#040: A Crash Course in Telepractice for SLPs

Marisha: Hello there and welcome to the SLP Now Podcast. I am so incredibly excited to have a fellow podcaster on the podcast today. Sarah Lockhart is an SLP who works in her own private practice in Ashland, Oregon. She also maintains a monthly blog with research and therapy techniques for busy SLPs. She also works in school contracts where she does a combination of travel work, and telepractice, which is what we're going to be diving in today. We've gotten a lot of questions about telepractice and so I'm really excited for Sarah to break things down for us and help answer some of those common questions.

Marisha: In addition, Sarah's clinical interests include autism, childhood apraxia of speech, and dyslexia. She's also as I mentioned, the cohost of the SLP Happy Hour Podcast. And it's a podcast focused on bringing light to burn out in our profession and offering easy lessons and encouragement to SLPs across the globe. So definitely worth subscribing to that podcast as well. She always delivers amazing information. And it's super relatable, which we can definitely use when things get a little bit crazy in our SLP world. So without further ado, crosstalk Sarah.

Sarah: Hi, I love that intro. It's so good and it's really fun to talk to a fellow podcaster. I'm really excited.

Marisha: Yeah. I think you might be the first podcaster that I've interviewed.

Sarah: Potentially.

Marisha: I'm wondering because we've been doing the podcast since May, so I think you are the first. Super exciting. And so thank you so much for coming on to talk about all things telepractice, teletherapy with us. And before we dive into some of the common questions, I'd love to hear a little bit of your story. How did you get started with telepractice?

Sarah: That's a good question. Let's see. So I started out in the schools. I think that's pretty common and I also think there are probably people listening who are currently working in the schools and have their eye on telepractice. So I'm hoping that this episode will be really informative for them, as well as new SLPs just starting out, and people wanting to maybe transfer in from an outside setting. I was born and raised in Portland, Oregon. Let's see, I started working in schools in Portland and they were, I would say a very low income school that was within the city. And I worked in schools for six years and it was so wonderful and so stressful. I loved spending time with the children. I loved running groups. I really enjoy working with children as a part of a group. I really enjoyed my coworkers and working with teachers. And at the end of the day, I just felt so satisfied that the children I worked with, they didn't have awesome private insurance. They weren't going to go see a private therapist at the end of the day.

Sarah: So as long as they qualified, I could help these children. And it didn't matter how much money their parents made, it didn't matter if they were in foster care, it didn't matter if their parents were in jail. So again, I was working with a population that really needed the kind of service that the schools were providing. So I still have a huge soft spot in my SLP world for the school setting. I think it's a fantastic setting. But over time, the paperwork got to be more and more, and the demands got to be more and more. The longer you work in one placement, wherever you are, the more work there is to do and the more people rely on you. And it just got to be so stressful that I would just feel the Sunday blues and the Monday melancholies if you want to call it that.

Sarah: But leaving that job was really difficult. And leaving that job was really difficult because again, I loved the students, but ultimately I had to figure out if it was possible for me to stay in the profession because again, I was exhausted. I was burned out. So could I stay in the profession in another setting? So that's when telepractice came into my world. I work for a small company that is based out of Portland, Oregon. I had a friend that worked there and I had been talking to her for years before I actually made the switch because for me, working in the schools was something I had done for years and there's quite a bit of security with that position. And you know, I didn't hate my job so I thought, "Should I even leave?" I remember the last day of working, I was crying so hard, my husband had to come get me and drive me home because I couldn't see the road and thankfully we only lived like a half a mile away.

Sarah: But yeah, he had to come pick me up and take me home because I was crying so hard because I liked my job. But there's a really wonderful phrase that I heard from a poet on another podcast and it was, "Does that which you love also love you?" And in the case of my school job, I loved those children and I loved running those groups, but it didn't love me. I had a lot of paperwork, I had a lot of stress. I had a situation with administration at one point that wasn't very supportive and it was causing me a lot of mental distress. So leaving that job was hard because I thought, "Well, wherever you go, there you are, right?" And I thought, "It doesn't matter where I go, I'm me, right? I'm still going to struggle." But what I did is I ended up making the switch to telepractice and my problems did not follow me and I found more time, I found more happiness, and I found more balance, if you can say that there is a balance.

