their voice.

So coming to speech where we’re asking them to communicate is really hard. And it’s going to take a big. It’s going to take a big emotional toll. And sometimes they might have the space for that, but sometimes they might have had a big day already. And it’s just feeling really tricky.

So at those times, it’s really key to be thinking about how can we have that repair to allow them to feel safe, that even though it’s hard today, we’re going to come back next time and try again. That’s the role of the therapist and that’s the role of the parent and modeling repair. So modeling that and actually not expecting anything back from that child. We can’t force them to repair. We can model it. We can repair from our end and then we can move on.

And I think that that’s something beautiful that I’ve learned from being a therapist. I’ve often. I don’t struggle in the therapy room with the things that I struggle with in my real life, like my emotional state. I just often wish that I could be in my therapist mindset my whole life. I’d be so calm.

But as a, as a parent turning up to a session with my child, which I have, you know, like, geez, that’s hard. And, and you’re trying. I turn into this. No, you must sit and you must listen and you. And I’m like, what are you doing?

You would never expect your child to do this. Like as a therapist, the therapist is saying to Me, it’s like that’s okay, Heidi, let her do that. Like, would you like something else to fiddle with or you know, like all of those little things that Yeah. That bring that together.

Parent Tips For Observing Versus Surveilling Child Progress
All right, now I want to talk like actions. You know, I’m the parent who wants to walk away with something to do. I want to talk about everyone’s job. We’ve talked about a therapist, the child and the parent and, or, or caregiver.

At Beyond Words. We talk about mothers in that generalist term where the mother, when we talk about the mother, we’re talking about the caregiver. If we’re talking about actions that we can take, what is the parent’s job in collaboration? What, what are the actions that they need to take to have that true collaboration so that therapy can succeed?

That’s such a really great important question. And the example that you gave me before made me think about this idea of surveillance versus observation.

So as a parent, if we are, we’re doing surveillance of our child, are they sitting still? We’re just checking. Is it good or is it bad? Right. That simple thinking again, are they behaving? That’s surveillance versus observation.

So in telehealth world too, as a therapist, I don’t have the full view of the child. I can’t see their full body. I can’t see their full entire room and space that they’re in. So one of the roles of the parent is to, to do that observation and to feed that back to us.

So observation is more curiosity driven. So what can we learn about the child through this experience? Okay, what does the child need from me here today? To be able to support them so you can see there’s just that slight shift. Surveillance to observation reminds that approach.

It’s almost like we need a bit of a mantra. I’ve, I have actually been doing this when I like take my supplements at nighttime. They taste horrible. Like say this tastes delicious and then I drink them. It’s like I’ve got to change my mindset. I can’t drink this. So it’s like the parent needs to go, okay, I’m an observer before they enter the session and you know, my job is to observe and their job is to be the eyes and the ears of the therapist. And especially in the telehealth setting.

Yeah, absolutely, yeah, that’s really important in terms of the parents job. What about consistency and what about like there is a lot that’s within the parents control that will either make or break connection and then success.

Using Predictability To Support Children During Telehealth

Yes. Okay. So what we know from studying the brain is that the brain loves predictability. It loves, it’s a prediction machine. Like, it loves to know what’s coming next. And so one of the really simple ways to help a child feel safe is to capitalize on that. How can we make this a really predictable experience for them that’s the same each time.

So that’s about having our same therapy appointment at the same time each week. So they know on a Tuesday afternoon they’re going to see Lucy. And if we have, a week off, a child has a nativity play they have to go to and they’re still like, oh, it’s Tuesday. But I normally have Lucy. Like, they know it.

Even though they don’t have a calendar or they don’t keep track. They just, they predict that and they know and they feel safe. So that’s the thing that they’re going to do at this time. The next part of it is supporting that transition.

And I know, sometimes, I have had telehealth appointments for myself where I have just been frantic like before the appointment and, and gone, oh my gosh, my appointment was two minutes ago. Quick, let me log on. And it’s that quick rush transition into that space. And that can, often that can happen in our therapy sessions. Too hard.

I can give an example of this because I started therapy with my older daughter for thumb sucking and some orificial myofunctional stuff to do with her, lisp. But we’re not going to be doing lisping yet because I know what the problem is. It’s our thumb and our teeth and some other things. And we need to do some therapy.

