Pivoting to Teletherapy: Amy Prince and Amber Ladd on Keeping Families Connected Through COVID-19

"We'd rather continue in some form with our families." That was Amy Prince's answer when asked what happens if insurance doesn't reimburse for teletherapy during a pandemic nobody saw coming. No hedge, no wait-and-see. Just a commitment to showing up, even when the rules hadn't been written yet.

Amy and Amber Ladd run The Talk Team in Fresno, California, a hands-on, in-person speech therapy practice that had never offered teletherapy before March 2020. Within two weeks of the first COVID-19 rumblings, they were researching platforms, contacting insurance companies, and rethinking what service delivery could look like when the waiting room goes empty. This special episode of Clinic Chats captures what that scramble looked and felt like in real time.

Preparation Started Before the Panic

Amy and Amber had a head start they didn't plan on. About a month before coronavirus forced closures across the country, they had begun transitioning their staff off paper data and onto iPads. When it became clear the virus could disrupt in-person services, that digital shift suddenly had a second purpose: it gave them the infrastructure to communicate with families remotely.

Two weeks before recording this episode, they started calling insurance companies to understand teletherapy reimbursement rates and whether contract changes were needed. They ramped up cleaning procedures, asked parents to wait in their cars instead of the waiting room, and stocked up on supplies. By the Friday before schools closed, they sent their first mass communication to families, letting them know the clinic would stay open with enhanced safety measures while exploring remote options.

That sequence matters. They didn't wait for a mandate. They moved early, communicated clearly, and gave families choices before panic set in.

Choosing a Teletherapy Platform Under Pressure

Neither Amy nor Amber had run a telepractice before. They spent the weekend before this episode taking boot camps, watching free webinars, and reading everything the Informed SLP had published on teletherapy research. The goal was not just technical competency but ethical readiness. They wanted to understand what effective remote therapy actually looks like before promising it to families.

For platforms, they landed on Clocktree, describing it as "super user-friendly" with a provider scheduling system that let their admin team manage appointments alongside individual therapists. Other platforms on their radar included TheraVee, the paid version of Zoom (not the free version, an important distinction for HIPAA compliance), and a platform called VC that came recommended at a training session.

The informed consent form came from another telepractitioner who shared an editable version, a small example of how the SLP community was pooling resources in real time. Within days, Amber had connected their therapists to Clocktree and built out a scheduling workflow.

Parent Coaching Over Direct Therapy

One of the most practical insights from Amy and Amber was their decision to prioritize parent coaching and consultation over direct child interaction during the remote period. Their reasoning was straightforward: many of their kids were not going to sit through a 30- or 45-minute teletherapy session, especially with the chaos of school closures and disrupted routines at home.

But parents still needed strategies. They needed someone to tell them what to work on, how to handle regression, and how to keep communication goals alive when the structure of weekly therapy disappeared. Amy and Amber saw that as the highest-value use of their time.

"We're more concerned about the parent support than the direct child interaction for many of our families, because our parents are going to need ideas and solutions and strategies."

That reframe, from therapist-facing-child to therapist-supporting-parent, is something every private practice owner can learn from, pandemic or not.

The Reimbursement Uncertainty

The hardest part was not the technology. It was the money. Most of their insurance and funding sources responded to teletherapy inquiries with some version of "this is all under review and we will let you know." The Department of Developmental Services in California had issued a press release allowing virtual services for parent coaching and support through regional centers, which opened one door. But the broader insurance picture remained unclear.

Amy and Amber made a decision: they would move forward anyway. They required their therapists to continue taking clinical notes and documenting every session so they could stand behind the work if reimbursement questions came later. For private pay families who couldn't afford to continue, they planned to set up informal check-ins at no cost.

"I don't think any of us are ready to just sit at home and not do this," Amy said. That willingness to absorb financial risk for the sake of continuity speaks to the kind of practice owners who survive disruption.

The Barriers Nobody Talked About

Amy raised a point that caught even her off guard: the biggest obstacle to teletherapy might not be the clinician's readiness. It might be the family's internet connection.