Sarah: I don't believe in work, life balance. I believe you have to choose and let things go. So that's where I started and in my switch to telepractice after I left working schools that first day, I worked for a small school district here in Oregon. I don't still work there. With telepractice, it's pretty common to kind of switch schools every year as different placements need you. And I had an SLPA, so an SLP assistant who was seeing the children and that person worked onsite at the school. She was there every day. It was fantastic. I supervised her. I did a lot of paper works. And then the company I work for does a hybrid model. So I'm about 75% telepractice and 25% onsite. So that means 25% of the time, I travel to the actual school. So I'm doing assessments in person, I'm doing as many IEP meetings as I can in person, although there's so many, I can't fit them all into those weeks. So that's the hybrid model that I do when I do telepractice.

Sarah: Right now, I'm currently working for a school district in California and it's a pretty similar setup. I have licensure in Oregon and in California, and I've been doing California schools for, I want to say about four years. So that's my story from switching to schools to switching to telepractice. A year after I started telepractice, I also opened my own private practice. I moved to a small town in Southern Oregon. I live in Ashland, Oregon. It has a population of 20,000 people. It's in a little valley. There's mountains all around me. And I just kind of moved for a slower pace of life. And when I moved, I opened up a private practice. So right now, I do about half my time in my own private practice and half my time in a school contract for again, a small telepractice company based in Portland, Oregon where I do 75% telepractice and 25% travel.

Marisha: That sounds amazing. I love that you were able to look at different options and find something that works for you. Super inspiring crosstalk and it was really cool to hear that story. And then I had just one curious follow up question. So when you were a completely different crosstalk SLPA.

Sarah: So California is interesting because there are crosstalk SLP assistants and SLP aides, and it's two completely different certifications. So the SLP assistant is more like in Oregon, for example, what we would expect. They have coursework in the profession. They have had a practicum. They have a minimum number of hours that the state has signed off on. SLP aides are really, all you need to do to be an SLP aide is to register with the state of California and describe what that person will be doing in their day to day operations. And then California can approve or deny it. So in California, I work with an SLP aide.

Marisha: Okay. And so I assume that crosstalk

Sarah: So I again, when you apply, it's like what can they do? And then we're getting into little things. I don't want to get too far into it, but when you [crosstalk 00:10:13], you just crosstalk exactly what that person is going to do. And the state can say, that's okay or that's not okay. And to be completely honest, in the state of California, there were not a lot of specific guidelines that I could use to figure out what the difference was, what they were allowed to do, what they weren't allowed to do. So for me and my comfort level and my agreement with the state, yes, my aide can go get the students. But also I feel like if something is written down, for example, if I have a picture scene and I've already had the WH questions that go with the picture scene, does she need specialized training to read those WH questions? I would say no.

Sarah: So I did put something in my application that was essentially that like if the directions are written and there's something that someone can read, she can go ahead and do that part. And then of course like behavior management and having the actual game or activity prepped and in front of the children is super helpful. So really she does all sorts of things.

Marisha: That sounds pretty amazing. I love it. Awesome. And then I'm curious too just a little bit more about kind of like what that looks for you. So you're doing about like halftime in the private practice, half time.

Sarah: Awesome.

Marisha: With that other company. crosstalk we can focus more on the telepractice crosstalk but what ages do you work with in crosstalk

Sarah: It compares almost exactly. Of course, what's interesting is in California, I'm in more of a rural ranching community. In Portland, when I worked in the schools, I was in an urban school so I was in a city school. So who the families are is really different just because of the location. But as far as the actual work, the needs of the students, it's the same, I would say are very, very similar. So you know, schools, our schools, are schools [crosstalk 00:12:24]. And one thing I tell people, especially thinking back into my own story and how I took two years to make the switch, cause I thought, "Oh, the learning curve is going to be so harder. Oh, I don't know how to do this.", and I didn't find that to be true at all. I found it extremely similar to working in the schools in a lot of ways. So that's the same for the job I have now.

Sarah: I serve again a rural school in a ranching community, and I work with ages, about more or less three to 13. So I do some ECSE, some preschool. I do elementary school and I do middle school. And for where I'm working, the high school is actually in another district. They don't even have a high school so that's the ages. As far as the population, there aren't a lot of resources there for students with high needs. So thinking about things that might be in other districts like a special day communication class, we don't offer that. So those students might go to another district that offers that. So as far as the severity of students, I would say because it's small district that doesn't have a communication classroom per se, they do have a special day class.

