This material is for therapists working remotely to support students with SEND in their own homes during the COVID-19 pandemic. It should help therapists ensure the quality of the therapy they provide to students with whom they would normally be working face-to-face in a college setting.
Many therapists will have a continuing face-to-face caseload in college and some may also be making home visits. These resources focus on the remote provision of therapy, whether by telephone, online video link, web-based resources, or through packs delivered to the students’ homes.
The resource pack includes
- characteristics of high-quality therapy for learners at home
- advice for therapists on planning, delivery and monitoring of high-quality therapy for learners at home
- effective practice examples
- resources developed by therapists working in Natspec colleges
- links to external sources of useful information.
The material has been developed by Natspec, working with a group of therapists from a range of member colleges. Contributors include:
- Maria Hawksworth, Physiotherapy Lead at Bridge College, Together Trust
- Michele Davies, Speech and Language Therapist at Leap College, Wargrave House
- Joanna Wadey, Speech and Language Therapy Lead at Nash College, Livability
- Verity Fisher, Physiotherapy Manager at National Star
- Dannii Keenan, Speech and Language Therapy Coordinator at National Star
- Suzanne Pollard, Occupational Therapy Manager at National Star
- Sally Edwards, Speech and Language Therapy Manager (Lead SLT) at Portland College and Landmarks Specialist College
- Judith Roberts, Education and Learning Coordinator at Ruskin Mill Glasshouse College
- Roxanne McPhail, Speech & Language Coordinator at St John’s School & College.
- Rosie Murray, Speech & Language Therapist at St John’s School & College
- Kate Beare, Speech and Language Therapist at St Piers College
- Kate Duggan, Head of Clinical Services at Seashell Trust
- Harriet Cook, Lead Physiotherapist at Seashell Trust
- Clare Aldridge, Lead Physiotherapist at St Piers College
- Amy Appleby, Lead Occupational Therapist at St Piers College
- RajVinder Singh Gill, Head of Wellbeing, Psychology and Therapies at St Piers College
- Sally Mosley, Head of Speech and Language Therapy at Treloar College
We are very grateful to them for sharing their expertise.
Characteristics of high-quality therapy for students in their own homes
The following characteristics of high-quality therapy apply to all disciplines and regardless of the mechanism for delivery. They can be used by individual therapists to help assess the quality of their own interventions and by senior managers in colleges to help set and monitor standards for therapy provision at a whole-organisational level.
To be of high quality, therapy offered to students at home should…
- be prioritised to focus on interventions with the most potential for enabling positive clinical change and minimising risk of reduction in physical and / or mental health status during this period
- be consensual so that the student, family and therapist are in agreement about the interventions to be provided
- be safe for the student and those supporting them to engage in, without the physical presence of a therapist
- be part of a coherent and holistic package of learning and support for the student
- be individualised, linked to the student’s own targets and goals, which may have been revised as a result of the current situation
- be easy to understand for those supporting the student at home and, as far as possible, for the students themselves
- be consistent with previous practice in college as far as possible to provide continuity for the student
- be engaging so that the student is motivated to participate
- be realistic and achievable, given the home circumstances (constraints, conflicting demands on families etc) and not overwhelming for either student or family / supporter
- fit into the daily lives of the student and those supporting them, as easily as possible, e.g. through embedding into daily tasks and routines in the home or being delivered at a time to suit the student / family
- remain consistent with professional standards and be evidence-based
- be consistent with any organisational policies and procedures for the provision of therapy, including those relating to safeguarding, confidentiality and any specific to the COVID-19 pandemic
You can download the Therapy Checklist in the form of a self-audit tool to help you RAG-rate your own provision of therapy.
Advice for therapists from therapists
The following guidance on planning, delivering and monitoring therapy for learners at home has been compiled by therapists working in Natspec Colleges and is based on their own developing experience.
What therapy to offer
- Consider clinical priorities – both those that directly relate to COVID-19 (e.g. chest physio) and those that do not (e.g. your dysphagia caseload). You could use a RAG rating system for clinical risk so that vital therapy is maintained, even if other input is reduced during this period.
