Blog

To Teletherapy, or not to Teletherapy…That is the Question!

Nov 17, 2015, 13:38 PM

For eight years of my career, I traveled approximately 120 miles, round-trip each and every day to get to and from my school.  For three of those eight years, my two children came along with me as they were enrolled in a day care close by to my work in case of an emergency; both boys were seated in my compact car by 6:00 am with a bottle of milk in one hand and an iPad for entertainment in another and let us not forget the substantial amount of coffee for me…I have truly become dependent on the coffee!  LOTS of coffee!!!  

My boys and I spent nearly four hours in the car each day just getting to and from work.  I worked half a day to work a whole day! So I ask, who wouldn’t want to travel less?  Considering a lifestyle change to benefit not only your family and yourself, but your students as well?  Want to go to work in your PJ pants and a nice top (because the student will only see your torso…ya know?  What can I say, I am a visual learner).  Sure wish telepractice was as accessible then as it is now.  I am certain it would be a no-brainer decision for me!

So, what exactly are the facts about telepractice?  Given my inquisitive nature and being the skeptic that I am, I find myself having so many questions about the ins and outs of implementing such a mode of therapy; here are a few:

  • What does ASHA think of telepractice? Is it in our scope of practice?
  • Is telepractice effective and efficient?
  • What type of licensure would I need?
  • How do you evaluate a student?
  • What materials can be used?
  • What other details should be considered before implementing therapy from a distance?

 

Here Are Some Keys to Telepractice:Telepractice SLP

1.What does ASHA think of telepractice? Is it in our scope of practice?

First and foremost, I look to ASHA for their guidelines.  The American Speech-Language and Hearing Association (ASHA) states, “Telepractice is an appropriate model of service delivery for audiologists and speech-language pathologists. ASHA requires that individuals who provide telepractice abide by the ASHA Code of Ethics, including Principle of Ethics II, Rule B, which states, “Individuals shall engage in only those aspects of the profession that are within their competence, considering their level of education, training, and experience” (ASHA, 2010).”  Does anyone else feel as if this opens a new door of opportunity, or is it just me?  ASHA has outlined more detailed information regarding the organization’s views on Telepractice.

2. Is Telepractice Effective and Efficient:

My first thought is, effective and efficient for whom?  The student or the clinician? Both is the simple answer.  Some thoughts to consider for each stakeholder:

  • Basic Pro’s for the Clinician:

    • It is clear that there are many benefits for the clinician. Far too many to list here, so here are only a few: less travel, you can make your own schedule, possibly provide service to another time zone for extra hours/pay after your regular job, avoid directly managing aggressive behaviors (like biting or scratching if you happen to work with a population that often exhibits such behaviors), you get to work from home, you often work with an e-helper to assist in guiding the student during the session which will then support greater carry-over of learned skills, and also many times utilizing a technology based interface will gain greater engagement with your student as most kids LOVE to be on the computer. From observation, the therapy session does take a bit of a shift from what the table top session looks and feels like, but once adjusted, it is as simple as can be.  And I just can’t get over the fact that there is simply no travel to work!  I could not be more impressed by that!
  • Basic Con’s for the Clinician:

    • According to one SLP blogger on www.reddit.com, RococoRissa, she stated one Con to telepractice is that “sometimes I feel ineffective in getting a kid back on track. If a kid is really squiggly or unmotivated, you can’t really follow them around the house/school if they walk away from the camera. This is very rarely an issue for me, though, and there should be an adult “helper” there if the kid is served at a brick and mortar school.”  But isn’t that the case in person as well?  I have spent many a session under a table trying to elicit any language from a student with avoidant behaviors.
    • Another aspect to consider would be how you are employed to provide the teletherapy. If it is via a contracting agency, which is common, then you need to know the details of how you are paid.  Many agencies will not pay for missed sessions, which could happen if technology is not working properly.  These are details that a considering SLP should check out before committing to the job, but again, that would be the case in a face-to-face interaction as well.  Nonetheless, it is worth checking into if that is something your lifestyle would not be comfortable adjusting to.
    • Lastly, do you have the space? Your home becomes your office.  So, you will need to have an area that will be quiet and professional (you might need to take down the Grateful Dead poster in your office if it is displayed in the view of your computer camera).
  • Basic Pro’s for the Student:

    • Many! It appears that the student is one of the greatest to benefit from this mode of therapy.  The student who is likely the best candidate would be one who lives in a rural region and may not have access to therapists due to supply and demand.  Many school districts are not able to supply a therapist, yet given teletherapy as a method, it would eliminate this issue, hence benefit the needs of the student.
    • As mentioned previously, many students thrive on computer interaction. But LIVE computer interaction is even better.  Customized to meet their needs.
    • Sessions can be recorded and replayed for the student to use as self-critique and feedback. It can also be beneficial for the students’ parents.  All sessions can be sent home for the parents to review and benefit the student by promoting further carry-over to another environment.

