Start with telepractice basics.
Telepractice is the newest addition to the field of speech pathology and has become more popular over the past three years. It is an exciting and innovative service delivery as it helps reach individuals in remote and rural areas where speech therapy may not be an option. Telepractice was approved by the American Speech-Language-Hearing Association (ASHA) as an appropriate service delivery in 2005. ASHA's position is that "Telepractice is an appropriate model of service delivery for the professions of speech-language pathology [and audiology]. Telepractice may be used to overcome barriers of access to services caused by distance, unavailability of specialists and/or subspecialists, and impaired mobility" (American Speech-Language-Hearing Association, Speech-Language Pathologists Providing Clinical Services via Telepractice: Position Statement, 2005). ASHA has recently added telepractice to its directory of special interest groups (SG-18) (2011) http://www.asha.org/SIG/18/About-SIG-18/
Starting your own telepractice can be overwhelming due to the technological aspects. Below are some basic facts that may help you get started with telepractice.
What is telepractice?
ASHA defines telepractice as "The application of telecommunications technology to delivery of professional services at a distance by linking clinician to client, or clinician to clinician, for assessment, intervention, and/or consultation." Telepractice typically occurs in real time and face-to-face with a clinician via online videoconferencing.
Who uses telepractice?
- To provide speech and language services to rural schools
- To provide voice, aphasia, or cognitive therapy to satellite clinics from hospitals or private practice, or to individuals in underserved or remote areas
- To provide speech, language, or cognitive services to remote home health agencies
- To consult /train individuals and/or families (e.g., communication training, AAC, early childhood parent training, etc.)
- To provide hearing screening
- To provide infant hearing screening
- To provide hearing aid training, etc.
Basic Equipment for Telepractice
- Web camera with 15 FPS (frames per second) capture rate (built-in or separate)
- Headset with attached microphone (analog or USB)
- High-speed internet connection (150 kbps minimum)
For Windows XP:
- 2 GB of RAM
- P4 with 2GHZ processor or equivalent
For Windows Vista / Windows 7:
- 3 GB of RAM
- P4 with 3GHZ processor or equivalent
For Mac OS X 10.4 (Tiger) or 10.5 (Leopard):
- 2 GB of RAM
- 2 GHZ
In addition to the above basic equipment, you will need a videoconferencing tool. Some “tele-therapists” are using Skype to provide online speech therapy (telepractice). Skype provides basic video and audio functionality, chat, and screen sharing, but the tele-therapist and the clients are not able to manipulate the exchanged materials, such as links, simultaneously. This may create certain limitations for therapy. For example, if the clinician is working with a client on following one-step directions, he or she will not be able to give control to the client or ask the client, for example, to “click on the dog” while viewing a website. In other words, clinician and client may view the same website, but the clinician will not be able to see where the client clicked on that website. The tele-therapist may also have to print and mail materials to clients, which may be time-consuming. Other tele-therapists use desktop sharing solutions such as “Webex,” which allows sharing of their personal desktops. The above solutions are general video
Clients are encouraged to continue to work at home at their own pace by logging on to their assigned homework. In addition, clients can view and track their progress by logging in to their accounts. Our games and activities make speech therapy more engaging and enjoyable.
Schools and other institutions can easily track the therapy hours of their students/patients, and schedule new students/patients at any time using the “client management feature.”
There may be some clients presenting with physical or cognitive challenges that may prevent them from benefiting from telepractice. Being able to sustain attention for a reasonable time, to follow simple commands, and to manipulate the mouse are some of the basic requirements. Tele-therapists should develop their own protocols to determine candidacy for telepractice.
Environment for Telepractice
In order to provide a high-quality telepractice session, the environment of both the client and the clinician must be considered. Light, distracters, noise level, comfort, and safety need to be evaluated and modified as needed prior to beginning the session.
Use of Facilitators
Younger children working from home may need the supervision of their parents, especially in the beginning of the program. The parent may need to teach the child the basic computer skills needed for speech telepractice and help the child set-up his or her session. Children who receive speech telepractice services from their school will need supervision as well. Facilitators may include a teacher’s aide or other on-site support personnel. The aide may:
- Escort children to and from therapy sessions.
- Set-up for sessions.
- Troubleshoot as needed.
- Control child’s behavior as needed.
- Communicate with on-staff teachers and staff about scheduling and changes.
When selecting a video conferencing solution, the security of the system must be considered. Virtual Speech Center complies with all of ASHA’s requirements and with federal and state laws and regulations. We use SSL encryption technology, which is currently used by a large number of health and educational institutions.
Protecting the privacy of patient records and information is mandated by ASHA’s code of Ethics Principle I, Rules K and L (ASHA 2010).
The two federal laws addressing confidentiality are the Health Insurance Portability and Accountability Act (HIPAA) and the Family Educational Rights and Privacy Act (FERPA). HIPAA requires that health records be kept secure and that telepractice sessions be protected from unauthorized access. FERPA requires that schools have a student’s consent prior to the disclosure of education records.
ASHA advises that tele-therapists should provide their clients with an informed consent form prior to conducting speech therapy online. The clients should also be informed regarding:
- Differences between telepractice and traditional therapy.
- Potential confidentiality issues.
- Description of equipment.
Speech pathologists currently need to be licensed in the states where their clients reside.