Considerations for Group Speech-Language Pathology Treatment in Telepractice

Many speech-language pathologists (SLPs) across clinical settings provide group intervention sessions, consisting of two or more individuals. The number of participants in a group session may be capped by specific payers (e.g., insurance company, Medicare, Medicaid). When providing group treatment via telepractice, as opposed to in-person, SLPs will need to take additional considerations into account.

View the ASHA Virtual Presentation Group Speech-Language Pathology Treatment via Telepractice—Discussion on Adult Services (recorded June 5, 2020) to learn about the differences between in-person groups and those done through telepractice and lessons learned through experience. Another ASHA Virtual Presentation, focusing on group speech-language pathology treatment via telepractice related to pediatric services (recorded July 23, 2020) is also available.

Service Delivery Considerations

Ensure that services you provide comply with the ASHA Code of Ethics and the ASHA SLP Scope of Practice.
Ensure that the group treatment you provide via telepractice is evidence-based practice and is at least equivalent to in-person clinical care.
Ensure that all participants can access the technology that will allow them to participate in the group activity (e.g., participants in a group activity that requires live online interaction on a shared screen would need access to the program and to screen-sharing capabilities during the session).
Ensure that the goals and activities are appropriate for all participants in the session.
Ensure that the session meets each individual’s needs as well as other factors that impact appropriateness for and eligibility to participate effectively in groups. Examples of factors to consider include physical and sensory status, cognitive abilities, types and severity of communication deficits, cultural and linguistic diversity, technological capabilities, the physical environment (e.g., presence of background noise and distractions), availability of interpreter, as needed, and the availability of trained facilitator to support the telepractice sessions, as needed.
Review informed consent in the client/family’s preferred spoken and/or written language and establish group guidelines to improve participation in the group session, set expectations, clarify goals, and ensure success of the treatment session.
Set expectations for recording of the treatment session (including audio, video, and screenshots) consistent with applicable privacy laws.
When appropriate, ensure that group services you provide via telepractice can be appropriately billed and reimbursed.

Privacy and Confidentiality

Privacy is a central concern in group treatment via telepractice. SLPs need to ensure that the privacy and confidentiality of all participants in the group are protected in compliance with federal, state, and local regulations, as well as any organizational standards that might be in place. While some privacy guidelines may have been relaxed due to COVID-19, ASHA encourages clinicians to use a HIPAA-compliant platform to provide the highest level of security for the group whenever possible. Consult related Family Educational Rights and Privacy Act (FERPA) guidance when providing services in school-based settings.

Potential breaches of privacy may occur via incidental disclosure of protected health information by the clinician, other participants in the group, facilitators, interpreters, or other individuals in the treatment room (either at the clinician’s or the participants’ locations). For example, during a group telepractice session, other people may be in a participant’s environment who are not actively involved in the services, and they may overhear private patient/client/student information. This introduces privacy concerns beyond those of in-person groups and may require you to take additional measures to ensure privacy of confidential information.

Additional setting specific considerations concerning privacy issues are outlined below:

Health Care and Private Practice

Ensure that technology and related privacy settings comply with organizational and payer requirements, which may be more stringent than federal/state regulations. Ensure that informed consent includes issues related to privacy, such as incidental disclosures of name, email, diagnosis, and treatment goal. Informed consent should also include information regarding benefits and limitations of group treatment via telepractice and any alternatives to telepractice services.

This level of consent is especially important in residential health care settings where the risk for breaches during a group treatment session may be higher since patients may not have access to private spaces for treatment (e.g., shared rooms), and the people in the immediate environment cannot be regulated.

Schools

The U.S. Department of Education (ED) provides guidance on FERPA and COVID-19 [PDF]. Review any documentation on record to determine if it includes a statement clarifying that a student’s identity and individualized education program (IEP) information may be shared in the presence of other students and their families during remote group sessions. If the signed consent doesn’t include this information, review the ED guidance on FERPA and COVID-19 with your administrators. A sample FERPA “consent to disclose” document is provided on the last page, which includes allowing the disclosure of personally identifiable information to other parents and household residents during telepractice instruction.

Documentation

Health Care and Private Practice

Confirm or establish that group services are included in the client’s treatment plan with appropriate justification for the group format. This may include developing goals specifically for group settings.
Ensure that session documentation explicitly indicates that treatment was provided in a group session via telepractice.
Document informed consent related to participation in group treatment via telepractice, and related risks and benefits.

Schools

In the school setting, the IEP may specify if services are to be provided in a group therapy format. Documentation of student and environmental factors is important in determining how to proceed with group telepractice services for students as well as for making considerations for service delivery once in-person therapy resumes. Consider documenting factors such as student engagement and motivation as well as environmental distractions (e.g., people talking in the background). The SLP may see students in a hybrid model (e.g., both in-person and via telepractice simultaneously). Students may bring their devices to the session to interact with one another. This should be done in consideration of confidentiality and privacy requirements within the state, state department of education, and local school district.