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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,[email protected],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,[email protected]