We’re about to turn four. We actually started six months ago at three and a half. She was very ready. And the hardest thing was that I’d booked it in on my work day. I had no transition for me or her. I’d have to race over to the house, grab her, bring her back quickly set her up, quickly transition myself out of work, quickly transition her into this space.

And like none of it was working. So I’ve now planned for it to be on my mum day when we can take transition slow. We can build up. I can have a bit of a social story around. Okay, today’s Lucy day and you know, I, I need time to transition her. As well.

Especially when they’re little, they need more transition time. I mean, and depending on the child, if you’ve got, neurodiverse child transition are super important. The parent is Responsible for also making that, especially if you’re doing telehealth, making that transition safe and helping the child to turn up in a safe space, not a rushed, like crazy, you know.

Yeah, quick, get out of the pool. We have therapy. It started three minutes ago. And you know what? That’s me. Like, yeah, you’ve met me. I’m always, I’m always, trying to do 10 things five minutes before I have an appointment. And it’s, it’s really my, it’s one of my worst traits. But I really need to set boundaries around, you know, myself so that I can, I can put that in place for my child.

Why Parents Are The Best Therapists For Their Children
The parents that are. I often say to the parent, it to parents, I actually say it all the time, you are the best therapist for your child. And like, what can parents do? They can learn with us. They can, we can. We are their coaches and they are the therapist I really want.

You said it’s their job to be curious and observe. You know, those winning conversations. Some of the most important winning conversations I’ve ever had with parents are around being firm, around how they give their child feedback and get the child asking the child to leave the room at the end and say, you can go and play and saying, okay, mom, let’s talk about some of those comments that you made today.

You know, let’s talk about those. Let’s explore those. Let’s think about how we can say them differently because what happened and, and, and getting them just. Honestly, I would. Reflection, reflection. And the mothers would say, yeah, I noticed he shut down. I’d be like, okay, beauty, so what are we going to do next time?

Because this is going to happen next week. And so then we would have a, we would prepare and then next week. So then also you find that you are building up the confidence of that mum to be a therapist. They haven’t learned modeling. They haven’t learned stuff that we’ve learned that we know works. And then they realize that. They realize as well that they get so much success. And it’s just that, builds your relationship.

That’s a difficult conversation to have to say, hey, mum, let’s talk about some of those comments today as you come from a real place of acceptance of the parent as well. You know, I, I don’t know a single parent that wants to, I don’t know every. Everybody wants to do the best job by the child. They come to therapy and they want to do the best thing.

And I think, yeah, and sometimes if we’re not sure what we’re meant to be doing. Now we probably do the surveillance and we give the feedback. And I also just feel that as a therapist, I really like being given that.

Like, sorry, when I’m a parent and I have been a parent in this environment, I love being told what to do. Like, heidi, I need this from you. Or. Or, Heidi, I need you to step back at the moment or, okay, Mommy’s not allowed to talk during this game or whatever it is, because. Okay, so mommy, you’re going to sit to the side and we’re going to get you to do this. This is your role in this game.

And you know, and some of that is. Some of that you can make fun and you can actually, as a therapist, really help the parent to know what their role is and should be. And I think that that’s. Now we’re moving into what the therapist’s job is.

I think it is definitely, and that’s something that the research has done too, is that if a parent knows their role, they know the goal of the session and they are feeling comfortable to actively jump in, even when they’ve not been specifically invited to jump in. That’s when we have a strongest engagement, collaboration.

Prioritising Unconditional Positive Regard In Teleplay Therapy

The therapist has a role in setting up that emotional, relational, physical safety for the child. And to know that, that child’s perception of safety may be different from the adults. That’s what I was talking about with my child who cried before the parent was fine. And so I.

So yeah, I. If I had my time again, I would go, okay, no, I’m. I, know we’re going to, we’re going to shift focus and we’ll come back to this or something. So sometimes there’s a mismatch. Sometimes there’s a mismatch. And we know, you know, some children, and especially kiddos that have a way of communicating that is using really big behaviors or, or they’ve been in therapy for a really long time and they may have had some negative experiences with adults in the past, so find it hard to connect and trust.

And so the therapist job is to have what we call unconditional positive regard, which is seeing the child in a positive light, no matter what, communicating to them that they are, they can come as they are, we will meet them there.

