SEASON 7 EPISODE 9

[INTRODUCTION]

[0:00:13] ANNOUNCER: Welcome to SLP Learning Series, a podcast series presented by SpeechTherapyPD.com. The SLP Learning Series explores various topics of speech-language pathology. Each season dives deeper into a topic with a different host, and guest, who are leaders in the field. Some topics include stuttering, AAC, sports concussion, teletherapy, ethics, and more. Each episode has an accompanying audio course on SpeechTherapyPD.com and is available for 0.1 ASHA CEUs. Now, come along with us as we look closer into the many topics of speech-language pathology.

[0:01:03] MM: Welcome to season seven. Telepractice: It's Not Just Screen Time.

[0:01:14] KHK: Hello, everyone. Welcome to the podcast miniseries, Telepractice: It's Not Just Screen Time, presented by SpeechTherapyPD.com. I am your host Karin Hartunian Koukeyan. I've been a speech-language pathologist for over two decades with 13 years experience in both special education and healthcare settings working in telepractice. Thanks for joining us for episode number nine, Navigating Case Management Through Telepractice. This audio course is offered for 0.1 ASHA CEUs.

[DISCLOSURES]

[0:01:47] KHK: Before we get started, we have a few items to mention. Here are the financial and non-financial disclosures. Karin Hartunian Koukeyan is the host of this podcast and receives compensation from SpeechTherapyPD.com. She is a sole proprietor who consults on telepractice services and works with professionals to improve their public speaking skills via telepractice. She is also employed as a regional manager at Parallel Learning. Her non-financial disclosure is that she is the current associate coordinator for ASHAÕs Special Interest Group for Telepractice Sig 18.

Kristin MartinezÕs financial disclosures include that she's receiving an honoraria payment from SpeechTherapyPD.com for this podcast. Her non-financial disclosure is that she is a member of ASHAÕs Sig 18 Telepractice.

[EPISODE]

[0:02:37] KHK: Now, here's a little bit about our guests today. Kristin Martinez has over 20 years experience in school-based speech-language pathology and brings her past decade of expertise in clinical teletherapy, implementation, best practices, and thought leadership to AMN as a Senior Director of Teletherapy. Joining AMN in 2023, Kristin is dedicated to leveraging her deep knowledge of school-based services and her passion for ensuring access and equity for all children to lead AMNÕs team and partnering with schools nationwide to develop impactful and sustainable teletherapy programs. Welcome to our podcast.

[0:03:19] KM: Thank you, Karin. Very happy to be here.

[0:03:21] KHK: I'd love to start with just like a general question before we dive into the course content. We would love to hear about how your journey began as an SLP, and then how you came to telepractice.

[0:03:34] KM: Sure. Well, [00:03:35 beginning as] an SLP. That goes way back. So, I was a psychology undergrad and I really did not know what I was going to do. I knew as a psych major, I would have to go to grad school to have a career that I wanted. But it really was not until my senior year of college that I even learned about speech-language pathology, knew what that was and that was through my neuropsych course. So, I loved neuropsych and, of course, was learning about the areas of the brain and the language center and found that really fascinating.

So, from there, it just kind of snowballed. I began exploring speech-language pathology and decided that that was what I wanted to do. So, I attended grad school and initially thought I was going to work with adults and was going in that direction. Then, about halfway through really flipped and I had done some clinicals and had different experiences and realized I really felt more connected to the pediatric side. The kids. Early development. So, that's where I ended up and that's what I've stayed with.

I know a lot of people in our profession, dip their toes in both sides, and I know you've done that, and move back and forth, and I really have been solidly in schools from the very beginning. So, I did work in person in my local school district for many years, and then very unexpected turn of events, I took a leave of absence for a year to just kind of help with some family things. During that time, I heard from a recruiter for a teletherapy position. I had no idea what teletherapy was. It was 2013. I knew no one doing teletherapy. But I decided, ÒWell, it'll give me a little bit of extra income during this time when IÕm on leave. Why not try it.Ó And itÕs really about a month in, I just realized I loved it and I made the decision to permanently leave my in-person job and that's it.

So, I stayed, I did teletherapy for a couple of years, and then moved over eventually into more of the clinical management, working with school districts and clinicians, and a lot of different variations around that theme over the years. But I really loved the model. For one thing, I really expanded my skill set, by moving to teletherapy. I really had to think about how I approached therapy, things that I maybe had relied heavily upon in person. I couldn't do anymore. So, having to think about how to approach certain goal areas or speech-language disorders differently, was really exciting. The kids were so engaged. They responded well to it. So yes, it just became another aspect of my years as a speech path and I also really love the ability to work with kids in all parts of the country and it was very eye-opening to me to work with different school districts and different states than I had ever lived or worked.

