TeleSpeech Therapy Pilot Project: Stakeholder Satisfaction

This pilot study of a school-based telepractice pilot project in a rural, remote county of North Carolina investigated the satisfaction of parents/caregivers, teachers, and administrators with a year-long telespeech therapy program delivered by a university clinic. Upon completion of the almost year-long project, a satisfaction survey incorporating a 5-point equal-appearing Likert scale (1= strongly disagree; 5= strongly agree) was disseminated to the stakeholders.  The results sorted by the three populations surveyed, indicated stakeholder satisfaction with student progress toward their speech and language goals, and clinician accessibility and responsiveness (mean ratings > 4 points). The respondents (N=23) also indicated they would “recommend TeleSpeech Therapy to other school districts” (mean rating: 4.3).  The only mean rating below 4.0 was associated with teacher responses to the statement: “My expectations for the TeleSpeech Therapy program have been met” (mean rating: 3.92).   Overall, parents/caregivers, teachers, and administrators appeared to find telepractice a satisfactory service delivery model for school-based speech-language therapy.          

Allied health video consultation services

Many Australians have limited access to health care services due to a range of barriers including living a considerable distance from health services. Furthermore, there are significant shortages of healthcare workers in many rural and remote areas. Traditionally, many people have had to either travel long distances to access healthcare, or go without. Telehealth is an alternative approach, using telecommunications and information technology to supplement face-to-face delivery of healthcare services

Investigating Program Evaluation Implemented by Rural Education Systems to Determine the Efficacy of Speech-Language Telepractice Services

Given the importance of providing speech-language services to students in rural areas, school districts have begun adopting telepractice as a primary service delivery model (American Speech-Language and Hearing Association [ASHA], n.d.b; Forducey, 2006; & Polovoy, 2008). However, as the demand for telepractice grows, so does the need for a strong method of program evaluation (ASHA, 2005a). The purpose of this study was to investigate the methodologies district level administrators use to evaluate effectiveness and ensure the validity of telepractice services. Two district level administrators from distinct rural educational cooperatives participated in this study. Both were from two distinctive Midwestern states and partook in semi-structured interviews. Four global themes emerged following data analysis: qualitative measures for evaluating effectiveness, quantitative measures for evaluating effectiveness, professional qualifications impact validity, and analyzing service validity. The participant identified themes revealed a strong need for a consistent, systematic approach to program evaluation that integrates quantitative and qualitative measures. The results may be considered by district administrators currently using or hoping to implement telepractice programs to evaluate services

Development of the Caregiver-Child Auditory Skills Tracking (CAST) scale: A Pilot Study on Caregiver Implementation via International Telepractice

Parent engagement is a key component during early language development for all children, but particularly for a child with hearing loss. Through the application of technology-based models of service delivery such as telehealth, researchers have found an increase in parent-child engagement during auditory-verbal therapy (AVT) sessions due to the physical absence of the provider and parents becoming the primary language facilitators. However, current measures of parent-child interactions do not have a coding system to monitor facilitation of auditory skills. This present study will discuss the development of the Caregiver-Child Auditory Skills Tracking (CAST) Scale to track progress of caregiver implementation of the auditory skill hierarchy. Initial development included using the CAST scale for a pilot case study of parent interaction during 2 sessions (6 months) of auditory-based sessions via international telehealth. The participants were Spanish-speaking parents of a 2-year-old child with bilateral cochlear implants who reside in Mexico and received intervention from an Arkansas-based clinician. Parent interactions were qualitatively coded by graduate student clinicians using the CAST scale to rate implementation of auditory skill hierarchy stages. Data was coded twice (approximately 4 weeks apart) for both sessions on the auditory skills strategies data sheet developed by the researchers. The statistical analysis performed on the data collection was a repeated measures ANOVA. The results of the analysis found that there is a significant effect of time on both session conditions (rating one and rating two). Specifically, the rater’s auditory skills training had a statistically significant effect on auditory skills strategies data. Additionally, telehealth was observed to increase parent engagement in both sessions. These findings provide a guideline towards continued progression of the CAST scale and adds to research that supports telehealth as a viable option of speech-language pathology service delivery

