TelEPRACTICE IN SPEECH-LANGUAGE
PATHOLOGY
A Forum on Best Practices and Future Directions
• Robin L. Alvares, Ph.D., CCC-SLP, Kent State
University
• Susan Grogan-Johnson, Ph.D., CCC-SLP, Kent State
University
• Katya Hill, Ph.D., CCC-SLP, University of Pittsburgh
and the AAC Institute
• Jacquelyn Taylor, M.S., CCC-SLP, Therapy Source Inc.
Activity 1
When it comes to telepractice are
you…?
1. a flirt (checking it out)
2. courting (considering going further)
3. in a committed relationship
WHAT IT IS
• Any delivery of services via
telecommunications at a distance in time
or space is considered teletherapy.
• videoconferencing vs. phone conferencing
• real time (synchronous) vs. store-and-forward
SERVICE DELIVERY MODEL VS.
TECHNIQUE
• TELEPRACTICE IN SPEECH-LANGUAGE
PATHOLOGY IS NOT A TECHNIQUE – IT IS A
SERVICE DELIVERY MODEL
• Primary use of telepractice has been to allow
services to traditionally-underserved populations.
• Individuals with physical disabilities or mobility
limitations
• Individuals with in geographically-distant locations
• Specialty consultation
QUALITY OF SERVICES
• Professional competency –
• Principle II, Rule B states that clinicians “…shall engage in
only those aspects of the professions that are in their scope
of competence, considering their level of education,
training and experience.”
• Refer to ASHA Knowledge and Skills Document
QUALITY OF SERVICES
• Adherence to ethnical and legal guidelines
(including FERPA and HIPPA)
• Evidence-based practice
• Quality control
Legal Issues
• From Denton (2004)
•
•
•
•
•
•
Interstate licensure
Risk management
Technical competencies
Use of support personnel
Informed consent
Privacy/confidentiality
Denton, David (2004). Issues related to telepractice.
Seminars in Speech and Language 24(4), 313-322.
Legal Issues-Ohio
Provision of services by telepractice
•
4753-9-01 Code of Ethics
• B(7) Licensees may practice via telecommunications within
the state where not prohibited by law.
R.C. 119.032
Provision of supervision by telepractice
• 4753-3-01 Application for License
• F(2) When onsite supervision occurs via telepractice
applications, supervision shall occur using real time,
synchronous, encrypted, videoconferencing and shall meet
the supervision requirements as specified in this rule.
R.C. 119.032
The components of EBP to consider in providing
telepractice
9
EBP- Pediatrics
• No specific techniques or practices directly
related to telepractice
• Available research documents use of various
interventions during telepractice sessions
Limited Empirical Research(Hill, A. & Theodoros, D., 2002)
Assessment (Palsbo, 2007, Waite, Theodoros, Russell & Cahill, 2010, Waite, Cahill,
Theodoros, Busuttin & Russell , 2006)
Stuttering (Lewis, Packman, Onslow, Simpson, & Jones, 2008, Wilson, Onslow, &
Lincoln,2004, Sicotte, Lehoux, Fortier-Blanc & Leblanc, 2003, Kully, 2002)
Supervision (Dudding & Justice, 2004)
Audiology (Krumm, Huffman, Dick & Klich, 2008, Lancaster, Krumm, Ribera &
Klich, 2008, Krumm, 2007, Krumm, Ribera, & Klich2007)
EBP- KSU
•
•
•
•
Year 1
NSD in two conditions as measured by standardized tests, progress reports,
NOMS comparison
Satisfaction Survey Results
(Grogan-Johnson, Alvares, Rowan & Creaghead, 2010)
•
•
•
•
•
Year 2
Students in both conditions made progress as measured by change in GFTA-2
scores. However, students in telepractice made significantly more improvement.
Chi-Square test suggests that students in telepractice were more likely to
Master IEP goals then children in side-by-side condition.
