Telepractice

Speech Pathology Australia is aware that interest in the use of telepractice (telehealth) has increased in response to the outbreak of coronavirus COVID-19. The following FAQs are intended to provide guidance and resources to members for responsibly implementing and maintaining clinical standards through telepractice. If you have further questions in relation to this document, please do not hesitate to contact Speech Pathology Australia on 03 9642 4899 or 1300 368 835 or [email protected]

Reference should also be made to Telepractice Resources.

What is Speech Pathology Australia’s position on telepractice?

The Association supports the use of telepractice as a service delivery model where it is based on current evidence-based practice and is at least equivalent to standard clinical care. Members who engage in telepractice need to ensure they have appropriate skills and technology and are bound by the Association’s Code of Ethics and other Core Documents. Speech pathologists are urged to become familiar with SPA’s Position Statement: Telepractice in Speech Pathology.

How do I know what services are appropriate to offer through telepractice?

As with other methods of service delivery, speech pathologists should seek evidence related to telepractice. SPA’s Position Statement: Telepractice in Speech Pathology contains a review of current evidence. Members may also perform a search such as “telepractice” or “telehealth” on SpeechBITE. The evidence for some areas of practice suggest that benefit is contingent on related factors, such as having a trained support person or other health practitioner onsite with the client. Where there is no evidence published, clinicians should utilise the same decision-making process for other treatments or methods that do not yet have published evidence. SPA’s worksheet “Ethical decision making: Should I use this therapy approach?” can help guide members through this process. Members are encouraged to seek professional support from those with experience offering telepractice services.

What clients are appropriate to be served through telepractice?

Clinicians should assess individual client needs and determine the appropriateness of this method of service delivery on a case-by-case basis. Speech pathologists should consider any factors that may impact the provision of services, including:

• Sensory and physical characteristics: This may include vision, hearing, motor dexterity, physical endurance and positioning
• Cognitive, behavioural and motivational characteristics: Consider attention, ability to sit and focus on a computer, understanding and perception of a remote interaction
• Communication characteristics: Including auditory comprehension, sign language use, speech intelligibility, skill and need for written language, use of AAC, severity of communication deficits and their impact
• Support resources: Such as availability of technology, ability of carer to support technology and service provision
  (Speech Pathology Australia, 2014 and American Speech-Language-Hearing Association, n.d.)

What technology is required to offer telepractice services?

Acquisition and use of technology should be driven by client needs. Speech pathologists are encouraged to familiarise themselves with technology options and how they can be implemented to accommodate specific situations. Areas to consider may include:

• Hardware: Identify what computer will be used at clinician site and client site. Determine if processing speed and memory support videoconferencing. Identify whether the device requires the client to sit at a desk or if it offers some flexibility and mobility.
• Webcam: Internal (embedded) webcams may facilitate face-to-face communication. External webcams or document cameras permit flexibility in observing or the ability to view work performed on a horizontal surface.
• Audio: Assess whether clinician and client microphone/speakers permit appropriate observation and communication. Some environments or communication needs may require a headset.
• Platform: Evaluate functions of your platform and how the client will interact during the session. Screen share, whiteboards, drawing tools and shared keyboard/mouse controls are features commonly used by telepractitioners. Assess the security features of the platform. Although some free versions of videoconference platforms exist, these often have a session time limit which may be disruptive to services.
• Connectivity: Determine if the internet at both the client and clinician site supports a clear connection. This can be assessed from websites such as https://www.speedtest.net/. The upload / download speeds required will depend on the platform and materials being used. However, a general minimum standard is 3 Mbps for static materials and 5 Mbps for video, gaming, etc.
  (American Speech-Language-Hearing Association, n.d.)

Clinicians should be familiar with technology and platform functionality prior to engaging in services and should be able to familiarise and guide clients and carers. Practices are encouraged to develop procedures and protocols to manage training and navigate technical support issues as they arise. Policy and procedure templates and guides, available on the Association’s Private Practice Essentials page, may be useful in developing these.

Does someone need to be onsite with the client?

In the majority of cases, it is beneficial or necessary to have a carer, or facilitator, present with the client. This individual may resolve technical issues, support service provision as appropriate, manage materials and camera angles, verify observations, and respond to urgent situations. Facilitators are key in ensuring that the client’s environment is private, secure, and distraction-free. Although some clients may be safely and effectively served without an onsite facilitator, having someone else present helps to reduce risk and promote generalisation of skills to other contexts.

Depending on the situation, the facilitator role could be filled by AHAs, parents, partners, teachers, support workers, or other professionals. speech pathologists should evaluate individual procedures and determine whether a facilitator requires specific skills to support them and if the facilitator has skills to support a session Speech pathologists should help facilitators understand the role of each person in the interaction and any activities, materials, etc. that are required in a session.