Because I think, you want to believe that services are very equitable, no matter where you are. Of course, I would think it, before I started teletherapy, in my mind, I would just think, ÒWell, it's federally mandated services. So certainly, they must be happening at a pretty equal rate and to a degree, and really learn that that's not the case that it's so impacted by staffing, geography, where the kids happen to live, access to things like bilingual SLPs. If they're doing appropriate, multi-bilingual evaluations of kids are being qualified appropriately. So, it was just very eye-opening. So, I really came to deeply believe in what teletherapy can do to bring greater access and equity to kids. So, here we are.

[0:07:41] KHK: Yes. I think you are uniquely positioned for this topic. So, I'm really excited to explore the topic with you regarding case management because you have seen across states the differences, as well as having to pivot and doing this over teletherapy. Today's learner objectives, for those of you participating. By the end of this course, participants will be able to identify potential challenges related to school-based case management for teletherapists. Two, describe some opportunities to prepare for case management responsibilities in a new teletherapy assignment. Three, lists five tips and best practices related to case management via teletherapy. And our goal here today is to really give a lot of practical tools that folks can hopefully take back to their assignments whenever they start one, or even after they've started one if things aren't working out, they're going to be able to hopefully take these tools and use them.

So, what I'd love to start with as a general question, I like to define what case management in the school setting is because we do have case management as speech-language pathologists in other settings as well, like early intervention, or maybe the medical model. But if you wouldn't mind defining for us, what does that mean for the school setting?

[0:09:01] KM: So, for SLPs in a school setting, you are identified as the case manager if the student on your caseload, if their primary area of eligibility is speech-language impairment. So, it's possible that they may have a related service like OT can be fairly common, but that is when the student was first evaluated. The team determined that speech-language impairment was the primary cause. That was their area of eligibility. It's a bit unique in the schools because OTs are never case managers. PTs are never case managers in the schools. They are related service providers. So, it's fairly common for an SLP to be a case manager, especially with younger students, preschool, early intervention preschool, because often, as we know, language delays, some articulation errors are often some of the first things to be visible to people, to parents. Those are some of the first things that impact how the child functions at home, in school. And so, the SLP is often the case manager.

As students get older and the academic challenges increase, sometimes it's determined that upon reevaluation, that possibly, speech-language impairment is no longer the primary. It might be specific learning disability. So, then the case management switches, then the SLP falls to a related service provider and not case manager. It's a logistical role, I think of, coordination. You're coordinating the IEP. So, if you're the case manager, you're responsible for making sure that all timelines are adhered to annual reviews, triennial reviews, and evaluations, scheduling meetings, sending out the appropriate paperwork. So, really just being on top of all those moving pieces, and making sure that of course, number one, that the student is receiving everything that they have a right to under their qualification on that IEP. But also, just keeping things moving. Making sure that you are maintaining compliance for your school district in terms of all of the paperwork and the timelines, and bringing the IEP team together as required and as needed.

It is a lot. I mean, management is the right word. It's really managing the process, managing that student's eligibility, as long as that primary eligibility is speech-language impairment.

[0:11:34] KHK: I think you touched on this, but at what point would maybe a student change their case manager? At what point would speech no longer be the case manager and somebody else might be the case manager? How do we prepare for that, like not all school districts are going to handle this similarly, and they're not all organized? So, we kind of stay on top of that.

[0:11:58] KM: Yes. I mean, this is the added responsibility of anyone in the case management position in the schools is ensuring that the student's needs are being appropriately met. That means that of course, for anyone not in the schools, you may not be aware of this, but the mandated timelines are once a student has first qualified for services, then, at least three years after that, there must be a re-eligibility. We have to look at eligibility again, if there are any new concerns, areas of concerns that maybe have come to light, or not present in the initial, then that's when the team would come together and make a determination if there's going to be formal testing in another area of concern.

So, that's the most common way where case management would shift is that, as I was speaking to earlier, if a student gets to kindergarten, first grade, and there starts to be concerns about early reading skills, if they're having difficulty with letter recognition, or if they're having trouble with using tools in the classroom. Then, at least at the Triennial Review. Now, it can happen earlier. If concerns arise before you get to that three-year mark, then somebody on the team, the parent can request that a reevaluation happens sooner to make sure that again, those students needs are truly being evaluated, and they have the appropriate placement.
If that happens, and if the student is identified as having a specific learning disability, then that will be the primary disability, because that is the primary piece that's impacting their access to general education is the learning disability. But if there continued to be specific communication concerns, if they are still found to be eligible under speech-language, and that can fall to a secondary eligibility. Some districts have a primary, a secondary. Not all. Sometimes it's just a primary, but then there's related services. So, the speech-language pathologist might stay on the IEP, still be part of that IEP team, but no longer be a case manager if that shift happens.

That's very often what can happen. Sometimes the transitions from, for instance, preschool to kindergarten, there can be shifts, again, depending on student needs and what kind of program they were in prior to kindergarten. But yes, the most common reason for change would be if there is another area of eligibility that's determined to be the primary.