Sarah: But I would say that overall, I'm dealing with mild to moderate communication disorders and I am seeing groups. So just to walk you through maybe a session, I'm trying to think. My first session of the day, it's going to be a couple of kids that are in the special day class. We have been working on concepts. So the SLPA will go ahead and go to the classroom and bring them to me. An activity we did recently was a smash mat activity with prepositions. And for me, I was just trying to figure out what location concepts they knew and didn't know. So it was kind of a really informal play time to see, you know, do they know between or under, over, so that I could make a list of what they needed to work on. And then the next day at the similar session, we focused on between. So we used some play doh smash mats. My aide was there. She got out the smash mats and the play doh. And all of our directions were between, because that's something that both of the students needed.

Sarah: And then after that, we worked on a picture scene because we've been really working on answering WH questions. So I had a seasonal picture scene and then some WH questions that were prewritten just to see how can they do in a picture activity like that since we had been working and teaching those WH questions. And then we did that, and then it was time for them to go because of course, sessions are never as long as you'd like them to be. So that would be like a typical language session that I might do.

Marisha: So helpful. I love that you went into like those specifics because I think that just really helps, just helps us imagine what it would be like. crosstalk and then I'm imagining that you use some kind of act to attend the session fortunately. And then how does that communication [crosstalk 00:15:59].

Sarah: Right, so let's work through maybe an articulation session. So let's say I have an articulation session and it's kind of dual crosstalk or group. If it's a group, I'm probably not going to see both kids sitting next to each other because one kid will get bored. So let's say I have a kid working on S blends and a kid working on K. So the child working on S blends can come up to the computer and work with me with headphones just so that I can hear them and see them really, really well. Well, I can see them the same anyway, but yes, they will attend better with the headphones and I can hear the sounds better. So they'll work with me. And what I can do is I can screen share my iPad. So whatever platform you use, there's tons of video conferencing platforms out there. I would say if you can find one that allows for screen sharing, that has been something that's been really important to me.

Sarah: So with this articulation session, I have the Busy Bee articulation app, which I think most SLPs listening know exactly what that is. So on my iPad, on my tablet, I will do airplay, A-I-R-P-L-A-Y. And I can do that by swiping down and it will play and basically cast onto my video conferencing image so the child will be able to see me as well as the iPad. So again, I have a kid, they're sitting in front of me, they have headphones, we're working on S blends. Let's say we're at word level because I can think of a kid that I am doing that with right now. And we'll go through the words, spoon, and they'll actually see the spoon on their screen. They'll be able to see me. And I might say, "Remember, tongue goes behind the teeth, watch me.", they'll look at me, I can see them. They'll try again and I can hear them extra super duper well because they're wearing the headset.

Sarah: So we might go through some S blend words on the articulation app, the Busy Bee articulation app. I have lots of apps that we can use if we want. Although I would say I probably only use apps in like less than 25% of my sessions. So we would do that while the child with K would be practicing like coloring a K picture. They could bring the picture to me, the kids would switch. And that child would say some words from their K picture, and then we might use a different app or the same app and we would do some Ks and words or some Ks in isolation, I would say, "Oh, look at me. Remember, we're going to keep mouth open. It's a back sound. It's a scratchy coughing sound. [crosstalk 00:18:30]", and we would work together. And then the students would probably do something at the table together that was kind of an artsy coloring type project or a game that focused on picture cues for their sounds and then that session would be over. So that's what, for example, an articulation session might look like.

Sarah: So with the language example that I gave before, that was something that I had already taught. So I wanted to see mostly where my students were. And then the person who's with the kids to ask a WH question doesn't need any special training. But for the articulation piece, you know, obviously an aide doesn't have any special training on that. So for that, the student would work with me one-on-one and then we'd switch again just so the other kid doesn't get bored. And so the sessions might look pretty different. Also a session might look really different if again, I was teaching a new skill versus reinforcing a skill. So I would be more involved in teaching a new skill or anything that was like data taking or assessment.

Sarah: Totally, and as long as they have something in front of them, they're pretty good.

