Science vs Tradition: How online health can benefit the ECEC sector during COVID-19
COVID-19 has changed the way that many children and families access support for allied health therapies which support children to be successful in early childhood education and care (ECEC) spaces. From speech therapy to general health consultations, many practitioners have taken their conversations and therapy delivery online in an attempt to safely comply with restrictions and manage concerns about COVID-19 transmission.
We spoke with Ed Johnson, speech pathologist, PhD candidate, and co-founder of online allied health services provider Umbo, about how online health care can support and benefit the ECEC sector at this challenging time.
As a clinician who has worked in digital practice (or “telehealth”) for a number of years, I’m not new to the possibilities and limitations of providing therapy online. There is a great deal of evidence behind its use in a variety of different clinical situations and across a variety of different health professions.
However, there are also many critics and sceptics of telepractice who believe it can and should cover only a small niche in service provision. Some believe that if a child has trouble paying attention, has complex and multiple disabilities, or has minimal verbal language capabilities, they cannot do therapy online. But this simply isn’t true, and the research is now clear on the differences between tradition and science.
It’s time to replace opinion with science
There has long been an attitude of negativity towards digital practice from allied health professionals, educators, families, and more. But the issue with this is that these negative attitudes come from opinion, and they simply don’t stand up to science. There is a growing body of literature which supports the effectiveness of online therapy for young children who have developmental delays, physical disabilities, intellectual disabilities, and behaviour support needs.
But technology can be scary – and it’s definitely not perfect – so despite the opportunities to improve, the industry has become comfortable with the tradition of an in-person service that focuses on a 1:1 interaction between child and therapist. It’s common to hear, “But we’ve always done it this way!”, and while this model is definitely effective in some situations, the literature is continuing to show its ineffectiveness in a growing number of contexts.
Also, for rural and remote Australians, the reality is that you often can’t see a therapist in-person even if you wanted to because there simply are none nearby. This has exacerbated the temptation to follow tradition instead of science. It’s so much easier to say, “No, that won’t work for my kid/client/student, so I want someone to see them in-person in 18 months instead of using a digital service right now.”
COVID-19 accelerated change across early childhood health care
At the start of the year, allied health services (occupational therapists, speech pathologists, physios, psychologists, etc.) were visiting kids in preschools as a matter of course. They’d drop in, take a child aside to work with them, and deliver their therapy, as they have done for decades.
After the emergence of COVID-19, an in-person service became less likely regardless of where you lived. In a matter of weeks, allied health practices began to offer their services online, and more and more families, educators, and clinicians became open to the possibility of doing therapy online. Many detractors became advocates of digital practice, and people had a greater choice in the services they accessed.
This change in attitude demonstrated that the resistance to online services in the past has largely been attributable to adherence to tradition, rather than following the large corpus of scientific evidence which now supports its use.
Research has introduced new and more effective therapy practices for ECECs
Through this period, ECECs have begun to access services for individual clients, seek training and upskilling opportunities for staff, and develop partnerships with digital practices in order to provide their families with continuity of care and a more timely service, which we know is crucial in early intervention.
One of the main misperceptions of digital practice is seeing it as simply using Zoom to call a child who’s plonked in a chair in front of the screen. The literature tells us that coaching and capacity-building of the people supporting the child is the most effective way to support children with disabilities in learning new skills. 1:1 therapy with the therapist is largely ineffective in many cases. When we don’t limit ourselves to a 1:1 interaction on video, the possibilities become almost limitless.
Many ECEC/allied-health partnerships are following best practice by coaching educators or aides, and then delivering those supports in natural contexts with the kids to increase the likelihood of success in the medium- to long-term.
Widespread benefits will see online therapy used long after COVID-19
The broader applications of people being exposed to digital practice are manifold. The tyranny of distance can be conquered to some degree, and we have the opportunity to share expertise more widely. Of course, we can get around quarantine and isolation restrictions in the short-term, too.
Allied health practitioners have an opportunity not only to help kids in need who would otherwise go without services, but we can support, train, and build capacity in the people around the children as well, leading to sustainable outcomes which decrease reliance on allied health in the future. Families can also experience a timely service, where 18-month waiting lists used to be the norm.
I wouldn’t go so far as to say that digital practice is “the new normal”, but it’s not unfamiliar to most of us now, and there are fewer people crying “Witch!” when an online service is offered. It’s certainly here to stay, and when we use it creatively to coach people around the child, rather than limiting ourselves to thinking it’s simply “Zoom + business as usual”, we have a huge opportunity to make a difference in the lives of kids across Australia.