Transition to Multidisciplinary Pediatric Telerehabilitation during the COVID-19 Pandemic: Strategy Development and Implementation

Telerehabilitation offers a unique solution for continuity of care in pediatric rehabilitation under physical distancing. The major aims of this study were to: (1) describe the development of telerehabilitation usage guidelines in a large hospital in Israel, and to (2) evaluate the implementation of telerehabilitation from the perspectives of healthcare practitioners and families. An expert focus group developed guidelines which were disseminated to multidisciplinary clinicians. Following sessions, clinicians filled The Clinician Evaluation of Telerehabilitation Service (CETS), a custom-built feedback questionnaire on telerehabilitation, and parents completed the client version of the Therapist Presence Inventory (TPI-C) and were asked to rate the effectiveness of sessions on an ordinal scale. Four goals of telerehabilitation sessions were defined: (1) maintenance of therapeutic alliance, (2) provision of parental coping strategies, (3) assistance in maintaining routine, and (4) preventing functional deterioration. Principal Components Analysis was used for the CETS questionnaire and the relationships of CETS and TPI-C with child’s age and the type of session were evaluated using Spearman’s correlations and the Kruskal–Wallis H test. In total, sixty-seven telerehabilitation sessions, with clients aged 11.31 ± 4.8 years, were documented by clinicians. Three components (child, session, parent) explained 71.3% of the variance in CETS. According to therapists, their ability to maintain the therapeutic alliance was generally higher than their ability to achieve other predefined goals (p < 0.01). With younger children, the ability to provide feedback to the child, grade treatment difficulty and provide coping strategies to the parents were diminished. Families perceived the therapist as being highly present in therapy regardless of treatment type. These results demonstrate a potential framework for the dissemination of telerehabilitation services in pediatric rehabilitation.

A Multisite Pre/Post Study of Mindfulness Training for Therapists: The Impact on Session Presence and Effectiveness

Background: To date, little research has tested whether the use of mindfulness by clinicians results in actual changes in psychotherapy sessions. The purpose of this multisite study was to test whether a brief 5-week mindfulness training program could lead to improved session presence and effectiveness for trainee clinicians (n = 31). Methods: At the end of 85 pretraining and 132 posttraining sessions, clients completed the client version of the Therapist Presence Inventory (TPI-C; Geller, Greenberg, & Watson, 2010) and the Session Rating Scale (SRS; Johnson, Miller, & Duncan, 2000). Results: Although the levels of client-rated presence did not differ between pretraining and posttraining sessions, sessions that occurred after the training were rated by clients as more effective compared to the pretraining sessions, t(170.91) = 2.63, p = .01, d = .30. Conclusions: This study provides preliminary session outcome evidence supporting mindfulness training for clinicians.

The Effects of Therapist Presence and Relaxation Training on the Efficacy and Generalizability of in vivo Exposure

The present study examined the effects of therapist presence and the addition of relaxation training on the efficacy and generalizability of in vivo exposure procedures in the treatment of multiply-phobic individuals. Thirty-two individuals who were severely phobic of at least two objects/situations were assigned to one of three treatment groups or a waiting list control group, but received treatment for only one phobia. The Exposure Alone group received prolonged exposure to a phobic stimulus while alone in a room with that stimulus. The Exposure + Relaxation group were also exposed to a phobic stimulus but had received additional training in a relaxation technique. Subjects in the Exposure + Therapist group were accompanied by a nonanxious/nonavoiding “therapist” during exposure sessions. All treatment groups improved significantly, but the Exposure + Therapist group demonstrated significantly greater extinction of fear responses related to the treated phobias than the other groups. The Exposure + Relaxation group demonstrated the greatest generalization of treatment effects to untreated phobias. Clinical and theoretical implications are discussed.