NETSLP 

FAQs

Q: What is Telepractice?
A: Therapy delivered from a clinician to a client via the web is referred to as “telepractice.” Telepractice enables a clinician to meet with a client who is at a remote site via the web. Telepractice is a service delivery model using telecommunications technology to deliver assessment, intervention, and consultation at a distance. Research and reports to date confirm its significant advantages to overcome barriers of access to services caused by distance, unavailability of specialists and/or sub specialists, and impaired mobility.

Q: How does Telepractice work?
A: A speech-language pathologist (SLP) directs a session with a student from a remote site using a secure high definition web based video conferencing system. The students(s) participate from school/home/other facility logged on to the same web program interacting live with their SLP. The SLP can see the student and the student can see the SLP with a picture-in-picture display. Stimulus materials and games are projected on the screen . A trained paraprofessional may be in the session with the students(s) if needed to assist with any physical prompts or reinforcement as directed by the SLP. Middle and high school students may log in to their session independently.

Q: What are the benefits to telepractice?
A: There are many benefits to telepractice.

  • Telepractice services enable improved access to services that previously were not available due to distance from the therapy site (resulting in excessive transportation time and/or lack of clinicians or specialized clinicians in a geographic area). 
  • Clients can receive services with minimal disruption to their home or school schedule.
  • Telepractice affords a greater opportunity for bilingual clinicians or providers with interpreters to reach non-English speaking clients or geographically isolated populations.
  • Clients find the stimulus materials delivered by computer engaging, often resulting in increased motivation and responsiveness.
  • Receiving services via telepractice eliminates the direct cost of travel and indirect costs of lost work productivity associated with travel time for clients and accompanying family members.
  • Telepractice can also eliminate the need to cancel sessions due to poor weather conditions.
  • Delivery of SLP services to areas that are difficult to staff on-site SLPs
  • Higher levels of transparency and quality assurance than traditional delivery
  • The ability to involve parents in speech-language sessions and bridge home and school practice activities

Q: What equipment is required?
A. Standard hardware and software is required to support a telepractice program. Telepractice for speech-language treatment requires some basic equipment at both the provider's location and at the "remote" site location:

Hardware Requirements:

  • Computer with monitor
  • Webcam w/microphone
  • Speakers and/or headset
  • Phone in the room
  • Printer (optional)

Software Requirements:

  • Online conferencing "platform" (video, audio, instant messaging), which may or may not include a shared work platform or desktop sharing

Internet Connection

  • High-speed Internet access by which the locations connect to each other

Q: Is training and implementation required?
A: Yes, NETSLP provides a comprehensive training series and implementation plan that are designed to ensure maximum use and benefit of our services.

Q: How secure is the Telepractice system?
A: Understanding that data security is of utmost importance, NETSLP uses a system that implements advanced SSL-encryption to protect data transmissions. Ensuring that all data, video, and audio transmissions remain completely confidential.

Q: Is speech telepractice effective?
A:  Yes. Since the 1990’s researchers have compared the effectiveness of telepractice and traditional on-site delivery. Research studies clearly support telepractice as an effective method of delivering speech language pathology. Telepractice best practices are continuing to evolve as it becomes a standard mode of delivery. Telepractice is endorsed by ASHA and the State Board of Examiners for Speech-Language Pathology and Audiology.

Numerous studies comparing the effectiveness of telepractice and traditional on-site delivery can be found on the American-Speech-Language-Hearing Association (ASHA) website and [telepractice journal] . Telepractice is endorsed by ASHA, which initiated a special interest division in 2012 devoted to supporting additional education and research to enhance telepractice practices.

