First in an occasional series of articles highlighting telepractice programs or services provided by speech-language pathologists.
"Do not go where the path may lead; go instead where there is no path and leave a trail."
-Ralph Waldo Emerson
Ralph Waldo Emerson's quote epitomizes the journey of our school-based Speech TeleTherapy program since April 1999. The Individuals with Disabilities Education Act (IDEA) guarantees all children with disabilities a free, appropriate public education, emphasizing special education and related services designed to meet their unique needs.
Although IDEA is a federal mandate and states like Oklahoma receive funds for special education, what happens if a rural school district is unable to recruit or retain a speech-language pathologist? One innovative and cost-effective solution to the challenge of health care provider shortage in rural America is telepractice.
Simply defined, our school-based Speech TeleTherapy program utilizes real-time, two-way interactive teleconferencing-point-to-point Internet Protocol (IP) videoconferencing endpoints with T1 or greater connections to the state technology network infrastructure (OneNet) to deliver speech treatment to students throughout the state of Oklahoma. We also use a document camera-"Elmo"-for viewing lessons and playing language-oriented board games to facilitate learning. Our services are recognized by the Oklahoma Department of Education as an alternative to on-site speech services for public schools in remote/rural areas of the state and promote compliance with state and federal regulations for public-school speech therapy services.
Costs for technology set-up varies depending on type of equipment, distance of rural schools, and sophistication of network infrastructure, both the "hub site" (clinic where the SLP telepractices) and "spoke site" (rural school setting). For our program, setting up a telemedicine suite costs approximately $7,800, which includes installation fee, telemedicine equipment, document camera, and wiring expenses. If dedicated T1 lines are used between clinic and school sites, there is a monthly line lease, which averages $800 per month for our program.
Success of our program over the years has been partially attributable to the recruitment and retention of skilled SLPs who are willing to integrate telepractice competencies into their skill sets. An experienced speech teletherapist orients and mentors our new SLPs on telepractice protocols and equipment utilization. Once this initial training and shadowing occur, SLPs in our program have expressed confidence in using the equipment. Access to our technology/network specialists during their sessions also increases SLPs' self-assurance in troubleshooting technological glitches.
Currently, we have five part-time SLPs providing contractual services to 99 students at seven school districts across the state, from the panhandle to far southeast Oklahoma. We invoice the school each month for hours of direct clinical service, case documentation, and lesson preparation. The contractual fee covers our personnel and operational expenses with a "break-even" business model. We certainly are not in this business to make a large profit, but to cover our expenses and provide a much-needed clinical service to students who otherwise would have minimal or no access to speech services.
Speech TeleTherapy program services include the following: speech and language screenings; group and individual speech therapy; standardized testing to document qualification for speech treatment; Individualized Education Plan (IEP) documentation; and participation in IEP and parent/teacher meetings via teleconferencing. It is paramount that the SLPs provide initial on-site evaluations and visits with students, teachers, and parents at the beginning of each academic year prior to telepractice implementation. This face-to-face contact helps the SLP establish a rapport, which is crucial for the success of our telepractice program. In addition, two to three on-site visits are provided during the school year as recommended by either the SLP, teacher, parent, or special education director.
Since the inception of our program, we have conducted nearly 11,000 Speech TeleTherapy sessions. SLP Beki Houston, a veteran with our program, says, "Most of my students are seen one to two times weekly from 20 to 30 minutes, depending on the severity of their speech-language delay or impairment," adding that she most often sees children with articulation/phonological disorders and children with language impairment.
"Some of these children exhibit both speech and language problems. In addition, I have one student with autism, one with a fluency disorder, and two with a hearing loss," she said.
She noted that orienting the paraprofessionals to use of the equipment is important. If the equipment or lines are not working properly, paraprofessionals are the staff members trouble-shooting those problems with the network architect.
Brenda Davis, another SLP involved with the telepractice program, praised it as "a great way to provide SLP services to rural communities. It is important to provide parent, teacher, and staff education about this mode of treatment."
"A consistent paraprofessional working with the students on-site is very important," she said. "The paraprofessional offers assistance with the scheduling of therapy, organization of materials, and task clarification as needed. I have noticed increased treatment time per session as the paraprofessional has the students ready for each session on time."
Davis noted that her students are very receptive to instruction presented through teleconferencing and are actively participating and accomplishing their speech and language goals.
At the end of each school year, our business analyst assigned to the program, Mickie Post, calls the schools to complete satisfaction surveys and collect constructive qualitative feedback for further development of the program.
Stringtown Public Schools Superintendent Richard Quaid stated, "There have been several students in the lower age group who have graduated from this program. We did not have that many graduates before because of inconsistent services. The longest we could keep an SLP down here was six months.
"This program has been a great success for us and is the best we have ever had," he said. "We don't know what we would do without it."