Five years ago, Waldo County General Hospital began telepractice-based speech and language intervention with preschoolers and school-age students in under- or unserved areas in rural Maine. Enabled by high-quality Web connectivity, we use many interactive websites, such as PBS Kids, in our telepractice sessions. Several of its Martha Speaks games specifically target early literacy and basic concepts, defining Tier 2 vocabulary words and promoting increased accuracy by fostering repetition of tasks. Students' ability to interact with such games is similar to hands-on materials we might offer them in person. Using these interactive websites, along with annotation tools in our Web platform (we chose WebEx, which meets the needs of our program), allows us to emphasize certain aspects of the student's work. Interactive language games serve as a starting point to model communication targets that parents can reinforce as they use provided materials after the session.
Our platform's mobile app also allows us to connect to telepractice sessions using mobile devices such as the iPad. In addition, desktop apps such as Reflection for the Mac and AirServer for the PC ($14.99 each, with trial options available) allow clinicians to share visual and auditory stimuli with young clients. For example, clients and clinicians can experience and discuss visual and auditory stimuli from apps such as the narrative-targeting Story Builder, the descriptive language-building Bag Game, and literacy-enhancing material via interactive books such as Toy Story Read-Along or through the iBooks app, all for iOS.
Connections with the iPad cannot be truly interactive, as the client cannot manipulate the same screen as is possible when sharing a web application. Opportunities do exist, however, for families to use the same apps that are demonstrated in treatment in parallel, skill-enhancing ways following sessions.
In addition to interactive websites, "Web 2.0" or creation tools are available across Mac, PC, and mobile platforms and allow students to continue learning after a session has concluded. For example, tools such as Kerpoof integrate text and visuals in the process of creating comics to build print awareness, story grammar, and narrative skills. Students can begin a creation during a treatment session and continue their work with the parent as home practice.
"Mollie's Advice" is an example of a blog we created for a student diagnosed with Asperger syndrome who needed opportunities to process information about a variety of social situations. Using a password-protected blog on WordPress mobile apps for iOS and Android are free, accessible only to selected family members and providers, clinicians began posting questions for Mollie and her mother to answer. We targeted circumstances that mirrored some of her real-life difficulties. This approach allowed her to use specific skills and concepts taught within sessions to promote generalization.
As we implemented our program, we made strong partnerships with teachers, e-helpers assisting students during sessions, and parents using a "Response to Coaching" approach (for more information, see our ASHA presentation on this topic). Parents were invited to observe sessions from their home or office computer. Parents also sent us digital pictures of their child and family, allowing us to individualize materials and create digital stories to promote literacy skills. "Store forward" capabilities can be used to record and share video clips with comments about the session to parents and teachers for viewing at their convenience.
We also were aware of the varied competencies needed to provide telepractice services, as the medium requires different pacing and skills in engaging the student. A presentation shared at ASHA's 2011 national convention includes information on our training program, essential competencies, approach to service delivery and results. Our telepractice successes with students with multiple diagnoses (autism spectrum disorder, attention-deficit hyperactivity disorder, behavioral disorders) stems from our use of this approach.
Recently, networking groups such as ASHA's Special Interest Group 18, Telepractice, have been invaluable in sharing initial steps and best practices in telepractice. The American Telemedicine Association also offers many networking opportunities. We have found it is essential to build these "connections" while building skills and competencies in the ever-evolving technology and approaches within telepractice.