Using Telepractice to Provide School Based Therapy Services in Rural Ohio

1. Using Telepractice to Provide School Based Therapy Services in Rural Ohio Sue Grogan-Johnson, Kent State University sgrogan1@kent.edu Robin Alvares, Kent State University ralvares@kent.edu Lynne Rowan, Kent State University Mark Krumm, Kent State University Nada Allender, OMNIE Project

2. How we got started • Fall 2006 • SLP Shortage Task force • ODE/State Board approval & funding • One of 8 initiatives to address the shortage

3. Answering concerns from the community • This position statement is an official policy of the American Speech-Language-Hearing Association. • Telepractice is the application of telecommunications technology to deliver professional services at a distance by linking clinician to client, or clinician to clinician for assessment, intervention, and/or consultation. 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 underserved 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. (2005). Speech-Language Pathologists Providing Clinical Services via Telepractice: Position Statement [Position Statement]. Available from www.asha.org/policy.

4. What our project all about • Pilot research project • partner with Kent State University • 4 years/planned expansions • Study the service delivery model • Children • IDEA regulations & paperwork • Costs compared to side by side • How about technology

5. Clip of therapy

6. Year 1 of the project • Hardin County • Students • Eligible if grades k -12 and current IEP • Started with 38 • Articulation/language/fluency • Not autism, significant cognitive impairment, ED • 13 F, 25 M, 4-12 yrs. Old • Selected from current caseloads • Obtained separate parent permission

7. Year 1 • Study Design • Split half • Ss reward • Data collection • Progress reports • NOMS • GFTA & language samples • Therapy Delivery • Telepractice – primarily individual with 4 students in group therapy and 2 students who received group and individual • Side by Side- primarily group ranging 2-4 students • E-helpers

8. Year 1 • Equipment • PC desktop computers • Logitech quick cam web cameras • Polycom PVX software • Polycom VSX 5000 with document camera

9. Year 1 • Typical sessions • Followed goals and objectives on IEP with exception of in-classroom objectives • Each session begins with review of goals for session, followed by therapy and a final review at end of session • For articulation students attempting to obtain a minimum of 70 productions in a 20 minute session • For language students incorporate literature based remediation as able

10. View clips

11. Year 1- Results • Progress reports

12. NOMS Comparisons Year 1 Results *K-12 Schools 2008 National Data Report, 2008 ASHA.

13. Year 1 Results • NOMS Comparisons *K-12 Schools 2008 National Data Report, 2008 ASHA

14. Year 1 Results • NOMS Comparisons * K-12 Schools 2008 National Data Report, 2008 ASHA

15. Year 1 Results • GFTA-2 Results

16. Year 1 Results • Language Sample Analysis by IEP Objective

17. Year 1 Results • Satisfaction Surveys (students)

18. Year 1 Results • Student comments • “What did you like best about having speech therapy on the computer? • “Her talks good and I like her.” • “playing games” • “I like to say playing games across the country. Isn’t that pretty neat?” • “What do you wish you could change about having speech therapy on the computer? • “Playing game on it and she can still talk to me” • “Get a better computer so we don’t have so much breakups.” “Make it less statically.” • Other comments • It’s awesome cause it like shows you and if I do really good she might give me like 3 stickers.” • “ Like it’s a lot of fun but it’s a little hard- like the stuff I don’t know about yet.”

19. Year 1 Results • Survey Results (Parents)

20. Year 1 Results • Parent Comments • “This project really got student’s name excited about his speech class. He looked forward to having this class each week. It was great!” • “My son has come so far this year with his speech! His improvement was shocking to his father and I! He still needs work, but he loved the telepractice and with his improvement it is wonderful. • “I believe they should have this therapy longer and more availability to more children. Student’s name enjoyed it and I noticed a big difference (positive) from the outcome of this project. Thank you for the opportunity.” • “I feel student’s name is learning a lot. He comes home and tells us what the therapist has told him to work on. He thought it was fun, and if learning is made fun I think it will stay with him.” • “Keep up the good work and help other kids I would let student’s name do it again if she needs for next year.” • “ Student’s name really enjoyed this program!” • “My son was happy to do the therapy via telepractice because he was more comfortable with doing it that way rather than face to face. He was excited about going to speech on those days. Thanks so much!”

21. Year 1 Results • Satisfaction Surveys (teachers) • 15 of 27 surveys were returned • Teachers did not know about the components of the program or student response/progress • One exception was student attitude toward telepractice (9/15 rated very good)

22. Year 1 Results • Satisfaction Surveys (Principals) • 4/4 surveys returned • Follow up with unhappy principal • Satisfaction Surveys (E-Helpers & Side by Side SLPs)

23. Year 1 Results • Reliability of Telepractice Services • 704 possible sessions • 189 missed sessions • 41 made up sessions • 556 total sessions (79%) • Of missed sessions • 20% teacher in-services (39/189) • 38% weather (72/189) • 15% student absent (28/189) • 13% school related activities (25/189) • 4% site based technical difficulties (7/189) • 0% KSU based technical difficulties (0/189) • 10% E-SLP absent (18/189)

24. Benefits of telepractice • Providing master’s level speech and language services to students in rural Ohio. • Increased productivity • Use of Computer and Internet-based resources • Students report that it is motivating

25. Limitations of telepractice • Cannot provide classroom-based, “push-in” services • Can limit collaboration with administration, teachers and other service providers • Difficult to deliver services to more than one student • Potential for problems with technology

26. Changes made from Year 1 to Year 2 • Expanded services to additional 50 students in Greenfield Schools • District employee schedules therapy times, meetings and manages paperwork • No group services • Personal contact made with all teachers and administrators and many related service personnel • Establishing baseline procedures for all students • Establishing criteria for descriptors used in progress reports • Evaluating other teleconferencing software options

27. Anticipated changes for 2009-2010 • Different teleconferencing software • Service delivery to preschool students • Study the use teleconferencing for language assessment • Further refinement of measures of treatment efficacy • Expansion of the project

28. Brainstorm – other uses for telepractice • Providing services to high-incidence students through telepractice to decrease caseloads for on-site services • Extended School Year • Screening • Consultation • ??????

29. Thank you! • Please download a copy of our on-line resources guide