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…

  1. 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
  2. be consensual so that the student, family and therapist are in agreement about the interventions to be provided
  3. be safe for the student and those supporting them to engage in, without the physical presence of a therapist
  4. be part of a coherent and holistic package of learning and support for the student
  5. be individualised, linked to the student’s own targets and goals, which may have been revised as a result of the current situation
  6. be easy to understand for those supporting the student at home and, as far as possible, for the students themselves
  7. be consistent with previous practice in college as far as possible to provide continuity for the student
  8. be engaging so that the student is motivated to participate
  9. be realistic and achievable, given the home circumstances (constraints, conflicting demands on families etc) and not overwhelming for either student or family / supporter
  10. 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
  11. remain consistent with professional standards and be evidence-based
  12. 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.

Planning Therapy

What therapy to offer

  1. 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.
  2. 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.
Treloar College’s therapy team has set up a YouTube channel containing ‘unlisted’ videos, aimed at specific groups of students. Links for individual videos are being sent to students and their families as relevant to their needs. Video topics include functional and motivating activities that link to students’ existing targets, such as laundry or gardening, ‘5 ways to wellbeing’ and fun story activities focusing on daily living and community skills.
Speech and language therapists at LEAP College, Wargrave House have designed a weekly choices and goals planner. This allows students to be involved in making choices and decisions about the activities they complete, based on their own priorities, whilst also providing a level of structure and a sense of achievement.
  1. 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.
  2. Try to stay as close as possible to existing plans for therapy but be prepared to change them to reflect new priorities.
  3. 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.
Occupational and speech and language therapists at LEAP College, Wargrave House have worked together to incorporate targets from two disciplines into one set of weekly therapy challenges.
Bridge College’s motto for home learning and support is ‘Quality, not quantity’. Staff from curriculum, physiotherapy and SALT teams had already been working on a sensory story for PMLD students. It is based on the Olympics and includes Makaton symbols and a physio task to complete at the end of each stage of the story. Learners have been able to continue with this at home, with support from family members. Occupational therapists and staff leading on positive behaviour support have come together to create a guide to Relaxation for Young Adults which includes practical strategies to reduce behaviours and improve overall wellbeing, along with guidance for families on how to use the material with their young people.

What delivery method to use

  1. 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.
  2. 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.
SLTs at National Star have started to use email correspondence as an alternative form of remote therapy for higher level AAC users. Direct intervention delivered via Teams proved challenging with this cohort of students as it was not possible for the therapist to see both the student and their device screen simultaneously. Using email as the primary method of contact enables the therapist to set a specific functional task and deadline, which the student can then take their time to consider and then create their message in response. The therapist then emails back some task feedback in the form of two positive comments and one ‘challenge’ to further develop the intervention plan.
  1. Think about what you could provide as a general resource for multiple students, which they can access at times convenient to them.
Physiotherapists at National Star have designed an easily accessible webpage specifically for the COVID-19 period. It includes Tai-Chi, seated fitness, stretching, standing fitness, and breathing exercises. Exercises are designed for different abilities enabling therapists to prescribe which is most appropriate to students on their caseload. It’s engaging and fun so all family members can get involved if they wish. As it is online students can complete the exercises when it fits with the family’s daily plans rather than having the pressure of a therapist calling at a set time.
Speech and language therapists working at Glasshouse and Argent Colleges sent students a pack including simple activities that can easily be done at home, covering attention and listening, understanding, expression and social interaction. As well as suggested activities, the pack includes simple explanations of the skills being covered, so that students and families understand what skills are being developed and why they are important. Students can complete as many activities as they like, when they like.
Speech and language therapists at Portland College have responded to requests from students for fun activities and support for learning new signs by creating a webpage which is updated weekly with new resources and challenges. Students and families can dip in as and when they want to. They can also email in completed challenges and give their permission for photos or videos they’ve sent in to be shared on social media for other students to see.
  1. 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.
LEAP College, Wargrave House has set up a central email system. All teaching staff and therapists involved with an individual student share a single email address. All these staff can then see the full set of email correspondence with the family. Simple queries from students or families can be responded to quickly by whoever first sees their email, while more complex issues can be first discussed by the team. They are then able to put a plan of action together as an MDT before just one member of the team communicates this back to the family.
At Bridge College, all contact is carried out through the student’s individual key worker who asks a standard set of questions of parents / carers during a weekly telephone review, including therapy and medical review questions. Information gathered is distributed to appropriate members of the MDT. Parents / carers can contact the therapist via this key worker if needed. This approach has helped the college collate up to date information, allowing them to put in place the most appropriate input / interventions for the individual students.
  1. 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.
  2. Consider, as appropriate, what the student can do independently and what may require them to have the support of others.
  3. Find out what the physical environment at home is like, for example in terms of space, privacy, equipment available.
  4. Assess whether it will be beneficial / possible to arrange for equipment to be lent or provided to the learner in their own home.
  5. 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.
Treloar College’s therapy team is encouraging students to continue to work and communicate within their usual class and peer groups where possible, using video-link group MDT sessions, closed Facebook groups, quiz sessions organised by students (with staff support as needed). They have also been acting as an intermediary between students, forwarding on messages for students who are not able to contact their peers directly.

