See the Telepractice Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.
Telepractice is the use of telecommunications and Internet technology to connect audiologists and speech-language pathologists (SLPs) with clients, family care partners, and other professionals for screening, assessment, intervention, consultation, and education. It may be the primary mode of service delivery or can be used in combination with in-person services.
ASHA’s definition of telepractice does not include technology that is used for supervision, mentoring, preservice, and continuing education. Such uses of technology are often called telesupervision/distance supervision or distance education. See ASHA’s Practice Portal page on Clinical Education and Supervision for further information.
Telepractice services may include the following:
Telepractice supports client and care partner needs. Clinicians should consider
Use of telepractice should be of equal quality to in-person services and delivered in a manner consistent with the following:
Clinicians weigh the following elements when selecting clients for telepractice:
Additional considerations include
Some limitations may be mitigated by care partner/facilitator training and environmental modifications. In some cases, a trial period of telepractice may help determine whether this model is effective and sustainable for the client and their care partners/facilitators.
States may have statutory and regulatory requirements regarding telepractice. Clinicians should verify state licensure/certification requirements in the state from which the clinician provides services as well as the state in which the client receives services prior to initiating services. Clinicians should also verify requirements including temporary location changes such as vacations and college attendance.
Each state’s statutory and regulatory language specifies the definitions for telepractice and any limitations and requirements surrounding it, such as the amount and type of supervision that is required when working with other practitioners like assistants. The state statutes and regulations take precedence over ASHA’s practice guidance. ASHA guidelines assert that telepractitioners must be licensed in both the stae from which they provide services and the state where the client is located at the time of service.
The Audiology & Speech-Language Pathology Interstate Compact (ASLP IC) is a formal agreement among participating states that facilitates the interstate practice of audiology and speech language pathology while maintaining public protection. Under the ASLP IC, audiologists and SLPs who are licensed and in good standing in a compact member state may be eligible to practice in other member states through a compact privilege to practice. Practitioners should consult the ASLP IC website for the most current information on participating states and privilege availability.
Civilian employees of the Department of Defense and the Department of Veterans Affairs may not be bound by the same licensing requirements. Contact the department in question to confirm the specific licensing requirements for your circumstances.
Clinicians who are planning to do telepractice in a school setting that operates in a state other than where they reside should communicate with the U.S. Department of Education and the licensure entity (in the state where service is provided) to determine whether licensure and/or teacher certification is required and to obtain further guidance as appropriate.
See ASHA’s state telepractice and telesupervision requirements (select your state for detailed information).
Telepractice may occur across international borders in multiple directions, including
When a clinician is physically located outside the United States while providing telepractice services to U.S.-based clients, the clinician should ensure that they (a) hold appropriate legal authorization to work and provide paid professional services in the country in which they are residing and (b) adhere to applicable U.S. state licensing laws where the client is located at the time of service. This may include, but is not limited to, valid work visas or other required permissions.
If a clinician is providing services to an individual in another country, they are advised to contact the applicable professional society or regulatory body in that country for guidance. If there is no such association—or for additional information—clinicians may request further information by contacting (a) the U.S. Embassy in that country or (b) the Ministry of Health or Ministry of Education.
ASHA’s resource on audiology and speech-language pathology associations outside the United States can provide assistance in contacting foreign associations.
Clinicians are responsible for understanding how their physical location may impact licensure compliance, professional liability coverage, reimbursement, U.S. and international privacy laws, and the lawful provision of services, regardless of where the client resides.
Clinicians should maintain documentation demonstrating compliance with work authorization requirements, as applicable, to support ethical and lawful service delivery.
Audiologists and SLPs are responsible for ensuring that telepractice services are safe, effective, and equivalent in quality to in-person care. This requires both clinical competence and proficiency in the service delivery model.
Core roles and responsibilities include the following:
As indicated in the ASHA Code of Ethics (ASHA, 2023), audiologists and SLPs who provide services via telepractice should be appropriately trained to do so.
Effective telepractice depends on (a) the hardware used by the clinician and the client as well as (b) the telecommunications platform that delivers the service. Clinicians confirm that each component supports high-quality care, complies with legal and regulatory requirements, and protects client privacy.
