Telehealth to In-Person: Rocking the Boat

At the start of August, I made my second major decision in my career. Starting EI full time! While it should have been exciting… duh, I’d be playing with babies all day… it was actually more nerve wracking than anything else. We’d been living in unsure times as a result of the global pandemic that riddled my life with broken self-promises, economic instability, emotional and mental stressors, etc.

My introduction to EI was not a great one. I began back in March on a rocky path on which everything I had trained for (in-person services) was switched up and next thing I know, I’m seeing my first children over a phone screen. The logic is essentially, “easy, I can do this from the comfort of my home and I don’t even have to wear pants (TMI) if I don’t want to”. I hated it. It seemed like the most useless way to connect with babies – they couldn’t even sit in front of the camera properly!

Slowly but surely I got a grasp of working with the parents and being flexible about my approach to applying techniques and stimulation over telehealth. Interaction with the camera was less and less important to me, as I became better at guiding the parents to do what I couldn’t. However, an even more difficult task than carrying out the session itself, was getting families to show up for the session. I received cancellations out the wazoo, and it could be for any variety of reasons – the child is napping, the battery isn’t charged, the place is too loud, the dog ate their homework and then a whale swallowed all the pieces ro their alphabet puzzle. You name it. Being in the midst of a pandemic, I tried to be understanding of crazy work schedules, and would change, reschedule, or switch around activities in my own life to make it work. Still, I was left hanging so frequently that sometimes I would only see 1/10 of my sessions planned for the week. When I was transitioning into EI full time, I went in with a dollar and a dream hoping that my in person experience would be different than what I had with telehealth. Thankfully, It turned out it was a complete flip of the switch. Even my telehealth cases got better, but they weren’t numerous for clear reasons. Making my own schedule came with great perks, but it was a bit of a headache when subtle changes or obstacles would throw everything off! Traffic, bad parking, or a bit of untimely gas…

I was at my best when I chose cases that were extremely close together and gave me time to navigate one neighborhood before moving onto the next. The give or take 15 minutes rule had to come into place after I got tired of apologizing for being late. It turned out I wasn’t the only one with this kind of rule. The PT treating one of my babies commuted from Staten Island to Brooklyn, and bitterly apologized, explaining that he had a give or take ONE hour rule, for which he effectively ruined my morning schedule.

I was also at my best when I followed a rigid organization schedule. I tried to keep up with a log to track every single bit of my spending  (miles, gas prices, parking fees, materials prices) for hopeful reimbursement and write-offs around tax time. I made it a big deal – after reprimanding – to have session notes written, signed, and delivered on time, and to ensure each note was free of error (see: The Billing Crisis).

Honestly, even at my best, I still struggle with the in-person transition. I loveeee my kids but each day I struggle with the fact that I am not getting paid like someone who is now doing real work!  If anyone tells you they’re in EI for the babies, and not the money, they’re trifling and lying all at the same time. EI money is just as beautiful as those little smiles you create… or so I thought. Getting into EI under an agency meant a need for having cushion money – which I didn’t… incredible organizational skills – which I didn’t… and a desire to work twice and get paid once – which, I mean come on now!

Telehealth was a steal and I didn’t even know it until I was transitioning to in-person. Still it isn’t quite my teaching style. Although I’ve maintained a couple of my telehealth cases, I still find it rare to have a session that feels whole, or even truly progressive. For about half of the time, I am observing play with only intermittent commentary or question. During the other half, I am giving more structured activities for the parent to carry out and giving feedback and suggestions more frequently. I don’t have my babies doing anything interactive over the screen because they aren’t suitable candidates for this approach… actually, so far, only one child has proven to be. And that’s okay! With the way things are going in NYC, telehealth is still a very viable option. While not quite the best option for me for this population, it offers a way to better manage time, money, and materials. I’m sure we can also agree the best kinds of freedom include a bedside workstation with no traffic, nor pants or socks required.