Marisha: Yeah, that's super helpful. crosstalk

Sarah: Like again, whether it's like crosstalk busy, just like when I worked in the school in person, you know, you can only really focus your attention on one child at a time. Not that we don't have divided attention, we all do it. But I would say, think about when you do groups in the schools, if you're working in the schools now or if you have experiences like working with groups, you're only really tuned into one kid at a time, and you're kind of watching the others and you know, trying to provide a cohesive activity that keeps everyone busy and engaged until it's their turn next. So very similar in that way to being in person, physically present at a school. And are you picturing my kids like wiggling back and forth, and like constantly grabbing at things because that's a part of it too. Okay, I may have a couple of those.

Marisha: Yeah. So helpful. And I love your describing abilities because I can really picture it. I haven't done teletherapy yet so it's just really cool to kind of get to pretend like I'm in on one of those sessions. So thank you for that.

Sarah: What I like most is not getting interrupted like 40 million times a day. So there's some research out there that crosstalk it can take you up to 20 minutes to refocus. crosstalk And that's what I did find in schools. crosstalk one of our students is having a meltdown in the hallway or someone walks in and it's like, "Hey, can you do a screening?", or your phone rings, or the office calls you, and I was really struggling to basically [crosstalk 00:22:15]. In the schools, we're pretty much at 100% productivity. We're pretty much with schools, with groups or in IEP meetings all of the day.

Sarah: So if I had 20 minutes, I needed to be writing a report or working on an IEP, and I never ever had time to do those things during the school day because of the number of interruptions and so that was a struggle for me. And that's something that I feel like I am able to, you know, if I have 20 minutes actually spend it on my paperwork and making sure that's as good as it can be. But again, case loads are big, whether you are in person or virtual, you're going to have a lot of paperwork to do. So that's still the same, but something that I like is just that the day is a bit calmer I would say, and I have a few more opportunities to get some of my paperwork done.

Sarah: So it's not the therapy, it's actually the perception that people will have of you coming in. So again, if you're doing teletherapy, it's very possible that you'll be in a new place every year. I've been lucky to be at the same place in California for, I believe, four ish years now.

Marisha: Yeah, that sounds great and that makes a lot of sense. crosstalk

Sarah: So when you go into a new place or when you meet a new family, someone will think, "Wait, how in the world can this work? How is this going to work? My kid won't interact with her. This isn't going to happen. This isn't going to be effective." And there is a ton of resistance. So I would say both with teachers who are concerned, who are wanting to advocate for their students and are concerned about the model, but also parents who are really concerned that you won't be able to help their student.

Sarah: So a few things I've done to address that, although it is still a struggle, is I write a letter at the beginning of the school year and especially if I'm in a new placement and I explain how it all works. And then I also let parents know how they can get ahold of me. I do have a work cell number that I got through Google voice that parents can call or text. I do have an email address associated with the school district and I also have a fax number. So I'm going to share that. I have not had issues with parents over calling me. So if you are concerned with that, you can just give them the school number and the school can take a message for you. But it's not a bad idea to get a Google voice number because as it rings your cell phone, it will show up as, "Oh, this is someone calling your Google voice number", and it'll have a different ring and you'll be able to see it on your screen.

Sarah: So you'll know, oh, this is a school call. Do I want to take this or not? Now ultimately, I decided to get two cell phones, which by the way, I work with some high school kids in private practice and they're like, "You have two cell phones?" They're really impressed by that. But it's just because I want to put my work phone away, and I don't want to, you know, on the phone that I'm like on Instagram on or texting my sister. I don't also want to get work calls on that phone. So that's something I did probably about my third year because I realized it was kind of stressing me out. So that's the first thing I do.

Sarah: The second thing I do is I offer a six week check-in. So if a parent is starting with me and they are super concerned or even a teacher, I say, "You know what?" [crosstalk 00:26:03], and I say this, I think that as women, but also as people in the helping profession, we don't talk ourselves up enough. So I say, "I've been doing this for 10 years, I'm good at what I do and I'm confident I can help your child or your student, and that this is going to work. So let's take six weeks. I'm very good at taking data. I will take data every single session.", which we do anyway, but parents and teachers don't know that. "And then let's meet in six weeks. I'm going to put it on the calendar and we're going to go over the results and how your child is doing or how your student is doing."

Sarah: Then I create a visual, and again, I'm only doing this for a few kids at a time because we wouldn't have time otherwise. But then I create a visual chart where we graph how the student has improved during that time. And as long as it shows improvement, which I would say it should if the child is a good candidate for speech therapy via telepractice, and if you're using good practice and good teaching techniques, you can show that and meet back and show that growth. So those are two things I've done to address that. So again, it's a friendly letter home with the opportunity to connect for parents, number one. And number two is offering a six week meeting and then at that meeting, providing a visual chart of the student's growth.