Hardware
Software
Telecommunications Platform
Additional Considerations
Clinicians providing telepractice are bound by federal and state regulations as they would be when providing in-person services, including administrative, physical, and technical safeguards. Privacy and security considerations include real-time interactions with the client as well as storage, transmission, and disposal of client information.
Clinicians must comply with all applicable federal, state, institutional, and professional requirements, including the following:
Because compliance is complex and requirements may vary, clinicians should consult institutional policies and, when needed, seek expert guidance on privacy and security.
Key safeguards include the following:
Clinicians obtain informed consent from the client to manage risk and to maintain compliance with ASHA Code of Ethics Principle I, Rule H (ASHA, 2023). Informed consent for telepractice should be documented and should include
Documentation may also note the type of technology used, the identity of participants, the session location(s), and transmission details. All documentation is provided in an accessible, health-literate format in the preferred language(s) of the client and family/care partners. For more information about providing accessible documentation, please see ASHA’s resources on communication access and health literacy.
See ASHA’s Health Insurance Portability and Accountability Act for more information.
Clinicians and/or organizations establish procedures to ensure client safety during telepractice sessions. This includes confirming the client’s physical location at the start of each session and obtaining a reliable local contact number in case of emergency. Documenting these procedures as part of the informed consent process helps clarify expectations and supports client protection.
Modifications for optimizing client interactions include
Some publishers of standardized assessments have developed guidance about the administration of tests via telepractice or offer assessments that are fully validated for administration via telepractice. Other researchers have compared the validity of in-person and remote assessment protocols (Sutherland et al., 2016; Taylor et al., 2014; Thai-Van et al., 2020; Weidner & Lowman, 2020).When using a test that has been validated for telepractice administration, document the interpreted scores as you would from in-person administration. Check with the publisher if the assessment tasks show evidence of in-person versus remote administration equivalency for administration via telepractice. Verify that your client falls within the norming sample of that instrument.
Some assessment tools have not yet been validated for remote administration. Use of nonvalidated tests may require modifications to the protocol in order to conduct the assessment via telepractice. As with any modified assessment protocol, standard scores are not reported. Use of a test in a nonstandardized manner may impact the billing of standardized assessment codes. Publisher permission is often required to copy, scan, modify, or record test materials in any way. Check with the test publisher for their most current policies.
Some assessment tools can be remotely controlled by the clinician, similar to in-person protocols. The clinician should be mindful of the test setup and have a clear view of the client to ensure appropriate and accurate test assessment.
Clinicians must state modifications made to test materials, administration procedures, or other aspects of an assessment in the interpretation and documentation of the assessment. This may include any or all of the following:
Nonstandardized assessment tools may also be used in telepractice. These tools include clinical observation, care partner report, functional tasks, and dynamic assessment. Such approaches are particularly valuable in telepractice because clients are often in their natural environments, allowing clinicians to adapt in real time based on client performance.
Therapy activities that clinicians use during in-person interactions may require modification for telepractice. Common modifications include
Modifications may be necessary for in-person, remote hearing aid fitting and programming. This approach allows an audiologist to collaborate with a trained facilitator to complete physical tasks (e.g., inserting the probe microphone for hearing aid verification) when working remotely with an individual. Such modifications may include
Be sure to document any modifications to treatment delivery and the impact on client performance or outcomes.
Captioning may be considered for all patients—regardless of hearing status—so that they do not have to rely on auditory information.
Asynchronous assessment and treatment materials should meet the health literacy needs of clients and should be formatted in a way that supports good documentation and care planning between the clinician(s) and the client or family/care partner.
Telepractice in school settings can help address shortages of qualified clinicians, reduce travel time across multiple buildings, and increase access for rural or remote districts. Telepractice may improve accessibility to direct services and assessment for some students and may facilitate remote collaboration with school staff and families receiving consultative services (Boisvert & Hall, 2019; Grogan‑Johnson, 2021). Telepractice may be used with individual students or with groups.
Telepractice can support follow‑up for referred school hearing screenings through real‑time or asynchronous models. This may help reduce loss to follow‑up and address provider shortages or geographic barriers to care.
