Is Telehealth and Telepractice Effective?

By: Blink Session

At Blink Session we are committed to helping clinics, schools, hospitals, and private practitioners advance the use of Telehealth. We are often asked about telehealth and telepractice effectiveness and have put together this list of research, stories, and other resources to help. If you have anything to add to the list, please email us at info@blinksession.com

Stories & Insights

What I’ve Learned About School Telepractice
Andrea Szwabowski, Leader Live — Happening Now in the Speech-Language-Hearing World (blog), February 5, 2018.

Pandora’s Story; Occupational Therapy via Telepractice to Remote Northern Territory
Therapy Connect

Children's Hearing and Speech Centre
Telepractice Programs, Richardson, Loretta L.,Volta Review 112, no. 3 (2012): 429–33.

Abstract Excerpt: "The article profiles the Children's Hearing and Speech Centre of British Columbia, which has provided a listening and spoken language option since 1963 for children who are deaf and hard of hearing. A discussion of a decision which the center made in 2006 to provide direct services via telepractice to families of children from birth to age five living outside of the greater Vancouver area, is presented. The features of the center's telepractice services, including the A Sound Move service and the Stepping Out service, are discussed."

Telepractice Services at Sound Beginnings at Utah State University
Blaiser, Kristina M., Marge Edwards, Diane Behl, and Karen F. Muñoz., Volta Review 112, no. 3 (2012): 365–72.

Abstract Excerpt: The article profiles the Utah State University Sound Beginnings program, which originated in 2007 as a laboratory school for children with hearing loss and in 2012 offers an interdisciplinary listening and spoken language educational option for families with services which include toddler and preschool classrooms, individual therapy, home-based early intervention, and onsite pediatric audiology services. A discussion of telepractice technologies and telepractice sessions which are included in the Sound Beginnings program is presented.

University of Maine Speech Therapy Telepractice Program (Video)

Seeing the World—From Inside School Walls
Wright, Kira, The ASHA Leader, April 2017

Telepractice in Schools: What Works Best?
Bryant, Cheval, Diana Parafiniuk, and Tracy Sippl, The ASHA Leader, July 2017

Social Mediating: Using Telepractice for Clients With Autism
Leader Live — Happening Now in the Speech-Language-Hearing World (blog), April 28, 2015

Speech Therapy Telepractice Program - University of Maine.

Is Telepractice Actually Effective?
Kendra Holloway, Orca Online Speech Therapy - Blog

Telepractice: Creating a Statewide Network of Support in Rural Maine
Hopkins, Karen, Barbara Keefe, and Angela Bruno, Volta Review 112, no. 3 (2012): 409–16

Abstract Excerpt: The article profiles the Maine Educational Center for the Deaf and Hard of Hearing, which is located on a small island off the coast of rural Maine and provides services to children from birth through age 21 who are deaf and hard of hearing. An overview of the center's Providing Opportunities for Integrating New Technologies (POINT) project, which has implemented a telepractice, distance learning collaborative that uses Tandberg videoconferencing technology to provides services to clients in rural locations, is presented.

Speech Pathology Australia Interviews Sue Cameron at Therapy Connect about Telepractice (Video)

Implementing Coaching in a Natural Environment through Distance Technologies.
Hamren, Kim, and Suzanne Quigley, Volta Review 112, no. 3 (2012): 403–7

Abstract Excerpt: The article profiles Listen and Talk, an early intervention and preschool program in Seattle, Washington, that offers auditory-verbal education and therapy to children with hearing loss and their families and features staff members who provide consultations on education for students with hearing loss to public and private schools across the state. A discussion of a coaching model which the program uses to support the parents of children with hearing loss, and of a decision which the program made in 2011 to implement a telepractice service to provide its services to families in remote locations, is presented.

How Some Colleges Use Teletherapy to Reach More Students
FIELD, KELLY, Chronicle of Higher Education 63, no. 12 (November 11, 2016): A14–15.

Abstract Excerpt: The article discusses various online therapy programs for counseling and treating college students with mental health issues. Topics covered include the Therapist Assisted Online (TAO) developed by former counseling center director Sherry Benton at the University of Florida, the WellTrack self-help program used in some colleges in the U.S., and the use of teletherapy in other U.S. colleges. It also discusses the SilverCloud online program used at the University of Minnesota-Twin Cities.

Effectiveness Research

Effects of a Tablet-Based Home Practice Program With Telepractice on Treatment Outcomes in Chronic Aphasia
Kurland, Jacquie, Anna Liu, and Polly Stokes, Journal of Speech, Language & Hearing Research 61, no. 5 (May 2018): 1140–56.

