Episode 71: Where To Provide Therapy

Quick Disclaimer all information, content and material of this podcast are the opinions of the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or medical treatment of a qualified healthcare provider. Welcome to the Untethered Podcast. I'm your host Hallie Balkan. I'm a certified orofacial myologist, feeding specialist, SLP and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional therapy, oral tissue and airway space. I challenge you to keep an open mind and join my mission to get this information out to the masses. Let's get started. Quick Disclaimer all information, content and material of this podcast are the opinions of the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or medical treatment of a qualified healthcare provider. Welcome to the Untethered Podcast. I am your host Hallie Balkan. I'm a certified orofacial myologist, feeding specialist and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional therapy, tethered oral tissue and airway space. I challenge you to keep an open mind and join my mission to get this information out to the masses. Let's get started. Hi, welcome to episode 72 of the Untethered Podcast. It is your host Hallie here and we have had so many requests lately about where to provide private therapy that we decided to extend the little mini business training and do one more day of it. If you have not participated in or listened to, I should say any of the mini business training episodes that we've done over the past two weeks, we had a series of six, so definitely go back listen to them. They're shorter than our typical episodes but jam packed full of great business tips and information that's going to help you move the needle forward. So definitely go back and listen to those. If you're somebody who is interested in either starting to see private clients or building your private practice or just, you know, getting out of your own way and make things happen. Definitely a series you're going to want to listen to. Do not miss it. The other thing I want to tell you about real quick is we if you're listening in real time when this episode launches, we are actually launching the MYO Membership Free training today. It is a training to help you scrapbook screen your first, myofunctional therapy patient using our Fast Myo screener which you can get@fastmyoscreening.com and then you're going to immediately want to go to the myomembership.com so that you can get all the information you need and be on the email list to get reminders for the free training we're doing this week. So make sure you get into the group, the Facebook group where we're doing the training. Look up the Myo membership. I want to upload my Mayo game and be in there. Right. You will see me screen my 5 year old, newly turned 5 year old who has her ALF appliance that will be coming out soon and who has had a tongue tie release in the past but who still has a few things we're working on from a myofunctional and speech standpoint. So definitely get yourself in the group so that you can join us this week as we go live and do the training. Nothing has been pre recorded as far as that training goes. We're doing it all live. So join us. Love to have you. All right, so let's jump right on into today's topic and discuss locations for providing therapy. Now I think the question came up because a lot of you who follow me here, a lot of you who are also in the Facebook group or one of my two Facebook groups, have mentioned that you traditionally provide therapy either in a clinical setting or in a home setting or in a school setting and you're not quite sure how to make to switch to the opposite setting. Right? So some of you are doing early intervention, you're not sure how to make a switch into a clinical setting. Some of you are in a clinic and you're not sure how to make a switch into the home setting. And so I just first of all want to just mention to you a variety of settings where you can provide therapy, number one. And then number two, we're going to talk about how you might make the switch over into one of these other settings. Okay? So number one, especially given a pandemic, if you're listening to this live and depending on where you're located, teletherapy is huge right now. So many people are engaging in teletherapy simply because people are, you know, there's quarantine to worry about. And the type of work that we do requires us to be in our patients faces very up close and personal and it could be really easy to transmit something. Right. And it could be very difficult to do therapy with a mask on. Because we really need to see the face or we might have food or drinking involved in the therapy that we're doing. So definitely some extra challenges. But we can remove some of those challenges by doing teletherapy. So that's a really great option. And that's primarily what I've been doing for the past five months now. Almost six months, I guess. My goodness. But I was actually doing teletherapy before the pandemic. And so if you're in my, my Feed the peds free group on Facebook, there was a free training that I did on teletherapy, like making a switch to teletherapy. So I'm not going to go into all that nitty gritty stuff here. Definitely get into that Facebook group and take a listen, watch, whatever, as I just walk you through the topic of teletherapy and how to get started. If you're someone who has maybe been off the summer and you're needing to learn how to get going with teletherapy, that would be great for you or if it's just an option you want to offer in your practice long term. Because we, like I said, we were doing it before the pandemic. So it's definitely a great option to