In this four-part article series, I will discuss what needs to be considered and provided on both the student and therapist side to ensure the best possible experience for students, schools, and clinicians.
Telepractice as a service-delivery model for school-based speech-language therapy has become an established and expanding format across the U.S. The American Speech-Language-Hearing Association (ASHA) defines telepractice as “the application of telecommunications technology to the delivery of speech language pathology and audiology professional services at a distance by linking clinician to client or clinician to clinician for assessment, intervention, and/or consultation.” While the history of speech-language services being provided via distance goes back decades (Houston, 2014), the past 10 years have established web-based, synchronous therapy services between students and licensed SLPs as the technological gold-standard of telepractice.
Part 1: Systems and Technology
I spent the first 13 years of my career as an onsite school-based SLP and in private practice, and given that I established my first email account upon entering graduate school in 1997, I had no awareness of (let alone ambition toward!) telepractice.
After family circumstances required that I step away from the demanding schedule (and commute) related to my onsite position, I made the decision six years ago to explore telepractice.
Exploration quickly turned to passion for this service-delivery model as I was suddenly presented with the unique opportunity to work with students and schools located hundreds and thousands of miles from my home.
It’s been a remarkable journey and I am continually energized by the multitude of professionals in this field who are dedicated to the exploration of telepractice and technology as a means to bring qualified, effective speech-language pathology services to all student populations.
Today, at this point in PresenceLearning’s history, my colleagues and I have delivered and coordinated over two million therapy sessions via telepractice for thousands of schools.
This experience, along with a growing body of research in the field of telepractice, has informed the identification of four essential areas that must be addressed in order for the successful implementation and delivery of school-based telepractice services:
1. Systems and technology
2. Client considerations
3. Brick-and-mortar vs. virtual students
4. Clinician considerations
At the risk of stating the obvious, web-based synchronous telepractice services require, at minimum: an internet connection, a computer, and a webcam for both the SLP and the student. Beyond these basics, it is also imperative to ensure:
- access to all necessary equipment and internet;
- an optimal learning environment;
- plan for troubleshooting if technical issues arise; and
- student information security and privacy.
Let's explore each one:
Access to internet and all necessary equipment
Ideally, in addition to the minimal equipment requirement of a computer and webcam, both the student and SLP would also have headsets with microphones to ensure the best reduction in background noise as well as the best sound clarity.
SLPs are often addressing IEP goals related to apraxia, articulation, and fluency. It is therefore imperative that the visual and auditory input being received by both the SLP and the student are optimal.
Another equipment consideration is the webcam: most laptops and Chromebooks have built-in webcams, however, if a desktop computer is being used for telepractice services, an external webcam might need to be purchased.
External webcams have the added feature of being adjustable, which can be of great use if the SLP needs to observe a student in play or interacting with other students (e.g., in a preschool setting), or if the SLP is running a social skills session and needs to observe the interactions of a small group (wide-angle external webcams are particularly helpful in these scenarios).
Optimal learning environment
Any SLP who has spent time working in school districts has likely encountered challenges when finding an appropriate location in which to conduct speech-language therapy sessions.
I have personally provided therapy in libraries, classroom corners, school hallways, and “renovated” custodial closets.
We as SLPs are nothing if not adaptable, however,when it comes to determining a location for telepractice services, finding the best possible environment is essential.
On the student’s side, the location of speech-language telepractice services must ideally provide an option of a hard-wire internet connection, or at least a strong WiFi signal.
Next, if the school staff member supporting telepractice services is not located in the same room as the student throughout the therapy session, the location must allow for line-of-site supervision.
And last but certainly not least, the location must allow for the best possible visual and auditory environment.
Appropriate lighting (avoiding back-lit orientations) and a quiet environment (separate room or corner of room with visual/sound separator) will allow the SLP to have the best possible visual and auditory input for each student session.
On the therapist’s side, all the above environmental recommendations apply.
However, SLPs working from home have the added requirement of establishing an appropriate home-office environment that will take into consideration those factors that could potentially interfere with the quality of a session: pets, doorbell, traffic, or kids coming home from school.
In addition, the home-based telepractitioner must ensure that the background being seen by students, school staff, and parents through the webcam is neat and professional – and better yet, is also engaging for students!
Plan for troubleshooting if technical issues arise
While the technology that allows and supports telepractice is continually improving, it’s essential to have a plan in place when internet, computer, or other equipment issues arise.
It seems too basic to mention (yet I will do so here because it is often overlooked), but the first step is to make sure that both the telepractitioner and school personnel (support person, principal, etc.) know how to reach each other quickly if communication through the computer and therapy platform is not available!
Maybe the video feed is clear, but the audio suddenly cuts out during a therapy session.
There’s nothing more frustrating than trying to give your support person advice on how to troubleshoot audio if you don’t have a backup mode of communication.
Therefore, consider the following:
PresenceLearning provides templates for the explicit purpose of making it easy for our providers to introduce themselves to school staff and parents, and to share professional background, personal interests, and contact information.
Establishing a clear path of communication early on is essential to a positive and productive relationship between the telepractitioner and the school and parents.
How would you like school staff and parents to reach you if email is either too slow or not the best mode of communication?
Will you give out your home or cell number?
Do you accepts texts?
Some providers who do not feel comfortable sharing their personal cell numbers have set up free voice-over-internet phone (VoIP) numbers that can then be forwarded to cell phones.
How can you quickly get in touch with the support person who is in the room with your student if your computer audio goes out?
Does he/she prefer that you call a cell number, or is there a landline in the room?
As long as there is a plan in place so that you can reach each other quickly, frustration will be minimized should tech issues arise during a therapy session.
I am thoroughly spoiled at my company by an essentially on-demand tech team that addresses any technical issues (on either the school or telepractitioner’s side) within minutes to prevent the loss of therapy time.
However, even if you are working as an independent telepractitioner, you will need to have a support plan, whether it’s a contracted tech support company or the support line for the internet and equipment providers.
Student information security and privacy
Telepractice has created virtually limitless options to connect students to SLPs, however, the related distance technology and the necessity to share information and documents digitally also increases opportunities for students’ personally identifiable information (PII) to be compromised.
It is essential that telepractitioners be educated on all relevant Family Educational and Privacy Rights Act (FERPA) and Health Insurance Portability and Accountability Act (HIPAA) guidelines, as well as any compliant or non-compliant electronic and web-based systems.
In addition to federal guidelines, the telepractitioner should also inquire about any additional district-level security requirements.
For instance, some school districts require SLPs living abroad to have a virtual private network (VPN) as an added layer of security prior to accessing any student information databases.
I look forward to any comments and feedback, and please look for the next topic in this series: "Client Considerations."
Houston, K. (2014). Telepractice in Speech-Language Pathology. San Diego, CA: Plural Publishing.
American Speech-Language-Hearing Association. (2019). ASHA Professional Issues: Telepractice. Available from https://www.asha.org/Practice-Portal/Professional-Issues/Telepractice/