Abstract Excerpt: Purpose: The aim of this study was to determine if a tabletbased home practice program with weekly telepractice support could enable long-term maintenance of recent treatment gains and foster new language gains in poststroke aphasia... Results: Home practice was effective for all participants with severity moderating treatment effects, such that individuals with the most severe aphasia made and maintained fewer gains. There was a negative relationship between the amount of training required for iPad proficiency and improvements on practiced and unpracticed pictures and a positive relationship between practice compliance and same improvements. Conclusion: Unsupervised home practice with weekly video teleconferencing support is effective. This study demonstrates that even individuals with chronic severe aphasia, including those with no prior smart device or even computer experience, can attain independent proficiency to continue practicing and improving their language skills beyond therapy discharge. This could represent a low-cost therapy option for individuals without insurance coverage and/or those for whom mobility is an obstacle to obtaining traditional aphasia therapy.

Comparing Traditional Service Delivery and Telepractice for Speech Sound Production Using a Functional Outcome Measure
Coufal, Kathy, Douglas Parham, Melissa Jakubowitz, Cassandra Howell, and Jared Reyes, American Journal of Speech-Language Pathology 27, no. 1 (February 2018): 82–90.

Abstract Excerpt: This investigation compared traditional service delivery and telepractice service delivery for children receiving therapy for the NOMS diagnostic category of “speech sound production.”...A total of 1,331 ASHA NOMS cases and 428 telepractice cases were included...Results: There were no significant differences in the median change scores between the traditional group and the telepractice group. Conclusions: These results suggest comparable treatment outcomes between traditional service delivery and telepractice for treatment of children exhibiting speech sound disorders.

Speech pathologists' perspectives on transitioning to telepractice: What factors promote acceptance?
Hines, Monique, Michelle Lincoln, Robyn Ramsden, Julia Martinovich, and Craig Fairweather, Journal of Telemedicine and Telecare 21, no. 8 (December 2015): 469–73.

Abstract Excerpt: Little is understood about factors that influence speech-language pathologists' (SLPs') acceptance of telepractice. The aim of this study was to investigate SLPs' perceptions and experiences of transitioning to a school-based telepractice service to identify factors that contributed to positive clinician attitudes...Results indicated that although SLPs reported initially having mixed feelings towards telepractice, they later evaluated telepractice positively and viewed it as a legitimate service delivery mode. The overarching theme was that positive beliefs about telepractice were associated with perceptions of its consistency with the underlying principles of face-to-face therapy. In evaluating telepractice, SLPs considered: (a) therapeutic relationships with children; (b) collaboration with parents and teachers; (c) adequacy of technology and resources; and (d) access to support for learning telepractice. Therapy assistants and specific clinician attributes emerged as key strategies used to manage threats to acceptability. Preparation of SLPs transitioning to telepractice should address factors that support positive experiences with, and attitudes towards, telepractice to ensure that training achieves the greatest, most sustained change.

Preparing Interventionists via Telepractice in Incidental Teaching for Children with Autism.
Neely, Leslie, Mandy Rispoli, Stephanie Gerow, and Ee Hong, Journal of Behavioral Education 25, no. 4 (December 2016): 393–416.

Abstract Excerpt: The purpose of this study was to evaluate the use of telepractice to train interventionists to implement incidental teaching with preschool children with ASD. Three interventionists were taught to implement incidental teaching using a telepractice training package consisting of an online module, self-evaluation, and delayed performance feedback delivered via videoconferencing...Results showed that following the telepractice training program, interventionist implementation fidelity improved and child mands increased. Within six telepractice sessions, all interventionists reached the preset performance criteria of four consecutive sessions above 90 % fidelity....These results suggest that telepractice is a promising method of providing instruction in incidental teaching to interventionists of young children with ASD.

Telepractice Versus In-Person Delivery of Voice Therapy for Primary Muscle Tension Dysphonia.
Rangarathnam, Balaji, Gary H. McCullough, Hylan Pickett, Richard I. Zraick, Ozlem Tulunay-Ugur, and Kimberly C. McCullough, American Journal of Speech-Language Pathology 24, no. 3 (August 2015): 386–99.

Abstract Excerpt: Purpose: The purpose of this study was to investigate the utility of telepractice for delivering flow phonation exercises to persons with primary muscle tension dysphonia (MTD)...Results: Perceptual and quality-of-life measures were significantly better posttreatment and were statistically equivalent across groups...The results of this study indicate that flow phonation exercises can be successfully used for patients with MTD using telepractice."

