Special educators in the state of Ohio faced a big problem in 2007: with an exploding population of school-age children suffering from Autism Spectrum Disorders (ASD) and corresponding problems with speech and language, there were not enough qualified SLPs in the state to provide adequate treatment in every school district. In the depths of the global financial crisis, finding more money to hire additional SLPs was unlikely, nor was it clear if there were enough SLPs available to fill the shortage in the first place.
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A new trend rising in other states caught the eye of the Ohio Master’s Network Initiatives in Education (OMNIE), however: SLPs providing fully engaged therapy sessions via live steaming.
OMNIE set up a pilot program to test the effectiveness of therapy rendered remotely. Two groups of children were offered treatment in two stages, one beginning with four months of conventional speech therapy, and the other with four months of videoconference therapy.
At the end of the study, the SLPs found that the video-based therapy was just as effective as face-to-face sessions.
With that discovery, Ohio joined the ranks of states that allow telepractice for SLP services, and by 2011 the program had expanded from serving 30 children to 190.
Modern Technology Increases the Range of Healthcare Service Providers
ASHA, the American Speech Language Hearing Association, chooses to call such service telepractice, but it is part of a larger trend in medicine known as telemedicine. In the digital age, it is simply more practical for service providers of all specialties to diagnose, consult, and render certain types of treatment via streaming teleconferencing services.
In many cases, the computer serves not just as the medium for live video sessions, but as an adjunct to the treatment itself. SLPs can use built-in whiteboard, recording, and screensharing features to expand on their treatment capabilities. For example, patients can be asked to draw or write on screen as an alternative way of communicating when they are having difficulty forming a particular word. The ability to record and playback video allows SLPs to review and demonstrate speaking techniques in detail and walk patients through a review of their own performance while offering coaching in real-time.
As the Ohio experiment suggested, telepractice can dramatically expand the presence of a limited number of SLPs. In more remote and rural areas of the country where it would be economically impractical to either post or send a traveling SLP, patients now have access to SLP services via telepractice; and at a much lower cost. And with the increase in bandwidth to private homes, patients who had previously struggled to find the time to visit clinics for face-to-face therapy can now see their SLP regularly.
The ability to schedule more patients without having to account for travel time or delays makes the telepractice SLP’s day more efficient. So does keeping a consistent office space, instead of having to adapt to whatever local accommodations are available at the locations they travel to—training aids and materials are always right at hand, in familiar places.
Many telepractice SLPs deliver therapy right from their own homes, which is another advantage. An ASHA survey conducted found that 11 percent of all SLPs made use of telepractice, and 14 percent delivered services from home.
Enhancing the Scope of Services With Telepractice
The same survey found that most SLPs offering telepractice services use them in conjunction with traditional face-to-face therapy sessions. Many SLPs felt that conducting some of the preliminary sessions face-to-face helped to build rapport with patients, while conducting counseling and follow-up services via telepractice was easier and just as effective as doing so on-site.
The survey also found a surprising range of conditions in which telepractice treatment was being used, including:
- ASD
- Aphasia
- Articulation disorders
- Dysphagia
- Motor speech disorders
Telepractice services can be offered synchronously or asynchronously. SLPs might choose one method over the other depending on the type of therapy being delivered. For example, in cases where they need to hear and correct audio feedback in real time, they would choose synchronous service. If the therapy simply required a homework assignment, which could be reviewed and graded at any time, they might choose an asynchronous service, making it more convenient for both the patient and themselves.
Like regular therapy, telepractice can also be offered to groups as well as one-on-one. Standard videoconferencing setups allow SLPs to teach a regular classroom with special education students or patients who share similar issues.
New Fields Have New Challenges to Meet in Service Delivery
Telepractice is still a relatively new way of delivering speech language therapy services and providers are still developing the best tools and techniques for using it. ASHA outlines a strict set of standards for telepractice service delivery and has been working to help both providers and regulators find appropriate ways to categorize the practice.
State and insurance regulations are still in their infancy regarding telepractice. Only about twenty states have provisions in their laws governing speech language pathology to explicitly allow telepractice services. The issue of providing services across state lines requires special reciprocity agreements for licensing, many of which have yet to be fully worked out. For federally-employed SLPs, such as those working for the Department of Defense or Veteran’s Administration, a special exemption has been made to allow telepractice across state lines.
Some SLPs report that telepractice can make it a challenge to stay on the same page with teachers or caregivers who work closely with patients every day. Since they may not participate in the sessions, extra effort has to be put into connecting with them to discuss treatment plans and progress.
Other, more mundane obstacles also create problems for telepractice delivery. In a face-to-face session, for example, if a patient with Attention Deficit/Hyperactivity Disorder (ADHD) tries to wander off, the SLP can physically corral them, blocking the door and refocusing them on the task at hand. But if the same patient decides to wander away from the video monitor, the SLP has little recourse to continuing the session. In such cases it may be necessary to have an aide, parent, or teacher accompany the patient during the telepractice session.
Issues with technology also continue to intrude, although they have tended to improve as the state-of-the-art in telepresence has become more generally available. Improvements in network stability and speed has also been a boon to telepractice providers.
Despite the various obstacles, the success of telemedicine and speech therapy telepractice speaks for itself. From our current vantage, SLPs can be certain that the trend of delivering services remotely will only accelerate.
Today’s SLP is likely to incorporate at least some aspects of telepractice. In the years to come, an increasing number of SLPs may be employed to provide telepractice services exclusively.