Telepractice and Schools
Optimizing Professional Resources Both Near and Far
Jeanne M. Juenger, MS, CCC/SLP
On Point Speech and Language Services
La Crosse, Wisconsin
Whether working in rural/remote or urban/suburban settings, school-based speech-language pathologists are doing more with less these days-often much more with much less. The combination of a critically limited pool of trained professionals, strained time and travel budgets, expanded workloads with each new educational initiative, and the never-ending paperwork requirements demand that we think about our service delivery systems in new ways.
Telepractice in speech-language treatment, the delivery of professional services at a distance via telecommunications technology (ASHA, 2005), is rapidly gaining interest nationwide as a service delivery model offering the potential to optimize resources. When judiciously implemented, a telepractice speech-language service delivery model:
- Promotes free and appropriate public education (FAPE) (US Dept of ED, 2007).
- Creates additional or more consistent direct and indirect service opportunities (Polovoy, 2008).
- Enables real-time collaboration with and support from dispersed team members (Luecke, 2004).
- Complements traditional, on site service delivery models (Whitmire, 2007).
- Energizes student learning (Robinson et al., 2009).
Preparation: Putting First Things First
Diligent preparation is key to the successful development and launch-and, even more importantly, to the sustainability and effectiveness-of a telepractice service delivery model. ASHA's foundational guidelines offer a wealth of information to support the efforts of the professional and the development team. Recommended documents include:
In addition to these resources, telepractice development teams are strongly encouraged to identify state licensing mandates and telepractice reimbursement rules. In general, practitioners who provide tele-services across state or national lines should be licensed where the service originates (the provider's location) and where the client or student is located (Denton, 2003).
Some school districts and educational support agencies require a formal review process for innovative educational program proposals. Work with your special education director and/or district administrator to outline and refine your plan to ensure acceptance of and financial support for your proposal.
Telepractice in speech-language treatment requires some basic equipment at both the "hub" (provider's location) and at the "remote" site (student's location):
- Computer with monitor or an integrated conferencing station
- Online conferencing "platform" (video, audio, instant messaging), which may or may not include a shared work platform or desktop sharing
- Broadband Internet access or ISDN lines by which the locations connect to each other
Optional, but recommended, devices include:
- Dual headphones with boom microphones
- Document camera
- In-room phone
The participation of a district technology associate or a colleague with some technology savvy will ease the technology selection process so that the SLP can focus on the planning and delivery of IEP-based services. The conferencing solutions continuum could include:
- No- to low-cost options like iVisit and Skype
- Mid-range products such as Adobe Connect and Go to Meeting
- Business-class integrated systems including Polycom and Tandberg
Each technology option presents unique advantages and disadvantages; draw on the technology representative's expertise to help the telepractice development team increase its technology skills.
In addition, telepractioners will need to familarize themselves with a variety of online treatment materials, services and useful Internet sites. As with the technology involved, such resources range from no-cost to low-cost options (such as PBS Kids and Scholastic and to commercial, subscription-level services). Telepractice teams will find a multitude of resources from Judith Maginnis Kuster, professor Minnesota State University at Mankato on her Web page Examples of Materials That Can Be Adapted for Therapy.
IDEA calls for local teams to determine the appropriateness of a service delivery model, frequency and location of services, and the most qualified person to deliver those services. Clear documentation of the format or medium by which services are to be delivered and the responsibilities of those involved in services allows parents to understand more fully the enhanced services the student will receive in a telepractice context and those received in a traditional, on-site setting.
As noted by ASHA in 2005, "candidacy for receiving services via telepractice should be assessed prior to initiation of services."
The following factors, while not exclusionary, may impact the success of the client's telepractice assessment/intervention:
- Attention (e.g., ability to sit in front of a monitor and attend to the clinician)
- Auditory comprehension (e.g., ability to follow directions to operate equipment)
- Cognitive ability
- Hearing ability
- Visual ability (e.g., ability to see material on a computer monitor)
- Speech intelligibility
- Behavior (e.g., ability to sit in front of a camera and minimize extraneous movements to avoid compromising the image resolution)
- Physical endurance (e.g., sitting tolerance)
- Manual dexterity (e.g., ability to operate a keyboard if needed)
- Comfort level with technology
- Willingness of client and family/caregiver (as appropriate) to participate in telepractice
- Cultural/linguistic considerations (e.g., availability of interpreter)
- Access to and availability of resources (e.g., telecommunications network, facilitator)
As with other educational initiatives, service efficiencies and program benefits may not fully be realized until two or more years following the program launch. However, a committed and dynamic team and a school culture favorable inclined toward innovation point to a greater likelihood of successful integration of a viable telepractice program.