Considerations for Group Speech-Language Pathology Treatment in Telepractice
Speech-language pathologists (SLPs) across clinical settings provide group intervention sessions, consisting of two or more individuals. Payers (e.g., insurance companies, Medicare, Medicaid) or education agencies may choose to cap the number of participants in a group session. SLPs must consider specific factors when providing group treatment via telepractice.
Service Delivery Considerations
Take these steps as you plan for and engage in service delivery via telepractice:
- Verify that services you provide comply with ASHA's Code of Ethics and Speech-Language Pathology 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.
- Confirm 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).
- Select goals and activities that are appropriate for all participants in the session.
- Plan each session to meet each individual student’s needs. Consider factors that may impact appropriateness for—and eligibility to participate effectively in—groups. Examples include the following:
- physical and sensory status
- cognitive abilities
- types and severity of communication deficits
- cultural and linguistic diversity
- technological capabilities
- physical environment (e.g., presence of background noise and distractions)
- availability of interpreter, as needed
- availability of trained facilitator [PDF] to support the telepractice sessions, as needed.
- Review informed consent and all related documentation 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 the treatment session (including audio, video, and screenshots) consistent with applicable privacy laws.
- When appropriate, ensure that the group services you provide via telepractice can be appropriately billed and reimbursed.
See this ASHA presentation focusing on group speech-language pathology treatment via telepractice related to pediatric services (recorded July 23, 2020).
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 is protected and in compliance with federal, state, and local regulations. For example, if an SLP qualifies as a covered entity under the Health Insurance Portability and Accountability Act (HIPAA), they must always follow HIPAA requirements. Providers should also consult related Family Educational Rights and Privacy Act (FERPA) guidance when providing services in school-based settings.
Potential privacy breaches may occur via incidental disclosure of protected health information by the clinician, by other participants, by facilitators, by interpreters, or by other individuals in the treatment room (either at the clinician’s or the participants’ locations).
For example, during a group telepractice session, the participant may be in an environment that contains other people who are not actively involved in that participant’s services; those other people may overhear private patient/client/student information.
This situation introduces privacy concerns beyond those of in-person groups and may require you to take additional measures to ensure privacy of confidential information.
Health Care and Private Practice
Confirm that technology and related privacy settings comply with organizational and payer requirements, which may be more stringent than federal and state regulations. Ensure that informed consent includes issues related to privacy, such as incidental disclosures of name, email, diagnosis, and treatment goals. 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 because
- patients may not have access to private spaces for treatment (e.g., shared rooms) and/or
- clinicians and staff cannot regulate the people who happen to be in the patient’s immediate environment.
For guidance in school-based settings, see the U.S. Department of Education’s resource list on FERPA, virtual learning, and protecting student privacy.
Schools
The U.S. Department of Education’s Student Privacy Policy Office (SPPO) develops student privacy policies and enforces student privacy laws—including the Family Educational Rights and Privacy Act (FERPA).
When service is provided via telepractice, the SPPO emphasizes the importance of safeguarding student information and privacy. Schools must evaluate technology platforms carefully to ensure that all students’ personally identifiable information (PII) is protected for all students. The SPPO developed guidance and tools for implementing a safe virtual learning environment for students.
SLPs must obtain informed parental consent to clarify—and acknowledge the possibility—that a student’s identity and individualized education program (IEP) information might be incidentally disclosed in the presence of other students and school staff during remote group sessions. This is especially relevant in the school setting—particularly when teachers and clinicians are delivering services in a collaborative classroom model or when small groups are interacting in shared spaces with limited privacy.
Documentation
Health Care and Private Practice
As you plan for and engage in service delivery via telepractice, take these steps:
- Confirm or establish that the client’s treatment plan includes group services—with appropriate justification for the group format. This may include developing goals specifically for group settings.
- Ensure session documentation clearly states that you provided treatment in a group session via telepractice.
- Document informed consent related to participation in group treatment via telepractice and the related risks and benefits.
Schools
In the school setting, the individualized education program (IEP) specifies the format of services (group, individual, in classroom). Appraisal and documentation of student and environmental factors inform and supports decision making around service delivery. Factors to note include:
- student engagement
- student motivation, and
- environmental distractions (e.g., people talking in the background).
The SLP may serve students in a hybrid model (e.g., both in-person and via telepractice simultaneously). Schools permit students to bring their devices to the session—so they can interact with one another. Schools and the student’s IEP team should do this in consideration of confidentiality and privacy requirements within the state, state department of education, and local school district.