An Evaluation of Virtual Home Visits in Early Intervention: Feasibility of 'Virtual Intervention'
Olsen, Sue, Barbara Fiechtl, and Sarah Rule, Volta Review 112, no. 3 (2012): 267–81.

Abstract Excerpt: The provision of consistent high quality home- and community-based services to children with disabilities living in rural and frontier areas is a challenge...Videoconferencing offers a viable means to address these challenges and is becoming increasingly accepted..This article offers a rationale for using a telepractice model for early intervention--virtual home visits (VHV) conducted via videoconferencing--and describes components of the service model, including equipment needs, costs, and training requirements.

Internet-Based Telehealth Assessment of Language Using the CELF-4
Waite, Monique C., Deborah G. Theodoros, Trevor G. Russell, and Louise M. Cahill, Language, Speech & Hearing Services in Schools 41, no. 4 (October 2010): 445–58.

Abstract Excerpt: The aim of this study was to validate an Internet-based telehealth system for assessing childhood language disorders. Method: Twenty-five children ages 5 to 9 years were assessed using the core language subtests of the Clinical Evaluation of Language Fundamentals-4th Edition (CELF-4; Semel, Wiig, & Secord, 2003). Each participant was simultaneously assessed online and face-to-face (FTF). Assessments were administered by either an online or an FTF speech-language pathologist (SLP), but were simultaneously rated by both SLPs. Results: No significant difference was found between the online and FTF total raw scores and scaled scores for each subtest....The results of this study support the validity and reliability of scoring the core language subtests of the CELF-4 via telehealth.

An Internet-Based Telerehabilitation System for the Assessment of Motor Speech Disorders: A Pilot Study
WHill, Anne J., Deborah G. Theodoros, Trevor G. Russell, Louise M. Cahill, Elizabeth C. Ward, and Kathy M. Clark, American Journal of Speech-Language Pathology 15, no. 1 (February 2006): 45–56.

Abstract Excerpt: This pilot study explored the feasibility and effectiveness of an Internet-based telerehabilitation application for the assessment of motor speech disorders in adults with acquired neurological impairment...Measurements of severity of dysarthria, percentage intelligibility in sentences, and most perceptual ratings made in the telerehabilitation environment were found to fall within the clinically acceptable criteria. However, several ratings on the FDA were not comparable between the environments, and explanations for these results were explored. Conclusions: The online assessment of motor speech disorders using an Internet-based telerehabilitation system is feasible. This study suggests that with additional refinement of the technology and assessment protocols, reliable assessment of motor speech disorders over the Internet is possible. Future research methods are outlined.

School-Based Language Screening among Primary School Children Using Telepractice: A Feasibility Study from India
Raman, Nitya, Roopa Nagarajan, Lakshmi Venkatesh, D. Saleth Monica, Vidya Ramkumar, and Mark Krumm, International Journal of Speech-Language Pathology, September 2, 2018, 1–10. https://doi.org/10.1080/17549507.2018.1493142.

Abstract Excerpt: Thirty-two primary school children underwent language screenings through in-person and telemethods. Screening through telemethod was conducted by a Speech-Language Pathologist (SLP) using digitised picture stimuli presented through videoconferencing and remote computing with assistance of a facilitator at school site...Language outcomes through in-person and telemethods revealed no significant differences in both receptive and expressive domains, suggesting absence of bias due to testing method used. Use of multiple internet options at both sites helped overcome technical challenges related to connectivity during screening through telemethod...Feasibility of conducting school-based language screening using multiple internet options and help of a facilitator at school demonstrates promise for delivery of services by SLP in resource constrained contexts such as India.

The Children's Attention-Deficit Hyperactivity Disorder Telemental Health Treatment Study: Caregiver Outcomes
Vander Stoep, Ann, Carolyn McCarty, Chuan Zhou, Kathleen Myers, Carol Rockhill, Erin Schoenfelder, Carolyn A McCarty, Carol M Rockhill, and Erin N Schoenfelder, Journal of Abnormal Child Psychology 45, no. 1 (January 2017): 27–43.

Abstract Excerpt: Tested the hypotheses that children and caregivers who received guideline-based treatment delivered through a hybrid telehealth service delivery model would experience greater improvements in outcomes than children and caregivers receiving treatment via a comparison delivery model...The CATTS trial supports the effectiveness of a hybrid telehealth service delivery model for reducing distress in caregivers of children with ADHD and suggests a mechanism through which the service model affected caregiver distress.

