Telepractice:
Providing Speech Therapy Online
Presented by:
Jacquelyn Taylor, M.S., CCC-SLP
• Telepractice is a way to provide speech/language
therapy services (service delivery model, not a
technique)
• Although it is relatively new to the speech,
occupational and physical therapy fields (within the
last 5 years), telepractice has been used for some
time to provide medical services and mental health
counseling
• Services are provided through the use of web
cameras and video conferencing systems in real
time.
ASHA Position Statement
American Speech-Language Hearing Association (ASHA*)
Telepractice is the application of telecommunications technology to deliver professional
services at a distance by linking clinician to client, or clinician to clinician for assessment,
intervention, and/or consultation. It is the position of the American Speech-LanguageHearing Association (ASHA) that telepractice (telehealth) is an appropriate model of
service delivery for the profession of speech-language pathology. Telepractice may
be used to overcome barriers of access to services caused by distance, unavailability of
specialists and/or subspecialists, and impaired mobility. Telepractice offers the potential to
extend clinical services to remote, rural, and underserved populations, and to culturally and
linguistically diverse populations.
The use of telepractice does not remove any existing responsibilities in delivering services,
including adherence to the Code of Ethics, Scope of Practice, state and federal laws (e.g.,
licensure, HIPAA, etc.), and ASHA policy documents on professional practices. Therefore,
the quality of services delivered via telepractice must be consistent with the quality of
services delivered face-to-face.
Reference: http://www.asha.org/docs/html/PS2005-00116.html
MYTH:
Speech Therapy must
be done in person
FACT:
Students who receive therapy online perform
just as well and in some cases better, than
students with an in-person therapist.
Research – Kent State University (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
• ASHA-certified Speech Language Pathologist (SLP)
• Actively licensed in GA, NC and SC
• Previously licensed in OH, VA, MD, AK
• SLP for 18 years, primarily servicing schools
• 4 years as an early intervention provider
• 5years providing services via telepractice
• 2 years: primary researcher at Kent State University
• 3 years: TheraWeb Manager at Therapy Source, Inc.
Gives schools assurance due to:
• Compliance with No Child Left Behind (NCLB) and
Individuals with Disabilities Education Act (IDEA)
• IEP requirements being met in individual or group
sessions
• Availability of services in all educational environments:
online, blended and brick-and-mortar
• Access to highly trained, Master’s level SLPs from across
the country
Bridges service gaps
• Maintains compliance
• Immediate coverage until in-person sessions are possible
Solves therapist availability issues
• Addresses shortage of qualified therapists in state
• Helps ensure schools’ compliance
Flexible scheduling
• Alleviates the pain of scheduling issues
• Increases parental awareness over child’s treatment
• Enables services before or after classes…including ESY
Significant cost savings: possible with telepractice!
•
Budget relief – costs go; successful outcomes can stay!
•
Trims expense of in-house therapist
•
Schools can allocate savings to other important resources.
•
Mitigates risk of complaints/mediation/due process
hearings: peace of mind.
•
Serves students in remote or under-served areas
•
Supports those with limited mobility
•
Ensures a comfortable, easy-to-access treatment
environment for those with severe disabilities and their
families
•
Motivates students to fully engage in therapy sessions,
resulting in progress and achieving goals
School-specific challenges:
•
•
•
•
Buy-in from teachers, administrators and parents
Technology: equipment/infrastructure and support
Startup and operating costs (e.g. “speech lab”)
Ensuring functional outcomes and carryover
General challenges:
•
•
•
Working effectively and ethically with a paraprofessional
Collaboration among therapist, school and parents
Documentation (e.g. IEP writing)
Big Picture: Telepractice is Essential
7. Motivated
students make
progress
1. Telepractice
enables consistent,
continuous therapy
6. School can focus
on student success
2. Students see
their own progress
5. Assured compliance
helps eliminate due
process
4. Parents and
students view
school positively
3. Involved
parents are
happy and
satisfied
Parent Satisfaction – KSU
Greenfield Elementary School, 2010
How would you rate the following:
0
Do not
know
1
Not very
Good
2
Below
Average
3
Average
4
Good
5
Very
Good
1. Delivery of speech language therapy services using
the telepractice technology
1
2
5
2. Your child’s overall therapy progress this year
1
1
6
3. The telepractice speech therapist’s availability for
communication with you regarding your child
1
4
1
2
2
4
2
4. Attitude of your child about receiving speech therapy
services via telepractice
5. Your attitude about speech therapy services via
telepractice
1
2
5
6. How do you think telepractice compares to face-toface speech therapy?
1
1
4
2
1
4
2
8. What is the likelihood that you would recommend
telepractice to other parents?
1
Staff Satisfaction Results - KSU
Greenfield Elementary School, 2010
How would you rate the following:
0
Do not
know
1. Delivery of speech language therapy services using
the present technology
6
2. Student’s overall therapy progress this semester
9
3. Speech Therapist’s availability for communication
with you regarding this student(s)
7
4. Attitude of the student(s) about receiving speech
therapy services via telepractice
4
5. Attitude of the parents about speech therapy
services via telepractice
1
Not very
Good
2
Below
Average
3
Average
4
Good
5
Very
Good
2
15
20
5
13
15
3
11
22
3
13
22
13
2
10
18
6. Your attitude about speech therapy services via
telepractice
2
5
11
25
7. How do you think telepractice compares to face-toface speech therapy?
6
5
17
15
8. What is the likelihood that you would recommend
telepractice to your colleagues?
