So far in my blog series, Telepractice: Prepare for Success, I have shared information and guidance related to Systems and Technology, Client Considerations, and Brick-and-Mortar vs. Virtual Schools. The final recommended area of consideration has to do with you—the clinician. Regardless of whether a clinician is providing services in a school-based or home setting, the following guidelines and best practices will ensure the best experience with your transition to teletherapy!

Part 4: Clinician Considerations

Licensure

One of the great benefits of being a teletherapist is the ability to work with students and clients in states outside of where you live—which also creates some challenges. 

ASHA guidelines “assert that telepractioners must be licensed in both the state from which they provide services and the state where the client is located at the time of service.” 

In addition, clinicians must educate themselves on all state-level regulations and licensure requirements. 

The Audiology and Speech-Language Pathology Interstate Compact (ASLP-IC) is working with states to ease state-by-state cross-licensure requirements for audiologists and speech-language pathologists residing in any of the compact states. 

There are currently 10 states in the compact; however, it’s important to note that if any states within the compact also require any sort of teacher’s certification in order to provide services in the school setting, these license types do not fall under the compact, and would still need to be obtained through the established processes.

Some states have detailed regulations related to teletherapy services, while others have no published language in this regard. 

In some cases, it might be necessary to call state regulatory offices for clarification if none has been provided through regulatory language.

Some specific teletherapy-related items to look out for are: 

• In-person requirements in order to initiate teletherapy services  
• Verbal or written informed consent requirements  
• Requirements related to SLPA/assistant supervision via teletherapy  
• Medicaid reimbursement stipulations related to teletherapy or tele-assessments 

Therapy Platform

Online, synchronous teletherapy services cannot exist without a platform through which the SLP and client can connect. 

And while a platform cannot make you a better teletherapist (teletherapy is a modality, not a new therapy type!), as an SLP who has worked in teletherapy for seven years, I can confidently share that there are platform features that are required, as well as other platform features that make planning and delivery of services much more efficient and fun!

HIPAA compliance is a no-exception requirement for anyone providing teletherapy services. To note, all HIPAA-compliant platforms should also meet FERPA requirements. Be sure to research the level of privacy related to any platform under consideration, particularly free versions of any platform.

Beyond HIPAA compliance, there is a range of features that can be used to support teletherapy services. 

One distinction to consider when reviewing platforms is whether the primary purpose of each platform is for business or therapy. 

Business platforms are certainly utilized to deliver teletherapy services, but they are not designed for teletherapy and do not have many therapy-supporting tools.

Therapy platforms, such as the proprietary platform built by PresenceLearning, includes various tools that support therapy sessions as opposed to just video conferencing.

PresenceLearning Platform features that support teletherapy sessions include: 

• Screenshare  
• SiteShare  
• Whiteboard tools  
• Interactive mouse functionality (e.g., clinician and client can simultaneously interact with the same activity within the room)  
• Ability to host 1:1 or group sessions  
• Multiple video feeds  
• Ability to alter video presentation (mirror, rotate)  
• Ability to manipulate size of video for both clinician and client  
• Ability to inhibit client’s mouse, volume, and video feed  
• Activity library  
• Interactive games  
• Ability to upload materials  
• In-session rewards  
• Training for platform use  
• Tech support 

 SLPs are resourceful and creative professionals who are known to make the best use of any available resources! 

However, I would recommend doing your research related to the platform you choose for teletherapy services, as this decision can impact your workflow, efficiency, and your and your client’s overall experience with this modality.

Clinician’s Office Environment

While holding the appropriate licensure and selecting the best therapy platform are both essential prior to initiating any teletherapy services, an important best-practice step is setting up an appropriate clinician environment. 

Typically, a teletherapist’s setting will either be a home office or a private office. 

Regardless, it is important to ensure the following items are considered: 

• Private, quiet location: Begin with consideration of HIPAA and FERPA compliance in all your online client and data interactions (coffee shops and public WiFi do not support privacy requirements!), but also consider times of day when noise might impact therapy sessions, and either mitigate the noise or schedule therapy sessions around these busier times.  
• Professional background: If you don’t have a separate office space and need to set up in a basement or bedroom, consider a curtain or screen that will prevent less-than-professional images (e.g., laundry or the, bed) from appearing to your client.  
• Lighting: As SLPs, we need to provide the highest quality visual modeling for our clients and poor lighting (e.g., light source behind your head) can have a significant impact on how we appear to our students and clients. Review lighting suggestions and test the placement of your computer in the room.  
• An office space that will support many hours spent on the computer: Second monitors, good seating, therapy balls, yoga mats, family pictures, and natural lighting are all features that can support work as a teletherapist. The ease with which teletherapists can schedule back-to-back sessions is wonderful for efficiency, but this ease can create some long-term issues if the office environment is not conducive to physical and mental breaks.

Teletherapy is an ever-expanding and developing field that is, if implemented according to best-practice guidelines, an effective modality for delivering speech-language services in a variety of settings, and a modality that addresses serious issues of access and equity faced by students and clients of all ages. 

I hope this series will be useful to those of you exploring teletherapy or wanting to build a stronger foundation for an existing practice.