have, especially right now, now if you're going from a clinic, right? So we could, where could we even provide therapy? Well, we know, we talked about teletherapy. We could be doing in home therapy, we could be doing in office therapy. You could have an office inside your home that patients travel to. Maybe you're going into the public schools. Maybe you're going into the private schools. Maybe you have an arrangement with a private school where you have a dedicated space within that private school and you' it's a large school and you treat a, you know, you treat their children in that school, their, their students. And then maybe you have a similar arrangement with another school and that takes up a lot of your time during the day to make up a big chunk of your caseload. Maybe you see patients in public settings and you, you rent the free library space. Right. Always have to be careful with certain public settings, just from a HIPAA standpoint. But they can work and people do use them. And I've even seen therapists, including my own team, getting really creative right now where they're doing outside therapy, whether permitting to be able to be around the child but to be an open air, right. And then they're making sure that whatever materials are brought and all that fun stuff is something that can be easily sterilized sanitized, you know, all that fun, all those fun things and. Or the families providing things that then they will take back and clarify, clean and bring back, you know, for the next session. So we're not getting into the whole topic of sterilization and sanitization, all that fun, you know, all that fun stuff right now as far as therapy goes and the pandemic. So I don't want to go off on a tangent there, but what I do want to focus on is how do we make a switch when it's not something we've previously done before? And if you've listened to some of the past episodes that I, that I recorded this week, you will know that one of the things that I said was let it be easy, okay? If you were in a private setting, and let's say you're just used to having a therapy closet, right? And you're used to being able to run to the therapy closet and grab whatever you want. And then, you know, you're used to also having, like, tools at your disposal that you can just go dump in the kitchen or the sink or wherever you leave. Tools that need to be sterilized, you know, that's going to look different if you go into a home setting. But there's always a way to make this change and make it very functional and effective. So before the pandemic, for example, if I were to go into, let's say, a preschool or even a private patient's home, what I would bring with me looked exactly the same when I was traveling to somebody. So don't overcomplicate it. Whether you're going to a patient's home, you're doing an outside session, something somewhere in public, or you're going into a school, right? Or a daycare is another place, it can all look the same. Like those five scenarios can all look the same. Now, obviously, if you're working out of your own home office, that might be very similar to a clinic, right? Because you have different levels of access to things, you may have more tools at your disposal, and you may have the ability to just quickly move something like out of your office and into an area where it could be sterilized later versus traveling. Right. So I kind of want to chunk it into just two different settings. One where you're stationed somewhere and versus when you're on the go. Right. It doesn't matter exactly where you're stationed per se, versus where you're going on the go. But I think if we make it simple and we think about it in that respect, it'll just make it. It'll make a lot more sense. Okay, so again, the pros of being in an office are you've got lots of tools at your disposal. You can take whatever you need to sterilize and drop it in the sterilization bin or whatever, you know, for cleaning. Later, you might have the ability to run to for a quick bathroom break or to sit down to the computer and type up a note real quick while you're waiting for your next patient. Or you know, there's definitely going to be pretty pros, right, to being in that setting now. There's always cons too. I'm not really going to go through a big pro con list on both per se. I'm just kind of looking at like, what do you get in one setting versus the other when you're on the go? I love it. It's a change of scenery. So I really, I'm not doing it anymore. But when I did travel to my patients, I really enjoyed the change of scenery. I really enjoyed, you know, the interacting with different people throughout the day. You still get that in a clinic setting, but it was just a bit different. The benefits too can be that it really forced me to become a more creative therapist because I didn't. Even though I had the nickname of bag lady at one point in my life, I really tried to cut down on how many things I was carting around with me when I was doing therapy on the go simply because one, I don't want to, I didn't want to like injure myself trying to lug all this stuff around everywhere. But two, you really. I had a teacher in grad school who said to me, the best therapist can do therapy out of their purse, right? And she was like, open your bag, like what? Pull out the first thing you see and now do a therapy activity with that. And that just kind of made me realize that it's not about the activity. And we spend so much time as therapists building activities that 50% of the time, let's be honest, the kids are not into or it just doesn't go as planned or it's like, throw that by the wayside, let's do we're going to do something else. Pivot, right? So I quickly