[0:14:38] KHK: All right. So, let's talk about what are the basic forms that are needed. We know that all IEP systems are not made alike, and certainly there's a lot of variation across states, even within states. But what are the general forms to keep in mind, especially, if you're going to be a case manager?

[0:14:58] KM: So, you need to be aware. I mean, of course, there's the IEP itself with all of the sections that need to be completed, which again, much of it is the case managerÕs responsibility to complete, ensuring that all the demographic information is correct. Specific information about the students, guardians, and kind of all of those logistical pieces. But you also need to ensure that you have sent out a written notice of the meeting. It is required that a written notice of this is sent to parents and other members of the team, but parents have to receive that, and it needs to be sent with time for them to be aware of it, give them time to bring any other concerns, let you know if there's anybody else that they would like to invite to the meeting, that their child has maybe another service provider, outside of the school. Some parents bring advocates with them to IEP meetings, so they need to have that time.

Then, with any action, anytime you hold a meeting, propose a change to the IEP, there's prior written notice. So, that is paperwork that has to be completed. The parents need to be offered their procedural safeguards. Again, every time you come together for an IEP meeting, and you're considering any kind of alteration to the student's IEP or eligibility, they don't have to take them. But there needs to be, again, a physical version offered to them, so that they can have that every time.

Those are the forms. Ahead of time, you also need to be aware of, again, this comes down to your understanding of the district, state, and district guidelines, regulations, policies, some school districts. Their standard is to have a draft of the IEP completed prior to the meeting. It will need to have ÔdraftÕ written on it so that that's clear. But other districts, specifically, do not allow that, because it's considered predetermination. So, again, depending on where you're working, so you may need to come prepared to the meeting with a draft, including gathering proposed goals from other team members, if there's any other related service providers and OT, PT, make sure that they have included their draft goals. But again, other districts, you can't do that. You can bring your notes, but you need to be ready to write into the IEP system in the meeting and create it with the parentÕs present, guardians, so the full team is making those determinations in real-time.

[0:17:35] KHK: Very good. That was very helpful. So, let's dig into the first big question. What are some challenges for school-based SLPs case managing via telepractice? That's a big one.

[0:17:48] KM: Yes. Having worked with hundreds of SLPs, new to teletherapy, over the years, I found the reason that I used to offer workshops on this topic and office hours because it was intimidating to some clinicians. How do you wrangle a team? How do you manage something remotely if they haven't done that before? Truly, the biggest hurdle is just that they understand the process in the first place. As long as somebody has had that experience being in-person in the schools, has case managed, then it's a logistical issue more than anything. It's logistics and communication are the pieces you need to think about.

Now, if there's an SLP, coming from a different setting. If they've not worked in schools before, even if they worked with kids, but it's been in the clinic setting, or something more on the medical side, that is a bigger hurdle, just because it's challenging to take that on if you haven't done it in person, to some extent, and really kind of understand how these teams function. So, I would advise, if anybody's in that situation, before taking on an assignment where there is case management, take a step back and make sure that you've had some education that you have really learned about the case management piece in the first place. You don't know what you don't know if it's not something that you've engaged in before. I would say it's even easier to miss pieces as a teletherapist if it's new to you.

But if you understand case management, then the challenges are more around, how do I bring a team together? How do I communicate effectively? How do I schedule these meetings? So, it's a lot of logistics. It's wonderful to ask a lot of questions. Hopefully, as the teletherapist, you have a person or a couple of people who are on-site members of the team, maybe a lead SLP who's on the ground or somebody in the district office who can be a bit of a mentor, just in terms of helping you understand the district. Helping you with things like, what is the process? What are the expectations around scheduling an IEP meeting? Does everybody have a shared calendar and I'm able to go into their calendar and schedule things there? Or do I need to email everybody? Do I call everybody? Am I the one who schedules? Is it me even, IÕm a case manager? Or is there maybe, an administrative assistant who works in the special education department of that building who actually does the scheduling for all of the case managers?

So, that varies, and you really just don't know until you ask. You have to find out from somebody what does this look like? It's very important that you have a clear understanding of state regulations around eligibility determination. What does that look like? What are those definitions? And what comes down from the state first, and then underneath that your district? 

The state information usually is pretty easy to find. You should be able to go to the State Department of Education website, search for the special education guidelines, eligibility guidelines, requirements. So generally, that is not too difficult to track down. Understand, the district information can sometimes be a little more elusive, depending on the district. But I usually advise SLPs to ask if there's a district handbook, if there's a special education handbook, if the Speech Language Department has a handbook or any kind of guidelines. If that's the case, that's incredibly helpful, if it actually has been written down. If they have done that in their district to create very clear guidance, because then that's something that for them, you're going to be able to get a lot of what you need, just from what has been created that applies to everybody across the district, and anybody working, any SLPs, everyone working with these students.

