Interview with Dr. Maria Wynne
Leslie Burby: Hi, thanks for joining me, I’m Leslie Burby, editor-in-chief of Autism Parenting Magazine and today we are here with Dr. Maria Wynne of Wynne Solutions and today we are going to talk about
Tele-health. Thanks for joining me today doctor.
Dr. Maria Wynne: Thanks for having me.
Leslie Burby: Can you tell us what Tele-health is and what you do at Wynne solutions?
Dr. Wynne: Sure. Tele-health is a method where we use therapy at some distance from the body. We at Wynne Solutions use different technological tools to be able to communicate with families; we use video Skype, any kind of method where we can get information on a day-to-day basis, sometimes in real time. It’s all going through the internet essentially. Also we use a lot of text messages and videos that are sent to parents to collect data. We primarily do parent education at Wynne Solutions.
Leslie Burby: Okay so you are teaching the parents to help their own children?
Dr. Wynne: Correct. Yes, I have a series of assignments that I give parents. I use a discrete video modeling tool that is created by a company called Gemiini Systems. They have created a library of over 12,000 videos that can model these skills. And so I can make these individualized assignments for these families and just say, “Watch this for a half hour a day” and it kind of takes place of those discrete trial segments with flashcards and we are seeing kids gain skills really quickly with this method as well.
Dr. Wynne: Well, I see a lot of issues because I work with all ages but the biggest issue that I contend with is probably when parents just can’t get their kids to communicate effectively. Lack of language development is a really big issue with these kids and I also see it with adults as well. So I come in and I really get a solid assessment of how are they communicating and then I help the parents really understand the method that is going to work to get their child to communicate effectively, whether that is vocal-verbal skills, or using sign and I also have a SLP [speech language pathologist], that I collaborate with. I work a lot with language and communication.
Leslie Burby: What kinds of communication have you tried?
Dr. Wynne: Well, I really focus on the vocal-verbal. I work with a lot of kids that have apraxia and we are seeing with using video-modeling, specifically discrete video modeling, that something is happening when these kids are watching, focusing in on the mouth so it actually models what the word I supposed to look like. It’s like a fancy video flash card system. So really getting these kids to vocally verbalize these words. Basically I’m working on the vocal-verbal skills but really it’s replacing behaviors like hand leading behavior. I have a lot of kids who use hand-leading. They might even be teenagers still getting their needs met by taking their parents’ hands because they are not even pointing to what they want in the cabinet. But having them vocally-verbalize something or showing a picture is obviously going to be less dependency on the parent and getting the individual to be more independent.
Leslie Burby: That’s great. I guess my one question about Telehealth would be is it kind of like an online classroom where instead of parents and clients coming to your office they can just see you through the computer, right?
Dr. Wynne: Yes the beauty of Tele-health is that it totally cuts out the amount of driving that we have to do and travel but also what I’m seeing is that I can gather data better than I was before when I going to the home. Now I should also say, that this is not replacing in-person – I still go see the client. For my clients in Ireland or who are overseas I can’t do that so I actually have never met those clients but I meet and spend time with about 95% of my clients because I make it a priority to get that face time. I will see that the individuals respond a lot quicker to me over this 2-D versus being there in-person. Now that shows me that they need to generalize those skills when they have that human face they have to be able to interact. So we work on that skill building with the parents. The parents really know how to do that pivotal response treatment and that generalization programing with the child. Again, integrating as much into that natural routine for the individual. But the tele-health method, it saves a lot of time. Before I used to have to travel, I used to work for a nonprofit agency in California for seven years and got great training (I still consult with them and still conduct some research with them). I had to travel a lot, I was with them in Los Angeles so I was in the car like four hours a day and still on the phone so I was able to do some supervision and management over the phone but using Tele-health, and using this video, is just so effective. I can see six clients back to back throughout the day from all different locations and I’m getting data every single day versus having to wait or wait for an email. If we have those chats set up I get data quicker and we can see progress a lot faster.
Leslie Burby: That’s fantastic! Honestly, I wish I knew about Tele-health sooner because when my children were young trying to arrange a therapist and the driving and then when there is a snowstorm, then the child won’t get therapy that day. With my daughter, it wasn’t just ABA, it was also physical therapy because she needed to gain much muscle strength to chew food, to walk and for everything. When I heard about Tele-health, I said, I need to learn more about them, I think it’s fantastic and I think I’ve seen firsthand when I have my meetings and interview people at home through the computer because I need to be around for my children. Sometimes my meetings are informal and there are times my children will walk in and join the conversation. It’s funny (ironic) because they are very excited and they think it’s cool to talk to someone through the computer. But when I bring people to my house, they often want nothing to do with in-person communication.
