What is Telepractice?

What is Telepractice?

In ASHA's recent position statements, telepractice is defined as "the application of telecommunications technology to delivery of professional services at a distance by linking clinician to client, or clinician to clinician, for assessment, intervention, and/or consultation."

ASHA's position is that "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 sub-specialists, and impaired mobility."

Telepractice offers "the potential to extend clinical services to remote, rural, and undeserved populations, and to culturally and linguistically diverse populations."


How Telepractice Is Being Used...

...By Audiologists:

* Infant hearing screening
* Hearing screening
* Hearing aid programming and counseling
* Auditory brain-stem response (ABR)
* Otoacoustic emissions (OAEs)
* Audiologic rehabilitation

...By Speech-Language Pathologists:

* To provide speech and language services to schools in remote or undeserved areas
* To provide voice, aphasia, or cognitive-communication treatment to satellite clinics from hospitals
* In clients' homes as an adjunct to home health visits
* For specialized services such as laryngectomy rehabilitation and augmentative and alternative communication


Client Selection for Telepractice

To select clients who are appropriate for assessment/intervention services via telepractice.

Knowledge and skills:

3.a. Understand the potential impact of physical and sensory characteristics on the client's ability to benefit from telepractice, and provide modifications or accommodations (as appropriate) for factors such as:

• hearing ability,
• visual ability (e.g., ability to see material on a computer monitor),
• manual dexterity (e.g., ability to operate a keyboard if needed), and
• physical endurance (e.g., sitting tolerance).
  

3.b. Understand the potential impact of cognitive, behavioral, and/or motivational characteristics on the client's ability to benefit from telepractice, and provide modifications or accommodations (as appropriate) for factors such as:

• level of cognitive functioning,
• ability to maintain attention (e.g., to a video monitor),
• ability to sit in front of a camera and minimize extraneous movements to avoid compromising the image resolution, and
• willingness of the client and family/caregiver (as appropriate) to receive services via telepractice.
  

3.c. Understand the potential impact of communication characteristics on the client's ability to benefit from telepractice, and provide modifications or accommodations (as appropriate) for factors such as:

• auditory comprehension,literacy,
• speech intelligibility, and
• cultural/linguistic variables (e.g., availability of an interpreter).
  

3.d. Understand the potential impact of the client's support resources on his or her ability to benefit from telepractice, and provide modifications or accommodations (as appropriate) for factors such as:

• availability of technology,
• access to and availability of resources (e.g., telecommunications network, facilitator),
• appropriate environment for telepractice (e.g., quiet room with minimal distractions), and
• client's and/or family/caregiver's ability to follow directions to operate and troubleshoot telepractice technology and transmission.
  

Selection of Assessments and Interventions

To use technology to deliver appropriate assessments and interventions.

Knowledge:

4.a. Knowledge of the potential benefit of providing assessment/intervention in the patient's natural environment

4.b. Knowledge of the appropriateness of commercially available computerized clinical tools

4.c. Awareness of the potential impact on standardized tests, diagnostic procedures, and intervention strategies when administered via telepractice

Skills:

4.1. Selection and administration of formal and informal diagnostic tools at a distance

4.2. Identify supplemental tools/technology (e.g., fax machines, telephones) for clients to receive optimal services at a distance


Cultural/Linguistic Variables

To be sensitive to cultural and linguistic variables that affect the identification, assessment, treatment, and management of communication disorders/differences in individuals.

Knowledge and skills :

5.a. The influence of one's own beliefs and biases in providing effective services


5.b. The need to respect an individual's race, ethnic background, lifestyle, physical/mental ability, religious beliefs/practices, and heritage


5.c The influence of the client's traditions, customs, values, and beliefs related to providing effective services via telepractice


5.d. The impact of assimilation and/or acculturation processes on the identification, assessment, treatment, and management of communication disorders/differences when delivered via telepractice


5.e. The clinician's own limitations in education/training in providing services to a client from a particular cultural and/or linguistic community


5.f. Appropriate intervention and assessment strategies and materials, such as food, objects, and/or activities that do not violate the client's values


5.g. The need to refer to or consult with other service providers with appropriate cultural and linguistic proficiency, including a cultural informant/broker, as it pertains to a specific client


5.g. Ethical responsibilities of the clinician concerning the provision of culturally and linguistically appropriate services


Use of Support Personnel

To train and use support personnel appropriately when delivering services via telepractice.

Knowledge:

6.a. Guidelines for training, credentialing, use, and supervision of support personnel as described in the ASHA Code of Ethics (ASHA, 2003) and ASHA practice policy documents (ASHA, 1996)


6.b. State regulations regarding credentialing and supervision of support personnel


6.c. Information needed by support personnel about the technology and delivery of services via telepractice

Skills:

6.a. Selecting clients, clinical activity, and technology that are appropriate for support personnel during telepractice service delivery


6.b. Providing appropriate training to support personnel in the delivery of services via telepractice (e.g., patient and family/caregiver instruction, equipment check and maintenance, clinical task performance, record keeping, universal precautions)

• appropriate training for privacy and electronic data interchange consistent with state and federal regulations

6.c. Providing appropriate supervision to support personnel (e.g., developing an effective relationship, providing feedback, and modeling appropriate communication and ethical professional conduct)