If that doesn't exist, then you really are going to have to ask and find out what those expectations are. It is some of the little things. Do I bring a draft IEP? Do I not bring a draft IEP? Is it common for people to pull up the IEP system and screenshare during an IEP meeting so that everybody is viewing it that way? Even for in-person, even if the whole team is there together, some districts have that. They have the whiteboard or they have something in the room, where they're projecting the IEP. So, if that's the process, you want to be aware of that and figure out how you're going to be able to hook into that. How you can connect to that process.

Systems, what is the district's IEP systems? That can absolutely be a big challenge. I unfortunately, know all too often of SLPs who come into a new assignment via teletherapy, and it might be the beginning of the year, or maybe it's mid-year, and the school district has been without an SLP for two months. Suddenly, there's this backlog of IEP meetings, and they want you to hold them all in two weeks. So, if you're brand new to the school district, and you don't even understand the IEP system, it's a system you haven't worked in before, it can be very overwhelming to know where to begin. Just know that it's okay to talk with your district and say, ÒI want to help you get back into compliance, maintain compliance. But first, I also need to meet with the students. I need to spend time with them. I need to be able to do some informal testing against their goals so that I have something to contribute to where they stand now. If I make any other recommendations around different goals, new goals.Ó

But also, if you don't know the IEP system, I always approach districts by saying, ÒWe want to help you maintain compliance.Ó So, having therapists who don't understand the system, try to go in and guess and figure things out, then if they're audited and something was missed, they're out of compliance. It really is, to everyone's benefit, that you are trained, that you have resources to help you understand the IEP system. So, just knowing that it's so Ð advocate for yourself. Advocate for your students that you want to help them with the IEP meetings as quickly as possible. But you need to have some training. You need to have some support on whatever systems they expect you to work in.

That is a reasonable request and expectation when you are coming into a school district, regardless of how urgent it is on their side. It's important. It's very important that you do have that knowledge of the system so that you're doing things the right way. I think probably one of the kind of more unspoken challenges, but a very real challenge is you may be coming into a school district where there are staff members, parents who have very strong, and perhaps negative feelings about teletherapy. Either they've had a bad experience, or they really haven't. But they're just making assumptions about teletherapy. Sometimes it feels like you are personally being challenged. Your clinical skill is being challenged. I think the very first IEP meeting I ever attended as a teletherapist, I was so excited, and I was feeling great about it, and I knew my student had been making progress. Then, the case manager who was running the meeting, introduced me as the person filling in until they could get a real SLP.

ThatÕs was how I got to chime in and it was very hard to hear. Over time, you just come to realize that you can't take those things personally, that there are just some preconceived notions and you do your job. Over time, people do understand that you are skilled and you do know your job and they kind of forget the teletherapy part. But that can be hard, especially if you're new to teletherapy, or if you're new to a school district, feeling that kind of energy, either subtle or not so subtle, can just be a bit draining. With that piece, I would just advise, just kind of keep your side of the street clean, do your job, to the best of your ability, focus on your students focus on communication with everybody, keeping everything very clear, and talking with parents, making sure that they have been introduced to you before an IEP meeting so they know who you are, and that they can reach out to you, and it will come around.

But I actually came to really love IEP meetings as a teletherapist because it was that opportunity to really talk about their child. Again, what they hear during that IEP meeting is that you know your job, you know the student, you are Ð and it becomes very difficult for that challenge to continue in that negativity when people realize you're they're doing your job, just like they are and teletherapy is a modality. It's not a different kind of therapy. It's just a different service delivery modality.

So, the I think the IEP meetings are actually a great opportunity to have those discussions, but just keep bringing that focus back to the students so that can help with that challenging piece is, rather than taking it personally and kind of getting sucked into almost defending yourself, because you're there as a teletherapist, trying to let that fall to the side and just stay focused on your job.

[0:27:58] KHK: I think we covered this, but I just wanted to make sure it was clear. So, a good place to go to find out the state regulations or requirements. Someone could probably Google words like Department of Education, or I don't know, are there any other keywords that they could use to kind of find this information?

[0:28:19] KM: Probably, a pretty quick way to find it is if you look up for whatever state you're working in states, special education eligibility guidelines because those will, should always be listed on any State Department of Education sites, that's common that you'll find the information there. So, Googling that, looking at those specific words. I think any anything around special education guidelines, understanding that some states actually are moving away from the terminology, special education. So, there is some of that shift happening too. Sometimes, it's more exceptional services. Just keeping that in mind that you may have to spend a little more time searching, but you should still be able to get to what you need.

But again, any state-level Department of Education website, under that, a subset of that should be these guidelines. Should be the regulations at the state level, both all the way from early intervention, early childhood, into the K-12 ages, through transition age, you should be able to find all that information.

[0:29:33] KHK: Excellent. Then, I know one thing I wanted to touch on is regarding HIPAA and FERPA. What's a good way to organize information because we are often working across school sites, or maybe even across different districts themselves. Some of us like to use spreadsheets. What are some things we should be aware of so that we're not compromising HIPAA or FERPA law?

