Telepractice Service Delivery Research Articles

Across Time and Place: A Focused Review of Telepractice in ASHA Journals

With advances in technology and the COVID-19 Public Health Emergency (2020–2023), telepractice has become a prominent service delivery model. This study explores the evolution of telepractice service delivery research published by the American Speech-Language-Hearing Association (ASHA) and the impact of the COVID-19 Public Health Emergency on ASHA publications through searches of the ASHAWire database using “telepractice OR telehealth OR virtual OR teletherapy” in February 2021, 2022, 2023 and April 2023. In February 2023, 1,683 records were identified and hand searched for relevance to the evolution of telepractice. In April 2023, 471 records published from 2020 to 2023 were systematically screened for relevance to reveal 148 articles that met inclusion criteria. ASHAWire is a reputable resource for articles on telepractice service delivery, especially after the COVID-19 Public Health Emergency. It is important, however, for researchers and clinicians to carefully examine methodology of studies as the use of technology may conflate search results.

A qualitative study assessing allied health provider perceptions of telepractice functionality in therapy delivery for people with disability.

Telepractice service delivery of allied health interventions to people with disability can potentially reduce access barriers and improve service equity. However, questions remain regarding telepractice functionality for people with disability. This study addressed questions related to how allied health clinicians and managers perceive telepractice as functioning in the provision of therapy services to people with disability. Thirteen interviews of allied health clinicians and managers from across Australia were conducted between 21 November and 22 February via MS teams. Qualitative methodology and critical realist theoretical paradigm underpin the study. Data analysis was completed using a reflective thematic analysis method and five themes were generated and described utilising an analytic metaphor. The study themes were described in relation to a shopping for shoes analytic metaphor and the five themes included (1) a shoe for every foot, (2) planned purchases, (3) shoe on the other foot, (4) you need both shoes and (5) help choosing their shoes. In summary, the function of telepractice fits differently for each individual, similar to pairs of shoes. Telepractice has its own strengths and weaknesses and isn't a direct substitute for in-person sessions, much like left and right shoes are similar but not the same. The results support participant perceptions that telepractice functions best as an adjunct to in-person sessions through a flexible hybrid delivery model in the provision of therapy services to people with a disability. A strategy for improving perceived usefulness may involve positioning telepractice as unique with strengths and weaknesses, not replacing in-person care. The paper forms part of a larger codesign process which included customer and carer participants throughout the design and planning of the project, inclusion of a peer researcher, and the selection of the analytic metaphor including in the findings of this article production.

Consensus on telepractice service delivery practices with vulnerable families: a Delphi study

ABSTRACT Objective: In recent years family services have been required to rapidly employ telehealth without access to a reliable and contemporary evidence-base for implementation. This study explores expert views on systems and practices that facilitate telehealth in the delivery of family support services to vulnerable families. Method: Using the Delphi survey method, an inventory comprising 124 telepractices was presented to an initial panel of telepractice researchers and practitioners (N = 23) for ratings across three survey rounds. The panel was asked to provide feedback and suggestions for further inclusions, leading to an additional 29 items. Results: Results indicate 119 telepractice strategies were endorsed as essential and/or feasible for family services. These strategies were spread across five domains including practices prior to service delivery, practices during telepractice, practices when working with group programs, practices when working with culturally and linguistically diverse communities, and support for practitioners. Discussion: Practices that facilitate organisational support for practitioners, flexible service modality, and equitable access and privacy attracted the strongest endorsement. The findings support a hybrid model of service delivery in family services.

A comparative study of perspectives on telepractice service delivery among Egyptian and U.S. Speech and Language Pathologists

ABSTRACT Scope: Although the discipline of Speech-Language Pathology (SLP) was established in Egypt over 50 years ago, telepractice is a new concept in Egypt. However, following the COVID-19 pandemic providers adapted to an online therapy format. Materials & methods: The current study used a retrospective pretest–posttest design to identify differences in barriers facing SLPs practicing in the USA (N = 38) and Egypt (N = 41) using telepractice. The online questionnaire assessed the domains of technical barriers, the applicability of various types of therapy, caseload characteristics’ barriers, caregivers’ challenges, and the therapists’ input. Results: Therapists in both countries had concerns pre-telepractice regarding the availability of materials for online sessions, time spent for online session preparation, guaranteed confidentiality, and protection of client personal details in teletherapy. Most US therapists held a positive attitude towards the adaptability of various types of therapy for online sessions and the applicability of online sessions for new cases, toddlers & infants, preschoolers, adults & group sessions. On the other hand, Egyptian therapists expressed concerns regarding technical barriers such as lower frequency of sessions and internet connectivity problems while also experiencing more issues related to caseload characteristics. Conclusion: This study offers preliminary data on telehealth experiences in USA and Egypt that may direct future research into ways to increase service delivery and access.

