NYU's Telepractice Guide

Dear Graduate Student Clinicians,

As a student in the NYU Steinhardt’s Department of Communicative Sciences and Disorders, please use this guide as a starting point for your training and education in tele-practice and tele-supervision, to guide you in the delivery of high quality, evidence- based practice to the client via remote technology.

As a graduate student clinician in the NYU Speech-Language and Hearing Clinic, you will use tele-practice for service delivery under the supervision of New York State licensed Speech-Language Pathologists to our clients currently residing and receiving services in New York State. Our faculty and staff are here throughout your journey to support you in your continuing growth as a developing speech/language pathologist.

ASHA’s Telepractice Update: Telepractice provisions extended to December 31, 2020

Graduate student clinicians in both professions who are enrolled in CAA-accredited and CAA-candidacy programs may engage in service delivery through telepractice when the clinical educator provides 100% direct supervision of the sessions in real time.

• Program and clinic directors have the authority to determine how many students can appropriately take part in an online teletherapy session with one client. Multiple students may participate in the same session. Each student will earn the full hour toward the completion of their clinical practicum.
• Programs must carefully consider which clients are appropriate for telepractice.
• As always, programs must adhere to all local/state/federal policies.
• It is up to the discretion of each program to determine how many hours may be earned through telepractice. There currently is no cap. These hours are separate from the hours earned through clinical simulation

Sincerely,

The Clinical Education Team

• NYU CSD clinical faculty have extensive administrative, clinical and training experience in providing speech therapy services for children and adults with communication disorders.
• Many children and adults with communication disorders, can benefit from practical and extremely cost effective telepractice.
• We are providing our graduate students with training and guidelines in demonstrating competencies in the acquisition of knowledge and skills in tele-practice services.
• During the period of social distancing, it’s essential to conduct an effective graduate-level tele-practice program in speech language pathology for the NYU Department of Communication Sciences and Disorders (CSD), emulating our in-person service delivery model.
• Telepractice is the future in health care delivery.

Use of telepractice must be equivalent to the quality of services provided in person and consistent with adherence to the Code of Ethics (ASHA, 2016a), Scope of Practice in Audiology (ASHA, 2018), Scope of Practice in Speech-Language Pathology (ASHA, 2016b), state and federal laws (e.g., licensure, Health Insurance Portability and Accountability Act [HIPAA; U.S. Department of Health and Human Services, n.d.-c]), and ASHA policy. (ASHA.org, 2020)

The training program comprises one week of intensive training, and ongoing support throughout the period of service. Classroom based instruction and accompanying labs are provided to train students in all aspects of telepractice and technology in order to:

• To provide the highest quality training of graduate students in communication sciences and disorders for the delivery of speech therapy telepractice
• To provide training for the professional use of technology in compliance with the ASHA (2020) standards, state and federal laws and licensing.
• To promote access and efficiency in delivering speech, and to overcome physical and environmental barriers through the use of technology.
• To promote self-sufficiency and carry-over by training e-Helpers and other support systems within any setting receiving speech therapy telepractice services.
• To promote the use of technology for building communication networks between individuals with communication disorders and their support systems.

Students will demonstrate knowledge and proficiency with telepractice , specifically in the areas of:

• Current national and NY state laws and regulations
• Ongoing evaluation of appropriateness of telepractice for each client
• Best Practices and materials selection
• Consent and confidentiality agreements between the clinic and client
• Components of and best practices with the video conferencing system, including:
  • The supporting software applications for developing digital materials
  • Web-based content management of digital materials, recording and editing therapy sessions
  • Complementary instrumentation
  • Best practices for training and working with client and caregiver
  • Interpersonal skills for interacting with individual and multiple users

Emerging evidence about speech therapy telepractice indicates that it is as beneficial a delivery system as traditional on-site service for different patient populations. Telepractice uses a medium that is highly motivating, especially to children, and is already familiar to them. Children in the US are exposed to and involved with technology from an early age, including media (e.g., cell phones, tablets, social media) as well as game consoles and virtual games.

Schools have a big role in making this technology present in every child’s life. Adults use technology in aspects of their work and for social networking. We look to states where the need for telepractice is long term and ongoing. According to the University of Maine, the telepractice component of their clinical service to rural communities across the state has been effective and cost beneficial for over five years.

A systematic review of telepractice assessment and treatment of individuals with aphasia indicated that these patients showed improvement from telepractice procedures (Hall et al., 2013). Other research has shown that children with stuttering impairments (e.g., Wilson, Onslow & Lincoln, 2004) and speech disorders (e.g., Waite et al., 2006) have demonstrated excellent outcomes after receiving speech therapy telepractice services. Another study supports the validity and reliability of the assessment of children’s literacy via a telepractice system (Waite et al., 2010).

Parents, teachers and administrators in a rural school district in North Carolina were satisfied with this service delivery model for their school-based speech therapy and recommended this model to other school districts (Crutchley & Campbell, 2010). Health care facilities in the state are using telemedicine technology to share information between facilities.

NYU CSD graduates will be well trained and familiar with the statewide plans to develop and use information technology infrastructure. NYU CSD graduates will work in all parts of the country where needs already, emergently, or potentially exist, and will generalize their learning here to their new professional locations.

• Use a private, secure therapy room to provide confidential services.
• Adjust lighting to ensure optimal audio and video quality during sessions.
• Be familiar with multiple platforms and mobile devices.
• Find and create appropriate telepractice materials: created digitally and stored on a shared website to assure an available supply of appropriate speech therapy materials
• Become familiar with digital interactive approach where the speech-language pathologist manipulates digital speech therapy materials on a computer in one location, while the client simultaneously manipulates the same materials as his/her computer in any location
• Learn file, application, and desktop sharing to allow ease of collaboration during sessions
• Share video files in real time and incorporate comprehensive multimedia experiences
• Understand the impact of real-time collaboration for different participants
• Be prepared to communicate with multiple, simultaneous webcam video feeds with voice activated switching especially for group use.
• Work closely with supervisors and co-treaters to ensure the best service delivery from multiple perspectives and approaches.

• Space: The ideal is a quiet environment. Sound and lighting adjustments should be made to ensure optimal audio and video quality during sessions on both sides.
• Equipment: Internet access is necessary and wifi stability is important. Student Clinicians may deliver telepractice services on multiple platforms and mobile devices. Clients may benefit from printed materials sent ahead of sessions.
• Materials: The internet is a repository of appropriate speech therapy materials that can be used in speech therapy telepractice sessions. The Resources section of this document provides materials relevant to all major speech and language disorders and levels. There are digital assessment materials, digital images and software, and videos that can be utilized and adapted. Current technology allows for an interactive approach in which the clinician manipulates digital speech therapy materials on a computer in one location, while the client simultaneously manipulates the same materials as his/her computer in any location. The department has compiled a supplemental materials list which is planned for continued growth over time, and students are encouraged to add to it.