[0:30:01] KM: Yes. It is very important, essential to be aware of these guidelines, especially via teletherapy. Of course, even in person, if you're an in-person therapist, you still have to be aware because people email each other and want to send documents. I would, I mean, you certainly can, again, Google information, look up guidelines. But this is another question I would ask the district is, do you have guidelines on your website? Or do you have something that you Ð what have you given the rest of your therapists? Because again, this isn't specific to teletherapy. There are some additional things that we have to think of, just because everything we're doing is virtual. But the onsite staff also have to be very aware of these guidelines and adherence to them.

So, I would ask for district guidance, so that again, you know exactly what they're asking, what is their guidance because there might be different guidance. So, some school districts might be okay, with an email going out with just initials for a student. But those initials can't be tied to any other identifying information, anything with a student ID number, or a birth date. So, you can do some communication, but it can't be, if anybody else outside of your district read that, they can't be able to identify the child with that communication. So, it's pretty limited. You have to be very careful about that.

Encrypting documents. There are ways to encrypt spreadsheets, documents. Again, I would be very careful about that and look to the district for guidance, if that is, what is permitted? Outside of a student information system, is there any other way that the district allows student information to be shared through encryption or some other method, but the district may require that all Ð any documents, any information be uploaded to those secure student systems, whether it's the IEP system, another student information system. That may be where the common place where everybody who has access, who's allowed to have access to the information, can go to look, to review documents, to review information.

I mean, email is the easiest way or text. I mean, I would say, keep everything off your personal devices. Also, if you have a personal laptop that you sometimes work out from home, ask district policy about that, about working from home. If you're writing a record at home, how should that be handled? How should that be managed? Of course, as a teletherapist, you're always working from home. So, you need to know the policies, because there are also policies about how you handle the studentÕs written information. If you print out a report, if you print out their IEP in your home office, there's still a standard you need to follow, even though it's your private home office, around securing that information, whether it's a locked file cabinet.

There are there are very specific guidelines. The most important piece is to be aware that you are required. You are required to follow any guidelines that do relate to the security of student information and make sure that those guidelines are clear to you, as you're working for any school district.
[0:33:39] KHK: All right, thank you. So, let's kind of delve into our second major question, which was, what can SLPs do to prepare for case management responsibilities as teletherapists?

[0:33:52] KM: So, some of these things are very Ð it depends on the district you're working for. The ideal scenario is that you are connected with a lead SLP. Somebody in the district who knows all the ins and outs of that school district, how to operate as an SLP, as a case manager, and they are willing to share their knowledge with you, including any resources, all those pieces. In the absence of that person, or having just one person who's really going to mentor you through that learning process, there's probably going to be more of you taking the initiative, taking that on, understanding the pieces of case management, everything you're going to have to do, and then tracking down the hows. Okay, in this district, how does this happen here? What does that look like?

When I was doing teletherapy, and I would always have, get my caseload at the beginning of the year, and I would have the list of students for whom IÕd be case managing. So, one of the things that made me feel better, that I like to do, is as soon as I had IEP system access, and I could get in there, I tried to find a few of their past IEPs. I would look at their IEP from the year before and for the student with speech-language impairment, as their primary SLP was case manager, and I would just read through the IEP. I would make a note of, okay, what sections are there? What forms? How do they write their present levels in this district? How do they organize them? How do they write their goals in this district? That's often a very district-specific kind of formula how they word goals? Do they specifically tie them to an academic standard in the goal? Do they put end dates on the goal?

There's a lot of different kind of norms around writing goals. So, it helped me a lot to look at a look at several, not just one because, of course, people, you can't necessarily trust just one IEP, but look across several. Make a note of just that model, that it's an example for you. Hopefully, if you look at, if you get an idea of what's expected. That was always very helpful to me. Again, if you need help on the IEP system, and you're not getting that, you do need to reach out, get that help. Sometimes districts really just don't think of it. It's interesting because most school districts, if they had an SLP physically walk in their door and start as a new therapist mid-year, they would train them. They would show them how to use the IEP system. All of those things, they put them through the same paces that the SLPs, who started at the beginning of the year, or they would offer that to them.

For some reason, teletherapists, sometimes they're not considered in the same way, especially to district that's new to teletherapy. I think many districts really come around and start to understand that the teletherapists are part of our team, just as any other on-site therapist, and they develop more protocols around how to train new teletherapists as well. But if that's not in place, again, ask for that. I find, again, the most convincing way to approach that is just that I want to make sure I am doing this paperwork in a compliant way. I want to make sure I understand how your systems and how I can help and just make sure I'm doing the job you need me to do. So, that's generally a less threatening way, than accusing them of not offering new resources, or getting angry about it. But that's certainly important to ask. 