Viewpoint Telepractice 2025: Exploring Telepractice Service Delivery During COVID-19 and Beyond

Purpose: The purpose of this article is to outline the challenges and opportunities faced by speech-language pathologists (SLPs) providing telepractice services as the profession approaches the 100th anniversary of the American Speech-Language-Hearing Association in 2025. As this anniversary approaches, SLPs nationwide will reflect on the profession's past, present, and future. Undoubtedly, issues concerning the COVID-19 pandemic and the use of telepractice technology during this time will be analyzed. This article will outline several challenges for the profession and clinicians to consider for the longevity of telepractice service delivery, including (a) consensus on eHelper/facilitator terminology, (b) designating a telepractice service delivery model, (c) exploring telepractice occupational culture, and (d) pursuing future directions (e.g., ethnographic applications and cultural-linguistic diversity). Conclusions: Although telepractice service delivery has existed for less than a century, there is evidence of rapid progress. Meeting the challenges ahead for SLPs using telepractice may have a lasting impact on clinical implications in the field of speech-language pathology in 2025 and beyond the COVID-19 pandemic.

Telepractice in Speech-Language Therapy During COVID-19 Pandemic

Objectives: The purpose of this paper is to review the recent literature and reflect on the studies conducted to investigate the efficacy of tele practice in speech-language therapy. This paper focuses more on the recent literature and the studies conducted during the coronavirus COVID-19 pandemic.
 Methodology: A review of the recent literature from 2012 to 2021 was studied on providing speech-language therapy intervention through tele practice. Key literature search sources included the Sci-hub, PubMed, HINARI (Health Inter Network Access to Research Initiative), and Google Scholar databases.
 Findings: The review of the literature provides evidence that telepractice delivery model for speech and language therapy services is an effective and useful way to cater to the needs of the patients. However, this paper also provides us with an insight that the hybrid model which is the combination of one-on-one and telepractice therapy session may be more effective and holistic way to provide therapy. There is a vital need for more investigative studies on the topic of telepractice. 
 Unique Contribution to theory, practice, and policy: Speech and language therapist may opt for a hybrid therapeutic approach to achieve more functional outcomes. There is a need for in-depth and comprehensive investigative studies to fully understand the effectiveness of telepractice service delivery model when this model is utilized for variety of different speech and language disorder. Moreover, policies at professional institutes need to ensure that therapists undergo trainings on telepractice techniques and functionality to provide holistic treatment to patients and support care givers.

Outpatient speech and language therapy via videoconferencing in Germany during the COVID-19 pandemic: Experiences of therapists / Videotherapie in der ambulanten Logopädie/Sprachtherapie in Deutschland während der COVID-19 Pandemie: Erfahrungen von Therapeut/innen

Abstract During the COVID-19 pandemic, videoconferencing as a synchronous form of telepractice service delivery models received a boost. In Germany, online-only sessions are not a standardised means of healthcare provision, while telepractice is already well established internationally. This study examines videoconferencing in outpatient speech and language therapy during the first period of the COVID-19 pandemic in Germany. The experiences of therapists are reported in this study. For this quantitative study, data were collected by an online survey. Speech and language therapists in Germany were surveyed (n = 816). Data were analysed using descriptive statistics. The results demonstrated that 87% of participants used videoconferencing in the early days of the COVID-19 pandemic. Videoconferencing was conducted with patients of different ages and disorder indications. In their use of videoconferencing, 78% of therapists described benefits. The mentioned benefits and limitations are similar to international findings, showing the potential for synchronous speech and language therapy via videoconferencing. German therapists display a general acceptance of the sustainable use of videoconferencing, and the majority of therapists can imagine transferring videoconferencing to standard healthcare.

The Effects of Virtual Caregiver Coaching in Antigua & Barbuda on the Implementation of EMT Language Support Strategies in Naturalistic Environments.