The Talk Team sits in Fresno but serves families in surrounding rural areas. Amber mentioned that her own home internet was unreliable. For families without stable broadband, video therapy was not a realistic option regardless of how polished the platform was. Add in the chaos of multiple children home from school, uncertain childcare, and parents suddenly working remotely themselves, and the picture gets complicated fast.

This is the kind of barrier that doesn't show up on a teletherapy checklist. It shows up when you try to connect and nobody can hear you.

A Silver Lining Worth Keeping

Despite the stress, Amy found something worth holding onto. What if teletherapy didn't have to end when the pandemic did? What about the medically fragile child who can't always make it to the clinic? The family that travels? The kid who's "a little under the weather" but could still benefit from a remote session instead of a straight cancellation?

"Could this be a secondary resource to families? That whole idea that necessity is the father of invention. Here we go."

Reducing cancellations, maintaining continuity for complex cases, offering flexibility for families who struggle with transportation, these are lasting benefits that outlive any crisis. The practices that figured out remote therapy workflows in March 2020 may have gained a permanent tool.

When your practice pivots overnight, your documentation can't lag behind. ClinicNote is a HIPAA-compliant EMR built for private practices and university clinics, keeping your notes, scheduling, and billing in one place whether you're in the clinic or working remotely. See how ClinicNote supports remote practice.

Transcript

Kadie: In this episode, we will be providing insight from one clinic about how they are working through adapting their private practice to continue services for families during this very unknown time. As you are all aware, coronavirus is causing havoc on small and large businesses alike. Small businesses are uncertain how to keep their cash flow, and university clinics are being put on pause with graduate students fearing meeting their clinical hours. As an EMR system, we realize that now is a crucial time to help you figure out how to work, conduct therapy, and carry on as best as possible through this season of unknowns. ClinicNote is here to help you with not only tips, but also a platform to help conduct remote work and therapy. Contact us via the show notes for discounted services. We're here to help, and with that, let's get into some valuable content.

Kadie: I have returning guests Amy Prince and Amber Ladd from The Talk Team here today. I know private practices are kind of scrambling right now, so I thought we would come on, get a special episode out, and try not to tell people what to do, but just give a little insight of what someone else is doing and what your perspective is. So The Talk Team is in Fresno, and you guys are taking some steps already due to the coronavirus. Can you begin by telling me your initial steps or thoughts, whether it was a couple weeks ago or yesterday?

Amy: Yeah, of course. I think that probably about two weeks ago, Amber and I, well, a month ago, we started the process of getting iPads just because we really wanted to get our staff off paper data. We've been on paper data for a long time. So I think that was kind of a gift to us because about two weeks ago, we realized that this could have an impact on our practice, and we started contacting our insurance companies to determine rates for teletherapy, if we needed to change anything in our contracts. And then we started to expedite the process of getting our iPads ready in case we needed to be able to communicate with our clients in different ways. Amber, what else?

Amber: I think around that time, we really worked on increasing just our cleaning procedures. Obviously, we keep our office very clean to begin with, and we clean all of our toys regularly, but we really started to increase how often we clean off surfaces. We started urging parents probably about a week ago to not wait in our waiting room, that we would meet clients out at their car so that we could really decrease the amount of people that are in one space. And then honestly, stocking up on cleaning supplies so that we could continue to clean our surfaces and our toys as emphatically as we've started doing.

Kadie: And did you send out a couple emails, hand things out, or explain policies as people came in last week?

Amber: We verbally spoke with a lot of families about our hygiene procedures and about the hand washing and the enhanced cleaning policies. But we were reticent to add to the inundation of emails that were already going out to our families from their schools and everything else.

Amy: Yeah, I don't think that we sent out a mass email to our families until Friday, at which point all of the local schools had decided to close down. And at that point, we did send out communication to all of our families that let them know that we would remain open with these very high standards of cleanliness procedures, and that we were exploring the option of teletherapy for clients that were appropriate for it, as well as parent coaching for families that wanted to continue that contact but didn't feel comfortable leaving their homes.

Kadie: Last week, were you already seeing cancellations and implementation of teletherapy, or do you think that's something that will be more prevalent this coming week?