became that therapist who I always joked that my therapy sessions were kind of boring because I'm not the one who shows up with like a ton of pre planned materials. I have them, they are sitting in the bottom of my closet over here in my office and they've been there for quite some time collecting dust. I haven't gotten rid of them because I like them, but I don't use them. Okay. I'm not the therapist who gets on and uses boom cards. I'm not the thera teletherapy. You know, I'm not the therapist who gets super into using all different kinds of like, games and fun things on teletherapy. No, I'm the one who might pull up like some pictures if we feel like we need them, but otherwise it's like whatever mom and child has on the table in front of them and whatever I might have on the table in front of me, and we just go, okay. And we've been very successful with that. Now, I'm not knocking you. If you're somebody who loves using boom cards and if you're someone who loves having all kinds of like, you know, different vers. Platforms and options and games and whatever, by all means, like you do you. That is awesome. I just don't have the patience for it to pull it up. And quite frankly, I'm also working on a lot of like, more like oral motor type things, feeding type things, myo type things in my session. So I don't feel that I have that need or it doesn't feel like a mandatory requirement of my online therapy that I'm providing, if that makes sense. So anywho. So definitely, you know, there are definite pros to traveling, and another one would be being in that child's more natural environment. I always felt like when I was traveling to the child, I was able to work on a skill with me and then immediately transfer it to a more natural environment with that child for that child, which I think is really important because I know sometimes one of the biggest complaints that we would receive from families is that when children go into a clinic and it's not their natural environment and they do. They do what they do there, they don't always come home and demonstrate the same skills at home. Right. It doesn't. They have a really hard time generalizing the skills to home or school. And so for me, that's. That's one of the reasons why I set up my business the way I did traveling to families, because I wanted to provide therapy in the child's natural environment, follow the child's lead while still achieving all of the things we had on that child's treatment plan. So I really think we just kind of need to get out of our heads a little bit and realize that you can do the exact same therapy whether you are on Teletherapy, whether you are traveling to the patient or whether they are coming to you, whatever the setting is. The setting is less important than what you're providing as a, like a speech language pathologist or an OT or a myofunctional therapist or whatever. Right. It's more important that you have the skill level to know what you're treating and why you're treating it, and you understand how you can take this child from point A to point Z. Right. But the games that you use to get there, they're just games. Right. And the logistics of delivering the therapy are really not that different. Right? Yeah. Okay. Being online is a little bit different than being in person, I will give you that one. But teletherapy is just as effective and in some cases with some of my patients, more effective than in person therapy. And I was able to dismiss a big chunk of my caseload because they made some tremendous progress over teletherapy, whereas a couple of them had halted in in person therapy. So maybe it was just a change of scenery, maybe it was a change of delivery, you know, delivery platform, I don't know. But what I'm basically telling you is these delivery models, like the locations of where you travel to provide the therapy is not as whether you're traveling to them or they're coming to you or you're doing it online as having the skills necessary to understand what therapy you're delivering, why you're delivering it, why you're doing what you're doing. That is really what we should be focused on. So I hope that that helps just to give everybody a little bit of peace of mind. Because I know that a lot of questions I got around this, like I mentioned at the beginning were surrounding like, hey, you know, I've been in a clinic since forever and now I'm switching to like going into the home setting and oh my gosh, I don't know what to do and I'm not really sure what to do. Well, I will tell you that whatever guidelines and boundaries and rules and all that stuff you did in the clinic, pretty much all of them apply in a home setting. So for example, right, you have, let's say you're doing a 50 minute session, okay. And that the parent wants to talk to you at the end of your session. Well, if you're in a clinic, you're going to have a rule that that's going to somehow either be built into the 50 minutes or maybe you have a 5 minute slot designated for like right after the 50 minute ends keep in mind, if you're traveling to somebody and you need to a lot for travel time between sessions, it might behoove you to include your chat with the parent in your session time. Right. That's what we did. If the parent was present, we would have that conversation with the parent or the teacher or the nanny or whoever was present during the session time, not after, because we had to get in the car and go to the next place. I also, this is another big tip. I used an electronic medical record system. It has an app where you can do the notes and I would do the notes during my session time. So at the end of the day I would go home and just download them and email them