Clinical and Quality of Life Outcomes of Speech Treatment for Parkinson's Disease Delivered to the Home Via Telerehabilitation: A Noninferiority Randomized Controlled Trial
Theodoros DG, Hill AJ, Russell TG, American Journal of Speech Language Pathology, May 1, 2016

Abstract Excerpt: This study investigated the noninferiority and validity of an intensive speech treatment for people with Parkinson’s disease (PD) delivered via telerehabilitation to the home. The effect of location on online delivery was also investigated...No significant effect of online treatment location was identified. Conclusions: Clinical and quality of life outcomes supported the noninferiority and validity of online delivery of intensive speech treatment to people with PD in the home.

The Effect of Telerehabilitation on Missed Appointment Rates
COVERT, LYN T., JOHN T. SLEVIN, and JESSICA HATTERMAN, International Journal of Telerehabilitation 10, no. 2 (December 11, 2018): 65–72

Abstract Excerpt: The purpose of this study was to examine the effect of telerehabilitation on missed appointment rates in a rehabilitation clinic. Clients fail to attend scheduled appointments for a variety of reasons. Unmet appointments represent a loss of financial support as well as diminished efficiency and capacity to provide services. Speech therapy utilizing multiple appointments is most difficult to maintain during a treatment regimen. This may cause individuals to miss appointments and therefore not achieve desired results. For this study, researchers utilized an intense speech therapy technique, the Lee Silverman Voice Treatment (LSVT®) to measure compliance with scheduled appointments. Participants were randomized to either in-person treatment or telerehabilitation treatment at a site distant from the speech-language pathologist. Participants in the telerehabilitation (TR) condition completed significantly more appointments than participants in the in-person (IP) condition. When comparing results of treatment for each condition, there were no significant differences in outcome whether treated in the IP or TR condition of the study for monologue and picture description tasks, which are closely associated with conversational speech. There was a difference in the reading task with participants demonstrating significantly better post treatment results in the IP condition. The reason for this disparity is unclear and warrants further study. Full Article

A Field Study of Telepractice for School Intervention Using the ASHA NOMS K-12 Database
Gabel, Rodney, Sue Grogan-Johnson, Robin Alvares, Leah Bechstein, and Jacquelyn Taylor, Communication Disorders Quarterly 35, no. 1 (November 1, 2013): 44–53

Abstract Excerpt: The purpose of this article is to describe the characteristics and effectiveness of a telepractice speech-language therapy program for school-age children. Outcome data related to the caseload, type and amount of intervention, and student progress from a school-based telepractice therapy program were compared with the K-12 Schools National Outcomes Measurement System (NOMS) of the American Speech-Language-Hearing Association. NOMS provides data for students receiving intervention through direct, in-person service delivery models. The findings suggest many similarities between the characteristics of the telepractice and direct, in-person service delivery models. The telepractice service delivery model was effective for most students included in the study. Results of this study support the described telepractice service delivery model as a viable option for speech-language therapy services delivered to public school students with communication impairments..

A Pilot Study Comparing the Effectiveness of Speech Language Therapy Provided by Telemedicine with Conventional On-Site Therapy
Grogan-Johnson, Sue, Robin Alvares, Lynne Rowan, and Nancy Creaghead, Journal of Telemedicine and Telecare 16, no. 3 (2010): 134–39. https://doi.org/10.1258/jtt.2009.090608.

Abstract Excerpt: We compared the progress made by school children in speech language therapy provided through videoconferencing and conventional face-to-face speech language therapy. The children were treated in two groups. In the first group, 17 children received telemedicine treatment for 4 months, and then subsequently conventional therapy for 4 months. In the second group, 17 children received conventional treatment for 4 months and then subsequently telemedicine treatment for 4 months. The outcome measures were student progress, participant satisfaction and any interruptions to service delivery. Student progress reports indicated that the children made similar progress during the study whichever treatment method was used. There was no significant difference in GFTA-2 scores (Goldman-Fristoe Test of Articulation) between students in the two treatment groups. Satisfaction surveys indicated that the students and parents overwhelmingly supported the telemedicine service delivery model. During the study, a total of 148 of the 704 possible therapy sessions was not completed (21%); the pattern of cancellations was similar to cancellations in US public schools generally. Videoconferencing appears to be a promising method of delivering speech language therapy services to school children.

Evaluating the Feasibility of a Play-Based Telehealth Intervention Program for Children with Prader-Willi Syndrome
Dimitropoulos, Anastasia, Olena Zyga, and Sandra Russ, Journal of Autism & Developmental Disorders 47, no. 9 (September 2017): 2814–25.