Sarah: So a couple things that come to mind. One is just that [crosstalk 00:28:07]. Yeah, so I'm thinking about this on two different tracks. I'm trying to decide, which one is [crosstalk 00:28:13].

Marisha: That is super helpful. I love those ideas. And I think those are good strategy to use regardless [crosstalk 00:28:18].

Sarah: Okay. So firstly I would say that, I'm going to give some examples. So again, in articulation session that we talked about before, a child using a P blends, let's say, and they were 70% crosstalk accurate. Would that data be different in telepractice? No. I'm going to take a tally of crosstalk and I'll know the level of prompting, just like if I was there in person. So the data itself is going to look really similar. For an example of maybe a language session, like the one I talked about earlier in the podcast, the example of the group where we were working on between, we had the smash mats, I do, if it's not visually on the screen. So for example, let's say a kid is sitting there and I say, smash the one where the boy is between the bears. I won't be able to physically see if he got it right or not. So that's where speech aide or an assistant or a helper or an educational assistant, a support staff member is really helpful.

Sarah: If I didn't have that, I could do all like online games, and there are companies that do things like that where it's just one student at a time and everything is on the screen. So that's totally an option. It's just not really my style. So in the case of the group working on between, the SLP aide did have to say like correct or incorrect, or she had to kind of let me know how they did. And sometimes she'll just like make a little dot and tell me at the end. But ultimately, I'm responsible for tracking the data. So that is a small piece where I might, let's say we're doing smash mats, I might say, "Hey, it looked like it was three out of four that they got, was that correct?", or, "Hey, will you tell me after each smash on the smash mat, if that was correct or not.", or I might just say, "You know what? I'm not going to take data on this and I'm going to do a reinforcing activity where I can see their response."

Sarah: So those are ways that data might be different. And also, I feel like I can't talk about data without talking about SLP toolkit, which is like that's just what I use to take data, to write my session notes to before an IEP do probes because ultimately, I don't have the brain space and bandwidth to track it and I hate having a million papers. So I think that's a good option for people who are already virtual and who are already used to taking data on the computer to import their data and track kids so that again, as I travel, I can just open that up and take a look versus dealing with physical student files. So I actually don't have any physical student files. Everything is virtual.

Sarah: Yeah. So full transparency. Some weeks, I am more organized than others, but I actually really love the planning aspect. crosstalk

Marisha: Yeah, that makes a lot of sense. And if you're on the computer anyway, taking that digital data, it sounds like a great [crosstalk 00:32:10].

Sarah: And I love to plan my sessions and figure out what I'm doing. So I have a Google doc and [crosstalk 00:32:16], we talk about HIPAA, privacy, et cetera, et cetera, but most districts should have a BAA agreement, which is basically an agreement with crosstalk that they sign, that means that everything is safe and sound, good to go, and technically if that agreement is [crosstalk 00:32:40], everything is encrypted and you can [crosstalk 00:32:41]. So with that said, I feel like that's the responsibility of the school district ultimately, but versus like my private practice, I had to do one on my own. So I use Google drive, I have a document, it has the students, it has the times and then it has the activity. So it has three columns and I have that ready for each day.

Sarah: So at a glance she can look, see the activity we're doing and then as soon as that group is over, when she's walking the students back to class and getting the next group, I have a couple minutes, I will open the Google doc and I will write what we're doing the next session. And to add to that, I think it seems more complicated than it is because going back to maybe our smash mat working on between example, maybe we did a smash mat last session and I want to see if they can transfer that knowledge into a new activity. So I'll write down what that activity is really quick. crosstalk That's my theme music apparently for being an SLP. And then I'll write down exactly what we're doing the next session. And it'll probably be kind of similar to what we did the session before, which I think is really helpful for any support staff that may be supporting you and have that note in there. And so then at the beginning of each day, and really at the end of each day, it's already complete for the following speech therapy day.