through a HIPAA compliant email address to my families, especially those who are not present for the sessions. Okay. So I just want to make sure that everybody realizes, like it can be done and can be done pretty easily, but you might have to set up some boundaries. And I can give you a laundry list of like my rules and Boundari and things that I did, but you're going to have to figure out what works for you. Okay, So I just gave you a couple ideas and those were one, do your session notes during the session. Two, talk to the parent or caregiver during the session, like at the, in the last five to ten minutes of the session. And then make sure you're, you're also leaving yourself enough travel time between sessions. Keep that in mind so that you're not constantly running late to the next appointment. But that would really be the biggest thing. I mean, I think that in home therapy you've got their toys or, you know, whatever they have present to use. And so you can fully use those things instead of having to plot your own materials. And then you don't really have to sanitize afterwards. If you're using what they have in the house, you wash your hands before you leave and you're done. So that's great. So, you know, I would, during the pandemic advise you not to carry around any tools that go in the mouth. I would require families to purchase those if that is necessary for therapy or something that you're recommending. I would figure out a way to do the therapy without the tools, which is entirely possible. You could use food instead of tools sometimes depending on the kid, or maybe there's a tool or two that the parent could buy that could work for a variety of things. Just think about, like, what can you do to take some of this stuff off your plate? Because I used to travel and I would have a kit for each kid and I would come home and I would sanitize things. At one point it was maybe like a couple kids a day who I was seeing for the oral motor work. It wasn't all of my patients, so it didn't seem extremely overwhelmin. But in a pandemic, I would not advise that you bring tools that have gone into a patient's mouth, into your car, into a vehicle while you're traveling. Because we don't really know enough about this virus right now to know, like, one, is that safe? And two, like, I mean, just really when is it safe? Is it safe? Is a big question. And it might be, but reduce your exposure the best you can, especially since you're then going to another patient's home and maybe gonna be working with them, right, with your gloves on and your mask on and possibly working in their mouth. You know, we wanna avoid our own exposure, but we also wanna avoid passing on any germs. So whatever you can do to make sure that happens, you know, have the family purchase what they can and, or whatever the bare minimum is that you need to do your therapy and have them be responsible for cleaning it between sessions. Remember to bring your gloves. Keep those, you know, handy. And your mask, of course, and a face shield if you, if you want. And again, this is not supposed to be like a, you know, a PPE or Covid type of like sanitization, sterilization episode. But I think it's important to discuss, you know, on very basic level for those of you who might be going to see patients in person, whether it's in office or home right now. So one of the other things that came up that wasn't specific to location per se, but was about marketing to families and getting clients. That's definitely a topic for a different episode. But this person also asked about how do you know when you have enough experience and training to begin seeing patients independently? My question for you is, one, are you doing continuing education regularly? Right, because that is how we grow our skill set. And two, if you're not a CF anymore and you are practicing independently, like, how much support are you getting in your current environment? Are you, do you have somebody present for every session? Do you have somebody present for 25% of your sessions? Do you have somebody present? Not at all like. Or maybe there is nobody present is probably the better way to say that. So if you don't have somebody present for your sessions currently and you're treating independently, then you can take on private clients. You don't have to go full blown and have a full caseload. You could start with just a couple on the side and like build up, you know, as time goes on. But there's no hard set rule about like how much experience you have to have and how much training you have to have to begin seeing patients independently, on your own, like on the side or even in private practice. Full blown, full caseload. But I would advise if you're somebody who enjoys being around mentorship, which I think is super important, and you're getting that in your current work environment, then it might make sense to stay there a bit longer while you build your skill set. But if you're itching to get into private practice and you feel like you can practice independently and you can then, you know, meet some colleagues, bounce ideas off each other, but also, you know, or seek out some other type of mentorship while also doing your continuing ed, by all means, like, go for it, right? There's no hard, fast rule. So I wanted to just touch on that because I think that. But in addition to overcomplicating things, one of the other things that I talked about in this series that we just did is self worth. And I think that we have to recognize that when we are competent and we have confidence, right, these things build up and we also have a sense of community around us. These are all things that are going to help us kind of stand