(Grogan-Johnson, Gabel, Taylor, Rowan, Alvares & Schenker, 2011)
•
•
•
•
Year 3
Comparison with School Age NOMS
Caution in interpretation
Similarities in caseloads/Amount of time in tx/Amount of change
•
•
Summer Project
NSD with listener ratings and test results for speech intervention provided via telepractice and traditional
intervention
Equipment Checklist
DEPENDS ON LEVEL OF VIDEO CONFERENCING
• Desktop/ Personal
• Small meeting / midlevel
• Dedicated video conferencing unit
• Telepresence
• Conferencing room
DeskTop/Personal
EQUIPMENT
• Computer &Webcam
• Headphones
• Cell phone
• Videoconferencing application
• Room with door
PROS & CONS
• Minimal equipment costs/readily available
• Lower bandwidth requirements
• No ability to control far camera view
Small Meeting Room/ Mid-level
•
•
•
EQUIPMENT
Dedicated digital
videoconferencing equipment
Headphones
Cell phone
Room with door
•
•
•
•
•
PROS and CONS
Moderate equipment costs
Typically can not data share beyond documents/ELMO
Higher bandwidth requirements
Control of video and audio quality
Control of far camera view
•
TELEPRESENCE/ INTEGRATED ROOM
Equipment
• Videoconferencing system
• Multiple
cameras/computers
• Dedicated room
•
•
•
•
PROS & CONS
Best video and audio
Advanced collaboration
tools
High cost $300,000 +
Network management
A word about bandwidth, speed and
firewalls
• IT Support & Protocols
available to you
• Available bandwidth
• Firewalls
Private Therapists’ Equipment
• Desk top or Laptop computer (at
least 3 GB RAM for therapist)
• Webcam (can be separate or builtin)
• Headset with Mic
• Printer
• Scanner
• Phones
• Direct line to Internet (no wi-fi)
• Teleconferencing Platform
• Email
Telepractice platforms
SKYPE
Infinite Conferencing
AdobeConnect
Megameeting
GoToMeeting
Microsoft Office 365
Cisco WebEx
iLinc
Blackboard Collaborate
Platform Comparison
Infinite
Conferencing
Adobe
Connect Pro
Megameeting
GoToMeeting
Microsoft
Office 365
Cisco WebEx
Blackboard
Collaborate
ILinc
Video/WebCam
integration
X
X
X
X
X
X
X
X
VoIP
X
X
X
X
X
X
X
X
Record Meetings
X
X
X
X
X
X
WITH PAID
ACCOUNT
Real Time Screen
Sharing
X
X
X
X
X
X
X
X
Whiteboard
Functionality
X
X
X
X
X
X
X
X
Document Sharing
X
X
X
X
X
X
X
X
Public/Private Chat
X
X
X
X
PUBLIC
CHAT
X
X
X
128-bit Encryption
X
X
X
For additional
fee
X
X
X
X
Meeting Scheduler
X
X
X
X
X
X
Max. Number of
Attendees
1000
50
250
15
250
25
25
3
Price per month
$35
$45
$45
$49
$22.50
$49
$49
Free
http://web-conferencing-services.toptenreviews.com/
Blackboard Collaborate
Document sharing
Application Sharing
WEBEX
Document Sharing
Application Sharing
AdobeConnect
Document Sharing
Application Sharing
iLinc
Document Sharing
Application Sharing
KSU’s Equipment
• Desk top computer
• Logitech webcam
• Microsoft Office Live
Meeting
• Headset
• Scanner
• Xerox Copier
• Fax Machine
• Cell Phones
• Priority status/KSU network
University of Pittsburgh & ICAN™ Talk
clinic’s Equipment
• Desk top & Laptop computers
• Logitech webcam and Bose
speakers
• Headset and/or microphone
• Internet services: Illuminate
Education website and/or Skype
• Security features: encryption
• Color laserjet copier and Scanner
• Fax Machine
• Cell Phones & Email
Brick and Mortar Challenges
• Buy in from teachers, administrators, & parents
• Technology – Equipment/infrastructure and support
• Start up and operating costs
• Ensuring functional outcomes & carryover
• Usual challenges
• Working effectively/ethically with a paraprofessional
• Collaborating with school personnel
• Documentation – e.g., Who writes the IEP?
SWOT Analysis: telepractice
• Strengths
• Weaknesses
• Opportunities
• Threats
Evaluation of client & service
28
Performance and outcome
measurement
Quantitative Data
• Clinical evidence
• Assessment and monitoring
• Performance measurement
Qualitative Data
• Personal Evidence
• User impressions of
effectiveness
• User satisfaction
• Quality service surveys
Language Activity Monitoring (LAM)
• LAM tools were developed to support the collection
and analysis of language samples.
• The LAM function is the automatic recording of AAC
device language events.
– Content (One or more letters or words)
– Time (One second resolution time stamp)
• The LAM Intervention
30
When We Know
The content of language events
and the time of language events,
we can deduce how
communication is generated
and measure many parameters.
