Dear Therapists
We know you and your clients are stressed, maybe anxious, after Sunday night’s presidential address. The now disaster status of COVID-19 in South Africa brings with it many questions and uncertainties, and we are here to help.
The basics
The corona virus causes COVID-19, the disease which has symptoms which develop gradually, so please make yourself familiar with the following timeline:
Day 1-3: Run a fever, mild sore throat
Day 4: Sore throat, hoarse voice, body temperature increases, anorexia, headache, perhaps diarrhoea.
Day 5: Fatigue, muscle pain and dry cough
Day 6: Mild fever, productive or dry cough, difficulty breathing, perhaps diarrhoea or vomiting
Day 7: High fever, cough with more sputum, body aches and pains, perhaps vomiting and diarrhoea
Day 8-9: Symptoms get worse, fever volatile, cough gets worse, difficulty breathing.
If you, or someone in your household, has any of these symptoms, please call 08000 29999 rather than going directly to your doctor to get tested.
You also need to look after you mental health: follow the link here https://www.bbc.com/news/health-51873799
But how do I handle my work environment?
There are many things to consider, so SAISI would like to assist you to take reasonable and responsible precautions and actions during this uncertain time. Based on the information provided by government, professional bodies, your practice will need to decide whether you want to or are able to continue face-to-face services at this time. Here are some questions to consider:
- Are you currently healthy? Do you as the therapist have a runny nose / cough / fever?
- Have you been travelling recently?
- Has anyone in your immediate family shown any symptoms or been travelling or been in contact with anyone who has been diagnosed with Covid-19?
- Do you work with children with compromised immune systems or chronic diseases?
- Do you work with very young children or babies?
We know that children with Sensory Processing Disorders or Sensory Integration Dysfunction are most likely to struggle with changes in routine, or limited access to the sensory experiences you provide. How can we maintain the health and functioning of these children and their families without going against the current recommendations, bans and guidelines?
If your practice has decided to continue offering face-to-face services for now, please let your clients know where things stand to decrease their anxiety and prevent unnecessary queries. Send out a statement and make sure that all therapists in the practice are on the same page. Here are our recommendations:
First and foremost are basic hygiene principles, making sure that your practice has adequate soap and sanitiser and that they are used.
Secondly, we need to consider our responsibility to keep ourselves and our clients safe and healthy, and “first do no harm”. That means using your professional ethics and integrity to know when you should no longer be providing services. If you, or your partner, or anyone else in your household, has come into contact with someone who has been diagnosed with COVID-19, you cannot provide contact services. We work with children and vulnerable populations and have to take every measure possible to protect them, regardless of the financial implications that may have for us. Also, if you are immune-compromised in any way, suffering from a chronic disease or other, you will want to limit your contact with children.
In the days since schools were closed in the United States we have seen many therapists getting very creative in the ways they will try to help families during this trying time, including offering Skype consultations. The HPCSA makes it very clear that we cannot do this, and you are referred to the Ethics Booklet 10, available on the HPCSA website, to read up further. That said, we have to do everything in our power to help families. You may not assess a child that you have never met over Skype, but it is possible to provide recommendations to a child you know, via a Skype or Facetime chat, or telephonic conversation. Coding must be accurate and it is perhaps possible to charge a 66401 (Recommendations) code in the same way that you would be able to chat to a parent after a session. Please note that you cannot charge therapy treatment codes for online assistance. Any advice or recommendations regarding billing codes and procedures during this time of isolation will be posted on this blog as and when received from OTASA.
Our aim should be to relieve the stress and anxiety in the parents and children we deal with. As sensory integration therapists we know that this time of isolation may manifest in less than optimal behaviour for the little people we work with. Try to be the calm space for them and their parents, a sounding board, and a resource for coping strategies. Use the time to update or create beautiful home programmes for parents. The best home programmes are the ones that use everyday household items in creative ways, and don’t expect parents to go out and buy craft materials. Make use of what has been made available online or use your social media platforms to share your creative ideas. Remember though, that when using public platforms your tips should be generalized (not for a specific client) and include a disclaimer.
For paediatric therapists continuing with therapy:
- Insist that children with a runny nose or cough may not attend therapy. If they do arrive they will be sent home.
- Anyone with direct family that has travelled in the past 30 days should let the practice know in advance and make alternative arrangements for consultation.
- Anyone who has been in contact with a high-risk person should not come to the practice for 4 weeks.
- Wash your hands and client’s hands before, during and after every session, with normal soap, for at least 20 seconds. This has been shown to actually break down any virus on your hands.
- Limit the time spent by clients in the waiting area. Space clients further apart to limit their contact with each other and request that they adhere to these times. Ask family to wait in the car.
- No eating or drinking in the waiting area.
