1. Using Telepractice to Provide School Based Therapy Services in Rural Ohio Sue Grogan-Johnson, Kent State University sgrogan1@kent.edu Robin Alvares, Kent State University ralvares@kent.edu Lynne Rowan, Kent State University Mark Krumm, Kent State University Nada Allender, OMNIE Project

2. How we got started Fall 2006 SLP Shortage Task force ODE/State Board approval & funding One of 8 initiatives to address the shortage

3. Answering concerns from the community This position statement is an official policy of the American Speech- Language-Hearing Association. 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-Language-Hearing 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. American Speech-Language-Hearing Association. (2005). Speech-Language Pathologists Providing Clinical Services via Telepractice: Position Statement [Position Statement]. Available from www.asha.org/policy.

4. What our project all about Pilot research project partner with Kent State University 4 years/planned expansions Study the service delivery model Children IDEA regulations & paperwork Costs compared to side by side How about technology

5. Clip of therapy

6. Year 1 of the project Hardin County Students Eligible if grades k -12 and current IEP Started with 38 Articulation/language/fluency Not autism, significant cognitive impairment, ED 13 F, 25 M, 4-12 yrs. Old Selected from current caseloads Obtained separate parent permission

7. Year 1 Study Design Split half Ss reward Data collection Progress reports NOMS GFTA & language samples Therapy Delivery Telepractice – primarily individual with 4 students in group therapy and 2 students who received group and individual Side by Side- primarily group ranging 2-4 students E-helpers

8. Year 1 Equipment PC desktop computers Logitech quick cam web cameras Polycom PVX software Polycom VSX 5000 with document camera

9. Year 1 Typical sessions Followed goals and objectives on IEP with exception of in-classroom objectives Each session begins with review of goals for session, followed by therapy and a final review at end of session For articulation students attempting to obtain a minimum of 70 productions in a 20 minute session For language students incorporate literature based remediation as able

10. View clips

11. Year 1- Results Progress reports Telepractice Totals for Fall and Spring SemestersOn Site Totals for Fall and Spring Semesters # of Students = 36 Total number of IEP Objectives= 126Total number of IEP Objectives= 112 # of Objectives Mastered = 50# of Objectives Mastered = 20 # of Objective Adequate Progress = 51# of Objectives Adequate Progress = 70 # of Objectives Limited Progress= 2# of Objectives Limited Progress= 4 # of Objectives No Progress = 0 # of Objectives Not Initiated = 23# of Objectives Not Initiated = 6 # of Objectives Not Scored= 0 # of Objectives Not Scored = 7 # of Objectives “Some Progress “= 0# of Objectives “Some Progress”= 4 # of Students Dismissed = 3# of Students Dismissed = 2

12. Year 1 Results NOMS Comparisons Functional Communication Measure D: Intelligibility Telepractice Project Subjects (n= 8) 2008 NOMS National Report* % of students who made no progress 37.5%29.2% % of students who improved one level 25%40.4% % of students who improved multiple levels 37.5%30.3% *K-12 Schools 2008 National Data Report, 2008 ASHA.

13. Year 1 Results NOMS Comparisons Functional Communication Measure G: Speech Sound Production Telepractice Project Subjects (n= 14) 2008 NOMS National Report* % of students who made no progress 28.5%20.9% % of students who improved one level 21.4%31.1% % of students who improved multiple levels 37.5%30.3% *K-12 Schools 2008 National Data Report, 2008 ASHA

14. Year 1 Results NOMS Comparisons Functional Communication Measure I: Spoken Language Production Telepractice Project Subjects (n= 7) 2008 NOMS National Report* % of students who made no progress 28.5%37.4% % of students who improved one level 28.5%41.2% % of students who improved multiple levels 43%21.4% * K-12 Schools 2008 National Data Report, 2008 ASHA

15. Year 1 Results GFTA-2 Results Telepractice Subjects (N =22) On site Subjects (N = 22) # of students whose standard score did not change 11 # of students whose standard score increased 1411 # of students whose standard score decreased 710

16. Year 1 Results SubjectsIEP Objectives 9/07 language sample % correct 12/07 language sample % correct 5/08 language sample % correct 1 Child will use correct irregular verbs or plurals with 80% accuracy while talking about an activity. (Language samples contained insufficient examples of irregular plurals to assess. Only irregular verbs including copula and auxiliary forms of “to be” and “to do” were assessed) 98%100%90% 2 During a variety of daily activities, child will clearly communicate using the correct word tense 80% of the documented time. 93%95% 3 Child will independently use socially appropriate, grammatically correct simple sentences with 4/5 accuracy on measured trials over three consecutive sessions (All C units were counted and dependent clauses that were judged complete within a conversational context (e.g. Examiner: “why did he eat it? Child: “because he was hungry). Sentences had no more than 30% unintelligible words. Automatic utterances (e.g. “I don’t know) were excluded). 63%75%86%  Language Sample Analysis by IEP Objective

