This is simillar to our plan, although the AMC hasn't cleared the brand of clear mask yet and is saying that if kid won't wear a mask we have to waer mask AND face shield so... ugh. We haven't actually done any in-person evals yet due to some administrative hangups which drives me nuts because I did a DI and brief observation of a kid who seemed really clear-cut but technology in their rural location is insufficient and i'm really frustrated- guess this might be a good use of that provisional dx option. So i have no useful tips. But I am curious to know what your remote process is for the evals - esp. for those 3-5 / mod 2 kids. We are still in a bit of a holding pattern for those as we figure out our process and focusing on the other ends of the waitlist instead.
Also curious to know- are you finding (as I am) that the remote evals are faster (for better or worse- I'm still thinking about the various contributors to see what i can learn about my own efficiency moving forward)
I have only done a few with kiddos over 3 who are in that MOD 2 range (for those of you not familiar, MOD 2 is used when the child displays consistent, non-echoed phrase speech). I kind of get a sense during the 1-hour intake how things will go via Zoom. Most of the time I'm letting the family know that I will just have to see them in-office when we are able to. Because there's only one other clinic in the area that these families could go to (other than some private pay ones that they couldn't afford) and the other one- while doing some in-person stuff- has a wait list well past the end of the year, telling them to go somewhere else that could see them sooner isn't viable. If there were other providers in the area doing quicker in-person stuff, I'd be sure to let families know, rather than keep them in limbo.
In those cases I have tried to do some of the conversational items to get a sense of the content and reciprocity of their speech. I also try to get a sense of their spontaneous play. I find that getting kids who "understand" zoom to ignore you when you are watching them remotely is pretty difficult! I do get some of the questionnaires done (e.g., SRS-2; Vineland). You can also get through some of the CARS. In these cases, I've basically let the family know that I don't have enough data to make an ASD diagnosis, though there's concerns and I can't rule it out. I have told them I'll see them in office ASAP, and have made referrals for other services- if indicated- in the meantime (things like speech therapy or wrap-around case management/behavioral services. It ain't great, but it's what we can do.
I do find that the zoom assessments with the younger kiddos generally take less time, but mainly because I'm only probing cognitive and language skills, vs. doing a direct assessment (e.g., Bayley). I am doing the Vineland Interview Form via Zoom, and I would typically have them do the Caregiver Form when in-office. All-in-all, I'm typically doing 90 minutes of semi-structured observations (e.g., ASD-PEDS; parent probes of some ADOS-@ items, like blocking/teasing toy play), put everyone in the zoom "waiting room" for ~30 minutes while i complete diagnostic profile and review/begin to score questionnaires and sketch out recommendations and prepare a letter as proof of dx, and then come back and do ~30-45 minutes of feedback, recommendations, etc. Report write up takes the same amount of time as for in-office stuff. Overall, I'm billing about 1-2 less hours per case, but will potentially make that up with some kiddos where i want them to come in just for an updated cog/lang or to fill in some gaps. I have been seeing more kiddos per week though, so have been overall more productive than usual (and i am typically VERY productive). We have been able to chip away at my LONG wait list as clinicians in my agency in less busy parts of the state have been able to "see" some of my kiddos remotely that they wouldn't have been able to efficiently see in-office (I work with a low-SES population that can't easily travel). There will definitely be some aspects of telehealth that we carryover post-pandemic (assuming, of course, that their ever is such a thing as "post-pandemic"). Personally, while I'm happy for the families that we have been able to continue to do assessments and get the kids services, this ZOOM stuff is getting old. I'm really missing that direct client contact and being in the room with the kids. ZOOM works pretty well if the goal is to do an assessment and make a dx and recommendations, but I also do this because it's really fun to play with the kiddos and the toys! I don't get that from Zoom.