Q: What is ASHA’s position on telepractice?
A: It is the position of the American Speech-Language-Hearing Association (ASHA) that telepractice (telehealth) is an appropriate model of service delivery for the profession of speech-language pathology. Telepractice may be used to overcome barriers of access to services caused by distance, unavailability of specialists and/or subspecialists, and impaired mobility. Telepractice offers the potential to extend clinical services to remote, rural, and under served populations, and to culturally and linguistically diverse populations. The use of telepractice does not remove any existing responsibilities in delivering services, including adherence to the Code of Ethics, Scope of Practice, state and federal laws (e.g., licensure, HIPAA, etc.), and ASHA policy documents on professional practices. Therefore, the quality of services delivered via telepractice must be consistent with the quality of services delivered face-to-face. American-Speech-Language-Hearing Association (2011.) Telepractice for SLPs and Audiologists: Key Points. retrieved from http://www.asha.org/practice/telepractice/.

Q. Why Is telepractice Needed?
A. In the 1990’s telepractice emerged as an important strategy in addressing the national shortage of SLPs. According to the ASHA 2000 Schools Survey, 51% of respondents reported a shortage of SLPs, particularly in rural and urban areas. Speech Language Pathologists have long ranked at the top of job shortages according. The Bureau of Labor Statistics reports that speech language pathology is expected to grow 19 percent from 2008 to 2018, faster than the average for all occupations. At the same time, as of 2003, BLS projected that 50% of all SLPs were expected to retire within the following 15 years. Shortages are not just experienced by rural districts, medium-sized followed by large districts and high percentage of free-reduced price lunch districts experience the greatest shortfalls. Exacerbating this trend, are continued pressure on special education budgets, increased expectations of transparency and demonstrated effectiveness, and a growing need for bilingual SLPs.

Q. What is the student experience during a telepractice session?
A session begins when the student logs into their dedicated telepractice session room and is greeted by their speech language pathologist or SLP. Depending on the student’s needs, they work alone or participate in a small group of 2-3 students. The SLP and student(s) see and hear each other through HD video cameras and either headsets or echo-cancelling speakerphones. Both the student and SLP will be able to see, hear, and interact in real time. Prior to the start of the session, the SLP will have created a planning document that outlines the material to be covered during that session. Where appropriate, SLPs coordinate with classroom teachers to increase the impact of the therapy session. After chatting to get comfortable, the SLP will conduct exercises and games to address the student’s needs as specified in the student’s IEP or learning plan. For the first session, the SLP may conduct some assessments to identify where best to concentrate their focus.

During a session, the SLP will generally have content and games loaded into the system for quick access. The SLP will provide a mix of activities and challenges to motivate and engage the student. If participating in a small group, the SLP will engage all students, often in a round robin experience. If appropriate, a teacher can separate students into breakout rooms. As the session progresses, the SLP records their SOAP notes on each students performance.

Q. How often does a student have the same therapist?
A. NETSLP will assign a student to a specific SLP upon enrollment. The student will continue to work with this same SLP throughout their therapy. In the case of an SLP absence, there will usually be a substitute SLP that works off of a lesson previously prepared by the usual SLP. If a substitute is unavailable, a make-up session can be scheduled.

Q. Are sessions and student data confidential?
A. Yes, all sessions are secure and cannot be accessed without permission as specified by district and NETSLP protocols.

Q. Does The SLP Receive Training In Telepractice?
A. Yes. All SLP’s receive training that includes:

  • Fundamentals of telepractice
  • Using telepractice tools and synchronous video conferencing
  • Selecting, preparing, and using content
  • Motivating and engaging students
  • Basic technical troubleshooting
  • Managing students in a telepractice environment
  • Professional aspects and strategies of telepractice
  • Experiential aspects of material development, behavior management and direct service delivery

Q. Does the school provide support staff?
A. Yes. Schools are expected to help each student login to each session and answer any basic questions. A teacher, computer lab monitor, teacher aide or other staff can provide this basic support. Schools can expect that most students need some support for the initial sessions but have few questions after that. School staff will act primarily as monitors, as they do not need to actively participate during sessions. NETSLP does expect the school to ensure that students are available to participate in each session.

