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 GA:Teleprac,ce

DeterminingClientCandidacyKris,nREdwards,MS,CCC-SLP

Disclosures

FinancialKris,nEdwardsisemployedbyPresenceLearningNon-FinancialKris,nEdwardsisamemberofASHASIG18:Teleprac,ce

Objec,ves

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Iden,fythenecessarycomponentsofahighqualityteleprac,ceservicedeliverymodel.

Listfourareasaclinicianshouldassesswhenconsideringaclient’sappropriatenessforteleprac,ce

Listatleastoneaccommoda,onforeachofthefourareasthatcouldbeusedtoincreasethequalityofthetelehealthservices

Research

AmericanSpeech-Language-HearingAssocia,on(2005).Teleprac(ce:KeyIssues[Client/Pa,entSelec,on].Availablefromwww.asha.org/policy.Teleprac,cehasbeenendorsedbyASHAasaviableservicedeliverymethodsince2005.ASHAhasworkedinpartnershipwithbothna,onalandstatespeech-language-hearingassocia,onstoeasecurrentrestric,onssurroundingteleprac,ce,andhassupportedeffortstomovetowardMedicaidreimbursementforonline-basedspeech-languagepathologyservicesinallstates.

PART1

Research

Tucker,J.(2012)Perspec,vesofSpeech-Language-PathologistsontheUseofTeleprac,ceinSchools.Interna,onalJournalofTelerehabilita,on,Fall4(2):47-60.InterviewswereconductedwithfiveSLPsexperiencedinthedeliveryofteleprac,ce.Fourmajorthemesemerged:barriers,benefits,reasonsforacceptanceanduseofteleprac,ce,andsugges,onstoresolveprofessionalissues.

•  Barriersincludetechnologyfailure,inadequatetraining,lackofspecifiedprocedures,etc.

•  Benefitsincludeaccesstoservices,individualizedprogramming,accesstospecialists,easetheSLPshortage,easilyacceptedbystudents,etc.

•  Reasonsforacceptanceanduseofteleprac,ce.

•  Sugges,onstoresolveissuesincludedimprovingtechnology,trainingthePSP,developingalistofprocedures,scheduling,etc.

PART2

Research

Lincoln,M.etall.(2014)Mul,pleStakeholderPerspec,vesonTeletherapyDeliveryofSpeechPathologyServicesinRuralSchools:APreliminary,Qualita,veInves,ga,on,Interna(onalJournalofTelerehabilita(on

Interviewsofparents,schoolprincipalsandtherapyfacilitatorsrelatedtopilotteletherapyprograminruralcommunity

Parentswhoaeendedtheirchild’steletherapysessionsreportedtheyhadalsogainedskillsinsuppor,ngtheirchild’scommunica,on

Despitesomeissueswithtechnology(AdobeConnectusedduringthispilotprogram),overallresponsewasthatteletherapywas“highlyacceptable.”

PART3

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WhatIsTeleprac,ce?

ASHA:

Teleprac,ceistheapplica,onoftelecommunica,onstechnologytothedeliveryofspeechlanguagepathologyandaudiologyprofessionalservicesatadistancebylinkingcliniciantoclient/pa,entorcliniciantoclinicianforassessment,interven,on,and/orconsulta,on.

Theuseofteleprac,cedoesnotremoveanyexis,ngresponsibili,esindeliveringservices,includingadherencetotheCodeofEthics,ScopeofPrac,ceinAudiologyandScopeofPrac,ceinSpeech-LanguagePathology,stateandfederallaws(e.g.,licensure,HIPAA),andASHApolicy.

WhyTeleprac,ce?✓ Addressesna,onwideSLPshortage

•  Accordingtoarecentsurvey,65%ofundergraduateandgraduatepar,cipantsindicatedapreferencetoworkinahealthcaresekngratherthanaschool-basedsekng,eventhough52.6%ofSLPswereemployedinschool-basedsekngsin2015.ThisdiscrepancymayfurtherperpetuateshortageofSLPsinschools.

•  2015-2016EducatorSupplyandDemandreportindicatesthatallUSstates,indicatesomedegreeofshortagerelatedtospeech-languagepathologists.

