Using Telepractice to Provide
School Based Therapy
Services in Rural Ohio
Sue Grogan-Johnson, Kent State University
[email protected]
Robin Alvares, Kent State University
[email protected]
Lynne Rowan, Kent State University
Mark Krumm, Kent State University
Nada Allender, OMNIE Project
How we got started
 Fall
2006
 SLP

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 SpeechLanguage-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
Clip of therapy
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

View clips
Year 1- Results

Progress reports
Telepractice 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
% of students who
made no progress
37.5%
29.2%
% of students who
25%
40.4%
37.5%
30.3%
improved one level
% of students who
improved multiple
levels
*K-12 Schools 2008 National Data Report, 2008 ASHA.
National Report*
Year 1 Results
 NOMS Comparisons
Functional Communication Measure G: Speech Sound
Production
Telepractice Project 2008 NOMS
Subjects (n= 14)
National Report*
% of students who
made no progress
28.5%
20.9%
% of students who
21.4%
31.1%
37.5%
30.3%
improved one level
% of students who
improved multiple
levels
*K-12 Schools 2008 National Data Report, 2008 ASHA
Year 1 Results

NOMS Comparisons
Functional Communication Measure I: Spoken
Language Production
Telepractice Project 2008 NOMS
Subjects (n= 7)
National Report*
% of students who
made no progress
28.5%
37.4%
% of students who
28.5%
41.2%
43%
21.4%
improved one level
% of students who
improved multiple
levels
* 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
Language Sample Analysis by IEP Objective
Subjects
IEP Objectives
9/07
language
sample
% correct
12/07
language
sample
% 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%
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
0
1
2
3
4
5
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
DNK
NVG
How would you rate the following?
B
A
A
AA
VG
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
 ??????

Thank you!

Please download a copy of our on-line
resources guide
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