- The student’s own targets, goals and aspirations should remain as key planning considerations, but be aware that these may have changed now the learner is at home.
- Try to maintain as closely as possible the provision set out in a learner’s EHC Plan, keeping a record of where you have deviated from this and why.
- Try to stay as close as possible to existing plans for therapy but be prepared to change them to reflect new priorities.
- Work within a multidisciplinary team to ensure plans for therapeutic interventions are part of a holistic home learning and support package for the student, avoiding unnecessary duplication, overlap or overload.
What delivery method to use
- Build up a clear picture of the individual student’s and family’s current priorities, preferences and home circumstances, before deciding on the best method for supporting them.
- Be flexible about delivery methods: ‘direct’ or ‘face-to-face’ input may be necessary for some; indirect support through provision of equipment, advice and guidance, including pre-recorded videos may suit others; some may benefit from a combination of methods. Don’t think of indirect support as ‘second-best’ – for many learners, it will be exactly what is needed.
- Think about what you could provide as a general resource for multiple students, which they can access at times convenient to them.
- Work as a multi-disciplinary team to establish the home situation and coordinate subsequent communications, so that families are not bombarded with requests for information or being asked to repeat themselves.
- Establish who will be supporting the student at home, their capacity to support with therapy, their level of understanding and the skills they have, how confident they feel, and what support, guidance and training they may need to help them.
- Consider, as appropriate, what the student can do independently and what may require them to have the support of others.
- Find out what the physical environment at home is like, for example in terms of space, privacy, equipment available.
- Assess whether it will be beneficial / possible to arrange for equipment to be lent or provided to the learner in their own home.
- Assess the benefits of 1:1 and / or group sessions; some students who normally only have 1:1 sessions may benefit from the social interaction afforded by a group session involving their peers.
How to shape the therapy offered
- Consider setting very small targets to help students return to routine or engage in daily life at home, which may be more relevant initially than targets to help learners engage in learning.
- Keep a strong focus on motivating the student, who may find it more difficult to engage and persist in the home setting without the physical presence of the therapist or of their peers; consider building in more ‘preferred activities’ than normal, or allowing the student more choice.
- Discuss plans with students and families, managing expectations about what is possible, realistic and achievable in the current circumstances.
- Ensure any resources, materials, guidelines or instructions are accessible and understandable to those who will be using them and provided in appropriate formats (e.g. hard copy if a family has no printer); continue to build on programmes or materials with which students are already.
- Consider previous therapeutic work completed with the student to help pitch therapy at the appropriate level, but be aware that they may present differently at home and you may need to reduce the level of demand.
- Be prepared to offer much smaller bite-sized chunks of therapy than in college, as attention spans may be more limited, there may be more distractions and the person supporting may have conflicting demands on their time; you may need to build up the length of sessions over time.
- Be flexible and responsive, adjusting plans in response to student’s or families’ requests or as your own understanding of the student’s current health or home circumstances develops.
- Ensure all plans for providing therapy for learners at home, including how you will communicate with students and families, are consistent with organisational guidelines, e.g. for use of technology, safeguarding, confidentiality
- Ensure the therapy you are planning is consistent with relevant clinical/ professional guidelines.
Preparing and Delivering Therapy
Preparing to deliver sessions
- Set clear expectations in advance about how sessions will be conducted, using accessible information
- Ensure in advance that you and the student and family are comfortable with any technology (e.g. Teams, Zoom) being used to provide the session
- Pre-arrange a time for individual sessions, accommodating student and family preferences as far as possible
- Ensure the student knows how long an individual or group session will last, what resources, equipment or physical space will be required, and whether a supporter will be needed
- Remind students and supporters, where relevant, at the start of the session what will be covered and why
- As far as possible, maintain consistency of approach in terms of session format, structure, sequence and resources or equipment used, acknowledging and explaining any unavoidable session changes to the student(s)
- Consider breaking down activities into smaller chunks than usual and / or building in short breaks, as students may find it more difficult to concentrate in the home environment; if appropriate, encourage the learner to move about get a drink or snack during breaks
- Include motivational activities and / or feedback to help the learner and supporter stay engaged
- Allow adequate processing time and avoid verbal overload for both student and supporter, as video or phone contact reduces the visual cues that might normally aid understanding
- Follow the student’s lead as they become familiar with this new way of working, anticipate that sessions may not go as planned and be ready to adapt them
- Where supporters are involved, bear in mind, some of them might find the experience quite stressful – they might feel uneasy if you are using video about ‘letting you into’ the family home; encourage them and thank them for their support
Providing indirect support
- Where therapeutic support is provided through provision of equipment, advice and guidance rather than direct support, set up clear communication channels so dialogue between students, supporters and therapist is ongoing
- Research any online information or resources carefully before sharing with learners or supporters, ensuring that they come from a trusted source and are appropriate and accessible for the student / supporter
- When devising your own materials to send out to students, remember the context in which they are working and try to ensure that you are helping to maintain and improve their overall wellbeing rather than adding to the load.