A Pedagogical Note: Use of Telepractice to Link Student Clinicians to Diverse Populations

Telepractice is the application of telecommunications technology to the delivery of telehealth services via the online connection of clinicians, clients, and patients for assessment, intervention, or consultation.  This article describes a pilot project in which speech-language pathology students in a university training program gained experience in working with culturally diverse preschool students using telepractice technology. The preschool students benefited by making gains in communication skills, while the university students acquired competency in the use of telepractice and in working with children whose cultural and linguistic backgrounds were outside of their experience.  To assess the training experience, a Likert-scale survey administered to student clinicians revealed a high degree of satisfaction and improved familiarity with the use of telepractice, and an increased comfort level working with multi-cultural populations.

Perspectives of Speech-Language Pathologists on the Use of Telepractice in Schools: The Qualitative View

Telepractice in speech-language pathology shows the potential to mitigate the current shortage of speech-language pathologists (SLPs) available to serve a growing number of persons with communication disorders.  Since a majority of American Speech-Language-Hearing Association (ASHA) certified SLPs work in schools and the population of communicatively impaired clients in schools continues to grow, research into the use of telepractice in the educational setting is warranted.  This article reports upon the perspectives of SLPs regarding the use of telepractice in school settings. In-depth qualitative interviews were conducted with five SLPs experienced in the delivery of telepractice. Four major themes emerged: barriers, benefits, reasons for acceptance and use of telepractice, and suggestions to resolve telepractice professional issues

Examination of Early Intervention Delivered Via Telepractice with Families of Children Who are Deaf or Hard of Hearing

The Individuals with Disabilities Education Act (IDEA) assures infants and toddlers with disabilities and their family members receive family-centered early intervention (FCEI). There is an extant body of evidence documenting the use, or lack of use, of FCEI provider behaviors when therapy is delivered in the traditional face-to-face (F2F) condition. This disparity between best practice and actual practice is investigated in this study. This study investigated providers’ use of FCEI strategies when intervention was delivered to infants and toddlers who were deaf or hard of hearing via telepractice. Telepractice is the use of information and telecommunications technology to provide health services to people who are located at some distance from a provider. The intent of the study was to look at ways in which telepractice might impact providers’ implementation of FCEI. There were two purposes for this exploratory study. The first purpose was to examine the potential relationships between provider attributes (i.e., highest degree, experience delivering FCEI, and experience with telepractice) and the use of FCEI provider behaviors (i.e., observation, direct instruction, parent practice with feedback, and child behavior with provider feedback) by professionals delivering FCEI. Statistical analyses were designed to identify any relationships among provider attributes, any associations between provider behaviors, and any connections between provider attributes and provider behaviors. The second purpose was to examine the frequency of occurrence of desired FCEI provider behaviors during telepractice sessions and to contrast them to the same behaviors used in F2F therapy. The main intent of telepractice is to provide access to qualified practitioners for families living in remote or rural areas. Sometimes, however, opportunities for change are incidental. The combination of video-conferencing technology and web-based software supporting synchronous two-way communication has created new opportunities for the delivery of FCEI. Many researchers, program administrators, and FCEI practitioners anticipate that the use of FCEI strategies will be enhanced through telepractice. Information about participant attributes was collected using a survey tool. The use of FCEI provider behaviors was measured by directly observing and coding digitally-recorded intervention sessions. There were 16 participants in this study working in eight different programs nationwide. Therapy sessions included the provider, the mother, and a child who was deaf or hard of hearing who was 36 months of age or younger. The attributes of providers and the use of four FCEI behaviors were investigated using Fisher’s Exact Test. A log-linear count model was applied to the data to assess the effects of provider attributes on provider behaviors. In addition, the data were used to identify the percentage of time FCEI provider behaviors occurred in the telepractice condition and contrast these with the use of these same behaviors in the F2F condition. There were some significant and marginally significant results demonstrating associations between provider attributes, relationships between provider characteristics and use of specific provider behaviors, and associations between provider behaviors. While there was a poor goodness of fit between the predicted and observed counts, the use of one provider behavior parent practice with feedback was generally the most closely associated with provider attributes. The Poisson distribution gave an expected frequency count for each FCEI provider behavior. This information uncovered relationships between experience and the use of specific FCEI provider behaviors. The results of the study demonstrated that selected FCEI provider behaviors occur in the telepractice condition more frequently than they occur in the F2F condition reported in the literature. Three of the provider behaviors observation, parent practice with feedback, and child behavior with provider feedback were used more frequently in the telepractice condition than in F2F therapy. Direct instruction was used in similar amounts in both treatment conditions. The findings can be applied to a training program for providers using or learning about telepractice. In future studies, it will be of interest to include more participants from more agencies. The information applies to infants and toddlers with all types of disabilities; therefore, future studies might investigate the provider skills of professionals from different disciplines. In future studies, with more participants, more than four provider behaviors documented could be included. The findings showed there were differences in the use of FCEI provider behaviors when therapy was conducted in telepractice. This increasingly accessible service delivery platform may make therapy more accessible to the parents of infants and toddlers with all types of disabilities. Telepractice is currently funded unevenly throughout the United States. If it can be shown that family-centered early intervention is conducted as well, if not more robustly, when it is delivered via telepractice, then funding agencies may be more willing to support it

