Talking TelePBS Episode 2

Talking TelePBS Episode 2
Podcast Transcript
July 2021

Podcast announcer:

Highlighting research and real life case studies, this is Talking TelePBS, a podcast exploring the delivery of Positive Behavior Support through telepractice and the benefits of incorporating an online approach and now here's your host, Orion Kelly.

Orion Kelly:

Welcome to Talking TelePBS, I'm Orion Kelly and I'm autistic. Now this podcast explores the delivery of positive behavior support through telepractice and its benefits. So whether you're a practitioner, a parent or a care of an autistic child or someone who's just interested in learning more about the adaption of PBS practice to an online environment. Well, you can view the many resources online at the NDIS Commission right now.

Podcast announcer:

Talking TelePBS with Orion Kelly, visit ndiscommission.gov.au/resources.

Orion Kelly:

Now on this episode I'm joined by educator and NDIS registered behavior support practitioner at Aspect Therapy, Jo Ann Thornton. Jo Ann, thanks so much for joining me.

Jo Ann Thornton:

No, thank you for having me now.

Orion Kelly:

Now I'd love to know a bit about you, a bit about your background. So what brought you to where you are today in your career?

Jo Ann Thornton:

Well, I started as a special educator and got my masters in special education in the eighties. '93, I think was when I finally finished and I had a real interest in Positive Behavior Support from the very beginning, back then it was real ABA style. So I just started following the leaders in the field and kept my interest and research up in the area, worked as a special educator, then when I came to Australia I started lecturing in the department of education and supervising prac teachers.

Jo Ann Thornton:

Then I got a job teaching in a school for kids with autism and that was for Aspect and yeah just really had quite an interest in both of those things and then still doing Positive Behavior Support plans in my role as a teacher and keeping up with the research in the area. Once I left the teaching, I ended up working for Aspect Therapy and ended up again with my interest falling into the field of doing Positive Behavior Support there and sort of kept on rolling with it. So I've been doing it for about 20 years.

Orion Kelly:

Jo Ann, how do we end up at telepractice and your involvement in telepractice? How did we get there?

Jo Ann Thornton:

Well I was asked to join a research project and have a go, have start and working at the university I had done online teaching and I've done another research project where I was doing online coaching of teachers as well. So I thought, well online that's good and PBS it really felt like it was a good fit because we gather a lot of information so there's a lot of contexts that we need to understand.

Jo Ann Thornton:

And a lot of that is done through interviews and reading reports and talking to people. So I thought that would work well but also being able to reach folks that wouldn't otherwise have the opportunity to have a behavior practitioner and that sort of expertise in their area and that was really the biggest push for me to be able to provide that support to others in those areas.

Orion Kelly:

I think the people listening to this are probably going to know what these terms mean but just for those who have decided, oh I might listen to this podcast, just so we're clear because I'm about to ask you a question about TelePBS. So just for those listening that aren't aware of TelePBS so in a fact, what we're talking about is not in physical contact with someone obviously phone, internet, telephone, whatever you want to call it, whatever is in the constitution. PBS so we're talking Positive Behavioral Support, is that essentially what TelePBS is?

Jo Ann Thornton:

Yeah, it's using technology to provide that support so technology like you said, it can be phone, it can be video call, it could be emails back and forth, it could be texts, it could be a phone and the video depending on how our technology's working and Positive Behavior Support is PBS yeah.

Orion Kelly:

And I can say as an autistic person, this is my best case scenario, the COVID is amazing. I don't have to go to a GP anymore, the GP will call me and give me what I need, it's amazing, this is the best thing ever but for you personally, how confident were you as a professional that TelePBS was actually going to work, not only for you but more importantly, I guess the people that you support?

Jo Ann Thornton:

I guess I kind of went into it with a bit of a blind confidence thinking oh yeah, this will work, I can do this but I was a little bit worried about is my ability with technology, problem solving in that area is not my best but you soon figure it out and as a teacher, you walk into a classroom and you've got, depending on your class size 6, 12, 36 students, all with different backgrounds and there's a lot of figuring it out as you go along and then once you figure something out, you need to get more information, you need to maybe possibly research a special condition that you've never experienced before.

Jo Ann Thornton:

So there's a lot of sorting it out as you go along so it was a lot of that at the beginning and now I think I've got quicker with my solutions and I have a bigger and better toolbox for both technology and for the clients that I have in the remote areas that I had never been to before.