Q. What does a typical session look like?
A. All sessions have live video and audio components. Our speech therapists use traditional speech therapy materials along with innovative materials including fun websites and games. Video capabilities include options to adjust the size of the video to more closely focus on mouth positions. This allows the SLP to closely examine the student’s articulation along with giving the student the ability to adequately see the speech therapist during articulation demonstrations and interaction. This is uncommon in most telepractice settings.

Q. Can school officials observe a session?
A. Yes, There are two ways to observe sessions. Sessions can be recorded for later playback. Recorded sessions can only be accessed by approved personnel. Alternatively, our system allows participants to observe a session without participating.

Q. How is session quality managed?
A. One benefit of telepractice is the ability for NETSLP  to regularly conduct quality assurance reviews by monitoring live sessions and reviewing recorded sessions. Our system allows quality assurance staff to monitor sessions and interact privately with the SLP during a session without interrupting instruction. Every SLP is monitored for quality assurance during their initial training period and on a periodic basis.

Q. What is the evidence-base on the use of telepractice in speech-language pathology?
A. Because this service delivery model is relatively new, there is limited information comparing the effectiveness of telepractice to traditional, on-site therapy.

Early studies of adults with aphasia (Georgeadis, Brennan, Barker & Baron, 2004) and motor speech disorders (Hill & Theodoros, 2002) found no significant differences in patient performance and clinician diagnoses for assessments done via telepractice and on-site assessment. Intervention studies of adults with voice disorders (Mashima, et al, 2003) and children with fluency disorders (Lewis, et al. 2008; Sciotte, Lehoux, Fortier-Blanc & Leblanc, 2003) reported no significant difference in progress and high client satisfaction with service delivery.

Grogan-Johnson, Alvares, Rowan and Creaghead (2012) studied thirty-six school-aged children from rural school districts in northwest Ohio. Subjects had no identified cognitive or physical handicaps. The children ranged in age from kindergarten through seventh grade and had articulation/phonology disorders, language, or language and speech disorders, One child had a fluency disorder. The students participated in a split-half repeated measures design. Qualitative and quantitative measures were used to document the implementation of a telepractice project in rural Ohio. Measures included the Goldman Fristoe Test of Articulation - II, a language sample, rankings on the National Outcome Measures, and parent, staff and student satisfaction surveys.

Given the heterogeneity of the population and the variety of factors identified as contributing to treatment outcome, data collected on subject performance was difficult to interpret. Results of the pilot study demonstrated that students performed similarly in telepractice and on-site conditions. These preliminary findings showed that telepractice is potentially a viable service delivery model in the school setting for some children.

Q. Can I bill Medicaid for telepractice services?
A. Yes, if permitted by state and local regulation.

Q. Are telepractice services used primarily to save money?
A. No. Generally, telepractice services are not less costly. First, the individual providing services is a master's level speech-language pathologist, and there needs to be an on-site e-helper. Equipment needs to be purchased to provide services. However, travel time for the SLP is virtually eliminated, therefore, the SLP may be more productive. Telepractice is another service delivery model, such as on-site services.

Q. What are the HIPPA privacy guidelines for using video conferencing?
A. While HIPPA regulations require the patient confidentiality, the law was written before telepractice became commonplace. The signal must be encrypted, but there are currently no required standards for encryption.

Q: Are Telepractice sessions confidential?
A. Yes, every telepractice session is confidential and has the latest SSL encryption in order to meet all federal requirements of confidentiality. NETSLP provides a private, dedicated online therapy room for each individual student. This allows our therapists to tailor the students online therapy room to each students individual needs as well as providing an added level of security.

Q. What is encryption?
A. Encryption is the use of software to "code" the signal so that it cannot be hacked. Internet teleconferencing (e.g. Skype, iChat, iLinc) is not automatically encrypted. Both the sending site and receiving site must have software and/or hardware for encryption.

