Using Technology to Increase the Generalization of Gains

Dear SMA Community,

The last two years have truly been like no other in many of our lifetimes, between the COVID-19 pandemic, the racial pandemic, and now the war between Russia and Ukraine. In March 2020, so many of us were quick to adapt our therapy to online to get services to clients regardless of where they were located and the status of COVID-19. It was remarkable to see the transition that providers, educators, and caregivers took to telehealth in order to continue to provide support to the youth and young adults with selective mutism, particularly against the backdrop of the mental health crisis that has burgeoned over the past two years. Although many have found ways to use technology to their advantage through videoconference sessions, classes, playdates, and more, some may understandably be experiencing “Zoom fatigue” or burn out of using technology and for many, there is a desire to be back in person. We wanted to share a few ways, that you may not be thinking about, to easily use technology to your advantage to generalize improvements in treatment to other places, people, and situations.

• Places: One of the main benefits of telehealth is the expansion of the reach of services to those who previously were not able to access care due to location of treatment centers, transportation difficulties, or other logistical obstacles like childcare for younger siblings. With the use of technology, families can receive treatment even if they live hundreds of miles away from the nearest provider with SM expertise! Providers also can run social groups, parent groups, support groups, and more, bringing youth, young adults, and/or caregivers together across the state or nation to increase the generalization of gains to more people in more situations in more locations. For a list of providers, click here.

• People: Another unique opportunity has come to light with the use of technology is the ability to expand one’s practice in speaking with extended family members or family friend circles that the child does not see frequently and previously could not participate in speaking practices for logistical reasons. Step-by-step remote guides for fading (found at this link for remote guide) in these new or familiar people in the virtual world have become more standard in practice and can be used to expand with whom the individual speaks. The use of technology allows for more flexibility in presenting new or familiar people into the speaking relationship and with as much or as little support the individual may need at that time.

• Situations: Telehealth also can allow a provider to offer support directly to patients in the environments where they need it most. For example, a patient may have made gains speaking to others in the home environment or in a provider’s office, but still struggles to speak in community settings. Moreover, the nuances of some situations can be extremely challenging to target in the office in simulated ways. With the use of a mobile app that allows for videoconference capabilities (e.g., Zoom, FaceTime), providers can provide live coaching to patients and/or caregivers to directly guide speaking practices in their community (e.g., a friend’s house, the playground). We know that expanding practices to outside locations can be extra challenging due to the added social pressures, limits of the location itself, and timing. The support of the provider during these difficult exposures could reinforce not only the individual’s ability to speak in these situations but also the caregiver’s confidence in implementing the exposure so that anxious avoidance does not interfere with the family’s success in the speaking practice. Technology also can be beneficial in supporting speaking practices at school, particularly when the provider is unable to be on site and the child is not yet speaking to any school personnel. A remote provider can use brave talking strategies as part of a shaping procedure, first with the client in the car with the windows rolled up while outside of school, then on the school campus on the sidewalk, and then eventually in the school building, and so forth. The provider is there each step to support the client as if they were there in person standing beside them, reviewing coping strategies and fostering bravery.

Despite all of the hardships the pandemic generated, it also led to some quick and smart growth in how and where we use technology to benefit our clients in day-to-day practice. Although some research had shown strong and positive findings for providing treatment remotely directly to clients in their own homes for youth with anxiety, disruptive behavior problems, and OCD, less was known about how vast the opportunities were for using technology to generalize treatment gains for youth and young adults with selective mutism. Luckily, we have seen tremendous growth and inspiration in the development of new strategies and ways to use technology to our advantage to better serve our clients with increasing their speech and their bravery across different places, situations, and people.

Sincerely,
Dr. Jami Furr
SMA Board of Directors