in our power, make us feel like really great therapists and that we can go out and conquer the world. Ok, so I want you guys to empower yourselves and figure out like, what do you need to, like what is the minimum you need to put in place? And remember, there's, there's all kinds of people out there who teach things about like opening a business in the business world or, or growing certain businesses or whatever. And everyone's going to have their own methodology and their own experience. So what that is for you might be completely different. For me, I was in the schools for three years because I got stuck there and had a contract and want to fulfill my, my responsibility in that contract. So I did that. I was miserable, did not enjoy it. I then took eight months off. I worked for a private practice for a year and then I opened my own private practice because I was, you know, it's funny because I was going to wait until after I had kids and I actually had a patient say to me, they were like, no, don't wait, do it now. Like, go, go, go. Like if you wait till after you have kids, it might not happen. Or it might happen, like way later than planned. And I was like, huh? And then I opened my private practice and I got pregnant, like within, I think five months or less of opening doors to my private practice. I think it was five months. And so I was like, hot jokes on me. I started the private practice and then I. Then I had kids, like, immediately. But no, the whole point of me sharing this with you is just that there is never going to be, like a right time to do something like this. There's never going to be a right time to start a private practice, to grow a private practice. You're never going to feel like you have enough time to do it. You know, when you work a full time job and then you have any other life commitments, you're busy, right? But we make time for the things that are important to us. So just figure out, is it important to you to start seeing private patients now or not? Do you want to do it now or do you want to do it a year from now? Like, what does that look like for you? And be okay with whatever comes up for you, whatever feels right for you, whatever you want to do, then go with it. Go for it. And just try to keep the process simple when doing so. And keep in mind, you can practice out of your home, online, in a private school, in a public school, in the patient's home, in a clinic. You know, maybe you rent a space in another medical provider's office. There are so many options of where you can provide therapy. You could even do it outside weather pending. You know that don't get all caught up on like, oh, I only know how to do it in one setting. I'm really nervous about moving to another one. Just until you, you know, everything feels uncertain when it's new. So as soon as you get out there and you just do it once or twice, you're gonna be like, all right, I got this, I'll figure it out. Right? And you just figure things out as you go tweak things along the way. This is kind of, you know, I'm not always a rah rah, rah person, but like, this is my little rah rah rah for you. Like, you can do it. Get out there. Just do it already. No, but really, we need more therapists out there treating patients. Patients would love for a therapist to be coming to them right now, even with the pandemic. So keep that in mind. We get calls all the time for in person therapy, despite the fact that we're in the middle of a Pandemic. And we can technically send therapists out right now based on our level of, you know, I don't even know what level we're in anymore for like how open we are in our quarantine levels. But technically we can send patients, we can send therapists to patients homes. So just understand like what your local community is dictating in terms of quarantine levels, especially right now. If you're listening to this later, then that might not matter a year from now, but that's where we're at at the moment. And yeah, just remember there's them coming to you or you going to them. Right. Everything kind of falls into that category unless you're online, which is our third category. And just think of it in simple terms of what do I need with me? Like what is the bare minimum I need with me in order to travel to them? And then that's going to be obviously different than what you have at disposal when they travel to you for therapy. Think of it that way. Keep it super simple like I mentioned and use some of the tips I've shared with you here today. Like an EMR that has an app on the phone where you can do your notes during the session, you talk to the parent during the session, and then you build in enough travel time between sessions to make sure that you can be on time for your next patient. I hope this is helpful. I know that it's not the most exciting topic, but we had so many questions about like locations for therapy and when to get started that I just, I really wanted to give you guys a little bit of encouragement because I feel like this is one of the easiest topics that we could probably talk about and one of those really easy things that we can keep simple and just kind of push out of the way while we focus on some of the bigger discussions as to taking on private patients or growing a private practice. So I hope this is helpful. I enjoy chatting business with you guys. So if you ever have more business questions, feel free to send them to clientcareadthepedes.com and we will definitely consider them for future episodes if you like I mentioned at the beginning of this episode. Want to join us for the free training this week? Five days to screening your first pediatric. Well, it's just pediatric but orofacial