Telepractice: - LiteracyAccess Online

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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
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Very Satisfied
Satisfied
Not Satisfied
Dissatisfied
Not Sure
CHILD’S PROGRESS SINCE
BEGINNING TELEPRACTICE
60%
50%
40%
30%
20%
10%
0%
Excellent Progress
Good Progress
Limited Progress
No Progress
Not Sure
CONVENIENCE OF TELEPRACTICE
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Extremely
Convenient
Moderately
Convenient
Moderately
Inconvenient
Extremely
Inconvenient
Not Sure
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


Some state Medicaid programs do reimburse


In 2012, laws passed in VA and MD require
insurance companies to reimburse for telemedicine
no differently than in-face therapy
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 email 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), 11-24.
 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), 19-30.

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), 134-139.
Law, B. M. (2012) Why CareFirst champions
telepractice. The ASHA Leader. Retrieved
fromhttp://www.asha.org/Publications/leader
/2012/121009/Why-CareFirst-ChampionsTelepractice
Waldo County General Hospital (2012). Speech
Therapy Telepractice [powerpoint slides].
Retrieved from conference October 2012.
QUESTIONS?!? COMMENTS?!?

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