Amy: We definitely saw cancellations. I'd say we were probably 20% down last week with illnesses, or we had a couple of people just not show up. We did not initiate any teletherapy. Ethically, both Amber and I have spent the weekend either reading or taking some of these boot camps that people have offered up so that we were prepared. And we had the blessing here in California that the Department of Developmental Services, DDS, that does all of our regional centers, did a press release and said that they would allow virtual services for parent coaching and support for these families. And so that was our first mass notification that, yes, we have this population of kids who we can continue to support, but we really wanted to use this weekend to make sure we knew what that support could look like, because we're not a telepractice. We are a very hands-on, very in-person practice. I think it was extremely important to us to make sure that we are going about this ethically and not jumping into something before we had an understanding of how we could make it work the best way possible. And people need to be aware of that.

Kadie: So have you all chosen a direction for implementing teletherapy?

Amy: Oh, wow. Well, that is really great. Fingers crossed that we're past this in three months when you guys are back to complete brick and mortar. Some other ones. I'll have to look up Clocktree. That sounds awesome. I've also heard great things about TheraVee. And I know there's, of course, the Zoom that you must pay for, not to be confused with the free version. Are there any others that you guys were investigating?

Amy: They actually, in the camp that I went to yesterday morning, one of the ones that she recommended for the size of our practice was called VC. I did not play on the platform yesterday, but that one came pretty highly recommended.

Kadie: So are you going to get each of your therapists a Clocktree account and send out some sort of release form to families? Is that your plan?

Amy: Yes. I already have the release form. Again, somebody out there doing telepractice shared her release form in an editable format. And so it's the informed consent that would allow us to do it. And then Amber's been working through connecting our therapists to Clocktree. And again, super user-friendly. There's just a platform that you just invite each of your therapists to come on as a provider. And then there's a schedule for each provider. And we have the capacity to either have them set up appointments as they speak with clients or our admin side of things can be setting that up as well.

Kadie: And you guys previously had some co-treatment sessions going on. Is that correct?

Amy: We did. We used to have an OT in our building, but they are not in our building any longer. And so we do have some behavioral co-treatment sessions, and we obviously are going to struggle to do those via teletherapy. But what both Amber and I want to push as heavily as we can in this period is we're more concerned about the parent support than the direct child interaction for many of our families, because our parents are going to need ideas and solutions and strategies. And so one of the things we want to push the hardest is that parent coaching and consultation for those parents that have the bandwidth to participate in it during this time.

Kadie: Absolutely. Yes. So much parent education can be done, even if a kiddo isn't quite ready to attend or whatever for a full 30 or 45 minute session, but still lots of parent education opportunities.

Amy: Absolutely.

Kadie: With the calls to insurance, will your reimbursement rate be greatly affected?

Amy: I honestly don't know yet. The majority of the response that we have received back from our funding sources is that this is all under review and they will let us know if this is something that will be allowable or not.

Kadie: Oh, wow.

Amy: And we've kind of been of the mindset that if we have to push forward and possibly not be reimbursed, we're okay with that uncertainty. We'd rather continue in some form with our families. I mean, I hate to say hope and pray, but I kind of think that's where a lot of us are, that I don't think any of us are ready to just sit at home and not do this. And so if we can continue to check in with them and in the hopes that insurance recognizes that we're still doing our jobs, we're making the girls take notes and continue to record what they do in therapy. So we'll be able to stand behind it if it comes to that.

Kadie: Yeah. Let's hope that the insurance companies come to some sort of agreement.

Amber: Definitely. And I think we both feel very strongly about being there to support our families right now with how uncertain everything is and how scary this is. So when we have private pay families who don't have the ability to pay to continue services right now, we are going to set up a means by which we still check in and are there for them.

Amy: Kadie, one of the biggest things that came out of yesterday that I think that those of us looking at telepractice for the first time have to be hyper aware of is it's less about our ability to do telepractice and more about what's going on at home. We're in a city, but we're around rural areas. And like Amber mentioned prior to us starting this podcast, her internet is not great. A lot of our families have that problem. And so that's definitely an area of concern that I don't think I'd even wrapped my mind around that even if I can get online and interact with you, can you get online? Can you hear me? Can you see? And aside from internet issues and just the platform in general, there's always their family situations. What their childcare is going to look like while the kids are off school, what the parents are able to do and help with. It's just really unknown.

