Marnee Brick on Speech Therapy Telepractice at CASLPA 2009

Speech Therapy Telepractice: Reaching the Need Marnee Brick, MSc Director of Speech Therapy TinyEYE Therapy Services http://www.TinyEYE.com

Grow a smile Mend a spirit Engage a child in his life

Telepractice is a medium through which a service reaches the need What IS Telepractice?

Today’s Speech Telepractice….

brings people together

for face to face and collaborative interaction

from different locations

for the purpose of growth and support

CASLPA Telepractice” refers to the use of technology to deliver audiology and speech–language pathology services at a distance. Telepractice may involve “live” or “store-and-forward” service. Live or real time service may include but is not limited to telephone, or videoconferencing. Store and forward involves the recording, storing, and subsequent transmission of audio and/or visual images for later examination (e.g., e-mail, fax, audiotape or videotape recordings). CASLPA – Position Paper on The Use of Telepractice for CASLPA Speech-Language Pathologists and Audiologists – January 2006

Types of Telepractice

Traditional Teleheath

Addressing Shortages in Schools via Telepractice Janet Brown, ASHA Jeanne Juenger, Houston (MN) School District Pam Forducey, INTEGRIS-Health

Mixed Solution

Shared desktop

Access on-line games http://www.cbc.ca/kids/games/

Fully Integrated Software

SLP 2-Point Supervision Supervising SLP

3-Point Supervision Supervising SLP SLPA or SLP Student

Peek-a-Boo Window

What technology do you need to do on-line therapy?

Hardware

Web-camera with 15 FPS capture rate

Head set with attached microphone

Requirements for On-line Therapy

High-speed internet

CPU = processing speed

3.0 GHz

2.0 GHz for dual processor

Requirements for On-line Therapy

RAM = memory Windows Vista: • 2 GB of RAM • P4 with 3GHZ processor or equivalent (or 2.0 GhZ Dual Core) Windows XP: • 1GB of RAM • P4 with 3GHZ processor or equivalent (or 2.0 GhZ Dual Core) Mac OS X 10.4 (Tiger) or 10.5 (Leopard): • 1 GB of RAM • Dual Core Processor Requirements for On-line Therapy

Bandwidth Requirements for On-line Therapy

SCHEDULE

• CLOSE PROGRAMS

• BW TOOL

• DEDICATED LINE

CASLPA’s Position of Telepractice The Canadian Association of Speech-Language Pathologists and Audiologists (CASLPA) endorses the use of telepractice in both speech-language pathology and audiology as a means of improving access to services provided by fully qualified professionals. (Read paper for the conditions under which it is endorsed) CASLPA CASLPA members who provide services via telepractice are expected to adhere to the CASLPA Code of Ethics (2005) and privacy legislation and abide by guidelines established by the regulatory body of the province in which they reside. Members may provide services via telepractice if they determine that it is in the best interests of their clients. Members shall base telepractice on best evidence and encourage ongoing research in this field. Source: http://www.caslpa.ca/PDF/position%20papers/telepractice.pdf

Regulatory Body - Ethics

Always refer to your provincial or state regulatory body.

Ontario

Alberta

Preventing vs. Providing Services

Regulatory Body - Ethics

The Influence of Perspectives

Concerns

Technology issues

Cannot help everyone

Not engaging – cannot build a rapport

Cannot do PROMPT or oral motor

It is not effective

It steals jobs

On the Other Hand …

Technology evolves

Can help many

Grow smiles, mend spirits, engage children in their lives

There is more in our toolbox, make good choices

It changes lives

It gives jobs

If your presence changes lives for the better – what do you think your absence does?

REACHING THE NEED: Problems Grow Solutions

So How is Telepractice a Real Solution? Equal Service Improved Productivity Lower Environmental Impact Lower Material Costs SLPs Can Be Located Anywhere

“ We had to advertise all year, and we simply had no applications.” -Special Education Director http://www.recordnet.com/apps/pbcs.dll/article?AID=/20060704/INSCHOOL/607040310/1001/NEWS01

REACHING THE NEED: Problems Grow Solutions

Headline: SLP Uses Telepractice to Reach the Need!

Two SLPs moved away, SLPA’s could not practice

Two SLPs serving large school board, no therapy

SLP sick and away for 20 weeks

Home programs not accessed

SLPA field placements

SLP wants to work, has disability

Telepractice brings more SLPs

to work!

'We are Americans living in Vienna, Austria. We can not find an American English speaking speech therapist for our son. He can speak German perfectly but the hard American "r" has always been a problem. Also, within the last month, we have noticed some other problems. Can you help us? How much will it cost per session? Thank you.

REACHING THE NEED: Problems Grow Solutions We are Americans living in Vienna, Austria. We can not find an American English speaking speech therapist for our son. He can speak German perfectly but the hard American "r" has always been a problem. Also, within the last month, we have noticed some other problems. Can you help us? How much will it cost per session? Thank you. 'We are Americans living in Vienna, Austria. We can not find an American English speaking speech therapist for our son. He can speak German perfectly but the hard American "r" has always been a problem. Also, within the last month, we have noticed some other problems. Can you help us? How much will it cost per session? Thank you.