Abstract Excerpt: Here we report the feasibility and acceptability of telehealth for direct intervention in children with Prader-Willi syndrome (PWS). Children with PWS have social-cognitive challenges that are similar to children with ASD. However, developing behavioral interventions for individuals with PWS is faced with the significant challenge of enrolling enough participants for local studies where multiple visits per week are indicated for effective intervention. This study delivered a 6-week play-based intervention via telehealth directly to eight children with PWS (6-12 years). Participants completed the program with minimal behavioral or technological difficulty (#sessions M = 11.875/12). Behavioral Intervention Rating Scale results indicate good acceptability (M = 5.54/6.00). These findings support using telehealth in rare disorders and delivering intervention directly to children with developmental delays through this modality.

Conducting Functional Communication Training via Telehealth to Reduce the Problem Behavior of Young Children with Autism
Wacker, David, John Lee, Yaniz Padilla Dalmau, Todd Kopelman, Scott Lindgren, Jennifer Kuhle, Kelly Pelzel, Shannon Dyson, Kelly Schieltz, and Debra Waldron, Journal of Developmental & Physical Disabilities 25, no. 1 (February 2013): 35–48.

Abstract Excerpt: Functional communication training (FCT) was conducted by parents of 17 young children with autism spectrum disorders who displayed problem behavior. All procedures were conducted at regional clinics located an average of 15 miles from the families' homes. Parents received coaching via telehealth from behavior consultants who were located an average of 222 miles from the regional clinics. Parents first conducted functional analyses with telehealth consultation (Wacker, Lee et al. Journal of Applied Behavior Analysis, ) and then conducted FCT that was matched to the identified function of problem behavior. Parent assistants located at the regional clinics received brief training in the procedures and supported the families during the clinic visits. FCT, conducted within a nonconcurrent multiple baseline design, reduced problem behavior by an average of 93.5 %. Results suggested that FCT can be conducted by parents via telehealth when experienced applied behavior analysts provide consultation.

Multiple Stakeholder Perspectives on Teletherapy Delivery of Speech Pathology Services in Rural Schools: A Preliminary, Qualitative Investigation
Michele Lincoln, Monique Hines, Craig Fairweather, Robyn Ramdsen, Julia Martionvich, Journal of Developmental & Physical Disabilities 25, no. 1 (February 2013): 35–48.

Abstract Excerpt: The objective of this study was to investigate stakeholders’ views on the feasibility and acceptability of a pilot speech pathology teletherapy program for children attending schools in rural New South Wales, Australia. Nine children received speech pathology sessions delivered via Adobe Connect® web-conferencing software. During semi-structured interviews, school principals (n = 3), therapy facilitators (n = 7), and parents (n = 6) described factors that promoted or threatened the program’s feasibility and acceptability. Themes were categorized according to whether they related to (a) the use of technology; (b) the school-based nature of the program; or (c) the combination of using technology with a school-based program. Despite frequent reports of difficulties with technology, teletherapy delivery of speech pathology services in schools was highly acceptable to stakeholders. However, the use of technology within a school environment increased the complexities of service delivery. Service providers should pay careful attention to planning processes and lines of communication in order to promote efficiency and acceptability of teletherapy programs. Full Article

Understanding Older People's Readiness for Receiving Telehealth: Mixed-Method Study
Houwelingen, Cornelis TM van, Roelof GA Ettema, Michelangelo GEF Antonietti, and Helianthe SM Kort, Journal of Medical Internet Research 20, no. 4 (April 2018): 1–1.

Abstract Excerpt: The Dutch Ministry of Health has formulated ambitious goals concerning the use of telehealth, leading to subsequent changes compared with the current health care situation, in which 93% of care is delivered face-to-face...To study this, we created a theoretical framework consisting of 6 factors associated with older people's intention to use technology...Performance expectancy, effort expectancy, and perceived privacy and security are direct predictors of older people's intention to use videoconferencing. Self-efficacy appeared to play a role in both older people's intention to use, as well as their actual use of technology. The path analysis revealed that self-efficacy was significantly associated with older people's effort expectancy. Furthermore, self-efficacy and digital literacy appeared to play a major role in older people's capacities to make use of digital technology. Full Article

Positions on Telepractice of Professional Organizations

American Speech and Hearing Association

Speech-Language and Audiology Canada

The American Occupational Therapy Association (Advisory Opinion for the Ethics Commission)

Telehealth Periodicals

Perspectives on Telepractice (ASHA)

International Journal of Telerehabilitation (University of Pittsburgh)

Telemedicine and e-Health

Journal of Telemedicine and Telecare

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