✓ Reducescaseloadsforon-siteSLPs,providingopportunityforimprovedoverallqualityoftherapy

WhyTeleprac,ce?

✓ Removesgeographicbarriers•  Reducesoreliminatestravel,meforon-siteSLPs•  ReducesdistrictlossofFTE,metotravel

✓  IncreasedopportunitytobringSLPswithspecializedtrainingtostudentswithspecificneeds(e.g.,bilingualtherapy,AAC,ASLcer,fied,etc.)

StateRegula,ons

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 Telehealthisviewedasmodeofdeliveryofhealthcareservices,notaseparateformofprac@ce.Telehealthisnotatelephoneconversa,on,e-mail/instantmessagingconversa,on,orfax;ittypicallyinvolvestheapplica,onofvideoconferencingorstoreandforwardtechnologytoprovideorsupporthealthcaredelivery.

 Thestandardofcareisthesamewhetherthepa,entisseenin-person,throughtelehealthorothermethodsofelectronicallyenabledhealthcare.Prac,,onersneednotresideinGeorgia,aslongastheyhaveavalid,currentGeorgialicense.

 Thelawsgoverntheprac,ceofspeech-languagepathology,audiology,andhearingaiddispensing,andnomaeerhowcommunica,onisperformed,thestandardofcareisnomoreorless.

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Telepractice State Licensure Board Requirements This state has licensure regulations for telepractice.

§609-13-.01 Telecommunications

Any person in this state or physically located in another state or foreign country who, using telecommunications and information technologies through which speech-language pathology information and auditory-vestibular system information or data is transmitted, performs an act that is part of a patient care service located in this state, including but not limited to any measures of speech-language pathology or auditory-vestibular system function or hearing instrument selection, fitting, or dispensing that would effect the diagnosis or treatment of the patient is engaged in the practice of speech-language pathology or audio logy in this state.

§609-13-.02 License Requirement

Any person who performs such acts through such means as described in Rule 609-13-.01 shall be required to have a license to practice speech-language pathology or audiology in this state and shall be subject to regulation by the Board.

§609-13-.03 Restrictions

No out-of-state or foreign practitioner shall have ultimate authority over the speech language or auditory-vestibular system health care of a patient who is located in this state. Any such practitioner in this state, another state, or a foreign country shall abide by the rules of the Board.

hBp://www.asha.org/Advocacy/state/info/GA/Georgia-Teleprac@ce-Requirements/

StateRegula,ons MedicaidBilling

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Asof2017,Medicaidhasbeenapprovedifbillingfortelehealthservicesforindividualorgroupsessionswithupto5students.ChecktheGAMedicaidmanualforuptodateinforma,on.

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ComponentsofaSuccessfulModel

• Useofmoderntechnologystandards.• TrainedPrimarySupportPersonorE-helper.• Listofspecificproceduresbeforestar,ng.• Establishingrela,onshipswithonlinepartners.

UseofModernTechnologyStandards

▶  Ensureadequateinternetspeeds

▶  Chooseproperlyfunc,oningequipment

▶  Setupdedicatedcomputerforonlineteletherapyuse.

▶  Providetechnicalsupportandtrainfor

basictroubleshoo,ng

TrainPrimarySupportPersonorE-helper

▶  Teachcuingstrategiestoredirectstudents▶  Meetaheadof,metodiscussother

responsibili,es(i.e.scheduling,IEPmee,ngs,etc.)

▶  Trainfortroubleshoo,ngoftechnological

issues

DevelopSpecificProcedures

▶  Useacomprehensivechecklistpriortotherapy

▶  TrainthePSPandhaveaback-upplanif

absent▶  Prepareampledigitalmaterialsaheadof

,me▶  ReviewthemostrecentIEPandcurrent

evalua,onreports

EstablishingRapport

▶  Communicatewithonlinepartnersconsistently

▶  Choosemethodthatworksbestforboth

par,es▶  Usephonecalls,emails,and

videoconferencing▶  Becrea,ve

DependenceonEnvironmentandSupport

Astudent’sprognosisisnotsolelydependentontheservicedeliverymodel;therearemanyotherfactors:

DiagnosisSeverityEnvironment(distrac,ons,techquality,frequencyandintensityofservices)Support(involvementlevelofthePrimarySupportPerson)

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KeyComponentstoClientSelec,on

ASHAiden,fiesfourmainareasforconsidera,on:

1.  Physical/Sensory

2.  Cogni,ve/Behavioral

3.  Communica,on

4.  SupportServices

Think:Whatwouldyouconsiderindicatorsofagoodcandidatefortherapyingeneral,andwhatindicatorswouldyouconsiderspecifictoteleprac,ce?

