10/16/16

1

+

Connecting to Communicate: Serving Children with Hearing Loss & Their Families Through Telepractice

K. Todd Houston, PhD, CCC-SLP, LSLS Cert. AVTSchool of Speech-Language Pathology & Audiology

The University of Akron

+Disclaimers

Dr. Houston is currently the author or co-author/editor of three books published by Plural Publishing:

Telepractice In Speech-Language Pathology (2014)

Assessing Listening and Spoken Language In Children with Hearing Loss (2015) – with co-author/editor, Tamala S. Bradham, PhD, CCC-A

Telepractice In Audiology (2016) – with co-author/editor Emma Rushbrooke, MA, AuD

Dr. Houston does not receive any monetary compensation from any of the manufacturers/companies of the technology discussed during this presentation.

2

+Learning Objectives

At the end of this presentation, participants will be able to:

n Identify current distance technology that is impacting early intervention and the education of children with hearing loss;

nDiscuss the role of parent coaching in telepractice; and

nDefine the use of telepractice as a service delivery model for children with hearing loss and their families.

3 + Terminology4

+History of Telehealth

5 +Evolution Leading to Revolution

6

5 Mb of Storage Being Loaded: 1956

10/16/16

2

+Evolution?

7 +Adopting New Technology

8

+Healthcare Access of the future

According to the

American Medical Association,70% of doctors visits and

40% of ER visits

could be avoided through telemedicine.

Increasingly, speech-language pathologists, audiologists, and other educators are adopting

models of telehealth & telepractice to serve more children with speech, language, hearing, and/or

learning needs.

9 +Wearables, mHealth, & the Quantified Self

10

+mHealth: Quantified Selfn Handheld & wearable devices will allow us to have our own

personal “health” dashboard.

n Individuals with hearing loss will be able to monitor their hearing technology’s response to sound, spoken language, or their environment – in real time.

11 + mHealth = Community-Based Interventions

12

Using smartphones, tablets or laptops to connect in meaningful situations/contexts – just in time learning, contextual learning & coaching

10/16/16

3

+Smart Phones to Smart Houses

13

The Internet of Everything

The Internet of Things

+Smart Phones to Smart Houses

nCaregiver alerts, alarms

nVoice prompts

nSmart beds to monitor sleep cycles, other health related conditions

nVital sign monitoring

nAuditory access/background noise

nTelevisions with built-in Internet access & webcam ~ “Telepractice” ready

14

15 + Convergence of Technology, Healthcare, & Education

Technology: Smartphones,

Tablets, Notebooks

Broadband Internet

Lowering Costs:ACA, Market

Pressures

Social Media/Networks:

Connections

Increased Demand for Telehealth Any Service,

Any Place,Any Time

16

+An Audiologist’s Perspective

“Telehealth has taken many years to become an “overnight” sensation…and now we have…a convergence of telecommunications and health care finally becoming a reality.”

--David Fabry, PHD

17

+Defining Telepractice

18

10/16/16

4

+Defining Telepractice

nAmerican Speech-Language-Hearing Associationn The application of telecommunications technology at a

distance by linking a clinician to client or clinician to clinician for assessment, intervention, and/or consultation.

nTelepractice is an appropriate model of service delivery for the professions of Speech-Language Pathology & Audiology.

nThe quality of services delivered via telepracticemust be consistent with the quality of services delivered face-to-face.

19 +Telepractice

nTelepractice is the application of telecommunication technology for the delivery of services at a distance (ASHA, 2013).

nTelepractice has become more widely used and is an emerging area of service delivery in Speech-Language Pathology (…and Audiology!) (Theodoras, 2011).

20

+Telepractice & Speech-Language Pathology

n Around the world, SLPs are using telepractice to delivery direct and indirect services for the following areas of practice:n Assessmentsn Speech and language delaysn Articulation & phonological disordersn Voice & fluencyn Non-verbal/AACn Traumatic brain injuryn Aphasia/Stroken Auditory-Verbal Therapy/Parent Coachingn Adult Aural Rehabilitationn Supervision, mentoring, & consultation

21

Boisvert, M. (2014)

+Telepractice & Audiology

nPatient Counseling

nHearing Screenings

nAudiological Diagnostics

nHearing Aid Fittings

nCochlear Implant Mapping

nAdult Aural Rehabilitation

22

+

Telepractice is not a different service but rather a different method of service

delivery.

