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Speech Language Pathologist: Conversion to Teletherapy

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Speech language pathologist Jessica W
Jessica W,
California

“I’ve never been interested in doing teletherapy. I realized that this was not going to be just a week of closing, it's going to be a long time. I started panicking a bit; I still have all these expenses, but I don't have any income anymore. So I begrudgingly did some professional development courses and have found it to be a lot better than I was originally expecting.”

Jessica is a licensed Speech Language Pathologist (SLP), who started Ocean Beach Speech, a private speech therapy company in San Diego, California. Prior to starting her own business, Jessica worked in a school but wasn’t fully satisfied with how much she could do to help the children. “You don’t get to see the kids individually as much and you sometimes can’t provide as much support as you would like.” She wanted to do more so she started seeing some early intervention clients on the side, mostly children three years and younger who weren’t talking yet. She found that she really enjoyed the freedom and the direct interaction with the parents.

As Jessica continued to grow her side practice, she began to wonder if she could make it on her own. Her initial plan was to slowly reduce her hours at the school while she picked up more clients, but the school had a full-time work policy that did not allow her to reduce her hours. With her fiancé encouraging her to take the leap and providing a small financial safety net, she left that full-time job, found a part-time job at another school and opened her business.

At the beginning, Jessica was driving around to clients doing in-home therapy sessions but as her client base grew, she decided it was time to open an office and found a perfect space in the heart of Ocean Beach. The increased overhead was a struggle at the start where she only had a handful of clients every week and was losing money. However, the clients continued to slowly build until last summer when she filled her caseload and grew beyond her capacity afterwards.

I was seeing about 16 or 17 kids a week within the three day, three or four days that I was at the office. I decided that 15 is my limit for being able to maintain the business side of everything and see clients. I was getting to the point where it was getting overwhelming. I was working every day until eight P.M. and then up bright and early the next morning trying to get everything ready. I just couldn’t keep up.” So she hired another therapist, right before the pandemic started shutting the country down.

With the pandemic growing around her, Jessica was worried for her high risk clients, those with conditions like asthma, illnesses or other disabilities. She wasn’t sure what she should do as she watched schools start to close around her. “I canceled a couple of my clients and then a couple others canceled. By Monday of the next week, I was still technically open, but I only had one out of six clients actually show up at that point. I just thought, I’m gonna close my offices. It’s too stressful to try and keep this open.

It didn’t take Jessica long before she realized that the closure was not going to be short-lived. She needed to find a new way to earn her living so she began taking courses in teletherapy, which she hadn’t been interested in before the pandemic. “I was pretty grumpy about it, not really wanting to do it but trying to keep an open mind. I’ve learned a lot of tricks and different ways to keep kids engaged, which has been the biggest hurdle. I feel like I’ve gotten better at doing it and better at trying to find different things to keep it interesting. I’ve learned from different SLPs who’ve been doing this for years. I learned about getting a green screen so we can play games with the items in the background. It’s been a learning curve, but it’s not been as bad as I initially thought it was going to be.

Upon the switch to teletherapy, Jessica hoped that her regular clients would come right back but it ended up starting much slower than anticipated and thus her income was slow to return. Teletherapy is just not practical for all children, specifically the young ones. So the clients built back up slowly but most did come back eventually and by June she was nearly back to her pre-pandemic capacity. She also had to figure out the pitfalls of getting insurance payments for teletherapy, which have caused delays in getting paid periodically. So she’s lost a significant portion of her income for the year due to the pandemic that she doesn’t anticipate getting back even though she is now back in the office part time.

Jessica was able to reopen her office in mid-June but being back in the office has come with its own set of obstacles with all the new Covid-19 guidelines and the concerns about getting the virus. She wears a face shield, but cannot always wear a mask since the children need to see her mouth. It’s hard to do speech therapy when you cannot show how to talk. Additionally, any toy or surface that wasn’t able to be wiped down was removed so now her office is more empty, which some kids may not like. Most of the children she works with are too young to wear a mask so while their experience might be the same, Jessica has a greater risk of contracting the virus. Also, now that she is gaining back her clientele, she is trying to give some of them over to her part-time therapist but that adds to the stress. “I’m just nervous to have somebody else in the office. I have another assistant who works a couple hours a week doing some things from home or something in the office. So she’s there sometimes, but she’s always in the waiting area.” With all the precautions, her week is now three days in the office and two days of teletherapy.

While Jessica continues to find the balance of in-person therapy and teletherapy during the pandemic, she postulated on how teletherapy would impact her post pandemic world. “If the pandemic ended today and I could go back full time to my in-person services, I would consider doing some telemedicine still, especially clients that moved away. Normally I’d be limited by who is going to drive to Ocean Beach for services. Now I can see anybody in the state, which are really only options through telemedicine. I might continue on with it after this is all over, especially for current clients that wouldn’t be able to make it into the office and if they would also allow me to hire more employees to do telehealth service.

This speech language pthologist has learned how to evolve in the pandemic world to keep her business open.

Read more on innovative solutions with how a mom opened a K-4 virtual learning daycare center.