I’ve never said an individual is not a good candidate for teletherapy right off the bat. I think that diminishes this format of providing services for those not sold on it as a reliable form of therapy. If you are given a student or asked if you can treat a client who has a list of sensory and communication barriers- please give it a try. Not just one time- that first session is an introduction and you will be able to gather a ton of information from a parent or an aide. Once you have met your client at least once or twice and have spoken with someone who knows them well, you can attempt to modify how you present therapy over the virtual platform you use. 

Here are a few common reasons one may initially think their client isn’t appropriate for teletherapy:

1. Is 30 minutes too long for them to participate in a productive session? You could break the sessions into two 20-minute sessions, or three 15-minute sessions per week (for example). Maybe even schedule 30-minute sessions and have the first or last 10 minutes be for consultation with a familiar adult. Typically students that struggle to sit for that amount of time could benefit from frequent pow-wows with someone who works with them often. 
2. Does the individual struggle to focus on the screen? Just as you would in person with someone who is working on joint attention skills, using highly stimulating visuals and/or sounds that are more likely to gain their attention. Provide occasional intermissions that involve music and movement. As you know from treating people in a brick and mortar setting, you can work on so many language concepts doing what feels like a fun break! For example, after 5 trials of something related to their goal you could reward them with something incredibly stimulating for them (e.g. a game, the Bluey theme, a Taylor Swift song, watching a clip of someone playing a video game that they love). 
3. Is behavior or lack of motivation preventing them from focusing on the visuals on the screen? Similar to the suggestion in #2, create choice boards in Google Slides (for example) with an appropriate field size of highly motivating activities and videos (I once had a client obsessed with old sitcom theme songs and between tasks she was allowed to select one to watch on YouTube). Set a timer between trials to get your student out of their chair and stretch (or jump). Be sure to give a ton of positive verbal reinforcement throughout the session. Another thing to consider before throwing in the towel, consider offering consultation sessions so you can model effective intervention options to the parent, teacher, and/or aide.
4. Will the client be using a device? Fantastic! There are many ways you can incorporate AAC in teletherapy. Just as you would in person, have activities that involve the client using their device to respond. Request that the parent or teacher use a webcam so you can observe the student accessing their device. If that isn’t an option, consult with them so they can understand prompt hierarchy as they inform you if the individual responded independently, used hand over hand, etc… A previous post regarding AAC in Teletherapy could assist you when in a bind. 
5. Is poor attendance an ongoing issue? If attendance is an issue, get comfortable with whoever is in charge of logging the student or client into the session. You could text them the morning of or even 15 minutes ahead of time to remind them of the session. Create an ongoing event in Google Calendar that gets sent to the client’s email (which should alert them 10 minutes before the session). There are also email extensions (such as Boomerang) that allow you to create weekly therapy reminders via email. Sometimes all of that communication still doesn’t improve attendance- so in that case, work with the caregiver by creating activities for home practice for the weeks they don’t show up (e.g. send a weekly activity via email). 
6. Does the client consistently struggle with logging in and/or doesn’t have a reliable Internet connection? See if you can contact the platform you use (e.g. Zoom) and have the help desk phone number saved. They may be able to narrow down the issue. If it is Internet-related, have them do an Internet Speed Test (you can find it on Google Search based on what company they use). 

I found a useful article you can refer to in hopes that at least one of the tips could help a family or school setting with a weak connection. https://www.wired.com/story/how-to-make-your-wifi-better-faster/

When you run into these barriers, be sure to reach out to other teletherapists to get their input. Perhaps they’ve been there and have found solutions. It’s also important to get creative. Think of how you would tackle these issues if they were in-person clients. Are you able to use the same techniques you tried back then in the virtual setting?

If you have truly tried it all and have insufficient data collection due to those problems, then it could be safe to say they are not suitable for teletherapy services at this time. 

Something to Remember:

A good portion of the people using teletherapy are doing it due to living in an area with a shortage of speech-language pathologists.  Please be sure to think of that before turning someone away from access to intervention.