This single-case multiple baseline design investigation set out to determine the effectiveness of using a telepractice service delivery model to coach caregivers in Antigua & Barbuda in the use of Enhanced Milieu Teaching (EMT) language support strategies with a child with language impairment. A slightly modified version of the Teach-Model-Coach-Review (TMCR) method was used during virtual instruction to train a caregiver on the language support strategies of environmental arrangement, matched turns, expansions, and time delay with milieu prompting. The caregiver attended sessions three times a week for up to 45 minutes for four weeks. The results of this study indicated a positive relationship between the intervention and caregiver use of strategies. The caregiver demonstrated increased responsiveness to the child's communication attempts and exhibited the use of language support strategies across activities. This study suggests that telepractice can be an effective service delivery model for providing coaching to caregivers.

Student Clinicians' Views of Telepractice and In-Person Service Delivery

Purpose: The purpose of this study was to compare graduate student clinicians' self-reported perceptions of in-person versus telepractice service delivery based on preparation/training, treatment process, client and clinician engagement, data collection, and client progress. Method: This study used mixed methodology to answer three research questions: (a) What are the differences between students clinicians' perceptions pre– and post–in-person and telepractice service delivery, (b) What are the differences between student clinicians' views of in-person and telepractice service delivery, and (c) How do changes in the pre- and post-surveys represent the student clinicians' views of in-person versus telepractice service delivery? Graduate students completed pre- and post-surveys and participated in focus groups following 16 weeks of telepractice or in-person service delivery. Results: Overall, findings revealed more similarities than differences between telepractice and in-person service delivery based on students' self-report before and after treatment. Similarities included preparation methods, use of evidence-based practice, amount of family involvement, and client progress. Differences included amount of time to prepare for the session, establishing rapport, and collecting data. In the end, participants' self-efficacy and implementation readiness increased for both service delivery models. Conclusion: Findings from this study provide a foundation for graduate training by relating telepractice to in-person service delivery models. Supplemental Material: https://doi.org/10.23641/asha.21498636

Recent Advances of Telepractice for Autism Spectrum Disorders in Speech and Language Pathology.

Telepractice or teletherapy is defined as the means of service delivery via technology-based platforms that allow long-distance interventions across populations, age spans, and geographical locations. Specifically, telepractice capitalizes on communication technologies such as online modules, videoconferencing, and computerized software programs, in servicing populations with communication challenges. Notably, telepractice has emerged as a potentially effective, low-cost, and promising means of conducting and completing online assessment, diagnosis, and intervention sessions for individuals with autism spectrum disorders (ASD). Moreover, telepractice allows the inclusion of parents, caregivers, and educators as potential facilitators in supporting treatment delivery in populations with ASD. This thematic review article aims to highlight and acquaint practitioners and other stakeholders with relatively recent information regarding the advantages and disadvantages of the telepractice service delivery model in ASD. Furthermore, the emergence of the COVID-19 pandemic has impacted service delivery in the field of Health Sciences including speech and language pathology (SLP). Consequently, the need to avoid face-to-face therapy sessions, recommended to SLPs as to all health practitioners, resulted in the call for adaptation and adjustment of service telepractice. This paper attempts to answer this call by suggesting supplementing traditional diagnostic and therapy resources with training modules consisting of online materials and use of animated and specially designed programs in SLP intervention with individuals with ASD. Lastly, the paper includes a discussion of research findings in the field, a conclusion, and a take-home message.

Telepractice Evaluations With Children Who Are Deaf/Hard of Hearing: A Clinical Approach for Early Intervention Speech-Language Pathologists

Purpose: With the onset of the coronavirus disease 2019 (COVID-19) pandemic, speech-language pathologists (SLPs) who specialize in working with children who are deaf/hard of hearing continued to provide diagnostic services to the birth-to-3 population. Families' needs for this type of service did not stop while “safer at home” orders were in place. In March 2020, the nation was shut down, and in-person services came to a screeching halt. The purpose of this clinical focus article is to outline the procedures adapted by our clinical team, which allowed our SLPs to continue to meet the needs of families when in-person services were not available. The value in these adaptations was meaningful and continues to aid our ability to better serve families who may not be candidates to physically attend clinical appointments. The COVID-19 pandemic challenged clinicians to adapt initial evaluation services and led to many questions that needed to be answered to continue serving children with a newly diagnosed hearing loss. Several strategies for providing services to families during the early intervention years via telepractice will be discussed. The clinical approach to decision making and methods utilized by our providers and graduate student clinicians, including the virtual meeting platform, correspondence and preparation with the family, assessment protocols, clinical recommendations, and parent guidance/counseling resources, will be outlined. Conclusions: The success observed using this clinical approach to initial evaluations and telepractice is notable. This clinical note is an effort to distribute the process to other SLPs and is considered necessary. The successful adaptations implemented have allowed clinic provision for our birth-to-3 population to thrive. Despite several identified barriers, telepractice will continue to evolve and be a vital service delivery model in the future. This article describes the overall processes implemented for SLP diagnostics using the telepractice service delivery model.