17. Year 1 Results Satisfaction Surveys (students) QuestionsYesNoI don’t Know 1. I like coming here.2720 2. I like having speech therapy on the computer with Ms. Robin. 2531 3. Speech therapy helps me learn to talk better. 2450 4. I would like to do speech therapy again using the computer. 2441 5. I could see and hear Ms. Robin during my speech therapy sessions. 2631

18. Year 1 Results Student comments “What did you like best about having speech therapy on the computer? “Her talks good and I like her.” “playing games” “I like to say playing games across the country. Isn’t that pretty neat?” “What do you wish you could change about having speech therapy on the computer? “Playing game on it and she can still talk to me” “Get a better computer so we don’t have so much breakups.” “Make it less statically.” Other comments It’s awesome cause it like shows you and if I do really good she might give me like 3 stickers.” “ Like it’s a lot of fun but it’s a little hard- like the stuff I don’t know about yet.”

19. Year 1 Results Survey Results (Parents) Questions How would you rate the following? 0 DNK 1 NVG 2BA2BA 3A3A 4 AA 5 VG 1. Delivery of speech language therapy services using the telepractice technology 200299 2. Your child’s overall progress this year 0001138 3. The telepractice speech therapist’s availability for communication with you regarding your child 2004610 4. Attitude of your child about receiving speech therapy services via telepractice 2001514 5. Your attitude about speech therapy services via telepractice 2003611 6. How do you think telepractice compares to face-to-face therapy 201496 7. What is the likelihood that you would recommend telepractice to other parents 2012611

20. Year 1 Results Parent Comments “This project really got student’s name excited about his speech class. He looked forward to having this class each week. It was great!” “My son has come so far this year with his speech! His improvement was shocking to his father and I! He still needs work, but he loved the telepractice and with his improvement it is wonderful. “I believe they should have this therapy longer and more availability to more children. Student’s name enjoyed it and I noticed a big difference (positive) from the outcome of this project. Thank you for the opportunity.” “I feel student’s name is learning a lot. He comes home and tells us what the therapist has told him to work on. He thought it was fun, and if learning is made fun I think it will stay with him.” “Keep up the good work and help other kids I would let student’s name do it again if she needs for next year.” “ Student’s name really enjoyed this program!” “My son was happy to do the therapy via telepractice because he was more comfortable with doing it that way rather than face to face. He was excited about going to speech on those days. Thanks so much!”

21. Year 1 Results Satisfaction Surveys (teachers) 15 of 27 surveys were returned Teachers did not know about the components of the program or student response/progress One exception was student attitude toward telepractice (9/15 rated very good)

22. Year 1 Results Satisfaction Surveys (Principals) 4/4 surveys returned Follow up with unhappy principal Satisfaction Surveys (E-Helpers & Side by Side SLPs)

23. Year 1 Results Reliability of Telepractice Services 704 possible sessions 189 missed sessions 41 made up sessions 556 total sessions (79%) Of missed sessions 20% teacher in-services (39/189) 38% weather (72/189) 15% student absent (28/189) 13% school related activities (25/189) 4% site based technical difficulties (7/189) 0% KSU based technical difficulties (0/189) 10% E-SLP absent (18/189)

24. Benefits of telepractice Providing master’s level speech and language services to students in rural Ohio. Increased productivity Use of Computer and Internet-based resources Students report that it is motivating

25. Limitations of telepractice Cannot provide classroom-based, “push-in” services Can limit collaboration with administration, teachers and other service providers Difficult to deliver services to more than one student Potential for problems with technology

26. Changes made from Year 1 to Year 2 Expanded services to additional 50 students in Greenfield Schools District employee schedules therapy times, meetings and manages paperwork No group services Personal contact made with all teachers and administrators and many related service personnel Establishing baseline procedures for all students Establishing criteria for descriptors used in progress reports Evaluating other teleconferencing software options

27. Anticipated changes for 2009-2010 Different teleconferencing software Service delivery to preschool students Study the use teleconferencing for language assessment Further refinement of measures of treatment efficacy Expansion of the project

28. Brainstorm – other uses for telepractice Providing services to high-incidence students through telepractice to decrease caseloads for on-site services Extended School Year Screening Consultation ??????

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