-- Janet Brown, 2010

23 + The Need for Telehealth/Telepractice

nClinician/specialist shortages

nMisdistribution of providers

nRural/urban underserved

nTravel time, cost & hardship

nDelayed treatment, intervention or rehabilitation

24

10/16/16

5

+ 25

…so what about audiologists and speech-language pathologists?

+Benefits of Telepractice

More Patients Served

Telepractice: Force

Multiplier

26

Boisvert, M. (2014)

+ Telehealth Benefits

n Reduces barriers to accessn Reduces travel, time constraintsn Reduces overall healthcare costsn Reduces delays in caren Improves quality of care, collaboration, &

coordination

More consistent therapy & intervention leads to improved speech, language, and learning outcomes for the children served.

27 +The Question for the Day

With the convergence of communication technology and healthcare, how will telepractice service delivery models impact the provision of audiological and speech-language intervention to children with hearing loss & their families?

28

+Technology & Service Delivery Models

29

+What is the Technology

Principal components

nEquipment (dedicated & software)

nConnectivity

Two Technology Approaches

nLive Interactiven Audio/Videon mHealth

nStore and Forwardn Audio/Videon mHealth

30

10/16/16

6

+Determining Technology & Equipment Needs

Goals & Clinical Population Setting & Delivery Model

Security Requirements Resources Available

SuccessfulProgram

31

Boisvert, M. (2014)

+Determining Technology & Equipment Needs

n Key Questions:n What is to be accomplished? (direct service, supervision,

mentoring, etc.)n What is the clinical population? (e.g., speech/language delay,

voice, fluency, articulation/phonology, AAC)n What is the setting of the services? (e.g., 1:1, small group,

classroom based, training)n What is the delivery model? (e.g., direct FtF, Store/Forward,

hybrid)n What are the security requirement?n What are the resources that are available? (i.e., existing

equipment, budget, IT support, administrative support, bandwidth)

32

Boisvert, M. (2014)

+

Technology: Things to Consider

§ Transmission methods and speeds

§ Types of technology§ Uses of technology§ Technical support§ Privacy/Security§ Funding Issues§ Applications

33 +Transmission Methods

nISDN (Integrated Services Digital Network)nT1-T4 lines

nBroadband/IP (Internet Protocol)nMobile/CellularnDSL (Digital Subscriber Line)nCablenSatellite

34

+Bandwidth is the KEY Technological Issue

nAll technology systems, regardless of cost, are effected by bandwidth

nBandwidth is an issue in all geographical locations (urban and rural)

nBandwidth is traffic dependent

nTraffic is dependent on time of day, weather, location

nBandwidth is increasing dramatically nation-wide, but so is traffic (thanks, Netflix and youtube!)

35 + 36

10/16/16

7

+ + 38

+Dedicated systems

nHigh quality audio and video

nTeacher can control family’s camera remotely

n IT support can be provided to family remotely

nProvides more secure connection

nNeed compatible equipment at both ends

nCan be expensive

nUsually remains in one location

Pros Cons

39 +Dedicated systems

Basic equipment

nHardware/software

nCamera

nMonitor

nMicrophone

nSpeakers

Looks like….

nPolycom, Cisco

nPTZ camera

nTelevision

nSeparate and/or internal

nThrough monitor

40

+Web-based systems

nHardware/software

nCamera

nMonitor

nMicrophone

nSpeakers

nSkype, facetime, etc.

nInternal or external webcam

nComputer screen/tablet

nHeadset or built-in

nHeadset, built-in or external

Basic equipment Looks like….