Sometimes that person, again, if you haven't been given a specific contact, then going to the district office, and sometimes even the administrative assistant who supports the special education director can be an amazing resource and might know everybody and tell you who to point to, point you in the right direction. Sometimes it can take a little time to kind of hook into that resource and then you can really start to expand from there. As you are also preparing, sometimes the logistics of scheduling the meeting, understanding where parents are supposed to go in a building. That can become very overwhelming. Especially, if you forget to think about that until it's the morning of the IEP meeting and you realize that you don't even Ð you're not even quite sure who is somebody going to bring the parents to the meeting room? What does that process look like? Do they check-in in the front office? And then somebody guides them? Or were you supposed to reach out to them and help them understand?

Sometimes those things you just take for granted when you're there in person and it can unfortunately, I speak from experience that the first few, you could sometimes just get caught and you realize there's something you didn't think about because it's the first time you have case managed in this format that you've done it remotely. So, thinking through just the paces of what does this look like and how do I do it this building? Is there going to be Ð am I going to be able to project the IEP? What room are we in? Is it always in the same room? Or do the IEP meetings move around to different rooms? Is there a phone in that room? If there is, it's really helpful to know how to get a hold of people.
If for instance, again, speaking from personal experience, if you are logged into whatever agreed-upon platform, which is something else, you need to determine and find out how this district wants this done. Is it in Zoom? Is it through your teletherapy platform? How would they do this? Well, if you're logged in, waiting, waiting, waiting for everybody, and nobody shows up, and you realize you have no way to contact them, especially if it's after hours, after school district hours, and again, you're stuck.

So, I always tried to have either the cell number of the person who was going to be there on-site, kind of facilitating the meeting, or the phone number in the room, or it's going to be just some way to reach out to people, so that you're not just sitting there panicking, thinking, ÒOh, my gosh, I have no idea what's going on.Ó That's a really important piece.

As I just touched on, another piece of understanding case management in that school district is for instance, if a student is, as we say, speech only, they are only receiving speech-language services. You're the case manager as the SLP. In some school districts, the IEP meeting only requires you as the case manager, and the parent or guardian, and the general education teacher. However, that happens in districts where the SLP is also the LEA, which stands for local education agency.

If in the district, the SLP can also serve as the LEA, only those three people are required, or four people, or parents, or guardians, gen ed teacher and you. You first need to understand that because in other districts, the SLP cannot act as the LEA. There actually has to be an administrator or somebody else who can fill that role.

However, as a teletherapist, do, you need to have somebody there physically with the parents who can do some of those logistical pieces that you physically can't. If it's a case manager, you're still running the meeting, you're leading it, youÕre on the agenda. But somebody needs to physically print out the procedural safeguards for parents and have them on the table. Somebody needs to be there in person to gather signatures, if required on any documentation. 

Oftentimes, that is an admin in the building, maybe an assistant principal, but it could be a lead SLP. Again, understanding if you already have to have another person to act as LEA, then it makes sense for that person to also be asked them to help you with some of these pieces. But if that's not required, then you need to determine that before the meeting, and make sure that they are on included, listed on the IEP as somebody who was present during that IEP meeting. 

So, doing all of those pieces and once you do this a few times, you'll probably find that you create your own checklist of, I certainly did have all the pieces just so I didn't forget, to make sure that I didn't miss anything. Then, you can. If you know all those pieces are taken care of, then you really can come to the meeting fully focused on what you're there to do, to talk about the students, talk about their goals, what you're doing in therapy, their strengths, what you see in them, that is so fantastic that you want to share with parents and you're excited about what challenges you're seeing, anything else you need to talk about. Because that's what you want to be there to do. You don't want to have to be worrying and stressing about, that you forgot to invite anybody else to the meeting, who could help you get a signature from parents. Or you forgot to ask them to print the procedural safeguards before the meetings and I have to wait for somebody could run out and print them.

I think that those are kind of the flop sweat and inducing moments when you realize you just didn't think about that part. You didn't think about how that would be done ahead of time. So, it's all about planning. Just thinking ahead and checking off the boxes.

[0:44:44] KHK: So, let's talk about what kind of questions to include in that checklist or like to-do list or however you want to call it. I know you've mentioned it throughout, but can we just kind of go through some of those must-have items that we need to ask ahead of time?

[0:45:03] KM: Yes, absolutely. So, again, like who schedules the IEP meeting? Because that is something that you need to kind of get done ASAP, especially if you're coming into an assignment where there's a backlog, or you have a lot of things. There's a lot of those moving pieces. So, finding out if you are going to be the person to schedule the meetings, or if there is somebody else in the building where that is their role, that they take care of that. How are, again, the logistics of it? Are you sending calendar invites to everybody? And they're expected to accept or decline, so you know if they're able to come to that meeting? Or is it kind of more, nope, you've got to give everybody a call. Since you can't walk into the room and say, ÒHey, are you available this time?Ó Is the expectation, is the standard in that building that you're going to call everybody, are you going to email them. What does that look like?
Is, again, the LEA piece. So, can you act as the LEA? Or is there somebody else in the building, an administrator, who is required to be in the meeting for those speech-only kiddos? Again, do they use a shared calendar? In addition to the written notice to parents of the meeting, what is the best way to confirm with them? Again, what is the standard? You very well may come into an assignment. In some cases, districts are bringing in teletherapy not as a proactive, we're going to get ahead of this kind of option. But because they are already very behind, or theyÕre already short-staffed. They are dealing with a lot already. So, sometimes you come in, and there really is no standard because they've had four SLPs in two years in this building, and everyone's done a little bit differently.