So a lot of research too on, where is this place and what happens there And what's the industry. I made the mistake of saying so what do you do with your friends with a teenager? Do you get together and maybe go have a meal together? Do you go the movies? And there was just silence and so I kept throwing out options and then he said, you're making me feel really bad, we have none of those things. He said, we have nothing here and I thought oh God, okay lesson number one, research the area a little better before you ask silly questions like that.

Jo Ann Thornton:

And also when we were having the fires and the floods, I would have clients all over the place where they were directly affected and I'm sitting here in my own comfy safe home so I need to understand what's happening for the people that I'm reaching out to.

Orion Kelly:

And that's why it's such a wide brown land that we call home. Telehealth is critical, telehealth is absolutely critical, we have to find ways of implementing it into new services like this study has shown. Let's talk about the actual assessment, so a functional assessment the orthodox approach clearly is direct observation as in you and the person in the room and maybe their parents and you kind of just watching them and I've done that as an autistic dad with a seven year old autistic son. It can be a bit like I'm the fireman that's supposed to put out a fire but I've been told to put my hose away, it's a bit strange. Anyway, how do you think it went? How do you even go about doing what is usually a direct observation via telepractice?

Jo Ann Thornton:

Well you bring up something quite interesting that I think that is one of the challenges I think that there's a couple but I think that was okay, how am I going to do this? And I think the fly on the wall method is the best. Where you just go, take me through your day, set me up there and let me watch if it's in school, let me watch how you transition from one place to another and let me watch the start of that activity. Or the other thing is getting video, which you have access to areas that you wouldn't normally if you were face-to-face because they would expect you to be there to see it but because they're so used to you asking for video, asking for more explanation, asking for don't take me there, show me I'm actually probably getting more diversity than I would have face-to-face because it's more accessible.

Jo Ann Thornton:

I suppose the difference is if I'm not getting that video, I'm getting someone else's perspective on what's happening so their recall is a perspective and it has its limitations as mine would have a limitation because I might not know the setting beforehand. So even face-to-face your observation would have still an element of, I'm missing something in this picture but I've also had video and then we watched the video together on the shared screen and there was some narration from either the client or the parents or the teacher where okay, well, this is where this has happened and you don't see this but there's another kid over there who's giving him this look.

So I've done it that way as well and the video tour I think is also good and it's a good ice breaker because you get someone to well, show me where you guys usually play or show me where you do your gaming and then by watching them interact with that, I'm able to get some information from that as well.

Orion Kelly:

Clearly it seems that absolutely the functional assessment can be done via telepractice and really it's about changing perspectives but in changing perspectives that's actually becomes a benefit and I think from my understanding with my own autistic child and being autistic is, when we take our son out of his safe space home, sometimes he's more well behaved, right?

But then if we're talking to you but we're home and you're in the office being the safe space, you may actually see more of the behavioral stuff we have come to you for, right? So in a way, there's the benefit there too that we're seeing people in their safe space potentially being more of themselves maybe that's not your experience but that's certainly my experience.

Jo Ann Thornton:

Yeah very much, not only the person with autism but the people around him as well. A lot of times folks don't want us in their home, they feel that it could be a bit intrusive or they need to clean up or put on something that is not real. So yeah, we are seeing something a little more real.

Orion Kelly:

And I think that's the benefit of it, now what about the collecting of data? I guess, talk us through, what did you try and do you think you got a good picture of the actual function of the behavior through the telepractice?

Jo Ann Thornton:

Yes I do but it takes probably a wider net, I suppose because if you're asking for someone to record data in a shape that sort of lets you know so okay, what happened before the behavior? Okay, then what did he actually do? Okay so then what did she do afterwards? Or what did you do afterwards? So that's called the ABC, so you've got sort of a big picture of what's happening. You still have that limited perspective and they're writing down things that they think is important but may not be as important as you think.

Jo Ann Thornton:

So you might collect some of that data, you might do that observational data, you might do some interviewing. I find myself asking for reports as well because I'm getting that professional perspective as well. As far as specific data on a behavior like a frequency, that's a little bit harder but I think it's not unique to telehealth, I think getting people to commit to data collection is quite difficult because it's not something they do in their regular day. So I don't think that's unique to telehealth getting that hard tick a box type or narrative type ABC form data is a bit difficult. So you just ask for a few different things.

