Administrators and clinicians are asking questions about telepractice and how to use it in school-based settings across the country. These discussions are full of all sorts of calculations about money and time, assumptions about what can and can’t be done, and worries about what sacrifices must be made.
At Hello, we’ve been at this telepractice thing for over a decade now. We’ve been a part of models that use telepractice to address a lack of specialists, high caseloads, low caseloads, crazy distances, and even unaffordable housing. ASHA’s Special Interest Group on Telepractice published a recent Perspectives article on the use of telepractice as a workload management strategy. Interestingly, all of these different implementations have developed not as an evolution towards The Perfect Telepractice model, but instead as a way for each district and each building and each team to use telepractice in the way that is the best fit for their circumstances.
Knowing that telepractice designs are endlessly flexible and adaptable is one thing, but actually sorting out a plan is quite another. To help get the ball rolling and your creative ideas flowing, here are 3 examples of hybrid solutions combining onsite and telepractice SLP services that have proven to be winning combinations for both districts and students.
Some of our SLPs work in schools with certified SLPAs. These licensed professionals have the training to work from an SLP’s therapy plan, lesson plan, and collect and report data. Using this telepractice design, a part-time SLP can combine time onsite with telepractice. They can complete case management tasks and paperwork for the whole caseload offsite, providing SLPA supervision via streaming video, and spend onsite time on evaluations, student observations, and collaboration tasks.
Why it’s win-win: Districts can use SLP time most efficiently with SLPA support. SLPAs learn and grow with direct and indirect supervision when they need it, instead of minimum minutes at the same time every week.
Bilingual Service Model
Some districts are serving a significant number of Spanish-speaking students, but don’t have the bilingual SLPs required to support them. One solution has been to hire bilingual facilitator/aides to co-teach with highly qualified SLP-telepractitioners. Using a 3:1 model and a hybrid schedule, the SLPs and bilingual aides can run sessions together over streaming video, and complete evaluations together during an onsite consult week.
Why it’s win-win: Buildings can hire facilitator/aides from the community more easily than finding licensed SLPs. The SLP provides the expertise to design and guide therapy and utilizes the bilingual assistants to conduct culturally and linguistically appropriate evaluations. As a bonus, the mentored and trained local aides represent a long-term investment in the community!
Direct Telepractice Model
Sometimes there are special circumstances that can accommodate telepractice in unique ways. One of our partner-districts decided to use SLP-telepractitioners at the middle school level. They had a high incidence of students with ASD and a variety of support models ranging from self-contained classrooms to scheduled time in classrooms to drop-in resources. The schools had no additional support staff to assign to a telepractice SLP. Their solution was to set up telepractice stations in small rooms adjacent to the support classrooms where students worked 1:1 directly with the SLP via telepractice. Because of the social nature of many of their goals, our SLPs pre-taught skills or reviewed videos during the 1:1 sessions, and worked in larger groups when they were onsite. Consolidating the students into larger groups during the onsite time also gave the SLP time to complete in-person assessment tasks.
Why it’s win-win: Districts can fill their need for SLPs without having to hire additional support staff. Students with social goals can access support within their academic schedule, in a variety of supported contexts.
The choice between providing traditional face-to-face services or providing services via telepractice streaming video is not as black and white as it once seemed. Our advice? Consider telepractice for what it is: one of many service provision models. Just like traditional options — seeing students 1:1, working in small groups in the speech room, seeing students in their classrooms — there is rarely one right answer that works for your whole caseload. We have to do the best we can with the circumstances and resources we have. Often, the outcomes that emerge when we get creative surprise us.
There are many combinations and varieties of service provision, and all kinds of reasons for choosing one design over another. Can you imagine a winning combination for telepractice and your unique caseload? Contact us or reach out to us on social (Facebook, Twitter, Instagram, LinkedIn) and let us know!