- No cellphones, laptops or cell phones in the waiting area.
- Pay specific attention to disinfecting shared items, bathrooms, access buttons and door handles
- Limit the use of ball ponds, hammocks, spandex or other tunnels and munch mats. If you use spandex, take it down after seeing the child and leave in a box in the sun (>27 degrees celsius) and do not use for 12 hours. You could place a PVC mat over the balls in the ball pond so that the children could still crash, and then it could be wiped. Cover mats and equipment with PVC.
- Use disposable tactile play such as shaving foam, an onion sack, bubble wrap etc
- Allocate play dough to be used and once the session is over, give it to the client to take home. Use air dry clay in the session and send it home.
- Be creative in using gloves, masks in play themes if needed e.g. super heroes, doctor doctor, fireman etc
- Spray and disinfect between clients, so leave enough time for a “reset” between clients.
- Get creative with spray bottles for fine motor use and cleaning surfaces and hands at the same time.
- Avoid closed and isolated places such as tents.
- Open air, flat mat crash so that you can clean easily after use.
- Use disposable climbing gloves with ropes and trapeze, and build it into your play themes.
- Fine motor and perception: use printed worksheets instead of actual games. That way you can send the end product home with the child, limiting transmission.
- Print out grids and cards to be used with each client to be used as disposables.
- Be creative while being hygienic and safe. Protect yourself first and maintain the safety of all your clients.
- If you are a practice that usually offers a sweet or surprise at the end of the session, allocate one per child and don’t let them stick their hands into a jar to choose.
Thank you to the North Gauteng Private Practitioners Group and Sensory Kidzone for sharing these ideas.
There is a Facebook group created by ASI Wise where therapists are sharing ideas for continuation of treatment. You are invited to join the conversation and contribute to this initiative – let’s help each other out. You can follow the link to join: www.facebook.com/groups/Covid19andsensoryintegration/
For those of you working in schools, the decision regarding continuation of therapy has probably been made for you. There are some therapists who have shared lovely resources for those staying at home. Feel free to use the links below and share these with parents:
- For seven OT-based packets: KidsMasterSkills.com and click on “Download your FREE Take-Home Packets here”. These include brain breaks, pencil control, kids yoga, scissor skills, writing practice, sight word practice and letter formation.
- TeachersPayTeachers: register and download various activity packs which have been made free for this period of uncertainty.
- Growing Healthy Children Therapy Services: Sensory Motor Activity Books downloadable at https://www.ghcot.com/sensory-motor-activity-books/
- A Facebook group by ASI Wise for parents: www.facebook.com/sensorystuckathome (You as therapists are also encouraged to contribute helpful ideas to this group)
Schedules and Routines
Being home 24/7 with your children, especially if they have special needs, can be a very trying time for parents. Share routines and visual schedules with parents, highlighting the importance of routine and variety in their child’s day. The one thing that we should all be wary of is too much screen time as we sit and wait for the time to pass. Try to include only one slot of screen time per day, whether that be used for academic (online learning), discretionary time, a reward, or social (e.g. Skype with friends or family). Include outdoor games, sports, bike rides and walks on a daily basis for gross motor activity, while reminding them to avoid communal play areas, restaurants, movies and ice-skating rinks. We have the benefit of still enjoying the last days of a warm summer, and the virus is scared of heat. What better reason to get out in the fresh air, let off some steam, clear our minds and chase the germs away!
The Star Academy shared a lovely colour-coded schedule which is available on SAISI’s facebook group, which helps parents schedule activities which are alerting (red), just right (green) or calming (blue). You could use this to help parents understand how to select activities.
Items to include in a schedule: ADL tasks: make bed, eat, bath, teeth brushing etc, academic tasks (depending on age), fine motor games, fun time: board games, discretionary time, reading time, down time/ quiet time: after lunch; and outdoor time and movement/exercise.
In conclusion
We, as occupational therapists, have a unique perspective on the effect that isolation will have on the population, and children with special needs. We have so much we can offer in terms of advice and support, but need to make sure that we
- Work within the limits set by the government during this time,
- Adhere to strict hygiene and social distancing protocols
- Stay within our scope of practice, and
- Work within the guidelines of the HPCSA.
Above all, we need to maintain the integrity and professionalism expected of us by the Health Professions Council of South Africa (HPCSA), the Occupational Therapy Association of South Africa (OTASA), and South African Institute for Sensory Integration (SAISI). If you are in doubt as to whether something is an appropriate course of action, kindly contact the appropriate body and ask one of the board members for advice.
As new information we will share it here on the blog, or on our Facebook page. Please feel free to share your creative ideas, concerns or questions on SAISI’s facebook page.
Wishing you all good health, and some much needed downtime with your families to reflect, heal and reconnect.
SAISI Board