- Whatever the delivery format, maintain adherence to professional behaviours, e.g. personal presentation / video-conferencing environment, standards or requirements, e.g. gaining consent / clinical note keeping / confidentiality / GDPR
- Continue to follow all relevant organisational procedures and policies, e.g. for raising safeguarding concerns, use of technology, remote working
Monitoring and recording progress
- As far as possible, continue to use existing systems for monitoring and recording progress
- Continue to maintain clinical records to enable reflective practice and ongoing intervention planning
- Think of the student’s return to home as a new baseline against which to measure progress, as this allows you to factor in the impact on their mental and physical health and wellbeing of the new situation
- Be aware of the level of support students are getting at home which may mean they appear to achieve more or less than they would within a college-based therapy session
- Ensure regular liaison / feedback with other key members of the student’s multi-disciplinary team (MDT), so that progress can be assessed holistically, and any changes planned together
- Consider recording some sessions, with the student’s/supporter’s permission, to allow the MDT to review and reflect on progress together
- Involve the student in self-assessment and ask for feedback from their supporters
- Capture evidence of learning/progress, e.g. through photos, video clips, reflective logs, using formats most relevant to the student and easiest for the family to provide
- Offer regular, motivating feedback to the student but also to the supporter, as they may well also be developing new skills in challenging circumstances
- Remember to reward efforts and achievements and celebrate successes.
Reviewing the approach
- Keep your approach under review and be ready to adjust it if it is not supporting progress for the student or if the student or family is finding it difficult to manage
- Check back regularly with the student and family that the agreed approach still meets their needs as circumstances may change during the period they are at home (e.g. availability of the supporter, changes in health)
- Keep a look out for new resources and guidelines, as more professionals find themselves working in this way and share their practice, which may help you improve your approach.
- Whatever the approach to monitoring and recording progress, maintain adherence to professional standards or requirements, e.g. for confidentiality / GDPR
- Continue to follow all relevant organisational procedures and policies
Useful documents and links
The following may be helpful in setting and maintaining standards for remote therapy.
Organisational policy / procedural documents
- Delivery of therapy services using telepractice: a policy document from Seashell Trust
- Clinical guidance for service delivery during COVID-19 pandemic: guidance from Seashell Trust
Please note that while these documents offer helpful examples, the college will be updating them as as government guidelines change. They were up-to-date when submitted in early May 2020, but may no longer be so. They may also need considerable adaptation to be relevant in a different setting.
Professional body and NHS / government guidance
- COVID-19 guidance: regularly updated webpage with a range of guidance material from the Royal College of Speech and Language Therapists (RCSLT)
- COVID-19: Maximising the contribution of the speech and language therapy workforce: guidance from RCSLT
- Guidance for rapid implementation of remote consultation from Chartered Society of Physiotherapy (CSP)
- CSP clinical guidance for respiratory practice during COVID-19
- CSP Keeping Updated about COVID-19 resources
- Teaching and Training Carers: guidance from CSP on working with carers/family members supporting a person with their physiotherapy at home
- COVID-19: Information for Registrants from the Health & Care Professionals Council (HCPC)
- Coronavirus Guidance & Resources from Public Health England (PHE)
- COVID-19 Information Governance advice for staff working in health and social care organisations from NHSX