Sarah: Yes, because it is a lot. I have a Google drive folder, so it'll be like, you know, elementary school articulation, elementary school language, middle school language, et cetera. So I will reshare the folder and I will say there, you know, our wires get crossed where I'm like calling the packet the wrong name, or they don't have the cover page so they don't know what the packet is called. And you know, my helper might have it, crosstalk and I might be calling it something different or describing it differently. crosstalk So then I'll resend the link and she'll be like, "Oh, I actually have that. We're good to go." So there is an organization piece there, but I would say it actually keeps me more organized to do telepractice because I can't just like wing it [crosstalk 00:35:24]. I have to know what I'm going to do because whoever's supporting me and helping me, I don't want to put them in a bad position where they feel stressed or they feel like they need to scramble at the last minute.

Sarah: Yeah. crosstalk yes, okay. Materials. So I would say that the ability to screen share with your iPad is a really great resource. But like you said, it's like if I have somebody who's going to offer to print out and laminate things, I'm just going to use my traditional materials that I'm used to using because that's what works for me.

Marisha: Yeah, that makes a lot of sense. And I think that really helps with the accountability [crosstalk 00:36:44].

Sarah: But with the iPad, I would say crosstalk and take a look, but the important thing to know is they can [crosstalk 00:36:47], but they can't like touch their computer screen and interact with the app. So that to me, that's not a problem because, for example, I might have like [crosstalk 00:37:00], or another one is [crosstalk 00:37:06], it's where the little kids [crosstalk 00:37:08], My PlayHome. My PlayHome, I'm sure you know that [crosstalk 00:37:12]. The kids have to tell me what to do. So for example, if I'm working with a preschooler and I am using an app, which again it's not totally my jam, I have lots of complicated thoughts about how much time kids are on screens and while also doing telepractice, which is on a screen so it's complicated.

Sarah: But I would say I don't use apps a lot, but when I do, for example, My PlayHome, they might say put the girl on the swing, or they might just try to point and I'll say, "I literally can't see you.", which I remember saying that to kids when I was in the schools, like, "Oh, tell me with your words. I'm not sure what you mean.", and like pretending like you don't understand. But with the apps or like, "Put Peppa on the toilet.", that's a great app because the kids think the toilet is hilarious. They have to tell me, "Wait." You know, I have to say, "Are you talking about the boy or the girl? Or which person are you talking about? Where do you want them?", and so it does provide for some language rich experiences. So I would say in telepractice, if you're wondering if telepractice is right for you, you do have to be flexible and think about ways to get around things like this.

Sarah: So for example, when I'm using apps, kids have to tell me what they want me to do and then I manipulate the people, which I've gotten like messages online, if you'd like to connect with me, I'm SLP happier crosstalk on Instagram. You can feel free to me questions, where they're like, "Oh, but the kid can't interact with it so I can't use it." And when I hear things like that, I think, you know what, if you want to be in telepractice, you really have to think creatively and you have to see a problem and find a solution. So yeah, as far as materials, I would say, again, some limited iPad use. I also wrote two blog posts that I can get you the links to for my clinic website, that are my favorite websites to use in speech therapy.

Sarah: So one is called, I believe, 15 great websites for speech therapy, and the next one is called 15 more. So if you're looking for resources that are online that you can use in your sessions, I have 30 options for you. And I would say resources and materials that I really like. I really like EET for my middle schoolers, which I'm sure you know, it doesn't matter whether you're telepractice or not for that. I really like picture scenes. So on Teachers Pay Teachers, I mean basically what I'm doing is taking digital materials and sending them afar. Picture scenes from Allison Fors where it's, she has seasonal scenes like the winter scene for example. Tons of things are happening in the picture. The kids can talk about it all day long. The WH questions are provided. There's some prepositions activities in there. So I use that very often.

Sarah: And then superpower speech has seasonal units. So for example, in winter it's called snow much fun. And there is preschool level one, level two, level three, and that provides me with something where I can just pick and choose. And of course, your program, the SLP Now materials are really great. I have a membership to that. And the nice thing is I can just log in, search for something that I am needing like verbs, download it and share it with the person who is at the school so that they can print it and prep it and we can work on skills. So now is a great time for not only digital products but no print digital products. So there are so many options. You will never run out of materials if you're looking in the right places.