Entering the Digital Therapy Room

School-based speech–language pathologists (SLPs) have been plunged into telepractice service delivery with the ongoing COVID-19 pandemic. However, this temporary shift to provide online instruction is not the same as fully implementing a telepractice service delivery model that is comparable with in-person service delivery. The purpose of this article is to provide the practicing SLP with a framework for delivering effective intervention services to school-age students with language impairments via telepractice. Within this framework, the SLP still must consider the available evidence base for an intervention and implement its core components, including repeated opportunities for skill and knowledge acquisition with sufficient intensity, systematic scaffolding, and an explicit focus (Ukrainetz, 2006a). Particular attention must be given to aspects of intervention planning, manipulation of the therapy context, collaboration with relevant stakeholders, specific intervention materials, and prompting because these are among the most likely to differ between the telepractice and in-person service delivery. We discuss these aspects and provide examples.

Pediatric Language Assessment and Intervention Using a Telepractice Service Delivery Model

Pediatric Language Assessment and Intervention Using a Telepractice Service Delivery Model

School-Based Telepractice Assessment (STA)

Over 50% of American Speech-Language-Hearing Association (ASHA)-certified speech–language pathologists (SLPs) are employed in schools (ASHA, n.d.). Speech–language pathologists increasingly provide services to students with speech and language disorders via telepractice. ASHA's Roles and Responsibilities of Speech-Language Pathologists in Schools document states that telepractice services must be comparable to in-person services (ASHA, 2010). This article presents the School-Based Telepractice Assessment (STA; Lundblom et al., 2021), comprising aspirational questions related to compliance with federal legislation; personnel; roles and responsibilities of school-based SLPs; and privacy and security issues. The STA is designed for use by SLPs, school administrators, and contracted providers. The guide comprehensively evaluates the range of school-based telepractice components such as diagnostic and therapeutic services, the use of support personnel consultation, preventative services, integration with the school culture and curricula, and compliance with federal regulations. The STA can guide both school-based SLPs and administrators as they prepare for telepractice service delivery and later appraise whether the telepractice services are comparable to in-person school-based practice.

Pediatric Language Assessment and Intervention Using a Telepractice Service Delivery Model

Pediatric Language Assessment and Intervention Using a Telepractice Service Delivery Model

Feasibility of Assessing Expressive and Receptive Vocabulary via Telepractice for Early Elementary-Age Children With Language Impairment.

Due to the COVID-19 pandemic, millions of school-age children with language impairment (LI) and their speech-language pathologists (SLPs) relied on telepractice service delivery models. Unfortunately, the dearth of evidence and procedural guidance available to SLPs has made this transition challenging at best. The current study utilized a sample of 20 young children with LI to determine the feasibility of procedures necessary for conducting vocabulary assessments via telepractice platforms and the reliability of scoring participant responses using standardized assessments. Study findings resulted in numerous practical suggestions for SLPs working with young children with LI via telepractice. Results suggest that these adaptations result in strong interrater reliability for scoring participant responses in an online format. Study findings suggest that conducting telepractice assessments can be a useful and reliable tool for school-based SLPs, with implications reaching beyond the pandemic era.

A Survey of Speech-Language Pathology Graduate Students' Perceptions of Telepractice Pre- and Posttraining During the COVID-19 Pandemic

Purpose: Many university programs in speech-language pathology that offer clinical training as part of their graduate training transitioned to a telepractice service delivery model in response to the COVID-19 pandemic. The purpose of this study was to survey speech-language pathology graduate student clinicians on their knowledge of and comfortability with telepractice before and after participation in a telepractice training program. Method: Graduate students in a speech-language pathology distance program participated in a remote summer clinical internship that included a 5-week telepractice training. Pre- and posttraining surveys were completed by 27 graduate students. Results: Results of a Wilcoxon signed-ranks test indicated that posttest telepractice knowledge question scores were significantly greater than pretest telepractice knowledge question scores. Likewise, posttest telepractice comfort question scores were significantly greater than pretest telepractice comfort question scores. Conclusions: These findings support the need to integrate a telepractice component to clinical education for speech-language pathology programs at the graduate level. Offering a specifically designed and hands-on telepractice training to graduate students in speech-language pathology can be an effective pedagogical piece to university degree programs.

