As part of my routine, I often check Facebook Groups, Pinterest, Instagram, etc. to see the recent chatter about telepractice. Frequently, I see clinicians of all stripes (young, experienced, retired, school-based, private practitioners, etc.) who are looking for a change, or looking to do something part-time. The two biggest questions that are asked are: 1) how do I get started?, and 2) Isn’t telepractice easier than in-person service provision?

 

Let’s start with the 2nd question first as I think this is important to know and understand before jumping into telepractice. Currently, most telepractice sessions are done in a school setting. While there are many private practices adding telepractice to their repertoire of services, it is not growing quite as fast as services in the public schools. I believe the reason for this primarily due to shortages.

 

My colleagues in private practice tend to begin offering telepractice services when they have a long term client whose family is moving, but they are wanting to stay with the same clinician. This makes the transition to telepractice a bit easier on both parties (clinician and client). A relationship has been established, they know each well and they’ve developed a trust so that adding a new mode of service delivery is not a big step. I believe in this scenario, it does make telepractice a bit easier.

 

However, in a school setting, clinicians must have a knowledge of the school culture first prior to engaging in telepractice, in order to be successful.  It is very difficult to transition to a new mode of service delivery ( telepractice) and have limited knowledge of school culture where you will be providing services. In addition, school culture is different from one city to the next, so you need a good working knowledge of the basics of how schools operate (the I.E.P. process, how to work with school staff, how to successfully work with parents, eligibility criteria, the difference between working in a private practice or medical setting and schools, etc.), then you must research the area where your school site is located. Having provided services in many different areas across the United States, I can tell that working in Dodge City, Kansas is very different from Santa Fe, New Mexico which is different than Miami, Florida!

 

Often, new telepractice clinicians believe that if they are providing services to schools, they are somehow absolved of all the required paperwork. These clinicians often state “I just want to do therapy”!  When you work in the schools, whether in-person or via telepractice, you still need to provide quarterly progress reports, hold annual I.E.P.s, meet with parents and teachers, evaluate/assess students for eligibility, file Medicaid paperwork, write legally defensible reports and I.E.P.s, etc.  If you are working in a school setting via telepractice and not providing these additional services, then some other person (SLP, teacher, administrator) is doing this which adds to their workload.  It does not make this individual very happy and can derail a telepractice program.

 

So, if you are looking into telepractice, please understand, that you will be continuing to do all the the things mentioned above as part of your job as an SLP.  If you understand this going in, then you will be a much happier clinician having gone into something new with your eyes wide open! This is not to discourage you at all, as great telepractitioners are needed just as much as in-person clinicians. Just make sure you know what you are getting into and understand the job requirements before you leave your current job.

 

Happy telepracticing!!

I recently read an article that indicated that if you want to write more, you need to write more! While this seems obvious, the article went on to say that the more you do something, the easier it gets.  I’ve been wanting to update my blog more frequently, but was having difficulty getting started. So, I’ve now added writing  time to my calendar in the hopes that it will encourage me to add to my blog.

As I’venoted before, I am passionate about telepractice. It is a service delivery model that could potentially change and improve the way SLPs provide services, making it easier for us to work at the top of our licenses.  Technology can be used to improve and enhance what we do every day.

We have to ask ourselves, is it a good use of our time to drill our clients? We know that many of our clients require many, many repetitions in order to improve their communication skills, but you don’t need to be an SLP to provide the drill.  Wouldn’t  it better to allow a SLPA, a family member,  or maybe even a computer,  to do this work?  I can hear you all gasping at this last question! A computer doing the drill work? How is that even possible?  With the advancement in Artificial Intelligence (AI) we could easily move in this direction. Please be clear that I am not advocating for replacing SLPs! I believe strongly, that, no matter how advanced AI becomes, there will always be a need for “live” SLPs in all settings.  Language is far too complex for AI to take over all that we do and to understand the nuances and subtleties of language. Plus, it’s difficult for a computer to use appropriate affect and intonation!