That can be challenging, if there's not just a very clear way that things are done. But do your best to reach out and again, just reminding people that you're not asking these questions, you're not reaching out to bother them, or because you don't understand your job. It's because you want to do the best job for the school and you understand that the last school you worked in might be different than how they do it. It might be Ð and you want to make sure that you are respecting their processes and what works for them.

I think that's kind of an Ð as an important side note, it can be easy to come in as a teletherapist, especially when you know the district has been understaffed, struggling to meet student needs to provide these required services. Sometimes it can be easy to kind of come in and feel like, ÒOkay, I'm going to come in and clean things up and take care of it.Ó Just remember that you are, you're new to the school district, you're a new team member. So, trying to first respect where they are. Even if it's a bit of a mess, and it might feel a bit chaotic, this is their home, this is where they have worked, and I think starting first was just that, honoring that, and being aware that just because things are perhaps chaotic and behind, it doesn't mean other people aren't doing their jobs. And it doesn't mean there shouldn't be that judgment. They are even doing what they can with the resources they've been given, and you want to come in to help. 

Certainly, I mean, you know your job. It's not that you are going to forget everything and just Ð because you also need to do your job and you need to make sure that you're maintaining ethics, and paperwork, and compliance. But I do think it's usually, a more successful way to approach teams that your brand new to, which can just be a little harder remotely. That's just the truth of it, that as hard as it is to, for instance, come into a school district mid-semester as an in-person therapist, it can be even harder as a teletherapist. So, having some patience for that, usually, helps you in the long run too.

Again, the platform. So obviously you are joining the meeting remotely, or are running the meeting remotely. But there might be other team members who are also joining remotely. Maybe the parents want to join from home. Or maybe the occupational therapist is scheduled to work in another building that day, so they would rather join remotely than drive across town to be there in person. What platform does the district want to use? Do they have a platform that they always use? I find that it's more common that a district will insist on something post-pandemic because a lot of districts adopted their virtual learning across a certain platform, and theyÕve just stuck with that.

If they don't have one, you can also offer, if it makes sense, to use your therapy platform. Some therapy platforms can bring in many people, you can join. Sometimes that can be a really great opportunity also for parents to see what their kids are seeing, what they what they're logging into, what does therapy room look like, that you're working with. But just find that out and make sure they know how to join. So, make sure that they have the link, or they know how to access whatever platform you're using for that meeting. Another little hint is, in general, for teletherapy, if you do it for any length of time, you pretty quickly figure out that having a second monitor, possibly even a third monitor, is not just helpful, but almost becomes essential. Because you're managing all of these things. It's really helpful in a case like this, during an IEP meeting, because then you can be on your main camera or in your main monitor, engaged in the IEP meeting, but then you could maybe pull up their IEP on the other monitor, and you can be referring to that as you're going through the meeting, or if there's any other resource that you need to refer to. So, that can be very, very helpful.

Again, just logistical pieces that you'd want on that checklist. Who's going to be the meeting? Who will gather signatures for you? Who's going to print any documents that you need printed? So, having all of those questions ahead of time and thinking that through will certainly help IEP much more successful as your case manage those meetings.

[0:52:49] KHK: There's a lot to talk about, isn't there? I did want to give you a chance to give us what would be like your top five or six must-haves that if you go in with those things, with those items, it'll help set you up for success for case managing an IEP meeting?

[0:53:12] KM: So, mostly from panic moments I had in the early days, one of the things that I learned to always do is to write down the names of anybody who is expected to be in that meeting. Have the all in a list and the role. So, parents names, guardians, anybody else they're bringing, classroom teacher, everybody. Because for one thing, sometimes if you have a poor audio connection because again, they might be joining from a computer that's not the computer the kids usually join. It may be a totally different computer, very different room. So, it's not it's not set up well sometimes for these remote calls. Sometimes the audio is not great.

I've been in IEP meetings where they had kind of a speakerphone in the middle of this big table, and then people are talking, but they're not necessarily speaking up. They're used to talking to each other. So, it's hard to hear their names. But if you haven't written down, usually, you can catch somebody's name. Okay, that's what I heard, but if you don't have that list, and you're trying to write things down, based on what you hear, that can be really difficult.