Marisha: Yeah, I can imagine doing this, I don't know, maybe even like 10 years ago where most of the materials were just like the crosstalk

Sarah: Yeah, I love the idea of course. The questions I would have on my, is teletherapy like for you quiz, would be, do you need health insurance? And I know that's, I don't know, may seem off topic but if you're working for a contract company, chances are you will make a little more money and you won't have health insurance. And so what you should probably do is crosstalk little more money and buy your own health insurance. And to me, it's a wash. It's financially crosstalk but to consider that as you make the switch. If you're needing family or you as a single unit, if you need that health insurance that you're getting from your current job, as you crosstalk telepractice is just something to consider crosstalk

Marisha: crosstalk navigate some of those changes like being able to adjust how you do therapy [crosstalk 00:43:23].

Sarah: Okay. Another question is are you flexible? Are you adaptable? Are you open to criticism? Do you have thick skin, or if not, can you develop it? Because people are really going to doubt the model and that you can serve the kids you're serving, and you're going to have to just deal with that. Are you organized? Are you comfortable with keeping materials online and knowing what to use? And are you of course detail oriented, which is again for any SLP. crosstalk

Marisha: Yeah, that totally makes sense. crosstalk I love it. And I love that you had like a variety of questions in there because we might not think about the health insurance component right off the bat. But I love like there's a solution for any problem. It's totally possible to purchase health insurance even if it's not provided. Yeah, I do too. So yeah, because I feel like that's a hurdle that I've heard a lot of people bring up, whether it's related to working for a contract company or like starting a business or whatnot, like, "Oh, I can't do that because then I won't have health insurance.", but that is solvable.

Sarah: Definitely. crosstalk one question crosstalk and even if you get promised one thing, you're going to show up at that school the first day and get something completely different. So that's something that I don't realize when I was starting, but I almost wouldn't even ask, because I've been promised reasonable case loads and then had like huge case loads and vice versa. You need to go where you're going to go and it's probably going to be a message because they've been looking for someone. You're filling an unfilled position. They really need you. So paperwork might be a mess. Team dynamics might be difficult, and just realize that you're going into a place that really needs your support and that in order to make that switch, you're going to be walking into some things that are difficult [crosstalk 00:46:52]. So I would say consider that.

Sarah: and then I would ask like what the hourly rate is, if there are any benefits, vacation days or [crosstalk 00:47:04]. If there are no benefits, you're going to have to look a the hourly rate and figure out if your increase in pay is going to equal out to that. And I can talk numbers if you want to and if it's helpful, so I am the breadwinner for my family. It's me and my husband, and we're actually adopting a child this year. So there will be three people on the insurance. With two, I am paying $900 a month. If I worked for a school district, locally, they'd pay 50%, which would be, let's just say it's $800 because I'm not good at math. They would pay $400, I would pay $400. So then I would say, okay. Am I going to make $400 more a month with this job or not? And if not, it wouldn't be a good position to step into.

Sarah: So again, just do the math. In order to get your own health insurance, you just like go to a friendly health insurance broker. They help you. It's not difficult. And see if the money is going to flush out for you as well. Another thing to consider is, are you getting paid for things like paperwork and IEP meetings? Are you getting paid if you're working a full eight hours? Are you getting paid for eight hours? We all know we work more than eight hours. Most of us, most days, but we're only getting paid for eight hours. But you know, if you're doing that and only getting paid for five or six hours because you're only paid for direct client contact time, like direct group time, I'm not sure that that's going to be in your best interest. So those are things I would ask companies before starting to work with them. So I get paid for eight hours a day and work at least eight hours a day. So I'm very happy with that. But not all companies do that.

Sarah: Exactly. Let's see. I would just say sort of zooming out if you will. I would say that for me, doing telepractice was a great opportunity for me to reduce my stress, increase my independence, and spend more time at home, which has ultimately made me happier. Will I do it forever? I don't know. I'm one of those people that loves change, but also love security and things staying the same. So like I truly don't know how long I'm in this for, but I'm really enjoying it right now. And it has given me those benefits, which to me are more important than a pension and health insurance.

Marisha: Yeah. crosstalk

Sarah: So really thinking about your values and what you'd like to get out of the job, crosstalk fit for you because it's not a good fit for everyone. But if it's a good fit for you, I can't tell you the transition is probably not as big of a deal as you are making it out to be.

Marisha: Okay. Yeah, that's super helpful [crosstalk 00:50:19].

Sarah: And you can be very successful doing telepractice [crosstalk 00:50:22].

Marisha: crosstalk because your hourly rate might be double, but if you only get paid for the sessions that you have, and if it's only if the students show up or what not, then that could get a little bit tricky. So that's a great point. Do you have any other tips or advice or things to think about?