Research, Studies, Feedback

Clinical research grants for CASLPA members to conduct research or engage in activities that increase research capacity

Two grants of $2500 each will be awarded in 2009

http://www.caslpa.ca/PDF/clincial_research_grant_application_form_CASLPA.pdf

Research, Studies, Feedback Office for the Advancement of Telehealth http://www.hrsa.gov/telehealth/ Association of Telehealth Service Providers www.atsp.org/

Mayo Clinic “ Telemedicine evaluations can be reliable beneficial and acceptable to patients with a variety of acquired speech and language disorders, both in rural settings and with large multidisciplinary medical settings.” (Duffy, J.R., et al. 1991, December) Telemedicine and the Diagnosis of Speech and Language Disorders, 1116-1122

The Institute for Stuttering Treatment and Research at the University of Alberta Outcome: Full assessment and treatment of stuttering in children and adolescents can be accomplished successfully via telemedicine (Sicotte, C., Lehoux, P., Fortier- Blanc, J., and Leblanc, Y. 2003. Feasibility and outcome evaluation of a telemedicine application in speech: language pathology. Journal of Telemedicine and Telecare 9(5):253-8).

National Research Hospital Survivors of stroke and traumatic brain injury participated in standardized assessments in both face to face video conference-based telerehabilitation setting. Across all subjects, no significant difference was found. Brennan, D.M., Georgeadis, A.C., Baron, C.R., & Barker, L.M. (2004). The effect of videoconferencing-based telerehabilitation on story retelling performance by brain-injured subjects and its implications for remote speech-language therapy. Telemedicine Journal and e-Health, 10, 147-154

The TeachSpeech project successfully demonstrated that modern videoconferencing technology can be used to support the delivery of speech and language therapy services into schools. (Rose E., Furner S., Hall A., Montgomery K., Katsavras E. and Clarke P. 2000. Videoconferencing for speech and language therapy in schools. BT Technol J, Vol 18, No 1, p 1001-4).

OMNIE PROJECT – Kent State University "We're finding that telepractice is a wonderful service delivery model that has the potential to fill a niche in speech-language treatment in public schools," Grogan-Johnson said. "It has the potential to provide master's level speech-language treatment to students who wouldn't receive services otherwise. cite as: Polovoy, C. (2008, July 15). Telepractice in schools helps address personnel shortages. The ASHA Leader, 13 (9), 22-24.

The day it all came together in the life of a child…

The day it all came together for the life of a child… “ I observed a session yesterday with (SLP) and was very impressed with what I saw and the SLPA & school is very happy with the kids’ progress. It is great to be providing a service to our kids after so long. Thanks” - District Vice-Principal for Special Education “ I was talking with (District Vice-Principal for Special Education ) and we are both impressed how every student gets to see the SLP once a week - there isn't any other way one SLP could pull off that kind of service. It's incredible!” -School’s program assistant Katie says: I have the best story to share with you! Conway finally got his /g/ and /k/. He came to me and said his day was ‘Good’. It is the first time – I am so excited especially since his name is Conway!

Alicia says: Marnee I am SO EXCITED!!!!!!!!! Alexa made her /k/ in isolation 8 times today!!!!!!! and was able to make some spilt word productions!!!!!!!!!!!!!! Michele says: Hi Marnee...I just finished my first "official" day …. I had a BLAST! Everything went smoothly…… Linda says: Hello, just wanted to let u know that the sessions went very well. Bev seemed very pleased and all the kids were laughing and smiling. Catie says: Everything went well and I enjoyed it. The new games look GREAT! Amanda says: Trent was amazing. He learned how to Make his “s” sound today and he was so proud. I tell you if you ever need proof that this is working for the kids, go and see Trent!! :)

How does telepractice benefit you? Work from home or office No driving on T-days! Better work-life balance Effort is client focused Reach the need – not the road Frequent online visits enable you to make a difference

Sandy says: After years of (SLP) school and feeling rushed and feeling like I didn't have time for my (own) children, you know how excited I am to do this. Again thanks for seeing this need for us and for the children who otherwise wouldn't get services.

Incorporating Telepractice into your Practice

On-line Speech Therapy: A Student Focused Model

GET YOURSELF READY

Start with your regional licensing body

Build a relationship

Integrity, transparency

Acquire and share knowledge

Document all communications

2. Choose your technology and become an expert

Training

Talent: character skill spark

Tech support plan

3. Choose your service and clients

Consulting and Building Capacity

Supervising

Direct Therapy

Clients – age, challenges

Plan your service to adhere to best practice

BUILD A RELATIONSHIP WITH

YOUR SCHOOL AND PREPARE FOR SUCCESS

Talk to your school about the benefits of telepractice

regular service, shorter lengths of stay, reduced costs and increased productivity, more focus on students …

Talk to the school about what a telepractice program would look like

Technology involved, challenges that could happen and plans to address them

People involved

Same-location visits

Commitment to students and proposed outcomes

3. Build relationships

Special Education Director

Tech Support

Contact Person, program assistant

Parents – informed consent

MAKE A DIFFERENCE

Grow a smile, mend a spirit, engage a child in his life

Turn the child into the expert, WOW

Heighten your senses and performance

Listening, looking, liking, learning, looping

Celebrating words

Dancing ears

High five

Skill Talent Character Spark

Put on the show

Bring them into an adventure

Educate and empower

Strive for excellence

“ Excellence can be obtained if you: … care more than others think is wise; …risk more than others think is safe; …dream more than others think is practical; …expect more than others think is possible.” ~author unknown

[email_address]