myofunctional therapy case is what I should say. Definitely. Join us. You can go to fastmyoscreening.com to get the myo screener and the myomembership.com will have information on when we reopen doors for the MYO membership Doors will be reopening. So just so we have all of our dates clear, the training is happening between August 24th and August 28th, 2020. And then we will reopen the doors to the myo membership on August 31st and they will close on August 4th. Okay. At midnight. Now that is important information because I'm not sure that we're going to reopen the MYO membership up again until 2021. And we have an awesome so I taught the first two months in the membership, but we have an awesome lineup of individuals coming in to teach continuing ed courses for the remainder of the year. Actually they're lined up through February. So in September we have Angie Lehman coming on, she's an RDH comm. We've got Ken Hooks coming on to talk about sleep studies in October we've got Autumn Reed Henning coming on slp. Com ibclc she'll be on in November and she's going to be talking about pre and post op frenectomy. Frenectomy content. Good stuff there. We're going to have Patrick McKeown from the Buteyko Clinic coming on in December to talk about Buteyko breathing. We're going to have my local dentist, I know at least one of them, possibly Both of them, Dr. Jen Tippograph and possibly Dr. Kim Baref to confirm with them coming on in January to talk about different types of types of growth appliances. And then I have Cheryl Shaver who's a dear colleague of mine coming on in February. She's an RDH comm. She will be on in February talking about the effect. I think goodness it is mal. We just decided on the topic but OMDs and malocclusion basically. So she'll be talking to us about the effect of malocclusion and orofacial myofunctional disorders. Anyways, all of these details are going to be on the website soon. So if I butchered something it will be there for you@themiomembership.com during the week that we open the course August 31st through September 4th, 2020. And again, we've already laid out who we have on over the next six months. So it's entirely possible that because I'm homeschooling my child this fall, like my kindergartner, wish me luck, I might not reopen this. I may not have the capacity to go through another launch and reopen doors until January. So if you're thinking about getting in, this is a great opportunity to get in. You get more than just CEUs. There are four pillars to the MYO membership. And the best part about it is you normally would pay what you're going to what we charge for just the CEUs. In addition to the CEUs, you also get research reviews. You get a monthly business training, and you get. And that's also monthly research reviews. Everything is monthly. And then you also get a virtual study club, which is awesome because so many of you have told me that you just can't find people in your area. So let's all come together and study some cases together. You'll be able to potentially submit your own cases if it has to go through a process of HIPAA compliance and all this other fun stuff. But you may be able to submit your case for review in the MyO membership. We will be doing a case together each month and be studying it together as a group, which is awesome. I'm really excited. The other thing I'll mention too, if you're considering joining, is that you will have access to everything that we did in August and July. And August. In July, we deconstructed the orofacial myofunctional evaluation and even did a self evaluation for our study club. Then we also created an entire myofunctional therapy assessment tool with a ton of other bonuses that I probably can't even remember, but I just keep adding things for the group because they're so fun. And then in August, we went ahead and pulled together all the results from the live evaluation that I did and the training that I did in July. And we made sense of all of the findings to then pull together to make a comprehensive plan and treatment, basically treatment goals for the cases, the two cases, both an adult and a pediatric case. So again, we had so much fun this week. We'll be doing our myostudy club and I will be assessing Lilly for a pediatric evaluation live. But you guys will have all access to all of these recordings when you join next week. And you'll be able to go back and watch all these things, plus have a ton of marketing tools and report shelves and all kinds of fun stuff that I popped in there for them already. So again, if you have any questions, feel free to email us@supporteethepedes.com if you have questions about the MYO membership. If you want to talk about any business ideas for future podcasts, email me directly@clientcareadhepeds.com and I cannot wait to see you in the training this week. Get in there. The Facebook group again. Is Feed the Pete. No, no, not Feed the Peas. It's the Mayo membership. It's the Myo membership. I want to up level my Mayo game. I'll see you in there. Can't wait to have a fun week with you all. Chat with you soon. Thanks for listening to this podcast. If you want to hear more of these Myotots, Airway and Feeding related episodes, be sure to leave a review on Apple Podcasts or pledge a small amount on patreon.com forward/the untethered podcast. If you found value, others you know in this space will too. So be sure to share this episode on your social media platforms and join us over on Facebook on my Facebook page at Hallecan Biz, on Instagram at at Hallebulcken. And you can head over to theuntetheredpodcast.com to grab a copy of the Show Notes where you can also subscribe to be kept up to date on the latest podcast episode.