We’ve put together our top tips for telehealth therapy with children during COVID 19 and self-isolation.
- Think about what you usually do and what works for your clients and do that online.As therapists we know what works for the children and families we see and we each have our own styles. Rather than trying to change that think about how you can do what you would do face to face online. For example, if you use puppets you can still do so via telehealth. If you do a lot of craft consider asking parents to get some materials ready or make the craft yourself and show the child craft online. You can still read books to children via telehealth if you tend to use these in your sessions and youtube has lots of great clips of books being read so you can always share the screen and listen together if you prefer. Similarly if you love to play card or board games in therapy find online versions that work for you. Don’t forget about your hands on materials. You can still show children cards if you have a favourite therapeutic set or hold up a brain model to show a child if that’s what you would typically do in your clinic room. Children can also be encouraged to use things they have at home, such as playdoh or toys.
- Embrace the space.Telehealth is a unique and different space. It’s a great opportunity to meet siblings and parents who you might not have the chance to have meet before. It’s also a great opportunity to get a better sense of a child’s home life so do meet pets, take a bedroom tour and let children show you their favourite things. You might like to show the child something of yours or introduce a pet too.Having children in their home environment can also be useful to help children regulate. You can ask parents to set the child up with activities, such as colouring, that are calming prior to the session to help them engage and focus. Similarly you can have some fiddle toys or a stress ball handy so you can model the use of this as a calming strategy and ask that the child find something similar at their house. If you use grounding activities to help children regulate, such as thinking about one thing they can hear, see, smell, feel and taste, you can continue to do this in telehealth sessions. Try drawing symbols for each of the above senses on the online whiteboard as a prompt or draw one on each of your fingers, holding up one at a time so the child can see these.
Movement is essential when working with children and it’s essential that we remember this when working over telehealth, given that the medium is in many ways better suited to talk based therapy. Small movements such as playing or colouring while talking will suit some children however other children will need opportunities for more movement, such as running or jumping. Generally if you have been working with children face to face you’ll have a good sense already of how much movement they need. Build it into telehealth sessions by being open to the child moving out of their seat and away from the camera for brief periods. Scavenger hunts, run and get…, and dance breaks are all great for building in more movement.
- Remember the context.This crisis is unprecedented and the impact on children and families is significant. Many children and parents are very anxious about the current situation and it’s important that we help families to understand the impact of this. Social isolation has impacts too and many children are struggling with not getting to see friends and relatives. Most families are faced with the challenge of schooling children in this time of high anxiety while continuing to juggle their own work. For many children the lack of structure and the attention and skills required to negotiate home schooling will be challenge, while for others the reprieve from social interaction will be a relief and they will struggle when the time comes for them to return to daily life.There have been many great resources on Covid-19 to support children to understand the virus, however many families will also need help to understand the impact of anxiety and of social isolation more generally is also likely to be helpful. Supporting children and families understand their own personal situation is important and helping them to develop practical strategies is essential over this time. Developing a household routine, practical considerations around space, building exercise into their day, checking in about how everyone is feeling and ensuring everyone is practicing good self care is crucial in supporting families over this time. While this might seem simple many families need support with these aspects, particularly during this time of high stress. You might, for example, need to help a family understand the sibling conflict they are describing and help them to build in some individual play time as well as strengthening sibling connections with cooperative games and providing guidance on how to manage conflicts.
In addition to working directly with the family part of this may involve service coordination, with a view to ensuring the family is well supported over this time. The risk of family violence is clearly heightened over this time and our focus needs to be on supporting families to manage this situation as calmly as possible.
Now is not the time for persisting with your previous therapy goals. It’s time to look at the family’s current situation and discuss together what they need at this point of time. It’s important to recognise that for many families the challenge of coping through this time will take all of their resources and they will be unlikely to be able to do more than that. Other families might re-adjust their focus and decide to use the time they have to build skills that are otherwise difficult to fit into their daily life, such as engaging children in household chores or developing self-care skills.
- Embrace the learning.We’ve all had a huge learning curve as we’ve moved to telehealth. It’s been anxiety provoking, we’ve made lots of mistakes along the way, and we’ve had to try lots of new strategies and systems. We’ve had to embrace the learning in order to continue supporting the children and families we work with and to continue supporting our own.This is an ideal model for many of the children we work with, particularly those who are anxious about trying new things, give up when they perceive something to be difficult, or are easily upset by mistakes. Don’t be afraid to try new things out in telehealth and share your mistakes and learning as a way of opening up the conversation and provide opportunities for children to be flexible with this too. Let a child know if you are trying something online for the first time and think together about how you might feel or what you might do if it doesn’t work. The less than perfect nature of our telehealth technology means that there are bound to be times when the screen freezes or something else goes wrong so there are often lots of opportunities for facilitating this sort of interaction and conversation.
- Look at the plus side whenever you can.There has been so much focus on what children and families are missing out on over this period and it is clearly a risky time for many, however it is also useful to think about the positives families may experience over this time. Children may share more with their parents about how they are feeling over this period, their parents may develop a better insight into the challenges they face at school, or they may find new ways of spending time together. Ensuring that you have space in therapy for exploring the family’s experience will allow you to draw on what parents have noticed and make meaning of this. You can also reflect on what they might like to maintain going forward. For example, families who have never walked or played board games together might like to think about how they can make this a part of their regular life.
- Be kind to the children and families you see and to yourself.Throughout this period we need to have compassion for the children and families we work with as well as for ourselves. We need to be ever mindful of how hard it is to support children and juggle work and other demands, particularly during a time of stress, walking a careful line between providing practical support to parents and being realistic about what they can do. We need to be compassionate and expect that there will be heightened emotions, greater arguments, and more screen time.We also need to accept that there are some limitations to telehealth. While it is a wonderful medium that is currently providing us with a way to continue supporting children and families we can’t do everything we do face to face online. Be mindful of the limitations and consider in an ongoing way the way telehealth is working for each of the individual children and families you see. You might, for example, find that you need to reduce the amount of direct child work you do and increase the amount of parent consultation for some families. Accepting that this is a different medium, with its own strengths and challenges, is important.
Many of us are parents too and are trying to support other families while being home and looking after our own. Having compassion for how challenging this is for us all and thinking about ways we can make this easier is important, which might mean scheduling sessions differently or having fewer sessions. Finding ways to care for and nurture ourselves over this time is essential.
Dr Fiona Zandt
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Our shared resources and posts are aimed at providing ideas for qualified professionals and are not a substitute for appropriate training and ongoing supervision.