Conducting a Community Engagement Studio to Adapt Enhanced Milieu Teaching.

Barriers to implementing evidence-based practices occur at various levels. Stakeholder input is required to identify challenges specific to clinical practice settings, client populations, and service delivery approaches. The purpose of this project was to solicit feedback from stakeholders on the telepractice service delivery and implementation strategies proposed for a future study of enhanced milieu teaching (EMT) in rural counties. A Community Engagement Studio was conducted with 11 caregivers of children with language delays living in rural counties. Caregivers and the researchers discussed early intervention service delivery for children with language delays in rural Oregon and the proposed telepractice EMT procedures. Researchers gathered feedback on three intervention components: session frequency and schedule, implementation strategies to encourage caregivers' use of EMT, and performance feedback techniques to teach caregivers. Findings from the Community Engagement Studio led to four primary modifications to the telepractice EMT study protocol. The principal investigator increased available days and times for intervention sessions and added text-message reminders for parents. A survey was also added for caregivers to identify their preferences for additional implementation strategies (e.g., tip sheets, checklist, e-mailed session summaries) and graphic representations of performance feedback (e.g., bar graph, radial graph, mountain climber infographic). Community Engagement Studios are a promising method for increasing community engagement in clinical research and soliciting stakeholder feedback on evidence-based intervention adaptations. https://doi.org/10.23641/asha.17774819.

Telepractice Delivery of an Autism Communication Intervention Program to Parent Groups

BackgroundSocial communication is a core challenge for children with autism and research confirms that early intervention positively impacts developmental outcomes. Families often experience barriers when accessing early intervention such as service availability, cost, and geographical location. Telepractice intervention has been used effectively with individual families to help overcome service barriers and to assist service access. This research investigated an expanded telepractice approach involving delivery of a manualized communication intervention to groups of parents. The research evaluated parent and child communication outcomes following participation in a telepractice-delivered, Hanen More Than Words (HMTW) group program. MethodA single case experimental design involving a multiple-baseline-across-groups was implemented with 11 mother–child dyads. Quantitative analyses investigated both parent and child interactive communication behaviours during baseline, intervention, and post-intervention research phases. ResultsResults demonstrated improved parental responsiveness and increased child social communication behaviour following participation in the telepractice-delivered HMTW. Changes in parent and child communication behaviour were maintained during the post-intervention phase. ConclusionsThe results support the application of telepractice for delivering a group-based early intervention training program. Expanding telepractice service delivery from individual to group-based intervention has the potential to increase service choice for families and to mitigate service access barriers.

Providing Telepractice in Schools During a Pandemic: The Experiences and Perspectives of Speech-Language Pathologists

The main objective of this study was to gain insight into school-based speech-language pathologists' (SLPs') perspectives on and experiences with telepractice as a service delivery model at the onset of the COVID-19 global pandemic. A better understanding of the facilitating and challenging factors that belie telepractice-based services will guide the creation of training and resource development to further support remote speech-language services in schools. Four focus group sessions using a semistructured format were conducted with 22 school-based SLPs from 14 states in the United States. The focus groups provided an opportunity for SLPs to reflect on their telepractice experiences, including pros and cons, necessary knowledge and skills, factors impacting telepractice service delivery, and student and family participation. Inductive thematic analysis was used to describe the collective experiences and perspectives of the participants. Three themes regarding telepractice emerged: technology use, locus of control for decision making, and student and family engagement. Participants reported experiencing a range of successes and challenges when attempting to meet students' needs and identified gaps in resources and school capacity for telepractice. The findings revealed how school SLPs experienced telepractice service delivery during the remote learning portion of the 2019-2020 school year due to the onset of the COVID-19 pandemic. The study increases our understanding of factors that facilitated and challenged the effective delivery of speech-language services via telepractice. To assist SLPs in future telepractice efforts, implications for professional development and further research are provided.