41 +Web Based Systems

n Quick and easy to set up

n Can be accessed from any computer with internet

n Inexpensive

n May have screen sharing

n Could be portable

nLimited camera angle

nTeacher can’t control the family’s camera

nRelies on family’s/school’s internet connection

nFamily must provide own IT support

Pros Cons

42

10/16/16

8

+Types of equipment

nHardware/software

nCamera

nMonitor

nMicrophone

nSpeakers

43 +

nDesktop or Laptop computer

nWebcamnHeadset with Mic; integrated

microphone & speaker

nPrinter & scannernPhones

nDirect line to Internet (no wi-fi)

nTeleconferencing PlatformnEmail

Clinician/Contractor Equipment44

+ Software

§ Price§ Features§ Necessary Downloads§ Compatibility§ Size§ Internet Access

+Web-Based Telepractice Platforms

nSKYPE (Free…No!)

nSKYPE for Business

nInfinite Conferencing

nAdobeConnect

nMegameeting

nGoToMeeting

nMicrosoft Office 365

nCisco WebEx

niLinc

nBlackboard Collaborate

nZoom

46

+WEBEX

DocumentSharing ApplicationSharing

47 +Additional Peripheral equipment

nDocument Reader

nConnect a laptop to the camera

nIndustry specific tools

nRecording devices

48

10/16/16

9

+Technology Considerations

n Up-front Costs

n Ongoing Service Fees

n Bandwidth & Reliability

n Technology Maintenance &

Support

n Quality of Equipment (video, image size, camera pan, & zoom)

n Recording telepracticesession

n Security, Firewalls

n Ease of Use

49

+

PhysicalSet-up

50

+Presenter’s space

nRoom size

nRoom location

nLighting

nAcoustics

nFurniture

nStorage

51 +Client’s / School’s Space

nAdequate work space?

nAppropriate furniture?

nAccess to floor space?

nRoom size?

nCamera placement

nDistractions

52

+Privacy, Security, & Licensure Considerations

53

+Security vs. Privacy

n Security is about firewalls, hacking, viruses and wormsn Location and hardware/software dependent

n Targeted use technologies (e.g., umi, xbox, videophone) are typically less susceptible to security issues

n Home locations are likely to be more susceptible to security issues than locations that invest in IT)

n Privacy is about protecting the rights and privacy of individuals per HIPAA and FERPA

n Standards-based technologies and Federal laws, particularly FCC regulations, help protect privacy

n There is no regulatory agency for the Internet—currently, ”Net Neutrality” means Internet use is unrestricted

54

10/16/16

10

+Privacy Considerations

nPrivacy rights are just as important through telepacticeservices as they are in traditional services

nPrivacy procedures must be in congruence with federal regulations:

nApplying privacy regulations:nObserving “live” telepractice sessions- informed

consent must be obtained before anyone observesnRecording telepractice sessions- permission from

family to record

55 +Licensing Issues

n ASHA requires the SLP to be licensed in every state that services are provided and purchase the license at own expensen Regulations may change as telepractice become more popularn New licensure standards may come about for medical services delivered

through telehealth

n Limited licensure is another point of discussionn Would allow states to monitor tele-practitioners who are providing services in

multiple states without restricting their practice

n Currently, no licensure/certification requirements for telepracticeprovidersn Require telepractitioners to have same credentials as traditional service

providers and stress importance of privacy regulations

56

+

Critical Skills of Practitioners

57

+General Clinical Skills & Procedures

n Telepractice is not about technology…rather it is another service delivery model.

n Telepractice is really about clinical interactions, rapport, and forming a strong working relationship with the client, family, and/or other practitioners.

n Telepractice does not remove existing responsibilities in service delivery.

n Telepractice must be the same quality as those delivered in-person.