Q. How do I get encryption?
A. Encryption can be accomplished a number of ways, but it depends on the teleconferencing system being used. First, there is video conferencing software with encryption "built-in". For example, Polycom software has automatic encryption. Skype and iLINC can be encrypted for an additional fee, and iChat can be encrypted as an option if you are a subscriber. In addition, Virtual Private Networks (VPN's) can be created. Contact your teleconferencing provider for more information about their encryption options.

Q. Is telepractice within the scope of practice for speech-language pathology as defined by ASHA?
A. Yes, but it is up to individual clinicians to determine if they fulfill the Knowledge and Skills requirements as outlined by ASHA Skills Needed by SLP's (ASHA)

Q. Can I engage in telepractice in my state?
A. States may permit the use of telepractice, though regulations vary from state-to-state. Consult your state licensing board or professional association.

Q. Does my license cover interstate telepractice?
A. In general, if engaging in interstate practice, it has been concluded that the practitioner should hold licensure in both states (Denton, 2003). All states that have licensure have concluded that services take place where the client is, not where the SLP is. Therefore, if an SLP wants to provide interstate services, they should be licensed in the state they are telepracticing to, as well as the state in which they reside. That means meeting licensure requirements in both (all) states.

Q. Does my insurance cover Telepractice?
A. The field of telepractice is relatively new, and issues related to malpractice, negligence, and contract disputes may have to be initially decided by the courts. Therefore, any SLP or entity engaging in telepractice should consult legal counsel prior to beginning telepractice. At present, it is incumbent upon practitioners to judge if telepractice meets the guidelines of preferred practice. Clinicians should always hold the welfare of their clients paramount and engage in evidence-based practice. There are very few studies on the efficacy of telepractice, and the service delivery model may not be appropriate for some clients or in some settings.

Q. Who supervises the student during therapy?
A. Online speech therapy depends on close classroom supervision of students. A telepractice assistant is vital to the success of our program. This is usually a paraprofessional who carries out a number of responsibilities within the classroom and ensures the proper implementation and continuity of telepractice-based speech therapy. The telepractice assistant is responsible for the following:

  • Provides close supervision during therapy sessions according to the students needs.
  • May provide prompts and instructions to the student under the direction of the speech therapist.
  • Communication between the speech therapist and the classroom including scheduling, cancellations, absences, and school functions.
  • Transporting students to and from their speech therapy sessions.
  • Ensures the proper operation of technology (includes setting up the computer each day and attaching the headset).
  • Also ensures the proper operation of technology by fixing or reporting problems the computer or equipment.

NETSLP  provides training to paraprofessionals or e-Helpers  who serve as a telepractice assistant to orient them to our conferencing technology and basic troubleshooting strategies.

Q. What is an e-helper?
A. The e-helper helps maintain and trouble-shoot equipment, manage materials, manage student behavior and may assist in scheduling and distributing materials to teachers, family, staff, etc. The e-helper is not a speech assistant and does not engage in any therapeutic activities.

Q. How are assessments completed?
A. Most assessments are conducted using the same format as online speech therapy. Our speech therapists are fully trained for completing standardized assessments online and can effectively determine what type of speech therapy students will need.

Q. What are the speech therapist qualifications?
A. Our speech therapists are fully licensed speech-language pathologists with Master’s degrees in communication disorders. They are fully credentialed with their state license(s) and ASHA CCCs (Certificate in Clinical Competence), and have strong communication skills.

Q. Can telepractice work for all situations?
A. Telepractice method works for the majority of students but not all. Our speech therapist will individually determine if telepractice is recommended for each student based on the student’s cognition, vision, hearing, attention, and communication methods.

Q. How does the speech therapist communicate with parents and schools?
A. Communication between therapist, schools, teachers, and parents takes place through a variety of modalities including online meetings, written communication, emails, and phone. You will receive contact information for your speech therapist to enable you to contact your therapist in a modality most appropriate to meet your needs.