Inter-Rater Reliability of Diagnostic Language Testing Administered via Telepractice

Federal law mandates children with language disorders receive free and appropriate intervention. Diagnosis is the first step in the intervention continuum; however, children in rural America are underserved due to personnel shortages. Limited studies have demonstrated the reliability of language testing conducted via telepractice. Further research examining the reliability of language tests administered via telepractice is necessary. The purpose of this study was to assess inter-rater reliability of three language tests administered via telepractice

A Case Study of the Use of Videoconferencing in a Speech and Language Therapy Setting

The subject of this thesis is the comprehensive evaluation of the telemedical Teach-Speech project which was a field study, designed by speech and language professionals. The TeachSpeech model of service delivery increases the therapeutic role of educational support assistants (ESAs) through the introduction of a videoconferencing link, used by a remote speech and language therapist (SLT) to support the ESAs in their work with children who have speech and language impairments in mainstream schools. This model of service delivery was contrasted with the traditional model of therapy where the SLT visits the schools to provide direct face-to-face therapy to the child. In contrast with the TeachSpeech model of therapy where the ESAs receive formal support across the videoconferencing link, the ESAs in the traditional model receive little formal support from the SLT. The two models of therapy were evaluated through consideration of the project performance, the users' perceptions and the communication process of the videoconferencing meetings. The performance was measured using log sheets to gauge how the therapists spent their time, by a cost analysis and with a clinical effectiveness tool as applied to the nine children in the TeachSpeech group and the sixteen children in the traditional model of therapy. Stakeholders were canvassed using questionnaires and semi-structured interviews to appraise their perceptions of the models of therapy. Finally, the process of TeachSpeech model of therapy was assessed using structural and content analysis applied to the transcripts obtained from video-mediated meetings. Results obtained with Enderby Outcome Measures showed that the two methods of delivery were equally clinically effective, thereby satisfying a critical requirement of the project. The technology was found to be unobtrusive, allowing the participants to adapt quickly to this innovative communication medium. The technology was found to support complex interaction such as the essential teaching-learning relationship that exists among the participants. In the small-scale pilot project considered, the TeachSpeech project was not cost effective. Under certain circumstances, extension to a wider population is believed to render the model cost effective. Results were mainly positive and suggested that consideration of a single evaluation criterion can be misleading. Despite being a small scale evaluation, the results were generally encouraging and suggest the potential benefit of this method of service delivery