#70 Telepractice Tips 'n Info (Part 3) [Parents: Is Online Therapy Effective?]

Greetings SLP! 

Maybe you read this.  Recently, on Facebook, an SLP wrote about an offhanded comment made by a parent during her teletherapy.  The parent said to the SLP, “The real speech therapist is coming in a few minutes.”  Huh???  If I were that SLP, my initial response would have been devastation. 

Typically, I’m not good on the uptake, but I hope I would have at least asked the parent what she meant.  Most likely, however, I would have just sat there in wide-eyed shock then seethed offline. 

We could all speculate as to the parent’s intention, so here are a few of my conjectures.  Maybe the parent’s use of the word real was in reference to physical in-person therapy sessions as opposed to online therapy sessions.  Or, maybe the parent believes that teletherapy is not as effective as in-person therapy, or at best, questions it.  Or, maybe the parent’s remark does reflect her view as to the type of therapy administered by the SLP and the level of progress made by the child.  Who knows?  Maybe it’s none of the above, maybe it’s all three.  Maybe she was kidding.  Only the parent knows.  And even if asked, she may not have verbalized the real reason. 

Bottomline:  She said it. 

This highlights the fact that we SLPs must communicate—frequently and effectively—with our therapy-parents.  Especially during telepractice times.  

If parents/caregivers are at home and accessible during your teletherapy, this is your golden opportunity to speak with them.  If you happen to work in the schools in-person therapy does not afford the chance to directly speak with parents but online therapy does.  Take advantage of it.  

Thing is, I know time is limited.  I know there’s tons of variables in doing this, e.g., your time, the parent’s time, the parent’s willing to participate, and of course, what to say.  As far as time, I would recommend aiming for no fewer than 3 parent-minutes each session.  The amount of time is not as important as the quality of what is said.  Plant productive seeds over time. 

I put myself in the place of a parent with a child in speech-language teletherapy and came up with these three questions:

1. Is online speech therapy effective? As effective as in-person therapy?  Or are we just spinning our wheels?
2. Is the SLP and my child really working or just playing games? It’s sure different from what the classroom teacher is doing online.
3. Is the SLP responsible for everything or is there is something I can do to help my child?

No doubt there are other questions, but I’ll offer my two cents for each of the above over the next few weeks.  Today focuses on parent question #1:  Is online speech therapy effective?  As effective as in-person therapy?  Or are we just spinning our wheels?

Suggestions

Admit to the parent, “You know, when I first started doing telepractice, I wondered if it was going to be as effective and helpful as doing therapy in-person.”  Then pause; it’s their time to chime in and express any concerns they have.

If this opening salvo takes your three minutes, wrap up, and say something to the effect: “I hear you, and as a therapist that’s done teletherapy, I have good news for you.  I’ve experienced good success with other children, and I’ve delved into this topic and read some amazing studies.  I’ll tell you about it next time.”  Leave it at that; you’ve opened the door.  When appropriate, follow through.  Open the topic again and share a quick example of your therapy results and a brief account of a study or two. 

Following is some info on recent studies you might want to mention to your therapy-parents.  It’s interesting to note that online services research started back in the 1990s. 

Overall, the research results of telepractice within the speech-language pathology field have been positive.

• An exceptional telepractice case study (Malandraki, et al., 2014) revealed improvement within four intensive weeks by a 6-year-old child with complex issues, including pediatric oropharyngeal dysphagia, Opitz BBB/G and Asperger’s Syndromes, and aerophagia. The study implies that motivated parental involvement and follow-through during treatment was the key to success.  “The patient demonstrated substantial improvements in swallowing variables and quality of life.  Follow-up interview analysis showed that most skills were retained or improved one-month post intervention.”

• In a systematic review (Wales, et al., 2017), the author’s findings suggest promising evidence to support teletherapy for delivering speech-language intervention services to school-age children. They concluded, “Both telehealth and in-person participants made significant and similar improvements when treatment effects were measured through five of the six outcome measures.”

