Telepractice in Schools: What Works Best? School telepractice experts shared their experience using different models and providers in a recent ASHA online chat. The Leader listened in. Overheard
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Overheard  |   July 01, 2017
Telepractice in Schools: What Works Best?
Author Notes
  • Cheval Bryant, MCD, CCC-SLP, is senior manager of speech-language services at the Houston Independent School District, which incorporates telepractice in its services. She is an affiliate of ASHA Special Interest Groups 14, Cultural and Linguistic Diversity; and 16, School-Based Issues.cbryant5@houstonisd.org
    Cheval Bryant, MCD, CCC-SLP, is senior manager of speech-language services at the Houston Independent School District, which incorporates telepractice in its services. She is an affiliate of ASHA Special Interest Groups 14, Cultural and Linguistic Diversity; and 16, School-Based Issues.cbryant5@houstonisd.org×
  • Diana Parafiniuk, MS, CCC-SLP, is chief marketing officer and co-founder of E-Therapy. She is an affiliate of ASHA Special Interest Groups 16, School-Based Issues; and 18, Telepractice. dparafiniuk1234@gmail.com
    Diana Parafiniuk, MS, CCC-SLP, is chief marketing officer and co-founder of E-Therapy. She is an affiliate of ASHA Special Interest Groups 16, School-Based Issues; and 18, Telepractice. dparafiniuk1234@gmail.com×
  • Tracy Sippl, MS, CCC-SLP, is a clinician with expertise in telepractice. She is an affiliate of ASHA Special Interest Groups 4, Fluency and Fluency Disorders; 16, School-Based Issues; and 18, Telepractice. ptsipp@yahoo.com
    Tracy Sippl, MS, CCC-SLP, is a clinician with expertise in telepractice. She is an affiliate of ASHA Special Interest Groups 4, Fluency and Fluency Disorders; 16, School-Based Issues; and 18, Telepractice. ptsipp@yahoo.com×
Article Information
School-Based Settings / Telepractice & Computer-Based Approaches / ASHA News & Member Stories / Overheard
Overheard   |   July 01, 2017
Telepractice in Schools: What Works Best?
The ASHA Leader, July 2017, Vol. 22, online only. doi:10.1044/leader.OV.22072017.np
The ASHA Leader, July 2017, Vol. 22, online only. doi:10.1044/leader.OV.22072017.np
Participant: What do you see as the main benefits and challenges for telepractice in school settings?
Cheval Bryant: The main benefit is that we are able to serve students who are not willing or able to attend brick-and-mortar schools for various reasons. Many of these students have disabilities such as autism, anxiety or other mental health disabilities. Telepractice allows us to reach those students where they are. In Texas, our board rules require that we evaluate students face to face. The main challenge for us [at the Houston Independent School District, HISD], as a school district serving students across the entire state of Texas, is that we find it difficult to find staff to fulfill the state requirement for a face-to-face evaluation and initial visit. However, we do understand the need for this requirement.
Tracy Sippl: Benefits are that students are very comfortable with technology and they are able to accomplish more in less time, as studies have demonstrated. A particular challenge from a teletherapist point of view is collaboration with both the teletherapy company you contract with as well as with staff onsite at the school. I have also run into issues with inadequately trained telehelpers. A challenge that future school teletherapists might want to consider is no pay over summer months. Additional benefits for those of you considering teletherapy: You will usually have summers off, you are working from home or while you travel (dependent on location), and you can set your own hours.
Diana Parafiniuk: Due to the therapist shortage, rural and inner-city schools face challenges and have difficulty staffing. Teletherapy offers an alternative for schools that have challenges finding in-person therapists to serve students. Challenges using teletherapy might be when working with the severe/profound population of students, where there really needs to be a team effort in providing services.

“A particular challenge is collaboration with both the teletherapy company you contract with as well as with staff onsite at the school.”

Participant: So do you have one professional evaluate a student face to face, then another professional provide services through telepractice?
Parafiniuk: Each state is unique. Not all states require an initial onsite evaluation. Most states allow evaluations to be conducted via telepractice.
