Blair Gordon
Nov 26, 2020
Updated: Sep 20, 2021
As telehealth becomes more prominent across different settings, the therapist-facilitator relationship is more important and varied than ever.
Facilitators are incredibly important when it comes to the success of the client and they play a vital role in teletherapy. The facilitator can be anyone, from the client’s parent, caregiver, teacher aid, student support specialist and so on.
With many parents or caregivers now stepping into the unexpected role of facilitator, without any training or experience, it is important to establish norms and expectations. Whether or not someone has any previous experience in such roles, it could be very helpful to ensure that they have a baseline understanding of what is expected of them. Knowing expectations and boundaries will be very helpful for getting the most out of therapy sessions. In this article, I’ll go through a few ways this is important.
As an occupational therapist (OT), when using facilitators, always make sure you are aware of applicable state policies and regulations (US-specific). It is extremely important to make sure the facilitator is properly prepared and knows expectations beforehand, so they can be as effective as possible during the therapy itself.
When practicing telehealth as an OT, having a facilitator can be the difference between a struggling or successful client. They play a critical role in promoting the attainability of teletherapy programs in schools and they allow conducting teletherapy sessions with certain populations to be much more fluid.
When the therapist is not physically present with the client, the facilitator plays a variety of important roles to make sure therapy stays on track. It is important they understand what those are, just as well as the therapist does, so the patient can achieve their full potential.
For example, some OTs worry about holding telehealth sessions because they are afraid they won’t be able to address mobility issues the same way with telehealth. While there are certainly limitations to practicing telehealth, many of these limitations can be overcome by an OT familiar with how to approach teletherapy, with the help of a well-trained facilitator.
It is also often believed that clients with complex comorbidities are not well-suited for teletherapy. However, these patients are sometimes the ones who see the greatest benefits. Teletherapy is also a great solution for those with autism, can be good for individuals with Down syndrome who are learning to use an AAC device, and individuals with severe behaviours.
There are a number of areas that are not well suited for work via telehealth, even with a good facilitator. While in certain situations this can potentially be done with a good facilitator - such as when there is no other choice, due to isolation imposed by COVID-19 lockdowns - these are not going to be a typical approach. Some of these include:
Transfer training
Balance activities
Neuro re-education
Hand therapy
Other acute rehab situations
Considering if a patient is a good fit for occupational therapy online? Here are some questions to consider about the patient’s ability level:
Are they able to sustain attention for a reasonable time?
Do they have any visual impairments and how severe?
Do they have any hearing impairment and how severe?
Do they have any cognitive deficits and how severe?
How comfortable do they feel with technology?
Do have a good support system or potential facilitator (e.g. family, a caregiver) at home?
Do they have any sensory issues and how severe?
Do they have any behavioural issues and how severe?
Do they have limited fine motor skills?
In these cases, having a facilitator can be incredibly helpful, because they allow the client to receive treatment with on-site assistance without having to go anywhere, which might otherwise be very challenging, or not possible.
To make the most of the facilitator-therapist relationship, it is important to communicate effectively and set clear expectations upfront. The facilitator and OT have to be able to work in unison as a team, to ensure the client is successful. To kick off the relationship, make sure both parties understand the following:
The common goal, which is to help the client be successful
What the facilitator’s responsibilities are and what the OT’s responsibilities are
How the OT will communicate various messages when needed throughout training
Make sure the client is attending the session on time, assisting with the process of logging in and getting started
Must be comfortable and competent with technology and help with any unforeseen technical difficulties, troubleshooting with video and audio equipment if needed
Manage the client’s schedule and help them navigate obstacles that might impact their attendance
Coordinate with the OT during sessions, to make sure they understand what the client is working on and to ensure the client is completing their activities
Form a strong relationship with the OT and be able to communicate openly with them
Have knowledge of (and sensitivity to) the clients’ cultural and linguistic differences and be aware of how these differences might influence the client’s participation
Must be organised and understand how to communicate progress, questions and challenges, between the client and the OT
Must be capable of giving clear direction to the facilitator, so that they understand which activities the client must be completing
Establish certain expectations before sessions begin, such as cueing and behaviours, reward systems and forms of physical support
Be able to build a working relationship with the facilitator
Clearly communicate client goals and expectations, so that the facilitator is on the same page
Must make sure the facilitator is adequately trained and capable of assisting during sessions
While it is important to keep the therapist-facilitator dynamic professional, it is equally important to treat the relationship as a relationship. Transparent communication, openness and expressing appreciation will take you far.
It is also important to build rapport, just as you would with a client. This brings the therapist-facilitator relationship to a human level, where you will be able to connect and begin to feel comfortable working together. Get to know each other and don’t be afraid to ask questions. The more comfortable you are working together, the more comfortable the client will feel during sessions.
Be empathetic when speaking with each other and use nonverbal behaviour to express that you are listening and engaged. Small things - like leaning in, nodding, making eye contact and being conscious of facial expressions and gestures - can go a long way. Through clear communication, expressing your appreciation for each other and the work you are doing and being genuine with one another, the alliance you form will be effective and transformative for your client.
Lastly, always address the relationship and set expectations when you feel as if you are not on the same page. Discuss why it is important to both have the same understanding of your roles and build a strong alliance. Ask how they are feeling and invite feedback throughout your time working together. Discuss goals and check-in with them frequently.
Make your facilitator your greatest asset. Having a facilitator during teletherapy sessions can be an incredible asset for OTs, if they know how to develop a strong relationship and make the most out of it. Sharing the common goal of helping the client be successful is a great foundation to build from. Implement these tips and watch how your relationships become more meaningful and your teletherapy practice becomes more effective.