How to shape the therapy offered

  1. 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.
  2. 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.
  3. Discuss plans with students and families, managing expectations about what is possible, realistic and achievable in the current circumstances.
Therapists at LEAP College, Wargrave House realised that in order to support their young people, families needed a basic level of understanding of the interventions they had been using with students in college if they were going to be able to offer support at home. They provided families with a short descriptor of the approach including links to more information where appropriate.
  1. 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.
The therapy team at St John’s College had already introduced students to a sensory story relating to the Zones of Regulation Program. They uploaded onto their YouTube channel a video of their speech therapist reading and signing the familiar story so that students can continue to access it at home. The therapist consistently refers to visuals that have been shared with parents, holding them up to camera, as a reminder of how these can be used to help students continue to develop skills they had been working on in college.
Physiotherapists at Bridge College modified complex individual physio programmes to create one generic Physiotherapy at Home Programme for all students. The single page programme allows parents/carers to support their young people with appropriate exercises, simply explained. The programme includes one individual task / outcome that is specific to the particular student’s current goals or aspirations. Their SALT team has produced a simple set of slides to explain intensive interaction to parents / carers so they can embed these strategies into everyday life at home and help their young people to continue to develop their social communication skills.
  1. 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.
  2. 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.
  3. 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.
In response to parent / carer request, Treloar College’s SLT team has developed a wide range of symbolised visual resources to support students’ understanding of the current situation. Examples include information about social distancing, use of PPE by carers, not being able to visit favourite places, along with visual schedules to support specific changes in circumstances. These are personalised for individual students as needed but some are being made available to wider groups of students.

Maintaining standards

  1. 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
  2. Ensure the therapy you are planning is consistent with relevant clinical/ professional guidelines.

Preparing and Delivering Therapy

Preparing to deliver sessions

  1. Set clear expectations in advance about how sessions will be conducted, using accessible information
Portland College has developed accessible guidelines for students on use of Microsoft Teams for video therapy sessions using Somerset Total Communication symbols with which students are already familiar. These include a consent form with basic information on how Teams will be used and a set of rules for students on how they should conduct themselves during Teams sessions.
Speech and language therapists at National Star have developed a set of remote working rules for higher level students at National Star to support their understanding and maintenance of professional relationship boundaries and therapeutic goals whilst accessing intervention remotely.
  1. 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
  2. Pre-arrange a time for individual sessions, accommodating student and family preferences as far as possible
  3. 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

Delivering sessions

  1. Remind students and supporters, where relevant, at the start of the session what will be covered and why
  2. 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)
  3. 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
  4. Include motivational activities and / or feedback to help the learner and supporter stay engaged
  5. 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
  6. 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
  7. 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

  1. 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
  2. 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
  3. 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.
LEAP College, Wargrave House SLTs have devised weekly social skills challenges for students, targeted around family engagement and maintaining social connection with others e.g. completing an online quiz with family, painting a rainbow and posting it to a family member or friend, doing the washing up after a meal. The challenges are reflective of what other young people are doing across the country are doing at the moment, giving students a sense of community and belonging at this time.
SLT teams at Landmarks College and Portland College were quick to provide accessible resources to help students understand the coronavirus and the current restrictions on their daily lives.

Maintaining standards

  1. 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
  2. Continue to follow all relevant organisational procedures and policies, e.g. for raising safeguarding concerns, use of technology, remote working

Monitoring progress

Monitoring and recording progress

  1. As far as possible, continue to use existing systems for monitoring and recording progress
  2. Continue to maintain clinical records to enable reflective practice and ongoing intervention planning
  3. 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
  4. 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
  5. 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
  6. Consider recording some sessions, with the student’s/supporter’s permission, to allow the MDT to review and reflect on progress together
  7. Involve the student in self-assessment and ask for feedback from their supporters
St Piers College has put together a simple survey for students and families to complete together. It allows staff to review overall progress, check how both student and family are coping and guide the therapists as they plan next steps. They have also created an accessible symbol-based version for students who want to lead on completing the response more independently.
  1. 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
  2. Offer regular, motivating feedback to the student but also to the supporter, as they may well also be developing new skills in challenging circumstances
  3. Remember to reward efforts and achievements and celebrate successes.
St Piers College physios have developed a 3-stage progress award scheme to keep students motivated and help them recognise their progress as they optimise both their skills and their independence.

 Reviewing the approach

  1. 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
  2. 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)
  3. 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.

Maintaining Standards

  1. Whatever the approach to monitoring and recording progress, maintain adherence to professional standards or requirements, e.g. for confidentiality / GDPR
  2. 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

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