Sippl: I have performed numerous evaluations during which I do all of the assessments without the student having any onsite assessments.
Participant: How do you determine which students are appropriate to serve via telepractice?
Parafiniuk: We communicate directly with the staff, review IEP goals, speak with IEP team members and discuss the caseload in depth. Once we have all the information, we make a professional, ethical and educated decision on who is suitable for teletherapy. Over the years, we have experienced that most students can participate in teletherapy. We also have seen that most students achieve great success with interventions via telepractice.
Sippl: I believe that almost any student can be serviced via teletherapy. Some students take more planning and may require more than one person providing the service, but it can be done. I have only encountered one student during my four-plus years providing teletherapy that I recommended for a different service delivery model because I did not feel that I was able to meet his needs appropriately. This student was diagnosed with all of the following: severe autism, Down syndrome, hearing loss, visual impairment and ADHD [attention-deficit/hyperactivity disorder]. If the student is unable to interact with a computer, they won’t be the ideal candidate for teletherapy. However, there are other ways to provide services without actually using the computer to interact with such a student.
Bryant: The state of Texas requires that the first visit be a face-to-face therapy session. We send someone to the student’s home to conduct the session and then write a therapy note indicating whether or not they are a good candidate.
Participant: I’m trying to get a sense of how a K–12 institution, such as HISD, thinks about telepractice speech-language pathology as part of its broader budgeting “process.” Is telepractice also viewed as a way to help out on the budget side?
Sippl: I think that is where much of the concern comes from when speaking with onsite SLPs. I know there are savings to be had since the school districts are no longer having to provide benefits (for example, paid sick days, insurance), but I am a firm believer that teletherapy should only be a resource for those districts that are unable to find qualified applicants due to remote location, staff turnover, etc. Teletherapy has a place, but I firmly believe that it is not to be used to replace staff, but to serve as a resource to supplement it. That’s not to say that teletherapy cannot be as effective as onsite therapy, but it shouldn’t take over SLP jobs that are currently filled.
Parafiniuk: Our schools have said that they have found it beneficial to use telepractice for their bottom line when working with a confined budget, especially for rural schools. To clarify, providing teletherapy can be helpful for a budget, in regards to saving on transportation costs. But, in no way is it to replace an onsite therapist. Our schools who can find an onsite therapist will always hire that therapist if possible.
Bryant: Well, in HISD, it made more sense for us to contract with a company that already had the available resources and platforms in place.
Participant: Have you ever worked with a child with ASD [autism spectrum disorder]? If so, do you have any tips? I find it difficult because that social piece is so important but hard to achieve during teletherapy.
Bryant: Yes. If you have the capabilities, try to set up group therapy via your teletherapy system.
Parafiniuk: We have found that when working with students with autism, teletherapy has been great. There are many interactive activities, videos and “groups” you can offer to students with ASD, in order to create social situations and interactions. The video windows also can provide great facial-expression feedback as well. Students with ASD really do wonderfully working on the computer and interacting digitally.
Sippl: I worked with a 3-year-old in the Philippines years back via teletherapy. He was nonverbal and on the autism spectrum. I found the best way to help this little guy was to work through the parents! I supervised via teletherapy and met with the parents before and after each session. This boy was receiving services in the home. In the school setting, I work with the students’ aides as well as their teachers and parents. Having weekly meetings about goals and objectives we wanted to accomplish and instructing the aides in what type of interactions to set up allow me to achieve the social skills goals. Use your creativity! My students with Asperger’s love teletherapy! When I’ve worked with middle-schoolers, using various resources on the internet geared toward their interests is very motivating. They are a blast to work with!
Participant: How does telepractice provide more consistent therapy than face to face? Is there support in the research for this?
Parafiniuk: Schools that are in need of therapists often find contractors who can only be onsite every other week or once a quarter due to travel and/or the remote location of school, or sometimes there is just a shortage of therapists in an area where a school is located. Teletherapy can offer therapy that meets the IEP frequency of service that is allotted to the student.
