Whether working in rural or urban settings, speech-language pathologists now do more with less—often much more with much less. The combination of a critical shortage of trained professionals, strained time and travel budgets, expanded workloads, and the never-ending paperwork demands that we re-think our service-delivery systems.
Telepractice in speech-language pathology—the delivery of professional services at a distance using telecommunications technology (ASHA, 2005)—is rapidly gaining interest nationwide as a service-delivery model offering the potential to optimize resources. Telepractice offers greater opportunities to serve students, enables real-time collaboration with remote colleagues, and boosts student learning (Polovoy, 2008; Luecke, 2004; Robinson et al., 2009).
Preparation for Telepractice
According to ASHA practice policy documents (ASHA, 2005) the use of telepractice does not remove existing responsibilities in service delivery, including adherence to the ASHA code of ethics, scope of practice documents, and federal and state laws. Telepractice services must be the same quality as those delivered face-to-face.
Diligent preparation helps ensure the successful development, launch, sustainability, and effectiveness of telepractice services. A good grasp of ASHA's guidelines will support the efforts of the clinician and the telepractice development team (see references).
Telepractice development teams also are encouraged to identify state licensing mandates and telepractice reimbursement rules. In general, practitioners who provide telepractice services across state or national lines should be licensed in two jurisdictions: the location of the provider and the location of the client or student (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 proposed plan to ensure acceptance and financial support.
Third-party funding for telepractice in speech-language pathology continues to be uneven nationally (ASHA, 2007). ASHA, state professional associations, practitioners, and other stakeholders are working to ensure that telepractice services receive the same funding as traditional, onsite services. Collaborate with your state association committees on schools or government relations to identify third-party support such as Medicaid or private insurance. School district foundations, local service agencies, corporate and regional development charitable foundations, and state educational grants may fund your telepractice project.
Economic stimulus funds also are promised to state departments of education and may be available to underwrite part of your telepractice plan. Familiarize yourself with what is available in your state and consider strategies offered on the ASHA Web site.
Telepractice in speech-language pathology requires some basic equipment and services at both the "hub" (provider's location) and "remote" site (student's location). The essential elements of a telepractice format include a computer with a monitor or an integrated conferencing station, a webcam, high-speed Internet, and software that enables conferencing and provides a shared, virtual workspace. Optional recommended equipment includes dual headphones with boom microphones, printer, copier, fax, document camera, and in-room phone.
The participation of a district technology associate or a tech-savvy colleague will ease the technology selection process, allowing the SLP to focus on planning and service delivery. Conferencing solutions range from no- to low-cost options such as iVisit and Skype, to mid-range products such as Adobe Connect and Go to Meeting, up to business-class, integrated systems including Polycom and Tandberg. Each technology option has advantages and disadvantages, so draw on the expertise of the technology representative to identify options.
Practitioners also will need to familiarize themselves with a variety of online treatment materials, services, and useful Internet sites. As with technology options, these range from no- or low-cost options (e.g., PBS-Kids.org, Scholastic.com) to commercial, subscription-level services. Telepractice teams will find a multitude of valuable resources on Judith Kuster's Web site page on "Examples of Materials That Can Be Adapted for Therapy."
A student's candidacy for telepractice services often depends more on the program's resources than the severity or type of disability. For example, a student with a mild articulation disorder might be a poor candidate for such services if you don't have dual headphones with a boom microphone. Conversely, a young student with physical or intellectual challenges might benefit from telepractice services if a trained speech aide is available at the remote site to support the student's involvement. The SLP is responsible for determining the student's capacity to benefit from telepractice with or without onsite staff support prior to the student's enrollment in telepractice services (ASHA, 2005).
The telepractice development team will want to identify students who are likely to adapt quickly to virtual service delivery while enhancing traditional, onsite learning opportunities to see demonstrated success early in the implementation phase. Students with articulation disorders, as opposed to students with language concerns, are often quick to benefit from telepractice services.
The Individuals with Disabilities Education Act (IDEA) calls for teams to determine the appropriateness of a service delivery model, service frequency and location, and the person most qualified to deliver those services. Clear documentation of the service delivery format and provider responsibilities allows parents to understand more clearly the enhanced services the student will receive through telepractice compared to those in a traditional, onsite setting.
As with other educational initiatives, program efficiencies and benefits may not be fully realized until two or more years following program launch. However, a committed and dynamic multi-disciplinary telepractice implementation team that appreciates diverse stakeholder expectations; a school culture inclined towards innovation; and time, energy, and patience all contribute to a successful telepractice program.