For many of my colleagues who have large caseloads in school, think about what your workload could look like if, for instance, you could teach a young student with an articulation disorder how to say his/her sound(s) in single syllable words, then allow them to sit at a computer to practice sound production and have the computer monitor and reward correct productions. You would then touch base, in person, with the student every couple of weeks to train new sounds and to ensure carryover. This would leave you more time to work with students who need more direct instruction, who have more complex language issues and to work on carryover for the students with more significant communication difficulties.

The shortage of SLPs is not getting much better, our caseloads are growing, our workloads are increasing, why not look at unique ways to improve our workloads.  Why not use technology to assist us? Think about it! Are there better technology solutions that will make our lives easier??

July 2017

It’s been awhile since I’ve posted on this blog. Life takes funny turns sometimes and, as I mentioned in my previous post, it is important for telepractitioners to be flexible, among other things!  

About six months ago, I took a position at a university across the country  to assist them in developing their telepractice program for graduate students in the Communication Disorders and Sciences program.  This adventure has been eye opening for me. First, I moved to the East Coast to facilitate working with the faculty and staff at the university. Moving from California (just outside San Francisco) to a less urban, more rural area has been quite interesting!  It has meant getting adjusted to a slower pace of life, learning to do things without my family around and finding ways to entertain myself when I am not working.

As part of my job, I have developed a course in telepractice for the CSD students. I truly enjoy working with these young students who are eager to become SLPs.  They believe that telepractice will be the way of the future with our professions.  At first, they were a bit shy during the first couple of class sessions with me. I suspect that was because there were no  students to ask about my teaching since I am new to the university! However, when they realized that I don’t bite, they’ve opened up and seem excited about being trained in telepractice.

Currently, there are only a handful of universities that offer telepractice training to their students along with some practicum experience. At the university I am working at, they are wanting to offer both.  One of the most difficult parts of my job has been to find practicum experience for them.

Part of the issue is that we wanted to give the students telepractice experience during their summer coursework, a few hours with one or two clients. However, I quickly realized that there are very few companies or telepractitioners that provide services over the summer. Most telepractice companies are providing their services to public schools and very few of these school districts are using telepractice during the summer. I then turned to my private practice colleagues who also turned me down, even if they had telepractice clients during the summer. The primary reason given was that they could not justify a client paying the full hourly rate for services if a student was providing the services-even though the supervising SLP would be observing the graduate student sessions and coaching them 100% of the time.

For full-time telepractice practicum experience we are  looking to contract with local districts-if we can get through to the special education directors! In my research on working with public schools, it seems to help if you know someone who can, at the very least, introduce you to the Special Education Director, or other administrator.

If any of you reading this, have any ideas about how to obtain a few clients, or have a contact with a school district in Florida that might be looking for SLP services, please let me know!

While this new adventure has been challenging, it has given me much insight into the workings of universities.  I can now say that I have worked in all the SLP settings on my bucket list!

 

A few months ago I was at a conference where I was often asked what it takes to be a good telepractitioner. While there are no studies available for SLPs regarding personal characteristics,  I do believe, from my experience, that there are a few traits that are important in becoming a quality telepractitioner. If you do not possess these attributes, you can work to improve them with your face-to-face clients before you jump into telepractice.

• Comfort with technology (computers, web browsers, basic trouble-shooting)
  • You don’t need to be an expert with technology, but must be comfortable enough with it so sessions run smoothly.
• Organized
  • It is essential to prepare for sessions prior to starting each day/session because it is not as easy to grab a new activity if what you are working on is not engaging for the student.
• Animated and Engaging
  • You must be able to engage your  client and keep their attention. This is a bit easier when working with older students and adults, but not so easy with younger clients.
• Great communication skills
  • Most clinicians are great communicators. It is imperative that clinicians, at least initially, over-communicate with on-site personnel or families.
• Flexibility
  • When things don’t work well, it is important that you are flexible and roll with the punches. Always remain calm and have a sense of humor when technology doesn’t work.
• Problem-solver
  • As they say, “stuff happens”. The ability to think on your feet, figure out the problem and solve it quickly will definitely come in handy when working in a telepractice session.