Do different funding streams support the use of telepractice for speech pathology?

• NDIS: Yes. Clients being served under NDIS, regardless of how their plan is managed, may receive speech pathology services through telepractice.
• Medicare and DVA: New temporary telehealth items have been introduced as a result of COVID-19. Please refer to the Association's COVID-19: Medicare, DVA and Private Health Funds web page for regularly updated information.
• Private Insurance: As a result of the advocacy work done recently, the Association is aware that various Private Health Funds (PHFs) are announcing that customers who have extras cover for speech pathology will be able to make a claim for speech pathology services delivered via telehealth. Members are advised to contact individual insurers, or have the client do due process to determine whether this would be covered by their policy. Please refer to the Association's COVID-19: Medicare, DVA and Private Health Funds web page for regularly updated information.

Are there specific risks associated with offering telepractice services?

Telepractice is a relatively new method of service delivery. As with any developing area there may be gaps in evidence, policy or precedent to guide these services. The largely digital and remote nature of telepractice also makes it susceptible to certain online risks. The following considerations may assist members to reduce professional and clinical risk and engage in responsible service-provision:

• Informed Consent: Obtain informed consent from both the service provider and clients or decision-makers. Ensure that each understand processes and procedures that will be used, disclose benefits and limitations of telepractice, and share any other relevant information, such as whether a rebate will be available for the session.
• Indemnity Insurance: All members are encouraged to have their own professional indemnity insurance. Those engaging in telepractice should inform their insurance provider and seek appropriate advice.
• Privacy: Ensure that the client and clinician site is secure and permits the session to remain confidential. Records and documents should be transmitted and stored in a secure way. Only use a secure internet server for sessions or to transmit information.
• Emergency Plan: Identify a plan to respond to urgent situations and confirm this with the onsite facilitator and other stakeholders. Identify contact information for local emergency or medical services.
• Recordings: If the speech pathologist believes there is a clinical need or justification for the session to be recorded, then the speech pathologist could do so after informing the client and obtaining their consent for the recording to occur.  If any part of a consultation is recorded, that recording forms part of the client’s record and must be managed and stored in accordance with the principles applying to all other elements of the client’s record.

If I provide interstate telepractice services, will I need to obtain a Working with Children Check (WWCC) for each state or territory where I work?

A WWCC is individual to the state or territory where it is performed. Speech pathologists who have a current WWCC in one state/territory are rarely exempt from obtaining a WWCC in another. Most territories and states have a process for applying for a WWCC interstate either online or by post. Members are advised that WWCC requirements vary between states. Speech pathologists should verify the unique requirements in each of the states/territories where they wish to practise and contact relevant organisations with questions. Further information can be found on the Association’s Working with Children Checks and Police Checks web page.

What considerations should be made by a speech pathologist providing telepractice services to schools?

As with telepractice in other settings, a speech pathologist providing telepractice services to a school should obtain informed consent from their clients’ parents. The consent form may identify the person(s) onsite who will support the client during sessions. Speech pathologists are also advised to work with principals to understand the technology resources and security of the school and collaborate to improve these where needed. The Association document FAQs - Technology, Privacy and Security for Telepractice may be helpful when assessing resources and security.

Where can I learn more about how to offer effective telepractice services?

The Association reminds members that the provision of telepractice is a learnt skill and encourages members to seek professional development and support prior to commencing services. Speech Pathology Australia offers various courses and resources on the Learning Hub.

Other resources:

• SPA's Learning to Use Telepractice: The Association has worked with Australia’s leading academics in the field of telepractice services to create a series of succinct webisodes on the provision of clinical services. Webisodes cover various topics and are free to access.
• SPA Webinar: To help members who have an urgent need to upskill in this area, SPA has made one of its webinars, Telepractice in speech pathology – principles and practicalitiess by Dr. Clare Burns, available to member free of charge.
• The Royal Institute for Deaf and Blind Children has published an instructional e-book, RIDBC Teleschool: Guiding Principles for Telepractice, available on iOS devices.
• The American Speech-Language-Hearing Association (ASHA) maintains a Practice Portal offering information on key issues and resources in telepractice. Although some information is specific to practice in the United States, many principles may be applicable to Australian practitioners.

References

American Speech-Language-Hearing Association (n.d.). Telepractice (Practice Portal). Retrieved March, 12, 2020, from : https://www.asha.org/Practice-Portal/Professional-Issues/Telepractice/

Speech Pathology Australia (2014) Position Statement: Telepractice in Speech Pathology. Melbourne, Australia. The Speech Pathology Association of Australia Ltd.

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Original: March 2020

Updated: October 2020

Download a PDF version

FAQs - Technology, Privacy and Security for Telepractice

Informed Consent for Telepractice template