Sippl: There is definitely research to support this. Students are so tech-savvy, and working in front of a computer is highly motivating to them. I have less difficulty with behaviors, I am able to hold students’ attention much easier, and we are able to accomplish more because of these factors. After working in the schools for over 24 years, I have found teletherapy to be a very refreshing way to provide services! I no longer need to stand on my head (tongue in cheek here) to keep “Johnny’s” attention. Seriously. Also, the companies I work with have a pool of teletherapists, so if I need to miss a day of teletherapy due to illness, etc., some companies have another step in to cover services that day. There is no need for missed services if the schools contract with such a company.
Bryant: We certainly have fewer missed days of therapy, and there are usually few interruptions for meetings, fire drills or therapist absences. Most, if not all, of our absences are the result of the student missing therapy. There are fewer distractions from other students. There are more opportunities for repetitive work.
Participant: What resources and support are important for a telepractice company or provider to offer? What resources should exist on the school’s side?
Bryant: It is most important for a telepractice company to provide personnel who are technologically savvy and who have excellent problem-solving skills. In addition, the SLP needs to be very self-sufficient and proactive in engaging with the families of the students they serve. It is extremely important that the telepractice company provides strong, accessible and responsive IT professionals. It is equally important that the district’s IT department is willing to work with the telepractice company when needed.
Parafiniuk: The school needs to make sure that they have aides or e-helpers to assist the student in getting to and from therapy. The provider should be in close communication with the school staff in order to implement and monitor a successful teletherapy program.
Sippl: I have found that some teletherapy companies do not always provide mentors or support for the teletherapist nor the schools. A brief training and a video do not typically constitute support, and I have, in the past, felt like I was alone. For future teletherapists, you will definitely want to ask this question when speaking with potential contracting companies. The schools usually provide the telehelper, but the teletherapy company typically trains that person. I have found that I usually end up training telehelpers about my expectations for them as well as how we will be working together. I ask the school to provide the materials I need to work with students, such as a quiet room, markers, scissors, paper, appropriately sized chairs, a lockable filing cabinet, etc.
Participant: Can it be lonely to do teletherapy as a full-time profession? What I mean is, if you are an SLP professional onsite, you see colleagues on a day-to-day basis. Is it lonely then to switch into a teletherapy role where you are by yourself in front of a computer?
Sippl: It is an adjustment. I found myself ready to be home, so it hasn’t been as big of an issue as it could be. It can be lonely, but I have involved myself in my community by volunteering and joining clubs to get that personal contact. What I miss most are the hugs from my students.
Parafiniuk: Our company provides a very interactive and communicative space for teletherapists. We really want to create an environment where therapists feel part of a community. The teletherapist lifestyle is most definitely different from an “in-house” therapist. Some therapists really thrive with working independently and having a more flexible work schedule, while others prefer to work onsite.

“Our company provides a very interactive and communicative space for teletherapists. We really want to create an environment where therapists feel part of a community.”

Participant: We had a teletherapist who worked for our district from a company. Our director had to replace her due to complaints from staff that she didn’t know what she was doing. It left a bad taste with the director about teletherapy. I don’t think it was the delivery—it was her inexperience. I really felt like it was because she was right out of her clinical fellowship and really hadn’t achieved the art of therapy skills. What checks and balances do the contract companies have to make sure their therapists are delivering good therapy?
Sippl: One of the companies I consulted with required at least two years’ experience in schools post-clinical fellowship to be a candidate for hiring as a teletherapist.
Parafiniuk: I completely understand your concerns as an SLP. Concerns are the same for onsite therapists as well as the teletherapist. For example, you want to make sure the therapist is capable of providing skilled therapy, problem-solving, engaging the student, addressing the student’s goals appropriately, tracking therapy, and following up with team members. Some therapists coming out of their clinical fellowship are great, with a keen understanding of how to be a great therapist, while others really struggle and need more support in order to do a good job. There are therapists who have been providing therapy for years and still do not offer high-quality therapy. It is really important to be able to identify good therapists, monitor services, and make sure the school and the therapist are a good fit.
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July 2017
Volume 22, Issue 7