Collaboration in Cyberspace: Delivering Intervention via Virtual Home Visits

1. Collaboration in Cyberspace: Delivering Intervention via Virtual Home Visits Barbara Fiechtl Sue Olsen Sarah Rule OSEP Sponsored Project #H327A080038 Early Childhood Strand Presentation #

2. Why Virtual Home Visits • Decrease cost: loss of interventionists’ travel time, salary/benefits, mileage reimbursement • Prevent loss of visits: weather, illness, scheduling • Increase service opportunities: children and families in rural/frontier areas • Enhance parent skills: to meet child’s needs by promoting parent use of developmental strategy

4. Selecting research participants: • Early intervention families identified • Project coordinator contacted families to explain the program

5. Delivery system • Families were surveyed about personal computer systems and need for computer hardware. • Families were provided with internet access if not already connected (cable, satellite, dish, and wireless cards).

6. Start Up Costs • Equipment • Laptops ($1,100 17”screen) • Videophone ($260) • Cameras ($10-$75) • Mics/Headsets ($5-$13) • Internet Access (10/15 families) Requires High Speed • Wireless Cards ($59/mo) • Satellite ($79/mo) • Dish ($35/mo) • Cable ($59/mo) • Software Applications for Desktop Conferencing • BREEZE/ Adobe Connect Pro ($56.00/month) No/low cost software • ooVoo oovoo.com ($10.00/ month per machine for recording) • SKYPE skype.com ($10.00/ month per machine for recording) • VZOchat vzochat.com

7. Cost data • Average time savings per visit: urban 12 minutes, rural 32 minutes, frontier 3 hours 25 minutes • Average personnel cost savings per visit: urban $12.75, rural $36.80, frontier $108.90 • Average mileage reimbursement savings per visit: urban $9.40, rural $16.45, frontier $119.85

9. Year 1

10. Parents’ rating of comfort with technology(Computer literacy) N-24, Yr. 2 4= Very comfortable 3= Somewhat comfortable 2= Somewhat uncomfortable 1= Very uncomfortable

11. Interventionists’ rating of comfort with technology (Computer literacy) N=6, Yr. 1 *4= Very comfortable 3= Somewhat comfortable 2=Uncomfortable 1= Very uncomfortable

12. Interventionists’ rating of comfort with technology (Computer literacy) N=16, Yr. 2 *4= Very comfortable 3= Somewhat comfortable 2=Uncomfortable 1= Very uncomfortable

13. VHV Quality How well could you see .. (Feb., 2010 VHV survey) The Therapist The Parent

14. VHV QualityHow well could you hear..(Feb.,2010 VHV survey) The Therapist The Parent

15. Parent Satisfaction with VHV (Feb., 2010 VHV survey)

16. Compare virtual home visits to home visits. Parents answered…Virtual visits are...(final visit, 2009)

17. Skills learned during VHV(post Year 1 parent survey) • Technical…. • Computer skills • Using the internet to call and using the camera • Strategies • Waiting and joint attention • Learned activities to help my son’s vocabulary • To be more expressive with words, colors, shapes, and pictures • Other ways to interact with M

18. Parent post project survey Explain the things this service provider does differently in the home and virtual visits-- list what she/he does more often during home visits and what she/he does more often in virtual visits. • Speaks more freely and easily in my home. • She did everything pretty much the same (5)

19. Explain the things this service provider does differently in the home and virtual visits. • During home visits she is more hands on. During virtual visits she explains things more. (4) • A is able to interact with my child more in the home visits. The virtual visits require her to model for me and then have me try it with my daughter. • In the virtual visits she has me do things with M.. and then critiques them. At the home visits she shows me by working with M.. the things she wants done.

20. How satisfied were interventionists with this experience overall? (final survey, 2009)

21. Mean Percentage of Intervals Across Families of Occurrence of Interventionists’ Interactions

22. Mean Percentage of Intervals Across Families ofOccurrence of Parent Interactions and of Child Behaviors

23. Post project survey- Early interventionists Describe the interactions you have with a parent during a home visit. • …Then, I will try to get the parent involved and I will coach as we go along. Sometimes I do most of the visit and I explain to the parent what I'm doing as we go along. But I am trying to get the caregivers more and more involved .

24. Describe the interactions you have with the parent during a virtual visit. Being physically removed from the visit.. forced me to explain very well to the caregiver what I'm trying to accomplish with the child, and... to convey changes in ... a coaching way, so that the caregiver doesn't feel that they are being "told what to do". I want the parent to understand... so that they will follow through in their daily routines.