Kadie: 100%. How many children are going to be affected and eventually be switching over to hopefully receiving teletherapy services?

Amy: I don't think we honestly have an answer to that yet.

Kadie: You're willing to still see kids at the brick and mortar?

Amy: Right now we are. We don't know 100% what that's going to look like. And we're going to be in bright and early tomorrow morning to talk through that. And if it ever becomes questionable to continue or unsafe to continue, we will stop completely. We've got to see the atmosphere of our therapists and our parents, I think, tomorrow and see what that looks like.

Kadie: Yeah, I think that's a great statement. I think every area is going to present a little bit differently. So the therapists and practice owners are going to really just need to evaluate and feel out the families and what they're all comfortable with. And yeah, other states are going to be more strict than others right now. There's just so many unknowns for everyone. But I do think just hearing someone else talk about it is so helpful. And then any specific resources you guys can give? Can you give the name of that teletherapy training that you completed?

Amy: Well, there's actually a bunch that have come through. The Informed SLP put out all of their teletherapy research and resources for free yesterday. And I think you can go to the Informed SLP and they have free telepractice research reviews for those of us making sure we're doing it right. The telepractice boot camp was presented by Launch Speech and Reading out of Madison, Wisconsin. And that one was paid. I did have to pay to attend. It was $75, but her information was very good. And then Jill, she did a free Facebook Live yesterday. And I was able to do that one and she just talked and answered some questions. And then there was one other one through Online Speech Services and they did a free Q&A webinar.

Kadie: And so there's quite a few out there that have been free. I've also seen some come through that are paid. And it seems like there's active groups on Facebook. Like there's a Telepractice SLPs group on Facebook that I think grew from somebody was saying from like 900 to 9,000 in the last week in members. But you can find a lot of information in it.

Amy: Absolutely.

Kadie: And for those who have never done teletherapy, I think it can be so scary to do it for the first few sessions or week, whatever it might be. But I've even dabbled in teletherapy a little bit between jobs and it's not so bad. So I'm here to reassure. It can be done. I've seen a variety of populations, whether it's the easy straight up articulation kids or you're getting down to social language and minimally verbal children. It gets tricky, but it can be done. And hopefully this is all temporary.

Amy: Yeah, exactly. And I think it's kind of an exciting opportunity for us as SLPs who have traditionally been brick and mortar to figure out if this is something we could use. We do have children who are medically fragile or we do have children who travel. Could this be a secondary resource to families? That whole idea that necessity is the father of invention. Here we go.

Kadie: Right. Yeah. Moving forward, you might have less cancellations if someone says, hey, little Johnny's kind of under the weather. Could we still do a teletherapy session for the week? I mean, wouldn't that be awesome to reduce cancellations?

Amy: It would be incredible. Or for families, we've got a young man in our practice right now who is diagnosed with leukemia and he's had to spend some time in the hospital. If we could continue to do parent coaching while he's there and those kind of things. I think this could be a mind expander.

Kadie: Well, that's definitely a positive perspective. I think that's about all I wanted to cover. I know there's a lot of stress in the air for so many professions as far as getting paid, keeping businesses afloat. So I just hope that this can be reassuring to some of our listeners.

Amy: Absolutely. We appreciate you putting this together, too, and getting this information and conversation out there.

Kadie: Thank you so much for taking the time. I know you guys are feeling scrambled and hectic, but I really appreciate you helping me out to get this episode out. Best of luck and stay healthy, everyone.

Amy: Thank you, Kadie. Have a great day.

Kadie: We hope this episode gave you some simple, valuable tips to implement into your clinic. Again, please contact us via our show note links and we can get your practice or university up and running with an EMR system to set you up for remote work. With that, we'll leave you with this. Don't worry about the things that you can't control. Let's focus our energy on the things we can and everything will fall into place. Thank you for joining me and listening to Clinic Chats. If you have a moment, please leave a five-star review for Clinic Chats to help other SLPs find our podcast. Please email me at kadie at clinicnote.com. That's K-A-I-D-E at clinicnote.com.