58

Adapted from Boisvert, M. (2014)

+General Clinical Skills & Procedures

nTelepractitioners should know how to troubleshoot the teleconferencing system:n Downloading & updating software

n Scheduling a meeting/session

n Inviting participants

n Screensharing with patients/others

n Annotation features

n Data collection/goal monitoring

59

Adapted from Boisvert, M. (2014)

+Skills Checklist for Providers of Telepractice

nHas basic knowledge of computers and other equipment being used

nCan troubleshoot video and audio equipment

nAttends to technology while conducting the session

nOrganizes materials for activities ahead of time based on naturally-occurring routines

nConducts activities that involve materials and actions that are easily depicted over video/audio

60

10/16/16

11

+Telepractice: Summary

Benefits

n Access to SLP/AuD services

n Individualized Programming

n Service Delivery Options

n Access to specialists

n Increased learning

n Acceptance by students

n Collaboration

n Benefits for families Benefits for the SLP, AuDs

n Ease the shortage of SLPs, AuDs

Barriersn Technology failures

n Lack of training

n Lack of procedures

n Nature of the environment

n Lack of physical contact

n Establishing therapeutic/clinical relationships

n Ethical concerns

n Dissatisfaction

n Lack of research

61 +

Telepractice & eLearning Laboratory (TeLL)

+ Telepractice & eLearning Lab (TeLL)School of Speech-Language Pathology & Audiology

n The University of Akron serves children with hearing loss and their families as well as adults with hearing loss

n Pediatric therapy focuses primarily on listening and spoken language & Auditory-Verbal Therapy

n Adult aural rehabilitation with a direct, patient-centered focus

n Training of future SLPs in telepractice service delivery models

63 +Why Telepractice?

nDistance

nLack of specialists

nReduced travel

nClient/family motivation

nFlexibility of scheduling, fewer cancelations = more consistent intervention

nFunctional “natural” environment – child & parents are more comfortable

nCrucial for Auditory-Verbal intervention: Parent participation is “built in”

64

+ Adult Learning Theory: Adults [Parents] like to…

nbring knowledge, skills, attitudes

nbring experiencenlike to solve

problems

nlike to apply what they learn to real situations

nlike to have choices

n like to share in the setting learning objectives

nhave variety of learning styles/preferences

ndo best in an environment where they feel safe, accepted, and respected

nwant and need feedback

nneed to have their abilities and achievements honored

65 +Types of Adult Learners

Do you prefer: hands on, risk taker, trial by error? ü Dynamic Learner...asks What if?

Do you prefer: experts’ opinions, directions?ü Analytic Learner…asks Why?

Do you prefer: learn the facts, then experiment?ü Common Sense Learner…asks How?

Do you prefer: listen, discuss, consult with others?ü Imaginative Learner…asks Why not?

66

10/16/16

12

+ Coaching and Adult Learning Theory

Joint Planning

Observation

Action

Reflection

Feedback

Generalizing knowledge and applying to other situations

67

Sequence Of Therapy Preparation

1. Referral to clinic

2. In-person visit for full evaluation

3. Completion of home inventories

4. Technology test session

5. Lesson plans emailed at least 48 hours prior to session

6. Parent gathers materials and prepares by collaborating with clinicians by email or phone

7. Session begins

68

+Conducting A Session

69

1.Reviewing goals and activities-Reviewing goals from previous week, new updates, review goals for current session, check hearing devices

2.Conducting the lesson/activity-Demonstration of new strategies/techniques, coaching the parent or adult, discuss integration of goals into daily home routines, strategies for improving/controlling communication opportunities (adults)

3.Debriefing-Allow questions from parents, discuss continuation or selection of new goals, summarize session and goals for the coming week

+Nancy & Alex

70

+Nancy & Alex

71 +Nancy & Alex

72

10/16/16

13

+Nancy & Alex

73 +Alex – the Super HEAR-O

74

+Alex…getting ready for school

75 +Future Directions

nTelepractice can offer a viable solution to meet the increased demand for services

nThere are tremendous advantages for clinicians and their patients when telepractice is utilized

nClinicians/programs should plan carefully before implementing a telepractice program

nTelepractice service delivery models will continue to expand & will be a regular fixture in health care

76

Questions?

Comments?

Ideas?