I've had moments where I didn't have an answer written down and I was anxious already and I had to say things like, ÒJessica's momÓ, not what you want to say when you're trying to form connections with the parents. That is helpful. I also started to create an agenda for myself, but also to share at the start of the meeting with everybody there. I mean, this is just a good practice, whether you're in person or via teletherapy, but especially, as a teletherapist as being the only person who's not physically there in the room, it was just very helpful for me. Helped us stay on track and help create expectations for everybody in the room of what we're going to go through.

Starting the meeting on a positive note was, again, I learned this in person as well. So, this is pretty universal. But I think I'd bring this up, again because sometimes as teletherapists, we do have a higher bar we have to pass with some of these parents, with some of these teachers. So, in my nervousness, the first few times I was running a meeting remotely by myself, I realized that I was just launching straight into the procedures, just getting it done, making sure I wasn't missing anything in what I had to go through the process. Then, it hit me that I hadn't really said anything terribly positive about their child.

We talked about goals, and we talked about percentages. So, not that I was being negative, but that I just realized, ÒOh, you know what, that's not how I want to start the meeting.Ó I always tried to find a few things I wanted to start with, at the top. Something that was funny that happened in a session. A story that Ð something that I was just so excited to see, progress they've made, or just something I really liked about their kid. I see them be so kind to other students in the hallway, or they came in and told me, like the most amazing story with all this detail and this is something they told me they love to do at home with your family. That just helps.

Anything that comes after that goes better generally, if you can start that way. Also, as a teletherapist, it helps them know that you are still making a connection with their child, even though you're not physically in the room with them, you still are learning about them, you care about them, which ultimately, I think is what most parents want to hear that somebody recognizes their child. Especially, if you're new to an IEP system, sometimes printing copies to have in front of you when you're running the meeting is really helpful.

I didn't initially for instance, trust myself to just refer to the IEP in the system, if it was new to me, I always click on the wrong thing, so I did initially print copies. So, I had that reference in front of me during the IEP meeting. Again, always hoping for the best, but having a backup plan. Mainly around the communication. Making sure you have phone contacts somehow, or text, some way to get a hold of people if technology does fail, and either they did not pay attention when you sent them the link, or they don't understand how to fix their audio or anything like that, that you do have a way to still communicate with people. So, that stress and anxiety isn't building because you just don't know how to get in touch with the people who are there waiting for you.

[0:58:40] KHK: Absolutely. All right. We have time for one question from our audience. I think we covered a lot of ground here. We have a question. Is there someone who schedules the IEP meeting for you on-site with the parent and teacher?

[0:58:57] KM: That's a good question and that is something you have to find out. So, when you first start an assignment, sometimes there is and sometimes there's not. It's really about what standard is in place already in that building and it's usually not even district-specific. This is often the very building level, how things are done kind of process. So, again, I would, if you don't have Ð again, if nobody has identified or contact kind of a teletherapy advocate sort of for you in that building, I would start with my other IEP team members in that building. So, resource teacher, if there's a school psychologist in the building, people who they also, this is the world they live into. So, they're going to know. They're going to know who does this, schedules with your case manager. I would say especially a resource teacher or another or another special education teacher because they are also often case managers.

So, what does that look like for them? Unfortunately, it's not the standard. It is just depends, sometimes on the building. I would say probably more often than not, you are going to be the person who is responsible for scheduling. So, you're going to have to reach out to make sure you know who else needs to be a part of that meeting. Are there any other related service providers? Is there an OT? Is there a PT? Parents and guardians? Who needs to be invited? Then typically, it's upon you to do that coordinating and that scheduling.

[1:00:50] KHK: Right. Thank you so much. Thank you, Kristin. We truly appreciate your research, education, and the expertise that you provided about navigating case management through telepractice. Please be sure to join us for our next episode in this series, episode 10, where I'll be speaking with Roxana Gonzalez, about the topic of tele assessments in the clinic setting. Have a great evening.

[OUTRO]

[1:01:16] ANNOUNCER: Thank you for joining us for today course. To complete the course, you must log into your account and complete the quiz and the survey. If you have indicated that you're a part of the ASHA registry, and entered both your ASHA number, and a complete mailing address in your account profile, prior to the course completion, we will submit earned CEUs to ASHA. Please allow one to two months from the completion date for your CEUs to reflect on your ASHA transcript. Please note that if this information is missing, we cannot submit to ASHA on your behalf. Thanks again for joining us, we hope to see you next time.

[END OF EPISODE]
[1:02:03] ANNOUNCER: Thanks for joining us at SLP Learning Series. Remember to go to SpeechTherapyPD.com to learn more about earning ASHA CEUs. We appreciate your positive reviews, and support and we'd love for you to write a quick review and subscribe. If you'd like this and want to hear more, we're offering an audio course subscriptions special coupon code to listeners of this podcast. Type the word SLPLEARN for $20 off. With hundreds of audio courses on demand, a new course is released weekly. It's only $59 per year with a code. Visit SpeechTherapyPD.com and start earning ASHA CEUs today.

[END]
SLPL S7E9		Transcript

	©Ê2024 SLP Learning Series	1