4
5
15
19
1
1
Parent Satisfaction – TheraWeb
Therapy Source, Inc., 2012
How would you rate the following:
1
Poor
2
Below
Average
3
Average
4
Above
Average
5
Superior
1. Delivery of therapy using Theraweb
0
0
17
25
19
2. Sound Quality during therapy sessions
2
3
22
19
15
3. Video Quality during therapy sessions
0
3
21
22
15
0
3
17
22
19
5. Your Theraweb Therapist's availability to communicate with
you
2
0
10
18
32
6. Activities completed during Theraweb sessions
0
2
12
25
23
7. Your child's attitude regarding therapy using Theraweb
2
1
11
24
24
4. Your Child's progress with IEP goals
using Theraweb
Parent Satisfaction – TheraWeb
Therapy Source, Inc., 2013
How would you rate the following:
1
Poor
2
Below
Average
3
Average
4
Above
Average
5
Superior
1. Delivery of therapy using Theraweb
0
1
17
37
34
4.17
2. Sound Quality during therapy sessions
0
2
27
33
28
3.97
3. Video Quality during therapy sessions
0
2
24
36
26
3.98
1
1
25
28
34
4.04
5. Your Theraweb Therapist's availability to
communicate with you
0
0
10
27
53
4.48
6. Activities completed during Theraweb sessions
0
1
14
34
41
4.28
7. Your child's attitude regarding therapy using
Theraweb
1
2
10
32
45
4.31
4. Your Child's progress with IEP goals
Theraweb
using
Average
Rating
Parent Satisfaction – Comments
Therapy Source, Inc., 2013
•
•
•
•
•
•
•
•
•
She has been able to accomplish more with my son online than others have in the past (combined)
within brick and mortar atmospheres.
This is the best speech therapy we have ever had
It has been wonderfully effective, I've seen leaps of progress in my child
Want this again for my child in the next school year
We both appreciate not having to drive to a facility for therapy. What a surprise to learn that she
could have speech therapy provided in this way
I was unsure about whether this would be an effective way to do speech therapy, but it has been
WONDERFUL! Mrs. ……has been so helpful, and you can't beat the convenience of not having to leave
our home. We give it big thumbs up and have recommended it to several people who have expressed
reservations.
My son greatly enjoys his therapy sessions....he gets to work on the computer {which is something he
never got to do with other speech therapists}. This made him enjoy his speech therapies more than he
ever has before.
In the beginning I was really unsure about how effective the online sessions would be. Now I'm a firm
believer. Jesse is so interested in the computer he stays more focused online than he would in person.
This was our first year doing speech online. He loved it. I loved the fact that we didn't have to drive to
another location.
*Speech, occupational, behavioral and physical therapy is available via telepractice; the
number and percentage of students currently receiving services under my management is depicted
below.
2, 0%
70, 6%
227, 20%
Speech Therapy
Occupational Therapy
Behavioral Therapy
856, 74%
Physical Therapy
• Not all states discuss telepractice in speech-language
pathology licensure laws
• 12+ states and the District of Columbia have specific
telepractice provisions for speech therapy
• South Carolina does not have telepractice provisions for
speech therapy
• The therapist MUST be licensed in home and students’
state
• South Carolina has issued guidance for telehealth for
occupational therapy*
*http://www.llr.state.sc.us/pol/occupationaltherapy/index.asp?file=TelehealthFAQ.HTM
DEPENDS ON LEVEL OF VIDEO CONFERENCING
• Desktop/Personal
• Small Meeting /Mid-level
• Dedicated video conferencing unit
• Telepresence
• Conferencing room
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
Desktop/Personal
Equipment
• Computer & Webcam
• Headphones
• Cell phone
• Videoconferencing application
• Room with door
• High-speed internet connection
Pros and Cons
• Minimal equipment costs/readily available
• Lower bandwidth requirements
• No ability to control far camera view
• Desktop or laptop computer (at
least 3 GB RAM for therapist)
• Webcam (separate or built-in)
• Headset with Mic
• Printer
• Scanner
• Phones
• Direct line to Internet (no Wi-Fi)
• Teleconferencing Platform
• Email
• Therapist conducts review based on IEP goals/objectives
• Therapist sets and discusses goals for the current session
• Student engages in 1-2 activities per 30 minute session
• Therapist and parent review the session
• Therapist may assign homework as appropriate
e.g. Students working on speech articulation skills can expect to
produce at least 100 productions during a 30-minute session.
• HIPAA compliance is critical: encryption with transmission
• ASHA: www.asha.org/practice/reimbursement/hipaa/securityrule.htm
• Encryption: minimum 128-bit Secure Socket Layer (SSL)
• Regardless of a school’s platform, sessions must be 100%
private
Questions
Error Sound
g
k
f
d
-ing
sh
ch
l
r
j
voiceless th
voiced th
v
s
bl
br
dr
fl
fr
gl
gr
kl
kr
kw
pl
sl
sp
st
sw
tr
Initial Error
d
t
p
t
t
y
w
d
d
d
b
t
b
b
d
p
p
d
d
t
t
-p
t
p
t
t
t
Medial Error
d
d
p
d
s
--
d
f
d
b
Final Error
----s
---
-f
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 Speech-Language Pathology, 15, 4556.
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.
References
(continued)
Kully, D. (2002, June 11). Venturing into telehealth: Applying interactive technologies to stuttering treatment. The ASHA
Leader, 11.
Lancaster, P., Krumm, M., Ribera, J., Klich, R. (2008). Remote hearing screenings via telehealth in a rural elementary
school. American Journal of Audiology, 17, 114-122.
Lewis, C., Packman, A., Onslow, M., Simpson, J., & Jones, M. (2008). A phase II trial of telehealth delivery of the Lidcombe
program of early stuttering intervention. American Journal of Speech-Language Pathology, 17, 139-149.
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-Speech-Hearing 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.
Jacquelyn Taylor
5215 Militia Hill Road, Suite A
Plymouth Meeting, PA 19462
Toll Free: 910-859-9228
Email: jacquelynt@txsource.net