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Using Telepractice to Provide School Based Therapy Services in Rural Ohio
Sue Grogan-Johnson, Kent State [email protected]
Robin Alvares, Kent State [email protected]
Lynne Rowan, Kent State UniversityMark Krumm, Kent State UniversityNada Allender, OMNIE Project
How we got started
Fall 2006SLP Shortage Task force
ODE/State Board approval & funding
One of 8 initiatives to address the shortage
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.
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
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
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
Year 1
Equipment PC desktop computers Logitech quick cam web cameras Polycom PVX software
Polycom VSX 5000 with document camera
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
Year 1- Results
Progress reportsTelepractice Totals for Fall and Spring Semesters On Site Totals for Fall and Spring Semesters
# of Students = 36 # of Students = 36
Total number of IEP Objectives= 126 Total number of IEP Objectives= 112
# of Objectives Mastered = 50 # of Objectives Mastered = 20
# of Objective Adequate Progress = 51 # of Objectives Adequate Progress = 70
# of Objectives Limited Progress= 2 # of Objectives Limited Progress= 4
# of Objectives No Progress = 0 # of Objectives No Progress = 0
# of Objectives Not Initiated = 23 # of Objectives Not Initiated = 6
# of Objectives Not Scored= 0 # of Objectives Not Scored = 7
# of Objectives “Some Progress “= 0 # of Objectives “Some Progress”= 4
# of Students Dismissed = 3 # of Students Dismissed = 2
Year 1 Results
NOMS Comparisons
Functional Communication Measure D: Intelligibility
Telepractice Project Subjects (n= 8)
2008 NOMS
National Report*
% of students who made no progress
37.5% 29.2%
% of students who improved
one level
25% 40.4%
% of students who improved multiple levels
37.5% 30.3%*K-12 Schools 2008 National Data Report, 2008 ASHA.
Year 1 Results
NOMS Comparisons Functional Communication Measure G: Speech Sound Production
Telepractice Project Subjects (n= 14)
2008 NOMS
National Report*
% of students who made no progress
28.5% 20.9%
% of students who improved
one level
21.4% 31.1%
% of students who improved multiple levels
37.5% 30.3%*K-12 Schools 2008 National Data Report, 2008 ASHA
Year 1 Results
NOMS ComparisonsFunctional Communication Measure I: Spoken Language Production
Telepractice Project Subjects (n= 7)
2008 NOMS
National Report*
% of students who made no progress
28.5% 37.4%
% of students who improved
one level
28.5% 41.2%
% of students who improved multiple levels
43% 21.4%* K-12 Schools 2008 National Data Report, 2008 ASHA
Year 1 Results GFTA-2 Results
Telepractice Subjects (N =22)
On site Subjects (N = 22)
# of students whose standard score did not change
1 1
# of students whose standard score increased
14 11
# of students whose standard score decreased
7 10
Year 1 Results
Subjects
IEP Objectives 9/07 language sample % correct
12/07 languagesample% correct
5/08 language sample% correct
1 Child will use correct irregular verbs or plurals with 80% accuracy while talking about an activity.(Language samples contained insufficient examples of irregular plurals to assess. Only irregular verbs including copula and auxiliary forms of “to be” and “to do” were assessed)
98% 100% 90%
2 During a variety of daily activities, child will clearly communicate using the correct word tense 80% of the documented time.
93% 95% 95%
3 Child will independently use socially appropriate, grammatically correct simple sentences with 4/5 accuracy on measured trials over three consecutive sessions(All C units were counted and dependent clauses that were judged complete within a conversational context (e.g. Examiner: “why did he eat it? Child: “because he was hungry). Sentences had no more than 30% unintelligible words. Automatic utterances (e.g. “I don’t know) were excluded).
63% 75% 86%
Language Sample Analysis by IEP Objective
Year 1 Results
Satisfaction Surveys (students)
Questions Yes No I don’t Know
1. I like coming here. 27 2 0
2. I like having speech therapy on the computer with Ms. Robin.
25 3 1
3. Speech therapy helps me learn to talk better.
24 5 0
4. I would like to do speech therapy again using the computer.
24 4 1
5. I could see and hear Ms. Robin during my speech therapy sessions.
26 3 1
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.”
Year 1 Results Survey Results (Parents)
Questions
How would you rate the following?
0DNK
1NVG
2BA
3A
4AA
5VG
1. Delivery of speech language therapy services using the telepractice technology
2 0 0 2 9 9
2. Your child’s overall progress this year 0 0 0 1 13 8
3. The telepractice speech therapist’s availability for communication with you regarding your child
2 0 0 4 6 10
4. Attitude of your child about receiving speech therapy services via telepractice
2 0 0 1 5 14
5. Your attitude about speech therapy services via telepractice
2 0 0 3 6 11
6. How do you think telepractice compares to face-to-face therapy
2 0 1 4 9 6
7. What is the likelihood that you would recommend telepractice to other parents
2 0 1 2 6 11
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!”
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)
Year 1 Results
Satisfaction Surveys (Principals) 4/4 surveys returned Follow up with unhappy principal
Satisfaction Surveys (E-Helpers & Side by Side SLPs)
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)
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
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
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
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
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 ??????