25. Describe the interactions you have with the child during a home visit. • During a home visit my interactions with the child are more involved and directed than on VHV. I try to show the parent the strategies and then ask them to try it. In the home, in the face-to-face situation, parents are more reluctant to try things and therapists are a little more hesitant, too, to tell/show/prompt them to practice.

26. Describe the typical interactions you have with the parent and child dyad during a VHV. During a VHV we both sign in, say hello on the computer, I wave and say hello to the child, I outline the lesson plan to the parent. They'll begin interacting with the child and I'll watch, make comments, redirect when needed. The VHV is far less personal, warm or inviting. It does, however, make the parent get more involved and keep her focused. One of my families dropped the home visits during the 6 month VHV and I can see that the child hasn't done as well. The other family maintained all home visits and for them I see the VHV work reinforced in the home visits.

27. Virtual meetings- Year 2 • Types- 6 month IFSP review • Annual IFSP meeting • Transition meeting • Service coordination

29. Virtual meetings-Parent comments • I am grateful for the information gathered and for the experience. I was disappointed that my microphone and camera were removed, I was glad however, that I could still participate by phone and be part of the meeting. It was nice to be part of the meeting from the comfort of my own home. • It is more convenient for me to communicate via VHV for this meeting rather than travel a significant distance with my children. • I would send myself a reminder on the day of the appt. because I have less prep work to do, the visits slip my mind.

30. Virtual meetings--Parent comments • I didn't have to cancel for illness! It was nice to be able to complete the visit without concern for the illness on either side. • I prefer them for adult conversation. I am still a bit leery how any observation of my child could be completed this way, she connects well to the providers in person and demonstrates things during play that have been pertinent to their observations. That said, she usually is shy of C in home visits, but her comfort was greatly increased during our virtual visit today. • Either way we get the know-how to help our little man. (that is what this is about)

31. Virtual meetings-Parent comments • Better: I am less stressed about virtual visits. The only thing I need to do is make sure I am dressed and at my computer. My kids can stay playing in the other room and they don't feel interrupted either. I think they will be especially convenient during flu season. • Worse: I am not sure how any visits would go that require my daughter to be present. I suspect she will be difficult for our providers to observe at play. She also associates the computer with entertainment, and may feel frustrated that she is unable to watch her favorite video clips during our chat time.

32. Virtual meetings –Interventionists comments • I was ill the day of the meeting and would have cancelled the meeting without the technology option. I prefer meeting in person, so the family transitioning to the school district has an opportunity to see the school and meet the school district personnel. • I think that it is a good idea for those families that live far away. It would be beneficial especially when the weather is bad. • Quick access to them without either of us having to leave for a 15 minute visit.

33. Equipment/Technology Barriers Unresponsive internet providers Older home computers Use of wireless cards during high use time Minor damage to loaner computers Timely return of equipment

34. Equipment/Technology Barriers • BREEZE • Slightly more difficult to use • Future cost • More technical problems (image freezing, echo) • ooVoo • Easier to use • Better picture quality • Less sound echo Vzochat • Good picture quality • No document sharing • Not available for Mac Skype • Easy download and install • Additional program for recording • Families already use

35. Equipment/Technology Barriers • Therapists comments: • Microphone issues • Internet difficulties • Keeping child engaged throughout • Having appropriate materials in home for visit • Dealing with interruptions virtually (parent leaves room, siblings, visitors, etc.) • Placement of home-computers (bedrooms/offices)

36. What we learned…. • Need to address comfort level of parent and interventionist with internet, computer hardware, and videos (seeing themselves) • When dealing with technology, important to ask the correct questions to problem solve (people say the computer crashed but it was really an internet problem). • Need to inform all parties that there will be technical difficulties- what to do “WHEN” rather than “IF”. • Interventionists do learn strategies to problem solve technical problems (especially if they are of the digital age). • Parents are more accepting of the difficulties with the technology

37. What we learned • Responding to parent/ interventionist recommendations (changes in cameras, microphones, etc.) improves cooperation/satisfaction. • Interventionists are good at adjusting their skills from teaching/modeling to coaching. • Technical assistance for the interventionists helped to produce ideas to create the environment necessary “virtually.” • Wireless systems have more technical problems in remote areas but sometimes are the only access. • Families are “fairly” responsible with loaned equipment.

38. ???Questions???

39. For more information… WWW.CPD.USU.EDU Search Virtual Home Visits Barbara Fiechtl Barbara.Fiechtl@usu.edu Sue Olsen Sue@cpd2.usu.edu Sarah Rule Sarah.Rule@usu.edu