• In a comparison study of 1,331 ASHA NOMS cases and 428 telepractice cases, they suggest that the treatment outcomes for the children exhibiting speech sound disorders were comparable. “The findings provided support for the use of telepractice for school-age children.”  (Coufal, et al., 2018.)

• Another interesting study of utilizing telepractice with young children (Behl, et al., 2017), concluded, “This study supports the effectiveness of telepractice in delivering early intervention services to families of children who are deaf or hard of hearing.”

This last study is presented in greater detail for you. 

Grogan-Johnson et al. (2011) conducted a study in a rural Ohio school district comparing in-person and telepractice therapy results of school children with speech sound disorders.  Their results indicated that the students in both service delivery models made significant improvements in speech sound production.  (At that time “side-by-side” was used for “in-person” and “telehealth” for “telepractice.”  The more current terms are used.)

The study took place during the 2008-2009 school year, and compared to current standards, the technology and tools for online therapy were new.  In addition, I like the fact that they did not pull the SLPs or the kids into a lab setting; they remained at school.  Here are some of the details:

• 13 children received services: 7 in the telepractice group, 6 in the in-person group. 
• They ranged from K to 6th grade; ages 6 years to 11 years.
• The children received individualized speech remediation services for the school year; the average session length was 20 minutes.
• Each telepractice child had an ehelper. That person and received a 1-hour training session on the equipment, trouble-shooting issues, responsibilities, and guidelines for maintaining confidentiality.  They were asked not to cue the child or contribute to the intervention process.
• A pre and post Goldman-Fristoe Test of Articulation-2 (2002) was administered at the beginning of the school year, and at the end.

Treatment:  One SLP worked with the in-person kids and another with the teletherapy kids.  They implemented a traditional therapy approach, including auditory discrimination tasks, sound production training, stabilization, and carryover.  

The traditional approach was used for both in-person and teletherapy kids via the TinyEYE Speech Therapy Software (Sutton & Brick, 2005).  The platform contained drill activities, games, and visual reinforcement activities, etc.  

The authors concluded: “Students in both service delivery models made significant improvements in speech sound productions, with students in the telehealth condition demonstrating greater mastery of their Individual Education Plan (IEP) goals.  Live interactive videoconferencing thus appears to be a viable method for delivering intervention for speech sound disorders to children in a rural, public school setting.” 

Interesting, huh?

Next week, a few suggestions for question #2: “Is the SLP and my child really working or just playing games?  It’s sure different from what the classroom teacher is doing online.” 

If you wouldn’t mind sharing, I’d love to hear how it goes with your therapy-parents.

Thank youfor all you do for your therapy kids.  Hang in there. 

Much admiration,

Char

References

Behl, D.D., Cook, G., Callow-Heusser, C., Moog Brooks, B., Dawson, P, Quigley, S., White, K.R.  (2017).  A multisite study evaluating the benefits of early intervention via telepractice.  Infants& Young Children, Vol. 30 (2),147-161.

Coufal, K., Parham, D., Jakubowitz, M., Howell, C., Reyes, J.  (2018).  Comparing traditional service delivery and telepractice for speech sound production using a functional outcome measure.  American Journal of Speech-Language Pathology, Vol. 27,82-90. 

Goldman, R. & Fristoe, M. (2002). The Goldman-Fristoe Test of Articulation-2. Minneapolis, MN: American Guidance Service Inc. 

Grogan-Johnson, S., Gabel, R.M., Taylor, J., Rowan, L.E., Alvares, R., Schenker.  (2011).  A pilot exploration of speech sound disorder intervention delivered by telehealth to school-age children.  Telemedicine Telecare, Vol. 3 (1),31-42. 

Malandraki, G.A., Roth, M., Sheppard, J.J.  (2014).  Telepractice for pediatric dysphagia:  A case study.  International Journal of Telerehabilitation, Vol. 6 (1),3-16. 

Wales, D., Skinner, L, Hayman, M.  (2017).  The efficacy of telehealth-delivered speech and language intervention for primary school-age children:  A systematic review.  International Journal of Telerehabilitation, Vol 9 (1),55-65.