I love that unconditional positive regard. That is our job. That’s what we were explaining before. It doesn’t matter where they’re coming from, what they say this child is. We are there to support this child, and that is our job.

So what is the child’s job. Yeah. I feel like I’m just thinking about this question. What is the child’s job? I think it’s. I don’t have a lot of jobs for the child, to be honest. I think there’s a lot that us, adults need to do. I think we need to have trust in the child and that they will bring what they need to bring.

And I also think, you know, the child has rights to have a say. So best case scenario, you know, the child does have a right to say if they need a break or they need help with something or. And, we. But I see that as the therapist’s job as well, to empower them to be able to do that. So we need to be leaders in that setting. We need to sense those feelings, emotions, behaviors.

We need to be able to give the child the chance or the ability to communicate those things however they can. You know, we’ve got clients who are non verbal, we’ve got children who are non verbal. We need to be able to facilitate that for the. Yeah, yeah, absolutely. And so, yeah, I think we just keep coming back to the adults, you know, in the room. And that’s important.

Yeah, I think so. But we involvement a traditional engagement. Like, we expect the child to sit. Like, right. That. That would have been the answer. To sit and listen and write and be engaged. Like, that’s their job. But it wasn’t your answer. So I. I quite like that.

Understanding Emotional Mismatch And Childhood Behaviour

Yeah. And I think as well, like, that comes from this place of understanding that no child chooses to misbehave. No child wants to be naughty or do the wrong thing. It’s never. Not like.

But also, Lucy, not everyone sees children like you do. And like, I do. Like I. Parents look at me like I’ve got two heads when I say that. I’m like, your child is not. Does not want to behave like that. And they’re like, what? But they do it to me every day. And I’m like, yes, but. But there’s a reason why it’s happening.

And, and it’s that unconditional positive regard that I find is our job. Because when you’re our parent and you are in the trenches and you are just struggling through sleep deprivation and. And it does feel like you’re a victim of your child.

Sometimes you need that therapist to lift you up and bring you to unconditional positive regard at, least, you know, for that session and to. And that’s actually what a great therapist will do. They will change your mindset of the behaviors or what’s happening around communication or the tricky things that your child is finding. And they will sit with you.

I like the boxing analogy. You know, they’re in your corner and, and you are doing this together and you’re. It’s like I like a fight because I, you know there’s a, the opponent is non existent but it’s, it’s like that we are, we’re, we’re fighting for the child together. And that how it should feel, I believe. Yeah, I think so too. Yeah. That’s beautiful.

Creating A Positive Narrative Around Speech Therapy At Home
And so I guess another really key part is the story that is told in the home around what happens in sessions. So something that can really support the child is by having a really positive story about speech therapy or about the therapist outside of sessions.

If, when we know children will take on what they hear, we tell them about Santa, we tell them about Tooth fairy and they believe that. So we tell them that this is something that’s really important and you know, your therapist is going to listen to you and really cares about you, then they’re going to hear that and take that in as well.

So that’s something like really practical I think that parents can do to support kiddos to feel safe. Absolutely. Parents mindset and, and the narrative around it can. Absolutely.

I just think about my most successful parents and I say that because it’s, it’s them that got the success for their children. It’s not me. Yes. It’s them. Yeah, they, they were, they were saying those things. They put me on a pedestal. It was, you know, let’s Ms. Heidi, let’s do this work. Let’s show Ms. Heidi. Let’s.

They built up. They didn’t just say it was important. They actually made me important to their child. And they encourage that relationship and they, they encourage the little videos of the. Hi, Ms. Heidi. This is my homework for the week or whatever it was. Yes.

And those, those little things each week that that parent was doing. I didn’t ask them to do those things. No. For those children supercharged their success in therapy and get greater outcomes. Hands down. Yeah.

And maintaining that connection with an invisible string throughout the week. You know, we dress up for book week. Let’s take a photo and we can show Lucy in the session. So. Or we can send it to her like that. That kind of thing really does bolster that connection throughout the week outside of the session. Absolutely. Oh. So special.

Navigating Technical Challenges In Telehealth Consultations

Is there anything that’s different if we talk about engagement online or therapy in particular? Online? Because that’s what we do here at Pop.

There are some differences. I think, and we have the research around engagement in face to face versus engagement telehealth. And there’s so much overlap, honestly, 99% is overlap.