Orion Kelly:

I guess that kind of data, not only the data collection but also the observations using the online environment obviously, as you say is not unique but it can be beneficial. Take for example, myself and my wife with our autistic son and other child, busy life, this kind of thing at nighttime not when it's appropriate for you in the office but when I can just log on and upload some videos or put in some observations or whatever, I guess too that provides a benefit for you. Like you said, it's a bit like a fly on a wall but also you can do that in your own time and in addition to that, maybe more people will start filling out your forms and maybe more people would be a part of data collection because of the online aspect of this.

Jo Ann Thornton:

Yeah, the flexibility is incredible, I think that's a huge asset, they don't have to do it then and there and the flexibility of having the sessions is also huge because I don't have to travel, you don't have to have that travel time. And yeah, the other thing is we have the opportunity to get data from more than just one person because it's easier to access a wider team, if there is a team there it's easier to access them using the teletherapy model rather than, oh are you going to come in? I don't know whether I have time to have you here, no it's just a phone call or a Zoom, oh okay, yeah sure, I got a half hour. That helps with that data collection because if one person struggles with it, another person could possibly get us some data.

Orion Kelly:

And it seems more efficient too, for example, if you're able to rather than try to dissect, I guess, hearsay and stories, you can just look directly at a video or listen to audio or read something that's been entered and then you can go, right okay and you can move on to the next steps, which I guess obviously is completely beneficial. Which we wanted to talk about now, so how do you actually go about the implementing and also, I guess pretty important actually monitoring the behavior support plan. I'd love you to talk through how it works, how it looks but also obviously any tips for those listening would be beneficial as well.

Jo Ann Thornton:

I have a lot of show me's, I have okay let's practice. I might see a parent or a teacher, or even with the client himself, I might say okay let's practice and then I watch it and then I say okay, then I can provide that feedback. So it's really a lot like coaching and it's that capacity building through providing that feedback and then saying, well how about if we put this in there and then we go back to the screen and we might look for a visual support online or I might look for a video that shows exactly what I mean by what I'm trying to explain.

Jo Ann Thornton:

So we troubleshoot together as we go along and that's part of the feedback but a lot of it is let's practice. So tell me what you've done or show me what you've done or show me now or video it happening and then I can give feedback. I sat through a lesson with SLSO with her student and she put in place so many of the strategies that we've been working on over the months. And I was in her ear watching and I'm like, okay, now just point to it and so she's just pointing because he would scratch her hands. So I had her sitting on the opposite side and I had him all set up with color coding and so he knew exactly what he was to do but before I started, she was doing hand over hand with him sitting next to him and she was getting injured a fair bit because he didn't want it.

Jo Ann Thornton:

So she gave him more autonomy by setting up the situation for him and I was sort of giving her some feedback and I wouldn't have been able to do that if I was standing there, he wouldn't have done the task if I was standing there because it would have been so intrusive. So that was a win, that was fun and it worked.

Orion Kelly:

But that's incredible I mean from my point of view because I have lived experience I mean, that is incredible, you can't do that as you say in an orthodox approach using the technology and you've talked about sharing screens and using technology to connect with more than just maybe one person, the whole team, the family, the friends, the support workers, carers or whoever and the coaching aspect of it. This is all completely unique to the tele model but just that one example, I find incredible to have someone kind of direct you through a situation that's mutually beneficial to all involved but that's a direct example of what simply can not work or happen in the orthodox practice, it's quite amazing.

Jo Ann Thornton:

Yeah, I've actually used some of the things that I've learned through doing the telehealth. I've been doing it for maybe two years now and sometimes I say, well I do have a bigger toolbox, I can offer that to clients who originally would half hour away, I would drive to the house but there's one young boy where I drive into his house. He's actually in an enclosed area in the living room because he's very shy, has some anxiety about having chats with people. So he's talking to me behind this curtain and I asked in the previous session, what do you think about just texting each other?

Jo Ann Thornton:

And so it took him that time to think about it and then when I came next he goes, text me. So I thought, fantastic so he sat there on his couch and I'm texting him and I wouldn't have thought of that if I hadn't had first done the telehealth because we've used the chat box for those who are really shy and find me staring at them really intimidating and shared the screen with things that we're working on so we drawing and chatting. So it works even if you don't have a telehealth client, there's tools there.