77 +References

n Boisvert, M. (2014). “Telepractice for School Based Speech & Language Services.” A paper presented at the Ohio Speech-Language-Hearing Association Annual Convention.

n Boisvert, M., Chacias, J., & Andrianopoulous, M.V. (2013). “Prerequisites to implementing telehealth in schools: The role of needs assessment.” Paper presented at the 2013 Convention of the American Speech-Language-Hearing Association, Chicago, IL.

n Boisvert, M., Hall, N., Andrianopoulos, M., & Chaclas, J. (2012). The multi-faceted implementation of telepractice to service individuals with autism.International Journal of Telerehabilitation, 4(2).

n Eastmond, N. (1994). Assessing needs, developing instruction, and evaluating results in distance education. Distance education: Strategies and tools, 87-106.

n Grogan-Johnson, S. (2012). Providing School-Based Speech-Language Therapy Services by Telepractice: A Brief Tutorial. Perspectives on Telepractice, 2(1), 42-48.

78

10/16/16

14

+References

n Jennett, P., Yeo, M., Pauls, M., & Graham, J. (2003). Organizational readiness for telemedicine: implications for success and failure. Journal of Telemedicine and Telecare, 9(suppl 2), 27-30.

n Juenger, J. M. (2009). Telepractice in the Schools. The ASHA Leader, 14(12), 20-21.

n Lemke, H. U., & Berliner, L. F. (2008). U.S. Patent Application 12/213,979.

n Martin (2011). TeleHealth Resource Center.

n McCawley, P. (2009.). Methods for Conducting an Educational Needs Assessment. University of Idaho Extension.

n Polovoy, C. (2008). Audiology telepractice overcomes inaccessibility. ASHA Leader, 13, 20-2.

79 +References

n Schmidt, H. A. The National Strategy for Trusted Identities in Cyberspace and Your Privacy, April 26, 2011. White House blog post.

n Tucker, Segal, & Hyler (2001). Psychiatric telemedicine for rural New York. Journal of Psychiatric Practice®, 7(4), 279-281.

n Tucker, J. K. (2012a). Perspectives of Speech-Language Pathologists on the Use of Telepractice in Schools: Quantitative Survey Results. International Journal of Telerehabilitation. 4(2).

n Tucker, J.K. (2012b). Perspectives of Speech-Language Pathologists on the Use of Telepractice in Schools: The Qualitative View. International Journal of Telerehabilitation. 4(2).

80

+Resources

nAmerican Telemedicine Association n www.americantelemed.org

nAmerican Speech-Language-Hearing Associationn www.asha.org/telepracticen SIG 18: Telepractice

nBroadbandUSAn http://www2.ntia.doc.gov/iowa

nCheck with your professional organization for additional white papers, position statements, & preferred practices

81 +Resources

n National Center for Hearing Assessment and Management (NCHAM). A Practical Guide to the Use of Tele-Intervention in Providing Listening and Spoken Language Services to Infants and Toddlers Who are Deaf or Hard of Hearing. Available from: http://www.infanthearing.org/ti-guide/index.html

n American Telemedicine Association’s A Blueprint for TelerehabilitationGuideline. Available from: http://www.americantelemed.org/files/public/standards/ATA%20Telerehab%20Guidelines%20v1%20(2).pdf

n Center for Telehealth and E-Health Law (Ctel):

http://www.telehealthlawcenter.org/

n International Journal of Telerehabilitation: http://telerehab.pitt.edu/ojs/index.php/telerehab

n Journal of Telemedicine and Telecare: http://jtt.rsmjournals.com/

82

+ Telepractice & Listening & Spoken Language

Monograph available from the Alexander Graham Bell Association for the Deaf & Hard of Hearing

83 +

Available from Plural Publishing:

www.pluralpublishing.com

Published: 2014

84

10/16/16

15

+ 85

Available from Plural Publishing

www.pluralpublishing.com

Published 2016

+

Put in all logos

Assistance Is Available!

Federally Designated

Telehealth Resource Centers

86

+Thank You for Listening!

K. Todd Houston, PhD, CCC-SLP,

LSLS Cert. AVT

Email: houston@uakron.edu

Office: (330) 972-6141

Facebook: K Todd Houston

Twitter: ktoddhouston

LinkedIn: www.linkedin.com/in/toddhouston

LinkedIn Group: 6 Sound-Off

87