Viewpoints—Telehealth: A Q&A With Kim Gooding

Kim Gooding, OTR/L, an Occupational Therapist at Waldo County General Hospital in Belfast, Maine, provides pediatric outpatient-based occupational therapy services through telehealth. She serves clients from across Maine in home, school, and community settings. She recently spoke with Jana Cason, DHSc, OTR/L, FAOTA, a Professor at Spalding University’s Auerbach School of Occupational Therapy, in Louisville, Kentucky, about how telehealth has been integrated into the pediatric outpatient services at her hospital. 

What population does your telehealth program serve?

Our telehealth program provides in-home occupational therapy services and school-based services to children from infancy to 18 years, including specialized pediatric feeding therapy.

What is your practice setting?

The telehealth program is part of an outpatient hospital-based program within the Pediatric Physical Therapy/Occupational Therapy department at Waldo County General Hospital. The practice setting includes outpatient, school, and home-based services.

How many occupational therapy practitioners are involved in delivering services in your telehealth program?

Our occupational therapy telehealth program began in 2016 with two occupational therapists. Currently, four occupational therapists and one occupational therapy assistant provide up to 300 telehealth sessions per month.

What type of occupational therapy services do you provide through telehealth?

We provide both direct and consultative services aligned with goals established during evaluation. Interventions may target sensory and/or reflex integration and feeding, fine motor, visual motor, and visual-perceptual skills. An eHelper (onsite facilitator) is present during telehealth sessions. Consultation with caregivers, teachers, and community practitioners supports carryover of therapeutic strategies in the children’s daily routines.

What type of technology do you use?

We use Zoom’s subscription-based, HIPAA-compliant video conferencing software. Therapists use a laptop or desktop computer with external USB camera. Clients connect with the therapist through a smartphone, electronic tablet, laptop, or desktop. 

How are services provided through your telehealth program paid for/reimbursed?

Services provided through the telehealth program are paid for by private insurance, Medicaid, and school contracts.

Why did you begin providing services through telehealth?

The telehealth program enables us to provide services to children living in rural areas with unmet needs. It also enables us to match children’s therapeutic needs with therapists with specialized training in those areas (e.g., feeding, sensory integration). The success of our speech-language pathology telehealth program resulted in development of the occupational therapy telehealth program. 

What benefits have you observed from the use of telehealth?

A key benefit is that telehealth enables us to serve children who otherwise would not have access to occupational therapy services. It has also been helpful for carryover with parents and other providers.

What challenges have you encountered?

There have been some challenges at times with technology, lighting, or access to materials (such as a family not having preferred foods or materials to use in a session targeting feeding skills).

What recommendations or “lessons learned” would you like to share with other occupational therapy practitioners interested in telehealth?

Practitioners should communicate with the eHelper [or whatever system they’re using] and send an email with needed materials before the session. Materials may include links to Internet games, images, or videos; activities or handouts created or found on the Internet (e.g., dot-to-dot, mazes, word searches); and a list of feeding supplies or other materials to target specific skills (e.g., scissors, coins). Additionally, having several activities planned along with being creative with materials available in the child’s environment is key. 

Do you have any other thoughts you would like to share?

Telehealth is becoming increasingly used to provide therapy services. Thinking outside the box, problem solving, and learning through trial and error are vital to provide effective treatments through this platform.

Check out AOTA's resources on telehealth. To be considered for inclusion in a future telehealth Q&A, email jcason@spalding.edu.