Teleassessment

The provision of remote services has expanded greatly since the beginning of the COVID-19 pandemic. Teleassessment refers to the evaluation between clinician and patient through a technology interface rather than both people being together in the same location. The goal of teleassessment is to determine a diagnosis and create a viable treatment plan. The information below addresses key points for the successful use of teleassessment in both audiology and speech-language pathology. Follow associated links for more in-depth information.

On this page:

Licensure and reimbursement
Technology and access for the clinician and client during teleassessment
Teleassessment considerations for audiology
Teleassessment considerations for speech-language pathology

Licensure and Reimbursement

Considerations	Resources
In-state service provision: Does the state have specific telepractice laws for audiologists and SLPs? Are you licensed in the state where you provide services?	COVID-19: Tracking of State Laws and Regulations for Telepractice and Licensure Policy [PDF] State-by-State Tracking of Laws and Regulations for School-Based Telepractice State-by-State
Out-of-state service provision: Are you licensed in the state where you provide services? Are you licensed in the state where the client receives services? Are there temporary practice provisions for out-of-state practitioners?	Serving Clients in Other States and Countries Through Telepractice in a Private Practice Contact states@asha.org with questions.
International service provision: Are you appropriately credentialed to provide services in that country? Are you licensed in the state where you provide services?	Audiology and Speech-Language Pathology Associations Outside of the United States Contact certification@asha.org with questions.
Reimbursement: What kind of insurance does the client have (if any)? Does the payer reimburse for telepractice services? What CPT codes do you use? Are modifiers required?	Reimbursement of Telepractice Services: Considerations for Audiologists and Speech-Language Pathologists

Technology and Access for the Clinician and Client During Teleassessment

Does the client have the necessary...

equipment?
private space?
adequate broadband speed?
apps?

Does the clinician have the necessary...

equipment?
private space?
adequate broadband speed?
apps?
video platform that is FERPA and HIPAA compliant?

Does the client need...

closed captioning?
facilitator due to cognitive, hearing, motor, and vision needs?
interpreter due to language needs?

Resources

Telepractice Practice Portal page
Telepractice Services and Coronavirus/COVID-19
5 Steps to Get Started in Telepractice [article in The ASHA Leader]
Pivoting to Telepractice: Adapting Audiology Care to our New Virtual Reality [article in The ASHA Leader]
Telepractice Checklist for School-Based Professionals [PDF]
Telepractice Documentation Data Checklist for School-Based SLPs [PDF]

Teleassessment Considerations for Audiology

Create a Plan

What type of teleaudiology services will you provide (i.e., screening, diagnostics, hearing aid fittings and/or follow up)?
Will you utilize a technician or an audiology assistant?
Synchronous (in real time) or asynchronous (pre-recorded) appointments?
High-speed Internet considerations for the clinician, patient, and the remote site?

Patient Selection

Some patients may happily welcome teleuaudiology services into their plan of care. Keep in mind: Not every patient will be a good fit for teleaudiology services.

Factors to consider for teleaudiology services:

cognitive ability
family or caretaker involvement
comfort level with technology, and access to technology, such as smartphones, tablets, or computers

Equipment

Technology considerations will vary depending on practice setting.

Hardware

video camera
laptop or computer
extra external monitor
PC-based audiometer and other diagnostic equipment
video otoscope

Software

videoconferencing platform
hearing aid manufacturer-specific software

You will also need support for troubleshooting if problems arise.

Other Factors to Consider

Optimize sound quality—turn off any radios or televisions in the background. Consider using a headset.
Set up your physical surroundings so that your back is to a bare wall, or use a backdrop.
Keep your space clear of clutter: If there are too many items in the background behind you, clients may find it visually distracting.
Implement privacy considerations while an appointment is in progress, such as hanging a “do not disturb” sign near your workspace.

Resource

Audiology Service Delivery Considerations in Health Care During COVID-19 [ASHA web resource]

Teleassessment Considerations for Speech-Language Pathology

If you use a standardized test, remember...	Document the interpreted scores the same way as you would for in-person administration. Contact the test publisher for questions about reporting scores using remote administration.
If you modify a standardized tool, remember...	Obtain publisher permission if you copy, scan, or modify test materials. This is required by law. On the publisher's website, look for a link (usually on the homepage) called "Permissions" (or similar) and follow the steps listed there. Include modifications in an evaluation report, which documents the following information: test materials used administration procedures followed an acknowledgment that you used a facilitator Note: Using a test in a non-standardized manner will invalidate standard scores and may also impact billing of standardized assessment codes.
If you include informal measures, think about...	dynamic assessment spoken and written language samples speech sound productions and intelligibility during conversation teacher and caregiver report and questionnaire observation For feeding and swallowing: observations at mealtime(s) use of any previously prescribed compensatory strategies for swallowing use of food samples that are culturally relevant to the person and their family use of (any) adaptive feeding equipment previously prescribed
If you're relying on caregivers to help with the assessment, remember to...	utilize scripts and visual aids to follow during the session discuss roles, expectations, and the importance of neutral feedback maintain a positive attitude when interacting with the caregiver arrange with caregiver to have potential positive reinforcers on hand offer movement or stretch breaks For feeding and swallowing: ensure that the caregiver has all required tools/stimuli for cranial nerve assessments and trial oral feeds familiarize the caregiver with emergency contacts and safety protocols that are in place at the patient’s/client’s/student’s location