Physical/Sensory

Whatiftheclientrequireshand-over-handassistancetou@lizetools?

•  ConsidertheroleofthePrimarySupportPerson

Whatiftheclienthasavisualimpairmentthatpreventstheabilitytoseecomputergraphicsandtext?

•  Similartobarrierswithface-to-facetherapy•  Mayrequireon-sitemanipula,ves,similarto

onlineOTservices

Whatiftheclienthasahearingimpairment(HI)andeitherhasalimitedabilitytoheartheclinician,orusessigntocommunicate?

•  Audiobootcanbefieedtoahearingaidifheadsetisnotappropriate

•  Consideron-sitesupportsalreadyinplaceforclientWhatiftheclienthassensoryissuesthatdon’tallowuseofheadsets,orthatareaggravatedbythelight/color/soundofthecomputer?

•  Worktomodifycomputer-relateds,muliaswellasgeneralroomenvironment

Cogni,ve/Behavioral

WhatifclienthasdifficultymaintainingsustainedaBen@on?

•  Studentshouldbereferredasanappropriatecandidate

Whatifclientexhibitsfrequentand/ordisrup@vebehaviorissues?

•  ConsiderroleofPrimarySupportPerson•  Maybenefitfromindividualtherapysessions

Whatifclientwithacogni@veimpairmentisnotabletofollowbasicoraldirec@ons?

•  Considerroleofon-sitesupportsalreadyinplace

Communica,onWhatiftheclientcan’treadorrecognizeleBers?

•  Considerac,vi,esavailabletoyouduringyoursessions

•  Whatwouldyourrequirementbeforon-siteservices?

Whatiftheclienthasaseverephonologicaldisorderorapraxia?

•  Neednotbeabarrier!•  Ensuresuperioraudio/video

Whatiftheclienthasahard@mefollowingdirec@ons?

•  ConsidertheroleofthePrimarySupportPerson•  Providevisualsupportsontheplaqorm

Whatiftheclientneedsbilingualtherapy? •  Sameasin-person•  Clientshouldbereferredasappropriate•  Canbeabenefittoteleprac,ce

SupportServices

Whatiftheclientdoesn’thaveinternetaccessorthespeedsareveryslow?

•  Musthaveinternetaccessforsynchronoustherapy•  Slowspeedscanbeanissue;needtoconsider

audio/videoquality•  Consideraccesstotechsupport.Whatifthereisa

problem?

Whatiftheclientneedsassistanceduetophysicalorcogni@velimita@ons?

•  ConsidertheroleofthePrimarySupportPerson•  Studentmayalreadyhaveaccesstoa1:1aide

Whatiftheenvironmentfortherapyisnotidealfortheclient?

•  Ourresponsibilityascliniciansistosupportatherapeu,cenvironment

•  Considerligh,ng,extraneousnoise,sea,ng,etc.

PrimarySupportPerson

•  Keytosuccess!

•  Partnerswithteleprac,,onertoensureasuccessfultherapysessionforthestudent

•  Scopeofresponsibili,esdependsondistrictpoliciesandclientpopula,on

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AreThereContraindica,ons?

☹ AbsenceofPrimarySupportPersontosupportclientduringtherapysessions

☹ Lackofinternetaccessordedicatedcomputer

☹ Clientwithphysical,sensory,cogni,ve,behavioral

orcommunica,oncharacteris,csthatimpedeorpreventeffec,vetherapyifappropriatelevelofon-sitesupportnotinplace

 Scenario#1

Diana’sStory:

Dianaisa9thgraderwhoisnonverbalandhasaniPadthatsheusesintheclassroomtocommunicate.Whentheprimarysupportpersongoestobringherforherspeechtherapysession,shebecomesangryandrefusestotalkeventosay“hello”toher.Lately,shewillthrowatempertantruminclassrightbeforeherspeech,me.