Working on these skills will assist in providing high quality telepractice services for your clients.  These are all traits that can be improved if you work at it.  Good luck with your telepractice endeavors!  It is an exciting way to provide speech and language services to children (or adults) who might not otherwise receive services due to lack of providers, or difficulty getting to/from clinics and other sites.

 

As telepractice continues to grow, more children are being  served via telepractice, particularly in schools. It is important that parents are informed prior to starting these services as they have a right (according to federal law) to know that there will be a change in the manner in which their child will receive speech and language services. For many of these families, this may be their first exposure to telepractice services and don’t know what to ask.  Below are a list of questions that they should ask. These questions may also be utilized by schools districts who are contemplating using telepractice to provide speech and language services to their students.

1. Are the SLPs licensed in the state where the students receive services, AND, are they licensed in the state where they are providing services from?
   
   1.  Do the SLPs have their CCC (certificate of clinical competence) from ASHA?
      
   2.  Do they have the appropriate teaching credential from the Department of Education in my state?
      
2. Did the SLP receive any training?
   
   1. Was the training focused on how to use the platform?
      
   2. Was there any training on best practices in telepractice?
      
   3. How many hours did they practice before providing services to my child?
      
3. Does the clinician have at least two full years of experience working in public schools?
   
   1. How secure is the video-conferencing platform being used?
   2.  What happens if someone hacks into my child’s speech and language session?
   3.  Will I be informed if there is a breach?
      
   4.  How quickly will I be informed?
      
4. How do I contact the SLP?
   
5. Who can I contact if there is a problem with my child’s SLP that we cannot solve together?
   
6. May I observe my child remotely?
   
7. How are IEPs handled when the SLP is not local?
   
8. How do I know my child is actually being seen by the remote clinician?
   
9. How  was it determined by  child would be appropriate for telepractice services and by whom was this determined?
   

There are many more questions that parents (or schools) can ask, but these are the essential and important ones that need to be asked first.

Telepractice services are great and can be engaging when provided by the right telepractice clinician. The SLP should have had training in providing services via this model, they should have knowledge about best practices and  be up-to-date on laws and regulations surrounding the provision of these services.  Just as you would vet an in-person clinician, you should ensure that you are comfortable with a remote clinician as well!

Many years ago, as a new clinician starting my first job as a school clinician,over and over, I heard that we needed to be careful with change when working with students. Whether it was changing schedules or therapy approaches, the mantra was that too much change would cause stress for our students. For two years I believed this! I was cautious about any changes I recommended for my students or any changes I made to their therapy routine. Eventually I discovered something very interesting-it wasn’t the students who couldn’t handle change, it was the adults!

How many of you have discovered this? The longer I worked the clearer it became as I observed my students in and out of the classroom, through many changes including disruptions to their schedules such as surprise fire/ earthquake drills, substitute teachers, and all the other changes a school setting can offer. Through all of this, amazingly, the students were just fine. It was the adults (teachers, administrators, specialists, parents, etc) who could not handle the change. More often than not, the students’ took it in stride, not blinking an eye, or batting an eyelash-they just moved on as long as the adults did not show their displeasure or discomfort with the change!

Another part of change is fear of the unknown. Most adults like their routine and are very comfortable chugging along in the same routine day after day. Not changing becomes very comfortable and we can avoid facing our fear of change. While this may sound good, we can become stagnant if we never change.

