By Laura Thornton
To get ready for Journey’s occupational therapy appointment, her parents, Ahsha and James, set up a laptop and yoga mat in Journey’s room. They click on the secure Zoom meeting link they’ve received specifically for the appointment, and voila! They’re connected in real time—via video conferencing—with their daughter’s occupational therapist. The session begins.
In response to the COVID-19 crisis, Kennedy Krieger Institute quickly expanded its telehealth services to allow patients and students, and their families, to continue receiving health services from their Kennedy Krieger doctors, therapists and other providers. Telehealth appointments take place via Zoom, a videoconferencing platform. It’s a similar experience, providers and families say, to in-person appointments.
Telehealth’s growth at Kennedy Krieger was swift: The week of March 9, Kennedy Krieger conducted 4,773 in-person appointments and 12 telehealth appointments. One month later, weekly telehealth appointments numbered more than 5,000, while in-person appointments were not quite 300. Since then, in-person services have increased, while telehealth services have remained high: In the last week of July, Kennedy Krieger conducted 4,587 telehealth appointments and 534 in-person appointments. The Occupational Therapy Department is just one of many Kennedy Krieger departments, programs and clinics using telehealth to continue to provide specialized healthcare services to patients during the pandemic.
Journey, 7, started occupational therapy at Kennedy Krieger in 2018. Born extremely prematurely, after only 23 weeks of gestation, Journey has chronic lung disease and, like other patients receiving occupational therapy, needs help developing her fine and oral motor skills, and her ability to do routine activities like dressing herself and brushing her teeth. Since September 2019, she’s missed numerous therapy sessions due to emergency room visits and hospitalizations for respiratory illness. Journey’s occupational therapist at Kennedy Krieger, Lori Tolen, knew the Institute’s launch of expanded telehealth availability would be perfect for Journey, especially with Journey’s history of repeated hospitalizations.
I’m so proud of our department for quickly coming up with a way to continue to provide services in such a hands-on profession.”
– Kristin Stubbs, director of occupational therapy for Kennedy Krieger Institute
During Journey’s telehealth sessions, “I help her position her arm, or hold her shoulder,” Ahsha says. “It’s a little workout for Mom, too, but that’s okay. My husband and I follow through with whatever Lori is doing, so it gives her an opportunity to say, ‘Try positioning her this way.’ She can actually see how we’re working with her.”
Observing patients via video conferencing has allowed Tolen, the Institute’s assistant director of occupational therapy, to notice details she’s not always able to see. “I can observe more. I can focus on small hand movements that I maybe couldn’t see before,” Tolen says.
Telehealth services can also illuminate patients’ behavior in their home environment. Previously, parents would tell Tolen about behavioral meltdowns happening at home during daily activities, but it wasn’t until Tolen began offering telehealth sessions that she could see the meltdowns in progress, and could begin to define the triggers.
Kennedy Krieger’s occupational therapists are embracing the opportunity to help patients and families with daily routines in real time. Tolen and her colleagues encourage families to use common objects from around their homes during telehealth appointments. Therapy sessions that include developing the skills needed to get dressed can now take place as a patient is actually getting dressed for the day. Zoom’s interactive white board offers additional engaging learning experiences.
I can observe more. I can focus on small hand movements that I maybe couldn’t see before.”
– Lori Tolen, occupational therapist
“It is such a privilege to be invited into our patients’ families’ homes,” says Kristin Stubbs, the Institute’s director of occupational therapy. “We’ve never been able to be with the child in their home to see the family rituals surrounding the meal or to see their normal dressing routine, for instance. In the clinic, we had to give them a fake shirt to practice putting on. But they want to practice putting on their Superman shirt and Superman cape, and now they can! We can work on bathing, dressing and other routines while in their home to help problem-solve.”
It’s an exciting challenge to work in the home environment via telehealth. “For children, this is helping to develop purposeful play and their daily living roles,” Stubbs says. “We want each patient to have something meaningful and purposeful in their life. I’m so proud of our department for quickly coming up with a way to continue to provide services in such a hands-on profession.”
Before the COVID-19 pandemic, telehealth services were not generally covered by insurance providers. But many are now covering them. Certainly, a positive outcome from this time of uncertainty is that Kennedy Krieger is paving the way for a hybrid model of care that uses both telehealth and in-person appointments to help patients like Journey receive the best care and treatments possible.