 

  • Basic Con’s for the Student:

    • Believe it not, there are few. One drawback is technology troubleshooting.  Should the internet or computer not be functioning, then it results in a missed session.  So having to rely on an internet connection and all the technology needed could be a hindrance from time to time.
    • Some therapy models do need more of a hands-on-approach. For instance, if you are using a Speech Buddies tool for articulation or the PROMPT method (PROMPT is an acronym for Prompts for Restructuring Oral Muscular Phonetic Targets. The technique is a tactile-kinesthetic approach that uses touch cues to a patient’s articulators (jaw, tongue, lips) to manually guide them through a targeted word, phrase or sentence. The technique develops motor control and the development of proper oral muscular movements, while eliminating unnecessary muscle movements, such as jaw sliding and inadequate lip rounding-The PROMPT Institute) where the SLP needs to physically cue the student, not being present would be an issue for such approaches.
    • The other component to consider is the type of student you are servicing. Some are really not able to sit and follow what is being asked of them via videoconferencing.  The student needs to have a certain cognitive level to interact with the video-style of learning.  For those who require more play based therapy and have significantly challenged eye contact, using a non-face-to-face interaction my not be suitable.  Telepractice is just not meant for everyone.
  • What about the research?

    This is a new service delivery model in our field, yet it is being researched a great deal resulting in very promising findings. It has been stated that students receiving teletherapy have even “outperformed control groups and national benchmarks” according to Towey, 2013 and Gorgan-Johnson, 2011 in the areas of expressive and receptive language, social pragmatics, as well as articulation skills.  The research is building quickly and the evidence points directly at teletherapy being an excellent avenue for therapy providers-both efficient and effective.

3. What materials can be used?

  • Basically, the therapy remains the same, but there is a computer screen involved. One obstacle could be playing a board game.  However, with some creativity, a board game could still be utilized if the e-helper assisted in implementing the game while the SLP instructed the students on their speech or language targets.  That way, a game is still possible.
  • I often use PowerPoint shows to create individualized therapy materials-this is an easy modality to select for a lesson. And once a lesson is created and saved, it can be used for others as well (in addition, it is more Earth friendly as it does not require a paper print out).   I have thousands upon thousands of PowerPoint lessons saved, which have videos embedded within for a quick and easy reference in the moment.  By far my favorite way to conduct a lesson.
  • Dittos can still be used when scanned into your computer as many of us house a huge collection of Articulation and Language workbooks-so do not worry! All your workbooks will not go to waste.
  • Videos! Kids love videos, and using the videoconferencing style could not make this easier!  For example, I have played Pixar mini-films, like La Luna, and the student is required to formulate the script as it is a “wordless” movie.  I have never had one student dislike such an activity.  It usually brings the best out of some of my most quiet students.
3. How do you evaluate a student?

Evaluating a child’s speech and language via videoconferencing is essentially the same as it would be when one-on-one at the table.  And, according to Boisvert (2013), “research has shown that assessment/screening results are equivalent when comparing telehealth to on‐site.”  However, it is necessary to consider a few factors discussed below prior to evaluating:

