Using Telepractice to Provide School Based Therapy Services in Rural Ohio

Sue Grogan-Johnson, Kent State Universitysgrogan1@kent.edu

Robin Alvares, Kent State Universityralvares@kent.edu

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

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 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 ??????

Thank you!

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