TELEPRACTICE: Speech therapy for preschoolers via videoconferencing

ASHA’s Definition: Telepractice is the application of telecommunications technology at a distance by linking clinician to client, or clinician to clinician for assessment, intervention, and/or consultation. ASHA, 2005 Speech Language Pathologists Providing Clinical Services via Telepractice: Position Statement

IT HAS GROWN! 2011 – Special Interest Group 18 (telepractice) formed 2013 – SIG 18 membership doubles in size in a year Future research for the use of telepractice in a variety of settings (i.e. schools, early intervention, etc.)

WHAT DOES IT LOOK LIKE?

EVIDENCE /RESEARCH A three-year pilot study conducted in public school settings by Dr. Susan Grogan-Johnson of Kent State University found telepractice to be an effective method of speech intervention, with clients making progress equal to that of traditional methods (2010). Based on an overview of research related to early intervention services, Jana Cason at Spalding University in Louisville, KY (2011) found telepractice has the “potential to enhance early intervention service.” Two case studies conducted by Michelle Boisvert, Nerissa Hall, Mary Andrianopoulos, and Jeanne Chaclas concluded that children with autism made progress on their IEP goals using the telepractice service delivery model (2012).

PRELIMNARY FINDINGS AT CHESAPEAKE: In a parent survey, parents rated the following: Satisfaction Child’s Progress Convenience Time Saved

PARENTS’ SATISFACTION WITH TELEPRACTICE

CHILD’S PROGRESS SINCE BEGINNING TELEPRACTICE

CONVENIENCE OF TELEPRACTICE

TIME AND GAS SAVED Parents reported that they save an average of 67 minutes of driving and waiting time on each therapy session by using telepractice Parents reported that they save an average of 18.6 miles of driving

QUOTES FROM CCTC PARENTS AND CLIENTS “I thought it was excellent, even from the first time” – Anonymous from survey “Telepractice saves time” – Jaden’s mom “I like to draw with the materials” – Jaden “We love doing therapy in our pajamas” – Jaden’s dad “I wasn't sure how it was going to work, so I was pleasantly surprised. Anything that makes learning fun is great in my book”- Anonymous

LEGAL CONSIDERATIONS The clinician must be licensed in the state in which the client is located Clinician’s must consider state-by-state laws 14 states plus D.C. currently have statutes regulated by state boards Inconsistencies of language across states make it necessary to check the clinician's and the patient’s states’ regulations before beginning to practice telemedicine Malpractice policies vary by carrier for telepractice providers

BILLING Private insurance reimbursement varies by state In 2012, laws passed in VA and MD require insurance companies to reimburse for telemedicine no differently than in-face therapy Some state Medicaid programs do reimburse Qualifying circumstances vary by state Medicare does not currently recognize OTs, PTs, or SLPs as telehealth providers

HIPPA Telepractice is NOT Skyping Programs are available that provide secured videoconferencing WebEx HIPPAchat (iPhone- secured facetime) Other considerations Persons present in the room (client and clinician) Advised consent for video and photography

BENEFITS “Telepractice may be used to overcome barriers of access to services caused by distance, unavailability of specialists and/or subspecialists, and impaired mobility. ” (ASHA position statement) Telepractice is Convenient Motivating for the child Interactive

REDUCED CANCELLATIONS 46 percent of all cancellations at CCTC are caused by weather or illness CCTC’s cancellation rate for in-house services is at15.7% CCTC’s cancellation rate for telepractice services is 2%

EQUIPMENT Computer/iPad/iPhone Internet- High speech broadband Webcam Microphone Headsets (optional) E-Helper

RESPONSIBILITIES – PATIENT, PARENT, SLP “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.” (ASHA position statement)

RESPONSIBILITIES, CONT Clinician: Receive training in use of the Telepractice service model Assure that all patients slated to receive this service have been approved by the Telepractice team Assure that parents have received the Telepractice handbook and have completed required consent forms prior to initiation of Telepractice services. Assure that their computer and internet connection are running correctly prior to start of the Telepractice session. Follow CCTC standards of practice for Telepractice sessions. Notify parent if any session or part of a session will be recorded, and receive verbal permission prior to initiating the recording. No session will be recorded or shared without signed consent and verbal permission for each session recorded. Notify parent if any session or part of a session will be observed by a third party, identify that third party and the reason for such observation, and receive verbal permission from the parent for observation. No session will be observed without specific permission of the parent. Perform ongoing assessment of the efficacy and suitability of Telepractice for each child, and discontinue this service model if it is not proving appropriate and beneficial for the child. Adhere to all standard privacy protections.

RESPONSIBILITIES, CONT Parent/Caregiver: Provide an adequate computer and internet connection, including audio and video capabilities Sign a consent form specific to Telepractice services Complete a video/photo consent form Provide an address for session link Be present with their child throughout the Telepractice session Comply with all CCTC rules regarding scheduling and attendance

RESPONSIBILITIES, CONT Child: Demonstrate acceptable behavior during Telepractice sessions Complete surveys as appropriate Enjoy a new way of getting their speech therapy!

PATIENT SELECTION Who is eligible? Considerations: Access to equipment Interactive abilities (hearing, vision, motor, etc.) Attention Each child is different Telepractice has been used with a variety of ages, diagnosis and needs

TELEPRACTICE IS ALL ABOUT BUILDING A RELATIONSHIP Children receive specific materials according to their needs Find a connection with the child It is more than just an extension of “traditional” therapy methods

HOW DO YOU STAY ENGAGED? Use the monitor (lighting, body positioning, etc.) Address objects in their environment Personalized materials Vary your voice (pace, intonation, etc.) Be ready to go with supplemental videos, pictures, etc. Utilize annotation tools and interactive features when applicable Use your E-Helper! Be prepared!

WHERE TO ACCESS MATERIALS Kerpoof Create-your-own powerpoints Premade powerpoints Websites available Copyright issues

EXAMPLES

CASE STUDY

EARLY INTERVENTION APPLICATIONS: THE COACHING MODEL “Coaching works best when it focuses on the entire person versus focusing on the skill development alone” Source: Harvard Business Review Provides real live opportunities to have a conversation with the caregiver regarding current progress, skills and techniques

CASE STUDY

ACTIVITIES TO USE DURING EI SESSIONS Take me around your home I have a car too! Let’s find “mama” Do you see that blanket behind you? Let’s play Peek-a-boo Watch the blocks fall down Online books

REFERENCES Boisvert, M., Hall, N., Andrianopoulos, M., & Chaclas, J. (2012). The multi-faceted implementation of telepractice to service individuals with autism. International Journal of Telerehabilitation, 4(2), Brown, J. & Cohn, E. (2012, April 03) SIG spotlight: membership in SIG 18, telepractice, more than doubles in a year. The ASHA Leader. Cason, J (2011). Telerehabilitation: an adjunct service delivery model for early intervention services. International Journal of Telerehabiliation, 3(1),

REFERENCES 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(3), Law, B. M. (2012) Why CareFirst champions telepractice. The ASHA Leader. Retrieved fromhttp:// /2012/121009/Why-CareFirst-Champions- Telepracticehttp:// /2012/121009/Why-CareFirst-Champions- Telepractice Waldo County General Hospital (2012). Speech Therapy Telepractice [powerpoint slides]. Retrieved from conference October 2012.

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