The State of affairs TSHA Telepractice task Force

1. The State of affairsTSHA Telepractice task Force SEPTEMBER 2010

2. What is Telepractice? • The American Speech Language Hearing Association (ASHA) defines Telepractice as: “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.” ASHA Position Statement (2005)

3. Teletherapy Based on old concept • Medical field first treated patients via telecommunications as early as 1906 • In the 1920s, ship radios were used to link physicians with sailors to assist during medical emergencies at sea. • In 1955, the Nebraska Psychiatric Institute was one of the first facilities to use closed-circuit television for healthcare purposes. • Today physicians are even performing telesurgery using videoconference and robotics

4. National Critical Shortages • The U.S. Bureau of Labor Statistics estimates that the nation will need about 141,200 speech-language pathologists by 2018, which is an 11% increase over time • In addition, U.S. Bureau of Labor Statistics estimates that that 49% of SLPs are age 45 or older and will be eligible to retire over the course of the next 15 years and 5% will leave the profession due to other reasons • Data indicates that rate of increase is not enough to replace those that retire or leave the profession

5. Critical shortages in schools • In the 2008 ASHA Schools Survey, 72% responded that job openings were more numerous than job seekers • In addition, 79% reported workload and caseload as an effect of the clinical service provider shortage • According to a study conducted in Utah, “Stress and burnout contribute significantly to the shortagesof school-based speech-language pathologists (SLPs).”

6. Implications from Shortage in Schools • Children are not receiving needed therapy • Best Practices are often compromised • Unnecessary cost of compensatory education and “due process” • High turnover of SLPs

7. Benefits of telepractice • Telepractice is efficient and effective • ASHA supports telepractice • Distance education is proven technology • Allows under serviced rural populations benefit of quality and consistent services • Eliminates commute time for both client(s) and therapy providers thus creating more efficient use of time

8. Other States using Teletherapy • Oklahoma INTEGRIS Health (2002) has documented positive clinical results, continues to use to service rural schools • Ohio began a study of the efficacy of telepractice in 2006, now in it’s third year of the study have expanded to include three “e-therapists” • Linguacare & Associates provides services in West Virginia to rural schools to address shortages of SLPs • Minnesota has completed two successful pilot studies involving Telepractice

9. ASHA Statement on Telepractice Position statement "telepractice is an appropriate model of service delivery for the professions of speech-language pathology [and audiology]. Telepractice may be used to overcome barriers of access to services caused by distance, unavailability of specialists and/or subspecialists, and impaired mobility.”

10. The ASHA Position Statement (2005) …emphasizes that “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, and ASHA policyndocuments on professional practices.” Therefore, the quality of services delivered via telepractice must be consistent with the quality of services delivered face-to-face.

11. Texas Rules and Regulations regarding Telepractice §741.41 Professional Responsibilities of License Holders (b) A licensee shall not: (9) evaluate or treat speech, language, or hearing disorders solely by written, telephone, or electronic/video correspondence or communication Note: State Board of Examiners for Speech-Language Pathology proposed new regulation in April 2009 and finalized /revised them on July 14, 2010. The proposed regulations will be open for public comment in September 2010. All questions should be directed to The State Board of Examiners for Speech-Language Pathology and Audiology for current guidelines and service delivery.

12. How does Teletherapy Work? • The remote speech-language pathologist directs a session using videoconferencing equipment/software, typically a desktop model from a remote site • The client(s) participate from school/home/other facility using videoconferencing equipment, typically a television with a closed circuit camera. • A trained paraprofessional is with the client(s) to assist with any physical prompts or reinforcement as directed by the speech-language pathologist.

13. Portable Units for 1:1 Treatment/evaluation

14. Teletherapy Students View • High definition camera/TV • Cart is light weight, small , and mobile • TV is mounted onto the cart

15. Speech Classroom View with Picture and picture

16. Example of Remote SLP Equipment • Allows for Picture in Picture • Therapist can control camera on the school’s side with the remote control • Zoom in on a particular student when needed • ELMO, document camera, (pictured on the left)

17. For Additional Information Contact a Member of the TSHA-Telepractice Task Force • Angela Geurin MS CCC-SLP (Chair) angelageurin@yahoo.com • Diana Christiana, MAT, CCC-SLP dianac@clinicalcom.com • Dr. Cindy Gill, CCC-SLP cgill@mail.twu.edu • Michael Douglas MA, CCC-SLP, LSLS, Cert. AVT mdouglas@centerhearingandspeech.org • Aitran Jaime MS CCC-SLP lachinita98@hotmail.com • Amy Greebon MS CCC-SLPagreebon@comcast.net • Rosanne Joseph MS CCC-SLP rjoseph@crosbyisd.org

18. References • American Speech-Language-Hearing Association. (2005). Speech-Language Pathologists Providing Clinical Services via Telepractice: Position Statement [Position Statement].Available from www.asha.org/policy. • Texas Speech-Language-Hearing Association http://www.txsha.org/TaskForce_SpecialInterest.asp • Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2010-11 Edition, Speech-Language Pathologists, on the Internet at http://www.bls.gov/oco/ocos099.htm (visited January 08, 2010). • American Speech-Language Hearing Association (2008). Schools Survey-Work Force Report. On the internet at http://www.asha.org/uploadedFiles/research/memberdata/Schools08WandWCTrends.pdf • Carpenter, J., Clark, Ph.D., P.G., Cloud-CIO, A., Hodge, B., Prouty, D., Scheideman-Miller, MHA, C., & Smeltzer, S.S., M.S., CCC-SLP. (2002). Two year results of a pilot study delivering speech therapy to students in a rural Oklahoma school via telemedicine. Proceedings of the 35th Hawaii International Conference on System Sciences 2002, INTEGRIS Health.

19. References • Grogen-Johnson, S. (2008)Telepractice Project Focus in Ohio’s Public Schools. www.omnie.org • Moore-Brown, B., Nishida, B., Uranga-Hernandez, Y., Parker, M., & Shubin, J. (2005). Finding them & keeping them: Coping with SLP shortages. American Speech-Language-Hearing Association Annual Convention 2005. • Palovy, C. (2008) Telepractice in Schools Helps Address Personnel Shortages. http://www.asha.org/about/publications/leader-online/archives/2008/080715/080715e.htm • Harris, S., Prater, M., Dyches, T., Heath, M. Communication Disorders Quarterly, Vol. 30, No. 2, 103-111 (2009)DOI: 10.1177/1525740108323856 • Burg G (ed): Telemedicine and Teledermatology. CurrProblDermatol. Basel, Karger, 2003, vol 32, pp 226–232 • "Operation Lindbergh: First Transatlantic Robot-Assisted Operation." WebSurg, 2003 [cited April 13, 2003]. http://www.websurg.com/lindbergh .Read more: Telesurgery - procedure, recovery, tube, removal, time, operation, Definition, Descriptionhttp://www.surgeryencyclopedia.com/St-Wr/Telesurgery.html#ixzz0bQwrFSK8