Conferencing | Feature

Speech Language Clinicians Connect with Telepractice

As Ohio's speech-language telepractice pilot enters its fourth year, the collaborative multimedia program continues expansion, and administrators are testing new ways of delivering therapy. The students love it, and plenty of sessions end with children asking, "Can't we do just one more?"

When those Ohioans responsible for speech-language pathology professional development observed other states using telepractice, they saw this technology as a potential solution to Ohio's challenges. The biggest challenge was that there were simply not enough speech-language pathologists to go around. So in 2007, Ohio Masters Network Initiatives in Education (OMNIE) launched a pilot program to test the efficacy of delivering speech-language therapy via telepractice.

The pilot program began with four rural school districts and 30 students. The research was designed such that students received teletherapy half of the school year and met with their therapists in person the other half of the year. This way, they believed they could best measure results.

Clinicians had to learn to use the technology, but, overall, there was little that had to be changed in the actual therapy sessions. They could follow the individualized education plan (IEP) as usual. They could, however, add to the sessions by electronically sharing documents, software programs, Web sites, or anything else on the Internet that would complement the session's goals.

The results: "Satisfaction surveys indicated that the students and parents overwhelmingly supported the telemedicine service delivery model.... Videoconferencing appears to be a promising method of delivering speech language therapy services to school children." In 2011, the program is entering its fifth year, now delivering telepractice in speech-language therapy to 190 students.

Telepractice Defined
The American Speech-Language-Hearing Association defines telepractice as "the application of telecommunications technology to deliver professional services at a distance by linking clinician to client or clinician to clinician for assessment, intervention, and/or consultation." ASHA has determined telepractice is appropriate for the application and is helpful in overcoming barriers of access caused by distance, unavailability of specialists and/or sub specialists, and impaired mobility. Furthermore, telepractice can extend clinical services to remote, rural, and underserved populations and to culturally and linguistically diverse populations.

An important consideration in today's economic environment is that schools and parents can avoid the expenses incurred when pathologists have to travel to deliver services. Schools may also more easily and affordably include the clinicians with teachers, parents, counselors and others in IEP planning meetings.

Scheduling speech-language diagnostics or therapy becomes far easier and less restrictive; schools and parents can obtain services during the day, evening, or weekends. In addition, those children who are home-schooled and those who are temporarily unable to attend school owing to illness, disciplinary issues, or any other reason may still be able to receive their speech and language therapy sessions.

Finally, having access to clinicians with varying expertise allows schools and parents to connect with a speech pathologist most familiar with a particular disorder. Stuttering, cognitive delays, and various levels of articulation can be treated by those most experienced with the challenge, for example.

Telepractice Applications
Telepractice for speech therapy can deliver basically any service a clinician would deliver in a face-to-face setting. These services may include, as mentioned, diagnosing disorders, delivering therapy, and attending IEP meetings. English as a second language is another service delivered successfully via telepractice. Another consideration is that bilingual therapists may be required in order to communicate with parents whose native language is not English. These bilingual clinicians are far easier to source and schedule via telepractice.

Some schools are also finding speech-therapy telepractice to be helpful for professional development for teachers. Teachers can be trained on how to recognize speech-language disorders, how this therapy fits into the overall IEP, and how they can be sure their classroom leadership reinforces the IEP. Staff also may benefit from direct therapy. Accent reduction therapy, for example, may help a teacher articulate better and ensure students understand the lessons.

How It Works
How therapy is delivered varies. The program in Ohio offers both small group and individual speech and language therapy sessions. So, in some schools, there may be speech therapy classes where a number of students with similar speech and language challenges attend therapy together.

In this setting, a video conferencing system with more bells and whistles may be required. A wide-angle lens video camera will allow the therapist to view all the children in the room at once so he or she can monitor their responses during the session. Audio may need to have noise-canceling technology or feature other audio enhancements so that as students talk over each other, the particular child being addressed by the therapist, and the therapist too, are not drowned out. It is also likely that the camera and image delivery (projector, LCD panel, or computer screen) on the clinician's endpoint will need to be high resolution so the therapist may receive an accurate depiction of the physiology of the child's speech and language practice.

For one-on-one therapy, a specialized computer video conferencing solution from traditional video conferencing vendors may be the best choice for schools that already have video conferencing equipment and network efficiencies installed. Those companies that provide large telepresence equipment generally offer desktop or other smaller-scale solutions as well.

One can use the free computer video chat software such as Skype. A student will need a computer with high-speed Internet connection, a Webcam, and often a headset. There are indications even something this simple can be effective. Ph.D. candidate Rebecca Matthews is currently researching the effectiveness of delivering therapy to children over Skype. One of her findings is that because children can't point to objects as they would in person, the students are encouraged to do more talking when on Skype.

Use caution, however, when attempting speech and language therapy with free video chat software. Quality of the video and audio is dependent on the computer's specifications as well as the bandwidth's speed and reliability. A video that flickers or stutters, or audio infused with gaps, or sessions that abruptly end and need to be restarted will mean a lot of wasted time, and these errors in data delivery can be counterproductive when it introduces into the session frustration on the part of both the clinician and the student.

There are also different approaches to sourcing and working with clinicians. A school or parent may elect to work with specific therapists, or a local practice or healthcare facility. They may also contract with companies such as Ellingsen and Associates and TinyEye that provide the therapists and usually have developed software solutions they use for sessions and also for reporting.

Telepractice: a Mainstream Solution
Telepractice for speech and language therapy is gaining popularity not only because it meets the challenges associated with a shortage of specialists, but because the technology has evolved to provide the quality necessary for diagnosis and treatment. Video conferencing for speech and language pathology is also a value proposition: Using technology is less expensive and more resource-efficient than having therapists travel to venues.

The Ohio project has proved so effective that organizers are trying something new now: providing speech-language therapy within the classroom. In one of the districts, they are pushing therapy into three classrooms and providing whole class intervention sessions. Classroom, individual group room, or individual instruction, the Ohio students are quite enthusiastic as the directors of the program said in a recent newsletter. "The students are usually very excited to see their therapist and participate in the activities during their sessions. Often we hear the students ask 'Can't we do just one more?'"