The administrative body responsible for defining telepractice services in a school or district carries out any or all of the following tasks:
Schools—not caregivers—are responsible for providing the equipment and connectivity required for telepractice. Schools ensure that
Schools provide a learning environment that
Audiologists and SLPs determine whether telepractice is appropriate for each student by considering
Facilitators are individuals who support clients at the client’s site while they work remotely with a clinician.
Facilitator duties depend on the service being provided (Coco et al., 2020). These duties may include
Any appropriately trained individual may act as a facilitator, including teachers, aides, school staff, assistants, licensed health care professionals, interpreters, and family/care partners, unless restricted by institutional or state policies or regulations.
Clinicians are responsible for ensuring that facilitators are adequately trained (see the ASHA Facilitator Checklist for Telepractice Services in Audiology and Speech-Language Pathology [PDF]). Adequate training includes knowledge of and responsiveness to clients’ cultural and linguistic differences and how such differences impact the use of telepractice (see ASHA’s Practice Portal pages on Multilingual Service Delivery in Audiology and Speech-Language Pathology and Cultural Responsiveness). See Douglass et al. (2021) for the proposed minimum competencies for telefacilitators.
Practitioners must be aware of applicable federal and state policies and regulations including privacy issues (e.g., HIPAA) and reimbursement allowances regarding the use of facilitators.
Interpreters are professionals trained to convey spoken or signed communications from one language to another. Interpreting in telepractice may be done by videoconferencing, by telephone, or in person. The interpreter may be located at the clinician’s location, the client’s location, or a separate remote site. Clinicians and facilitators should be aware of privacy and ethical concerns related to interpreter use.
It is not appropriate to require a family member or care partner to act as an interpreter. Professional medical interpreters are recommended to ensure accurate and neutral communication. See ASHA’s Practice Portal page on Collaborating With Interpreters, Transliterators, and Translators for details.
Coverage and payment of telepractice services varies widely across federal, state, and commercial payers (e.g., Medicare, Medicaid, private health insurance). Payers may not always cover telepractice services or may limit the type of services included in their telepractice benefit. It is critical for clinicians to verify with each payer that they cover audiology or speech-language pathology telepractice services and confirm guidelines for coverage, payment, billing, coding, modifier use, and student/clinical fellow supervision before initiation of services. See Payment and Coverage of Audiology and Speech-Language Pathology Telepractice Services for detailed coding, Medicare, Medicaid, and commercial insurance information.
Telepractice clinicians should be prepared to educate payers about how telepractice services are delivered and the benefits to clients and payers. Educational materials may include research articles, organization policies and procedures to ensure clinician training and quality services, educational/informed consent materials for clients, video clips, and testimonials.
Audiologists and SLPs providing group therapy via telepractice should consider the following:
Audiologists and SLPs may use a hybrid model that blends telepractice approaches and/or in-person services. Clinicians ensure continuity of services across modalities.
Hybrid models may be useful in the following contexts:
This list of resources is not exhaustive, and the inclusion of any specific resource does not imply endorsement from ASHA.
