What It Took to Launch Telepractice in Nevada Schools Installing a statewide telepractice program held its share of challenges and lessons learned. School Matters
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School Matters  |   December 01, 2014
What It Took to Launch Telepractice in Nevada Schools
Author Notes
  • Nancy L. Kuhles, MS, CCC-SLP, co-chairs the Nevada Coalition to Address Personnel Shortages in Special Education and Related Services. A retired school-based clinician, she is an ASHA State Education Advocacy Leader for Nevada and Western Regions SEAL champion. kuhles119@sbcglobal.net
    Nancy L. Kuhles, MS, CCC-SLP, co-chairs the Nevada Coalition to Address Personnel Shortages in Special Education and Related Services. A retired school-based clinician, she is an ASHA State Education Advocacy Leader for Nevada and Western Regions SEAL champion. kuhles119@sbcglobal.net×
  • Christine L. Verre, MS, CCC-SLP, co-chairs the Nevada Coalition and is a clinician for the Washoe County School District. christineverre@sbcglobal.net
    Christine L. Verre, MS, CCC-SLP, co-chairs the Nevada Coalition and is a clinician for the Washoe County School District. christineverre@sbcglobal.net×
  • Kimberly Smerkers-Bass, EdD, is an organizational specialist and educational consultant with the Nevada Coalition. She coordinates the University of Phoenix Northern Nevada College of Education teacher preparation program. kmerkers@hotmail.com
    Kimberly Smerkers-Bass, EdD, is an organizational specialist and educational consultant with the Nevada Coalition. She coordinates the University of Phoenix Northern Nevada College of Education teacher preparation program. kmerkers@hotmail.com×
Article Information
School-Based Settings / Telepractice & Computer-Based Approaches / School Matters
School Matters   |   December 01, 2014
What It Took to Launch Telepractice in Nevada Schools
The ASHA Leader, December 2014, Vol. 19, 34-35. doi:10.1044/leader.SCM.19122014.34
The ASHA Leader, December 2014, Vol. 19, 34-35. doi:10.1044/leader.SCM.19122014.34
In Nevada, the number of students varies radically between urban and rural counties—and so does the number of students receiving special education services. For example, the Clark County school district—home to Las Vegas—educates more than 35,000 students with disabilities. In comparison, Esmeralda County, in the rural west, and Eureka County, in the rural north, have fewer than 25 students with disabilities.
The education systems face other complications as well: communities in remote areas, geographic obstacles, severe weather conditions and poor communication systems.
Every year, Nevada faces a shortage of special education personnel, including speech-language pathologists, in its rural and urban districts. To address this shortage, Nevada launched a statewide telepractice service delivery model in 2010—a model that has sharply increased districts’ ability to provide services.
In the spring of 2010, the Nevada Speech-Language-Hearing Association’s Coalition to Address Personnel Shortages received a grant from the Nevada Department of Education to launch telepractice services. The grant included funds for training, equipment and materials. The project began with a statewide initial pilot phase in 2010–2011 and concluded with statewide monitoring 2013–2014.
Implementing a statewide telepractice delivery model posed several challenges, identified from evaluations given to SLPs who participated in project training workshops and from end-of-year updates. We identified three categories of barriers: human, technological and organizational. We take a look here at each of these, and how they can be overcome.
Ease the anxiety
Human barriers included SLPs’ hesitance to try the model, fear of new technology and desire to have direct contact with the student, and administrators’ reluctance because of equipment costs and questions about meeting legal mandates. A number of strategies can help clinicians become more comfortable with telepractice:
  • Use ASHA’s Practice Portal to increase awareness of and knowledge about school-based telepractice services.

  • Help educate administrators in charge of speech and language services about telepractice. Develop and circulate FAQs about benefits, considerations and potential limitations. Prepare a cost analysis of launching and implementing the services.

  • Seek training that focuses on the nuts and bolts of telepractice—for example, legal mandates, criteria for selecting students, technology, equipment, benefits and limitations, adhering to the ASHA Code of Ethics, and privacy rules—and provides hands-on experience. Several aspects of telepractice require specific skillsets: delivering services while simultaneously managing the virtual environment and communicating with support personnel.

  • Build your competency with the equipment—webcam, document camera, video platform, headsets and materials—used in your telepractice sessions.

  • Practice with a colleague to hone your skills.

  • Prepare your student by practicing onsite before moving to telepractice.

  • Prepare for technology.

Talk with the techies
We identified several technological barriers: limited Internet access, broadband connections and equipment usage. You can overcome these barriers with some of these tactics:
  • Identify what equipment and resources you have and what you need.

  • Identify the Internet bandwidth at your location and your students’ sites to determine if they can support telepractice services.

  • Identify the informational technology support (IT guy) in your district, and the district’s conferencing system.

  • Determine the appropriate equipment, based on your district’s system, that will support telepractice services.

  • Maintain ongoing communication with the IT guy.

  • Identify IT barriers, such as firewalls, that may prevent student access to the conferencing system.

  • Be aware of circumstances that affect connectivity, including weather, many students using the computer lab, and heavy time-of-day usage.

Overcome organizational barriers
Organizational barriers included lack of communication among stakeholders, accountability, mentoring/coaching support, and an ongoing plan to address issues and evaluate the services. We suggest tackling these barriers by:
  • Identifying all stakeholders—SLPs, administrator, the IT guy, teachers, parents, students and support personnel—as well as efficient and preferred ways of communicating with them.

  • Identifying a champion to support the initiative.

  • Establishing mentoring or coaching support for the SLP telepractitioner, especially during the first year of implementation.

  • Designing and implementing an ongoing plan and evaluation for goals and objectives of the service delivery.

Results
Nevada uses a hybrid telepractice/face-to-face model: typically, the SLP provides treatment in person to every student once each month and the remainder through telepractice.
In the four years of the project, up to seven districts implemented telepractice services with some measurable results:
  • One rural district was able to fill its open SLP position and provide consistent and continual services.

  • In one rural district, the number of students served increased from one in 2010–2011 to nine in 2013–2014.

  • Districts save money on transportation costs incurred by SLPs traveling from school to school.

  • SLPs who received coalition training have trained other SLPs in their districts and shared information, such as strategies, techniques and materials, with other districts to keep the service going and to troubleshoot barriers.

  • Nevada launched a viable and sustainable service delivery option for our school districts by identifying, addressing and working to solve human, technological and organizational barriers. You can do it, too!

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December 2014
Volume 19, Issue 12