Watch children play on the school playground, at the park or in your neighborhood They are fearless! Watch them swing from the bars, jump from a tall rock, or leap over a log. It is amazing! Kids are fearless when they are young which is why they do not have difficulty with change. They have not yet learned fear. Somewhere along the line, as we near adulthood, we may begin to develop fears. As adults we can’t believe that we participated in some of those childhood activities; yet we often watch with envy! As an example, when I was around 13 or 14, I took a friend with me to visit my aunt in San Francisco. She lived in an apartment building in an area with many other buildings that were 6 to 10 stories tall. We had a great time, going up on the roof of my aunt’s building, and jumping (yes, jumping!) from one building roof to the next. Now if you know San Francisco, you know that the buildings are close together-maybe 12 to 18 inches apart. However, as I think back on this childhood activity, I cringe thinking about what could happen! As an adult, I certainly have developed some fears.

These fears can translate into fear of change and fear of new things which can stagnate our careers and our lives. I, for one, learned to embrace change as my career unfolded. Initially, I was complacent, and did not want to change, as I was comfortable. Eventually, I became bored and wanted something new. This is when I began to embrace change which has allowed me to explore the many options that are opened to speech-language pathologists.

My first glimpse of embracing change came after almost four years of working in public schools. While I had (and still have) the utmost respect for colleagues in the schools, I began to feel antsy and wanted to try something different. This meant a huge change for me in terms of my worksite, skills and comfort level. I decided to switch to working with adults. SLPs know that switching from the schools to adult rehab(or the other way around) is a big jump and it required honing skills that I had not used for about four years. However, I was ready for a change and excited to be in a different setting. I did my homework to be prepare myself and went in search of a new work setting. It was scary and uncomfortable, but I knew I was ready.

To make a long story short, I left the schools and lasted all of 6 months in a rehab setting working with adults! However, I appreciated the colleague that hired me, supported me and understood when I knew that I wanted to go back to working with children.

During these six months, I discovered much about myself, including the fact that I loved working with children, but didn’t feel the schools were the right setting for me. Once again I began some research and decided to open a private practice serving children. This was a fantastic setting for me as I was able to add to my skills by obtaining continuing education in new areas in which I could offer services to children. I did that for 20+ years and was quite happy as I could change or add to my areas of expertise, which kept me fresh and excited for many year.

After many years in private practice, I was presented with an opportunity to work with a start-up providing telepractice to children in the schools. This opportunity came at a good time for me as I was wanting another change. So, off I went to this new company. Again, I embraced change (after doing my due diligence on telepractice). It was exhilarating to work in an up-and-coming company and interesting to be at the forefront of a new service delivery model.

I can’t tell you how much negative feedback I received from colleagues ( and friends) asking why I would go into something that is not proven. There were so many people talking about how it would change our profession negatively. Once I was able to explain what I was doing, and why, and t discuss the research, I calmed their fears and even turned some of them around to so they now embrace telepractice! It was an exciting ride.

Just recently, I made the switch back to consulting after an unexpected change. This time, it was a bit more difficult for me to embrace the change, but with the help of good friends, who assured me I had the skills and abilities to make another change to my career, I once again embraced this unexpected change and now welcomed it as it is allowing me to do some things on my career bucket list!

The best way to approach change, if you have some fears, is to do your research. Get as much information as you can that will assist in making sound decisions. You have to become a bit of a daredevil again (like you were as a child), but you can do it with a bit more thought this time around! Know the downside, but be willing to take some calculated risks. Taking a risk, doesn’t necessarily mean getting on a hoverboard for the first time and going as fast as you can before you really know how to control the hoverboard or understand the safety features. Do what you can handle, even if it means taking baby steps!

If you are presented with change within your work setting or outside, whether it is by choice, or it is forced on you, take it one step at a time, or jump in with both feet. Do what is comfortable for you. You will be amazed at what you learn and how good it feels to tread into unknown waters, one step at a time. Change can be refreshing, rejuvenating and exhilarating. It can also be scary if you are not prepared.

Prepare yourself for change by doing your homework, talking with colleagues, reading and networking. Find someone who you can talk with and share thoughts about how to embrace the changes. Going in with a positive outlook can make all the difference in the world on how you handle changes, big or small.

Next time: Will telepractice really change the way speech-language pathology is practiced?