Diana

 PossibleSolu,ons

 Changethe,meofdaythestudentisservedasitmaybethe,meofdaythatisupsekngthestudent

 Exploremo,va,ngac,vi,esforthatstudentandhavethoseavailableforthestudentduringtherapy,me

 HavethePSPbethe“hands”andtheSLPbethefacilitator

 Useatradi,onalrewardsystemforcomple,onoftasks

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 Scenario#2

Jared’sStory:

Jaredisa5thgraderwhoisdiagnosedwithAu,smSpectrumDisorder.Hereceivesservicesintheareasofspeechandlanguage,socialskills,occupa,onaltherapyandspecializedacademicinstruc,on.WhentheprimarysupportpersonescortsJaredtothespeechsessionandplacestheheadphonesonhishead,heimmediatelypullsthemoffandrefusestowearthem.Whenheseeshisimageonthescreen,hestandsupandwalksaway.

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Jared

 PossibleSolu,ons

Placethecameraawayfromhisfaceandslowlylowereachsessions

Havehimexploreviewinghisfaceoncameraoutsidehisspeech,me

Useearbuds

Donotuseheadsetsbutratherthecomputer’smicrophoneandexternalspeakers

Slowlyintroduceheadsetsoutsideofthetherapysessiontodesensi,zetowearingthem

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 Scenario#3

Tyler’sStory:

Tylerisa3rdgradestudentwhohasamoderate-to-severehearingloss.Hewearshearingaidsinbothears.Hisspeechandlanguagegoalsfocusonauditorydiscrimina,onanddevelopingfunc,onallisteningskills.Currently,heisbeingseeninthecomputerlabforonlinespeechservicesandduringhissession,thecomputerteacherisinstruc,ngclass.

Tyler

 PossibleSolu,ons Changetheloca,onwherethestudentisbeingserved

 Addabarrierifunabletochangeloca,ons Changetheservice,metowhenthereisnotaclassinthecomputerlab

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 VideoExamplesVideoLinks

 hep://videos.presencelearning.com/watch/5_ID2pJsYGvrmRJzm-sVBg

 hep://videos.presencelearning.com/watch/kSoh34_qYrZLb0q6Lx29-w

 hep://videos.presencelearning.com/watch/RPQ0vjoRCJ3xIJVWLielmqQ

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 Ques,ons?

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References Reference 1 2015 Educator and Supply Demand Report, American Association for Employment in Education Reference 2 American Speech-Language-Hearing Association (2005). Telepractice: Key Issues [Client/Patient Selection]. Available from www.asha.org/policy. Reference 3 American Speech-Language-Hearing Association (2015). Highlights and Trends: Member and affiliate counts, year-end 2015. Retrieved from http://www.asha.org/uploadedFiles/2015-Member-Counts.pdf Reference 4 Tucker, J. (2012) Perspectives of Speech-Language Pathologists on the Use of Telepractice in Schools. International Journal of Telerehabilitation, Fall 4(2): 47-60 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296828/#b6-v4n2-art-10.5195-ijt.2012.6102 Reference 5 Leonard et al (2016) Emerging Practice Preferences of Speech-Language Pathology Students, Contemporary Issues in Communication Science and Disorders, Fall (43): 285-298 Reference 6 Lincoln, M. et al. (2014) Multiple Stakeholder Perspectives on Teletherapy Delivery of Speech Pathology Services in Rural Schools: A Preliminary, Qualitative Investigation, International Journal of Telerehabilitation Reference 7 Molini-Avejonas, et al, A Systematic Review of the Use of Telepractice in Speech, Language and Hearing Sciences Journal of Telemed Telecare (2015) Reference 8 McDuffie et al (2016) Early Language Intervention Using Distance Video-Teleconferencing: A Pilot Study of Young Boys

 ContactInfo:Kris,nREdwards,MS,CCC-SLP

 kris,n@presencelearning.com