American Speech-Language-Hearing Association. (2016). Scope of practice in speech-language pathology [Scope of practice]. https://www.asha.org/policy/
American Speech-Language-Hearing Association. (2018). Scope of practice in audiology [Scope of practice]. https://www.asha.org/policy/
American Speech-Language-Hearing Association. (2020). Assistants code of conduct [Ethics]. https://www.asha.org/policy/
American Speech-Language-Hearing Association. (2023). Code of ethics [Ethics]. https://www.asha.org/policy/
Boisvert, M. K., & Hall, N. (2019). Telepractice for school-based speech and language services: A workload management strategy. Perspectives of the ASHA Special Interest Groups, 4(1), 211–216. https://doi.org/10.1044/2018_PERS-SIG18-2018-0004
Coco, L., Davidson, A., & Marrone, N. (2020). The role of patient-site facilitators in teleaudiology: A scoping review. American Journal of Audiology, 29(3S), 661–675. https://doi.org/10.1044/2020_AJA-19-00070
Douglass, H., Lowman, J. J., & Angadi, V. (2021). Defining roles and responsibilities for school-based tele-facilitators: Intraclass correlation coefficient (ICC) ratings of proposed competencies. International Journal of Telerehabilitation, 13(1), Article e6351. https://doi.org/10.5195/ijt.2021.6351
Grogan-Johnson, S. (2021). The five W’s meet the three R’s: The who, what, when, where, and why of telepractice service delivery for school-based speech-language therapy services. Seminars in Speech and Language, 42(02), 162–176. https://doi.org/10.1055/s-0041-1723842
Sutherland, R., Hodge, A., Trembath, D., Drevensek, S., & Roberts, J. (2016). Overcoming barriers to using telehealth for standardized language assessments. Perspectives of the ASHA Special Interest Groups, 1(18), 41–50. https://doi.org/10.1044/persp1.SIG18.41
Taylor, O. D., Armfield, N. R., Dodrill, P., & Smith, A. C. (2014). A review of the efficacy and effectiveness of using telehealth for paediatric speech and language assessment. Journal of Telemedicine and Telecare, 20(7), 405–412. https://doi.org/10.1177/1357633X14552388
Thai-Van, H., Bakhos, D., Bouccara, D., Loundon, N., Marx, M., Mom, T., Mosnier, I., Roman, S., Villerabel, C., Vincent, C., & Vernail, F. (2020). Telemedicine in audiology: Best practice recommendations from the French Society of Audiology (SFA) and the French Society of Otorhinolaryngology–Head and Neck Surgery (SFORL). European Annals of Otorhinolaryngology, Head and Neck Diseases, 138(5), 363–375. https://doi.org/10.1016/j.anorl.2020.10.007
U.S. Department of Education. (n.d.). Family Educational Rights and Privacy Act (FERPA). https://www2.ed.gov/policy/gen/guid/fpco/ferpa/index.html
U.S. Department of Health and Human Services. (n.d.-a). Health Information Technology for Economic and Clinical Health Act. https://www.hhs.gov/ocr/privacy/hipaa/administrative/enforcementrule/hitechenforcementifr.html
U.S. Department of Health and Human Services. (n.d.-b). Health Insurance Portability and Accountability Act. https://www.hhs.gov/ocr/privacy/
Teleaudiology: Assessment of quality and cost effectiveness. Journal of Hearing Science, 2(2), 81–85. https://doi.org/10.17430/882767
Weidner, K., & Lowman, J. (2020). Telepractice for adult speech-language pathology services: A systematic review. Perspectives of the ASHA Special Interest Groups, 5(1), 326–338. https://doi.org/10.1044/2019_PERSP-19-00146
Content for ASHA’s Practice Portal is developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. ASHA extends its gratitude to the following subject matter experts who were involved in the development of the Telepractice page:
In addition, ASHA thanks the members of the Ad Hoc Committee on Telepractice in Speech-Language Pathology and the Telepractice Working Group whose work was foundational to the development of this content.
Members of the Ad Hoc Committee on Telepractice in Speech-Language Pathology were Pauline Mashima (chair), David M. Brennan, Michael Campbell, Diana Christiana, Vickie Pullins, and Janet Brown (ex officio). Vice Presidents for Professional Practices in Speech-Language Pathology Brian Shulman (2006–2008) and Julie Noel (2009–2011) served as the monitoring officers. ASHA staff members Janice Brannon and Amy Hasselkus also contributed.
Members of the ASHA Telepractice Working Group were Mark Krumm (chair), Gregg Givens, Amy C. Georgeadis, Pauline A. Mashima, John M. Torrens, Janet Brown (ex officio), and Pamela Mason (audiology staff consultant). Roberta B. Aungst, vice president for professional practices in audiology (2004–2006), served as monitoring vice president.
ASHA seeks input from subject matter experts representing differing perspectives and backgrounds. At times a subject matter expert may request to have their name removed from our acknowledgment. We continue to appreciate their work.
The recommended citation for the Practice Portal page is:
American Speech-Language-Hearing Association. (n.d.). Telepractice [Practice portal]. https://www.asha.org/Practice-Portal/Professional-Issues/Telepractice/
Content Disclaimer: The Practice Portal, ASHA policy documents, and guidelines contain information for use in all settings; however, members must consider all applicable local, state and federal requirements when applying the information in their specific work setting.