  • Quality of the audio: If you are testing a child’s receptive language skills, there must be a quality audio component to ensure the student is receiving the proper level of volume and the vocal output from the speaker is not impacting the results of the student. Similar to when you test a student in person, both the student and clinician need to be situated in a room that has no background noises (fans, other children working, music, hallway noise, etc). If the student’s ability to clearly hear the administrator is compromised, then accurate results will not prevail.  The same must go for the clinician.  When testing a child for an articulation or phonology disorder, you want to be sure you are hearing the child’s productions loud and clear.  You may want to consider using a recording so you are able to go back and review the students’ sound productions.  To accomplish this, you may need to utilize the e-helper or assistant.  It is also wise to use a microphone to capture the best quality recording.
  • Observation in the classroom: This is where it begins to become a bit tricky.  Being you are not on-site, you are not able to just pop in and observe a student at any old time during the school day.  You do need to rely on another person to set up a monitor so you can observe in a class.  And even then, you are limited as your view is dependent upon the person in control of the laptop or camera being used.  Whatever you want to see, you need to rely on another person to guide the camera.  However, on the other hand, it may be just as easy if that helper would just take some time on a mobile device, camera or iPad to record a class and send the recording directly to you via GoogleDoc or an iCloud.  Where there is a will, there is a way.  I said tricky, not impossible.  And with a recording, you will be able to analyze the classroom interaction and language output in greater depth.  Although at all times, you will need to consider the rights of others when it comes to video recording.  Some parents do not agree to their student being video recorded, so you must be sensitive to such issues.  Authorization is needed.
5. What type of licensure would I need?
 
To follow the rules, it is suggested to be pro-active on your own behalf.  Make sure you clearly check into the state requirements for the states where you are providing the therapy (and it would not hurt to check what your own state requests). It is suggested that you seek what is required at the state level for licensure as well as what each state requires for your teaching certification.  This may vary from state to state, so be sure you have done your homework.  However, ASHA has done the hard work for us.  Please see their link for further guidance on state telepractice requirements.

6. What other details should be considered before implementing therapy from a distance? Here are a few more points to consider when contemplating a career as a distance therapist.


  • IEP Meetings: A therapist is still able to attend and represent at IEP meetings as one can be dispatched in via videoconferencing on a laptop or a tablet.  Another avenue would be the simple, good-ole, speakerphone.  Effective and easy for everyone.  Being across the country or just a few states away will not prevent you from being present at an IEP meeting.
  • Interaction with the school in general: I feel like I am part of my school as a community- a part of a family.  For those who are teaching from a distance, this may not occur.  It is much more challenging to build rapport with the faculty when you are not in the building on the daily.  You are not a known face.  You do not eat in the teacher’s lounge and hear the details that are shared outside the classroom.  You will miss out on this interaction.  Depending on what kind of a person you are, this might be a Pro or a Con…your decision.
  • Prep time is really your time: One excellent benefit of implementing distance learning is when you are offline; you have your home to yourself.  Your prep time is not going to be interrupted by anyone walking in to say “hi,” or ask a random question, thus making your very brief 40 minutes of prep time dwindle.  I am sure your ability to focus is greater without uncontrolled distractions.
  • The parent’s perspective: Here is a great link from a parent whose child has been taught from a distance.  Good to hear their perspective to guide how well we implement our therapy.

So, considering only six basic questions regarding telepractice, it is clear there is a lot to consider.  While telepractice offers great opportunities, its implementation requires preparation, resources, time and skill-development.  If you have any further questions, do not hesitate to reach out!

  • IEP Meetings: A therapist is still able to attend and represent at IEP meetings as one can be dispatched in via videoconferencing on a laptop or a tablet.  Another avenue would be the simple, good-ole, speakerphone.  Effective and easy for everyone.  Being across the country or just a few states away will not prevent you from being present at an IEP meeting.
  • Interaction with the school in general: I feel like I am part of my school as a community- a part of a family.  For those who are teaching from a distance, this may not occur.  It is much more challenging to build rapport with the faculty when you are not in the building on the daily.  You are not a known face.  You do not eat in the teacher’s lounge and hear the details that are shared outside the classroom.  You will miss out on this interaction.  Depending on what kind of a person you are, this might be a Pro or a Con…your decision.
  • Prep time is really your time: One excellent benefit of implementing distance learning is when you are offline; you have your home to yourself.  Your prep time is not going to be interrupted by anyone walking in to say “hi,” or ask a random question, thus making your very brief 40 minutes of prep time dwindle.  I am sure your ability to focus is greater without uncontrolled distractions.
  • The parent’s perspective: Here is a great link from a parent whose child has been taught from a distance.  Good to hear their perspective to guide how well we implement our therapy.

So, considering only six basic questions regarding telepractice, it is clear there is a lot to consider.  While telepractice offers great opportunities, its implementation requires preparation, resources, time and skill-development.  If you have any further questions, do not hesitate to reach out!

 

Many Thanks for Reading!
Meghan Dreyfus, MA CCC-SLP
Speech-Language Pathologist
Invo HealthCare Associates Therapeutic Consultant