The Government of Tamil Nadu has taken several measures for early identification and intervention of childhood disabilities. The office of the State Commissioner for Welfare of the Differently Abled, established the District Differently Abled Welfare offices in 1993 in each district to provide early identification of disability and Early Intervention Centers in 2011 to provide special education and therapy for children with disabilities below 6 years of age. These initiatives are significant milestones yet their functionality is limited due to stark contrast in demand versus capacity. In 2015 the ‘Mobile Therapy Unit’ was implemented to improve consistency of rehabilitation services, increasing last mile coverage. However, this initiative is also challenged by higher demand on professional’s time, who are engaged in both clinical services and administrative work.

Tele-practice is the use of information and communication technology to provide health care services. Ramkumar and colleagues validated tele-practice for diagnostic testing using real time tele-Auditory Brainstem Response in a rural district of Tamil Nadu. They later found that it is cost effective to conduct a community-based programme integrated with tele-practice approach.

Ramkumar and colleagues also found that a bottom-up grass root level tele-practice approach was successful in achieving better coverage, diagnostic confirmation and early intervention of middle ear diseases in a community-based program for individuals with cleft of lip and palate in two rural districts in Tamil Nadu.

These efforts suggest that, integration of a tele-practice approach in community-based programs is likely to be beneficial to both provider and patient.

About

This project aims to develop, implement and evaluate the feasibility of a new intervention using a comprehensive tele practice model of screening, diagnosis and rehabilitation of children below 6 years with hearing and speech-language disorders using ICT.

Designs and Method: Currently, we are conducting situational analysis in two districts (Perambalur and Ariyalur, Tamil Nadu) using qualitative methods to understand needs and challenges amongst caregivers of children with disability, public sector professionals, administrators grass root workers, NGO staff in accessing or providing services. The situational analysis will also inform the readiness for the intervention using tele-practice, among the various stakeholders in the community. Parallel to this, we are developing and validating a mobile/tablet-based hearing and speech-language screening device. Later, the intervention (comprehensive tele-practice model*) will be implemented in Perambalur district. The outcomes will be evaluated using mixed methods feasibility study, with comparison to standard practice district (Ariyalur).

Conclusion: At the end of this project, we expect to have a feasible, effective and a comprehensive tele practice model that will enable early identification and rehabilitation of young children with speech language and hearing disorders.

Impact: Since COVID 19, tele-practice has gained momentum in India. Tele-practice guidelines are framed for various health care disciplines including for Speech, language and hearing sciences. In this context, the results of this study will help to translate a feasible tele-practice based intervention for early identification and rehabilitation of children with hearing and speech language disorders in other districts of Tamil Nadu.