Orion Kelly:

It's a clear evolution, it's a further step forward I think from hearing what you say, it just seems like quite a win-win for everyone involved but I guess let's talk about some pros and cons from your experience. Is there particular contexts, particular people or particular behaviors in your experience that you think TelePBS works better for or conversely doesn't work for?

Jo Ann Thornton:

I think it works better for folks who have verbal language or who can chat in the chat box if I'm providing direct therapy. So if not, they need a support person with them to help with that interaction just until we figure out how we're going to communicate with each other. It works really well for those who have some worry about me being there, in their house that when I come in, the behavior changes, their comfort level changes, it works really well. When it doesn't work is when someone doesn't want to be on screen, where they get on screen, they think I have got a computer in front of me, this is what I play with, not what I communicate with and they just want to get on their gaming so the computer is actually very distracting and the focus on what our purposes is, is difficult.

Jo Ann Thornton:

It works really well for someone who is motivated to learn, obviously. I had two clients who were teenage boys who had some anxiety around socializing and they were actually aware of others feeling awkward around them and them feeling a little bit awkward and I thought, well how am I going to do this? Because usually you need to be in a social context, so I can observe them and see what's going on but well, it ended up that it was so good because I can see their body language so clearly through the video and then when we started just using the chat box, I could see where the language barrier was.

We were able to really break down what is missing in that communication, what he was missing in the topic and the conversation. I was able to show him so many more visual supports on graphs and flow charts and things like that, that helped him to make sense of social situation.

Jo Ann Thornton:

And I didn't end up needing that social context so I thought, how do you teach social skills to an only child at home? You go into their home every day where you could teach it with you but it's another adult but if you start playing with what you've got on the computer, it can work so you just find a way to use that. It works really well with folks who use the computer for everything other than gaming. It works really well for that as well because they're comfortable with that medium and we can talk to that rather than talk to each other. So we're talking to something that we're sharing and it's comfortable So that's another asset for that.

Orion Kelly:

A bit like you and me talking to a wave form at the moment, I'm comfortable with that, seeing your voice in a way for and we're having a conversation. Just last question, what about restrictive practices?

Jo Ann Thornton:

So I do come across restrictive practices in the telehealth area and I think to a certain extent, telehealth works towards identifying them because like I said, you have access to environments and situations that you wouldn't normally, if you just show up on a day and you're in the same place all the time. So you're asking for video and you're asking for a tour, which you probably wouldn't get if you were in person, not as comfortably anyway. You're able to ask questions also, where you wouldn't easily ask them face to face because you're often asking for clarity when you're using the video platform because you might've missed a facial expression or you might've missed something as it dropped out. So it's common that you say, what do you mean by that? Or what does that look like? So it's easier to ask those questions because you have to really ask the right questions, not only to collect data but to understand, well how do you keep yourself safe when that happens?

Jo Ann Thornton:

And you can ask that face to face but asking more and more direct questions seems easier and less intimidating as well because there's one step removed. So as far as a downside is you may not see some interactions or some things if you don't ask for the tour and if you don't ask those questions. So until you realize you need to start asking those questions and taking those tours, as part of your practice, you could miss it. I guess a little bit of advice is, make sure that you cast your net again wide enough to get a really good picture.

Orion Kelly:

It sounds like a extraordinarily exciting time in the sector and obviously TelePBS has some amazing work to be done and I think it's fascinating talking to you about it.

Jo Ann Thornton:

Well I've enjoyed talking about it, I hope others get into the mode. I'm sure we all are now that COVID hit, we've been forced to use it a little bit and it's come a long way since I started, it was like, oh yeah okay, I guess we can do that and now it's okay yep. Let's do that then and yeah.

Orion Kelly:

Fantastic.

Jo Ann Thornton:

It's good.

Orion Kelly:

Jo Ann, thank you so much for your time, I really appreciate it.

Jo Ann Thornton:

Thank you very much.

Orion Kelly:

My guest was educator and NDIS registered behavior support practitioner at Aspect Therapy, Jo Ann Thornton. Talking TelePBS is a podcast produced in collaboration with the NDIS Commission, autism spectrum Australia and the University of Sydney. I'm Orion Kelly.

Podcast announcer:

Thanks for listening to Talking TelePBS with Orion Kelly, a podcast exploring the delivery of Positive Behavior Support through telepractice and the benefits of incorporating an online approach to learn more about adapting PBS practice for the online environment, visit ndiscommission.gov.au/resources.