But what we know in online is that what I was mentioning before, we can’t see the full vision of the child. So we need that collaboration to see. They might appear really calm, you know, in their face and their shoulders. But are they really, really? Yeah. Are they bouncing out of the table? Are they, yeah, yeah. And are they.

Are they actually working really hard to regulate themselves in the session? But we actually haven’t picked up on that. So that requires collaboration. We also have a slight kind of difference in that usually with. And we can change settings. It’s uncomfortable, but usually all parties can see themselves, which is also a bit strange.

Like we don’t have that in the normal outside world. We can’t always just see ourselves when we’re talking. That can be something that might feel a little bit uncomfortable for some families, or might be something that feels like it could be a bit distracting or something for the child.

So we do have ways to be able to tweak that and to modify how we set up the space. But I think that’s just an additional thing that we have to think about. How we’re setting up our camera, how we’re setting up our sound.

If we can’t hear each other properly, then our connection, our relational connection is going to be challenging if our Internet connection is not working. So I had in the early days, yeah, 100% technical difficulties are inevitable, that we are always going to come across them and that’s okay.

And we’re very patient and we problem solve and we have tech support. Anyway, we’re all set up. Whenever we’re in a video call, we’re sitting directly across from each other as well, which we wouldn’t normally do.

You know, like you go out for a coffee with a friend, you might kind of sit side by side or we have these great conversations. We could access this really, you know, deep part of our thinking when we’re walking side by side a friend and we’re going on a long drive. And so that signals some safety in our brain.

So when we are sitting face to face, it can feel a little bit different. But I, always just do say to people and give permission, you don’t, you don’t have to stay here like this. You can sit in any way you like. We can be moving around. We can. I don’t much Just listen to your body, tune in. If it feels uncomfortable, please do whatever you need to do and I will too.

Transitioning Children Smoothly Into Online Therapy Sessions
And then the last piece is about the transitions. Yeah. So if we are going to a clinic in person, for example, there’s so many millions of more steps of things that we have to think about to get to that appointment. Right. Like we need to.

We have a great visual about this, actually. About. You have to pack your bag, you have to get everyone in the car, you make sure everyone’s gone to the toilet, whatever. Before the car drive, you have to physically walk into the space, maybe wait in the waiting room, then physically walk into the therapy room.

So there’s so much mental preparation that goes into that session, whereas sometimes for telehealth, it’s like what we’re saying before. If we don’t intentionally make a change about it, it might be, quick. It’s starting right now. Let’s do it.

So, so something that we need to be really intentional about is having that lovely transition. And I often will encourage families to even set a timer 30 minutes before their session where they can kind of check in.

Does anyone. Do we need a snack? Do we need to go to the toilet? Where are we going to set up today? Let’s think of something. If we want to bring something to show ac and that’s how we can be really prepared to enter the session and feel ready in our body and mentally ready as well. Yeah. Ready for connection and collaboration to happen.

Key Takeaways For Improving Child Engagement In Telehealth

All right. If I’m a parent and what’s the just takeaway message that you want me to know about engagement in therapy?

My key takeaway is that you are so important to your child and you are so, so important in this process. And, collaboration is so key and therapy needs to be a partnership.

So the best success will happen when you can feel safe to work together with your therapist as a team to support your child, with you being the person to be able to trust your vet and know what the child needs because you know them better than anyone and having the trust in your therapist that they know the clinical stuff and you can meet halfway with that.

So I guess prioritizing the relationship and everything else will grow from that. Thank you so much for your time. Thanks so much for having me.

Podcast Wrap Up And Medical Disclaimer

I hope you enjoyed this episode with Pop’s clinical lead for engagement in Telehealth. Lucy, we’d love to hear your questions on this topic and hopefully, hopefully we can answer them in a future episode.

You can reach me by leaving a comment on our podcast app or sending us a DM on our Facebook or Instagram. Our handle is @beyondwordsbypopfamily. That’s all one word. Head to the Show Notes to get the resources we talked about today, plus follow us for even more episodes.

Before we wrap up, I would like to acknowledge the traditional custodians of lands, seas and waters throughout Australia and pay respect to elders past, present and future.

Please also remember that this episode is not clinical advice. If you or your child are facing challenges in the areas we discussed today, please seek an individualised speech pathology assessment or chat to your GP. Take care and we’ll catch you in the next episode.