Sarah: Right. So I've been in the telepractice game for a long time, so I do get questions especially on social media, that's like, who should I work for? Who do you work for? Tell me the company name, right? Which you're not asking that, but I would say that's like the number one question people ask. And I just say look, I've been doing this for like I actually lose track of how many years. I think it's six or seven? Hold on. Seven. Okay. So I've been doing telepractice for seven years. And so when I was in the market looking for a company, things were so different. Half the companies that are available now weren't available then. So I am not the expert in finding a good teletherapy company because I did that seven years ago and I got super lucky. So I would say if you're looking now or if I was looking now, what I would do is I would follow some companies on Instagram. I would follow some companies on Facebook.

Marisha: Super helpful. And so if crosstalk

Sarah: And then there are so many Facebook groups that are focused on telepractice, teletherapy topics. And you can ask a question, like that you can go into the group and search the past discussions, and just put in teletherapy companies because people ask that question all the time. And what I tell people when they ask me is like, my information is seven years old. So go there and see what are people talking about right now, you know. What did someone say on Facebook last week in one of these groups? Because that's going to be your best source of current information. I don't know. Some days. Totally. Correct. [crosstalk 00:52:58]. Yes.

Sarah: Yeah, and I do want to add.

Marisha: Yeah, that's super helpful. You are such a good problem solver. crosstalk

Sarah: I would say if you value attendance, some downtime like for example, one of the schools I work at, the aid has like a 20 minute [crosstalk 00:54:09], and I love that I can crosstalk and come back in like 20 minutes. I don't take 20 minutes but I have a minute. And that's something as I couldn't get, so for me, things like health insurance, it was important that I could solve that problem. I just needed more bandwidth, and so again, whether you work in schools on telepractice or in person, that case it's probably going to be big. You're probably going to have more paperwork, and there will always be upsides and downsides, so you need to decide what you're looking for.

Sarah: And for me, my values were family time and what's, and when I learned those values to my crosstalk to that and I had to put down everyday, like computer shut down, done. I've gotten like, so really think about what you're willing to live with and then what you value and what your non-negotiables and try to find something that winds up with that. Even if telepractice is a great switch for you, if you are unhappy in your work setting, you have crosstalk work setting or you're out of a job, because again, just like the story, I told at the beginning of this episode crying so hard that I couldn't drive myself half a mile home on my last day of work. It was so hard to like leave, but I never looked back. And it led to a lot of increased happiness. So if you are considering a shift, you should probably make it. Happy people don't consider shifts usually. So really give it some thought and have confidence in your ability to navigate that change.

Sarah: Oh my gosh, you're giving me like free time and space to say whatever I want and it's so exciting. I don't even know what to do. I would say that if you're navigating a job change, again build your confidence, but it may be helpful to see a therapist. And that was something that was really helpful for me when I was going through burnout. But also when I was navigating a job change because she was able to sit with me and say, "Okay, we're going to use this self care strategy and this self care strategy and we're going to give it this length of time and then we're going to talk about it." And I did all the self care in the world and I still felt so exhausted at the end of the day, so drained and I really wasn't there for my family or my friends.

Sarah: There was work Sarah. And then there was what we call on our podcast, the dried out sponge Sarah. It has the dishwater and then you like ring it out. That's how I felt at the end of the day. So if you're finding yourself in a situation like that, I would recommend seeing a therapist just to help you navigate that change. It's a big change, but chances are you'll be able to make the switch and you'll have so much more confidence, your skills and your abilities and you'll definitely be happier.

Marisha: I've definitely connected and I've had some of those moments too, so it was really helpful to be able to hear all of that. And do you have any last tips you want to share or are you good?

Sarah: You got it. Oh, if you want my speech therapy blog, it is sarahlockhartspeech.com/blog or I am the only speech language pathologist in my town, so if you're not sure how to spell my name, you can search speech pathologist, Ashland, Oregon, and again, Sarah Lockhart.

Marisha: Awesome. That is a perfect note to end on. Thank you so much Sarah. And if you want to find out more about Sarah, you can follow her at SLP Happy Hour on Instagram. Check out her podcast too, which is also SLP Happy Hour. And then the blog is also slphappyhour.com. Right? Okay. Any other places to share or are we good to go? Okay, awesome. Thank you again and yeah, I so appreciate you.