Dr. Wynne: Right, right, which, there you see, there’s a gap there with the social skill but we can train to that specifically. That’s the hardest part. That’s where you’ve got to be creative as a therapist. So it gets me as a behavior analyst and as a therapist to do what I do well and not kind of waste time on the rote stuff, where you can really do that through technology. But the parent education piece is so important just talking face to face. And then the child coming in and also hearing my voice and all of that is one thing and then when I come into the home, I model those skills that I want parents be able to do. So they are not looking at me in the face, so getting down on their level and getting their attention and getting them to repeat the words that I’m saying live in-person; that is really, really important. And also sometimes if the child has some more needs, I do recommend that a behavior agency locally comes into the home and works with the child on a daily basis and also providing that parent education, but also that collaboration is happening with me as well. So I’m talking to the behavior agency, I’m talking to the speech pathologist, and the SLP on my team also works with the speech pathologist, the OT, PT, even the medical doctor. We all have collaboration but the parent is the one who is the number one advocate. They’re the one that is gaining the skills to be able to advocate for their child throughout life. So we want the parents to be able to advocate, or any caregiver effectively, in a way where we’re working with the team members, not coming in trying to fight with anybody because we want to get something, but that we’re understanding what everyone’s perspective is. If somebody is sharing a perspective that doesn’t jive with the group, they will eventually not be part of the group. So we shape that collaboration and that team and we have that strongest team and you are getting all the experts in their area. When I came in as a behavior analyst on these collaborative teams, I listened to that speech pathologist because I’m not a speech pathologist, I’m not an OT, and I sit down and I’m gaining all of this knowledge from all of these different experts and the parent is the one that really has to become an expert. I mean the parent becomes like a supervisor, you start to know ABA better than anybody else for your child; same with the OT and SLP practices, very, very important that the parent has the skills to be able to advocate because the parent is going to have to teach their child how to advocate for themselves when they get older. And that’s another thing I do, I work directly with the client to make sure they know what to ask for when they are going into college. And they know how to react to some social situation, like being bullied. How are you going to react to that? They are able to advocate for themselves. And so having these conversations on going, and more face-time we can get of each chat, there is no other way to do it if they are living in eastern Oregon, or in Ireland, or in Los Angeles, so I can serve all this clients. And really how I started my Tele-health services was because I moved from LA to Portland, Oregon to be closer to my fiancé, I’m getting married in a couple of weeks.
Leslie Burby: Congratulations.
Dr. Wynne: Thank you. Thank you. So this was almost a year ago and I wanted to be able to maintain my clients, but here I am in Portland, Oregon, so I used the phone then started using Skype and it just kind of took off from there. Because I was saying, “Oh my gosh, I’m getting these great outcomes just by sitting in my kitchen, you know, just sitting in my home. And I’m so excited about the discrete video modeling because I’ve been conducting research on it and I’ve seen kids that they speak sometimes immediately. I’m starting to hear kids say words that parents have not heard, they are in their teens and they are starting to say words. It’s just unbelievable to see the gains. But the parents are absolutely committed to the program because I make sure they know upfront that they have to put in those hours every day working with their child. If I have that commitment and that they understand that that’s what they need to do, we have the best gains that way.
Leslie Burby: It’s true being a parent and coming from the education background but ultimately the parent is the one with the child 24/7 or at least majority of the time. You need to know everything because you have be their number one advocate and you have to teach them when the therapist goes home or when they are home from school. So you do need to continue to incorporate all those skills especially because generalization is such an issue when kids will learn they are good with social skills class and have learned that skill. When they come home mom and dad would take the child out to a park and they can’t carry that skill over into a different atmosphere so it’s important that the parent knows how to get them to use that skill in another situation, right?
Dr. Wynne: Correct, yes, and repetitively and consistently. The more times they’re going to be using that skill that pathway’s going to fire and they’re going to have that skill. You know practice, practice, practice is key and the same skills across settings and across people, very, very important to get that right away. That’s what I love about discrete video modeling because you can do all the front loading through this computer program and then you are just programing those core words and then you start see the kids using these words across settings and you really see the best gains and the parent knows exactly what to do. And that they are consistently implementing the strategies.
Leslie Burby: Great, So I guess my last question to you is, and I ask this to everybody; what is the number one thing that you wish you can tell parents?
Dr. Wynne: Number one thing I’d say: The more you do at home, as a parent for your child, the more you integrate the strategies within the natural routines, the better your kids will gain those skills, the more your kids will gain skills and you as a parent as well. The more you do, the more you put within the natural routines across every single person, every single environment that the child is in, the better your outcomes are going to be, hands down.
Leslie Burby: All right, well thank you so much for joining me today and explaining Tele-health and what you do at Wynne Solutions, I wish you all the luck and congratulations on your marriage.
Dr. Wynne: Thank you very much.
Leslie Burby: Have a great day. I’m Leslie Burby, editor in chief of Autism Parenting Magazine. If you would like to get a free copy of Autism Parenting Magazine please go to www.autismparentingmagazine.com