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.
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:
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.
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.
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.