31
LAM implementations
AAC Performance Report
AAC System
Upload
Upload
Editing
Edit
Manual
Coding
Edit
Analysis
Analyzing
Report
Report
32
LAM Recording Protocol
• EXAMPLE: From actual logged sample interview
– “It’s faster than spelling everything out which is what I used to do “
16:26:05
16:26:08
16:26:14
16:26:41
16:26:42
16:26:45
16:26:45
16:26:46
16:26:47
SEM
SEM
SEM
SPE
SPE
SPE
SPE
SPE
SPE
"It's "
"faster "
"than "
"sp"
"e"
"l"
"l"
"i"
"n"
16:26:48
16:26:49
16:26:58
16:27:02
16:27:05
16:27:08
16:27:11
16:27:14
16:27:19
16:27:22
SPE
SPE
SEM
SEM
SEM
SEM
SEM
SEM
SEM
SEM
"g"
" "
"everything "
"out "
"which "
"is "
"what "
"I "
"used "
"to do "
33
34
LAM routine at home
35
Flexible cameras allow unique client positions
Another unique position
Private Practice Considerations
 Business Licenses (state to state specific)
 State specific speech and language Licensure
 Other clearances as needed by individual states
 Insurance (liability, workman’s compensation)
 Criminal Clearances
 Legal Consultation
 Accounting/Billing
 Taxes
 Contractors
 Facilitators
 Teleconferencing Platform, Security, and Technical
Hiring the right SLP
SLPs with experience
SLPs comfortable with technology
Organized
Intelligible
Flexible
Willingness to learn
Training the slp
 SLPs meet with trainer and room features are
explained and practiced
 Written procedures and examples are provided to SLPs
 SLPs MUST practice with others to be comfortable with
platform
 Trainer is available to answer questions during the
practice period
 Once comfortable, SLP holds mock therapy session
with trainer
 If the SLP demonstrates proficiency during mock
session, students are assigned
 Trainer observes initial session, if there are concerns
Managing the Contractual SLP
•
•
•
•
•
•
•
•
•
•
Maximizing Schedules
Assigning Schools
Assigning Students
Troubleshooting sessions
IEP Questions
IEP Meetings
Sharing Materials
Evaluations
Observations
Satisfaction surveys
References
Dudding, C., & Justice, L. (2004). An E-supervision model: Videoconferencing as a clinical training tool.
Communication Disorders Quarterly, 25(3), 145-151.
Grogan-Johnson, S., Alvares, R., Rowan, L., & Creaghead, N. (2010). A pilot study comparing the
effectiveness of speech language therapy provided by telemedicine with conventional on-site therapy.
Journal of Telemedicine and Telecare, 16, 134-139.
Grogan-Johnson, S., Gabel, R., Taylor, J., Rowan, L., Alvares, R., & Schenker, J. (2011). A pilot exploration of
speech sound disorder intervention delivered by telehealth to school-age children. International Journal
of Telerehabilitation, 3 (1), 31-41.
Hill, A., & Theordoros, D. (2002). Research into telehealth applications in speech-language pathology.
Journal of Telemedicine and Telecare, 8, 187-196.
Hill, A., Theodoros, D., Russell, T., Cahill, L., Ward, E., & Clark, K. (2006). An internet-based telerehabilitation
system for the assessment of motor speech disorders: A pilot study. American Journal of SpeechLanguage Pathology, 15, 45-56.
Krumm, M. (2007). Audiology telemedicine. Journal of Telemedicine and Telecare, 13, 224-229.
Krumm, M., Huffman, T., Dick, K., & Klich, R. (2008). Telemedicine for audiology screening of infants.
Journal of Telemedicine and Telecare, 14, 102-104.
Krumm, M., Ribera, J., & Klich, R. (2007). Providing basic hearing tests using remote computing technology.
Journal of Telemedicine and Telecare, 13, 406-410.
Kully, D. (2002, June 11). Venturing into telehealth: Applying interactive technologies to stuttering treatment.
References
Palsbo, S. (2007). Equivalence of functional communication assessment in
speech pathology using videoconferencing. Journal of Telemedicine and
Telecare, 13, 40-43.
Sciotte, C., Lehoux, P., Fortier-Blanc, J., & Leblanc, Y. (2003). Feasibility and
outcome evaluation of a telemedicine application in speech-language
pathology. Journal of Telemedicine and Telecare, 9, 253-258.
Waite, M., Cahill, L., Theodoros, D., Busuttin, S., & Russell, T. (2006). A pilot
study of online assessment of childhood speech disorders. Journal of
Telemedicine and Telecare, 12, 92-94.
Waite, M., Theodoros, D., Russell, T., & Cahill, L. (2010). Internet-based
telehealth assessment of language suing the CELF-4. Language-SpeechHearing Services in Schools, 41, 445-458.
Wilson, J., Onslow, M., & Lincoln, M. (2004). Telehealth adaptation of the
Lidcombe program of early stuttering intervention: Five case studies.
American Journal of Speech-Language Pathology, 13, 81-93.