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Clinical & Program Support

 

Switching to Telepractice: How to Ensure a Smooth Transition

Switching to Telepractice: How to Ensure a Smooth Transition By Rachelle Comeau
Speech-Language Pathologist, The Hanen Centre


The world has changed drastically in the past month, forcing many of us to come up with creative ways to do the things that once seemed so routine. “Game nights” with friends, exercise classes and even music events are now occurring via online platforms so everyone can practice social distancing. But what about work? With social distancing, our roles as speech-language pathologists look very different – we can no longer see children and their families in person, so many are turning to the alternative: telepractice.

Telepractice: What makes it work?

If you have never provided therapy via telepractice, you may be a little nervous about trying it – especially during such a chaotic time. The good news is that The Hanen Centre has done the groundwork for you when it comes to knowing what works best to provide our programs via telepractice. We are very excited to share how we’ve accomplished this and how it relates to recent research findings.

So, what does the research say is important for telepractice to be successful? A study looked at speech-language pathologists’ (SLPs) experiences and perceptions of transitioning to telepractice to determine which factors resulted in a positive experience, and which factors presented challenges. The authors interviewed 15 SLPs who provided 1 on 1 therapy for school-aged children after they transitioned from face-to-face therapy to telepractice.

Following these interviews, the authors were able to identify four key components to ensuring a positive telepractice experience:
  1. establishing therapeutic relationships with children;
  2. working collaboratively with parents and teachers who assisted with therapy by sharing information on the child’s home life, providing feedback on the child’s progress and supporting the child during the sessions;
  3. having adequate resources and technology; and
  4. having access to support for learning how to provide services via telepractice (Hines, Lincoln, Ramsden, Martinovich, & Fairweather, 2015).
While our programs involve working with parents as opposed to children, there are some interesting outcomes related to the above-mentioned factors that provide insight into making the transition to telepractice as smooth as possible.

Building therapeutic, collaborative relationships

Most of the SLPs in the study were initially concerned about the ability to develop a relationship with the child through their computer screen but were surprised how easily they formed a connection. However, of more interest to us is the SLPs’ experience interacting with the parents or therapy assistants. The SLPs indicated that having an assistant or parent involved in therapy was very beneficial.

The SLPs indicated that, although it took more time to develop relationships with parents and assistants via telepractice than during face-to-face therapy, these relationships and collaboration were crucial in order to adopt a child-centered approach to intervention. They reported that it was helpful to have one consistent person following up and working with the child. When that parent or assistant was actively involved in therapy, they could share details about the child’s goals and progress with other important people in the child’s life. This included people with whom the SLP may not be in touch – babysitters, day care providers, grandparents, etc. As a result, the child could receive support from many people, in a variety of contexts.


Addressing therapeutic relationships and collaboration in Hanen Programs via telepractice


We know that building a relationship with parents is key to ensuring their success in the program.

No private conversations in programs offered via telepractice

In your in-person programs, you might get to know parents by chatting informally before the session, during the break or after the session. You may have the opportunity to do this online if a parent joins your session early; however, we have found that this occurs less frequently in telepractice programs especially because there are no private conversations — everyone can hear what is being said during the sessions. Therefore, most communication with parents during an online program is done through email or by phone, as necessary. By establishing open communication through email, the SLP can build rapport and help parents feel like they can reach out if they have any questions or concerns.

Note: Email isn’t a secure form of communication and we always get parents’ consent to communicate via email. SLPs must always perform a thorough analysis of privacy regulations and requirements in their region and have permission to use email from relevant parties, acknowledging that it is an insecure form of communication.


Collaborating with parents in various program activities

We also know that actively collaborating with the parents and including them in decision-making leads to a stronger rapport.
  • Pre-program consultation — just as in an in-person program, the collaboration with parents starts at the pre-program consultation by engaging them in identifying their child’s stage of communication and selecting communication goals.
  • Home plans — parents complete a home plan form every week. On this form, they note their child’s goal, the activity they plan to try and how they will implement the language facilitation strategies they’ve learned during that session. They share this plan with the SLP, who may ask questions and have a general discussion about how they will apply this plan during the week. To make this easier for telepractice, we’ve digitized the home plans – they are now fillable PDFs that the parents can easily complete on their computers and send to you!
  • Parent-parent support — there is an additional layer to therapeutic relationships in Hanen programs, which involves the relationships between parents in a group. Hanen Programs via telepractice are still run with no more than 8 families in a group to promote optimal engagement between parents. Group discussions occur in a gallery view, so all participants can see one another, making it easier to talk to each other. We have found that families connect with one another online just as they do in person. We still use ice breaker activities to help parents get to know one another and breakout groups to give parents a chance to speak in smaller groups, just as they would in a live program. While we have found that there are fewer opportunities for incidental conversations between parents during the online sessions, there are alternative ways they can form connections. For example, the SLP can encourage them to create a closed Facebook group together to connect outside of the sessions.


Helping parents build relationships during a Hanen Program via telepractice

  • We provide time for parents to have discussions in smaller breakout groups, so they can get to know one another.
  • We share tips on how to facilitate a group via telepractice in the section titled “Managing group dynamics via telepractice” in our telepractice manual. For example, we provide tips on how to ensure each parent can participate during a telepractice session. This is more challenging during a telepractice program because it is easy for parents to talk over each other if they don’t realize another person is about to speak. In order to avoid having parents talk over one another, the SLP can call on specific parents to comment during discussions.


Having adequate resources and technology

One of the negative factors of telepractice that SLPs in the study identified was having to create their own resources. They preferred to use resources that were already created and available.

They also identified that technology itself can create issues. Not surprisingly, they indicated that a good internet connection is vital for an effective telepractice session. They also indicated that it can be difficult to pick up on the children’s subtle behaviors through their screen.


Addressing resources and technology during a Hanen Program via telepractice

In our Hanen Programs offered via telepractice, we have duplicated every component of our in-person programs, including the PowerPoint slides with video clips, fillable flip charts, small group discussions and video feedback sessions. It’s the same program you know, provided in a new format. We’ve also created resources to show you exactly how to offer the programs in telepractice format so there is no guesswork involved! On each PowerPoint slide, there is information in the “Notes” section to help guide you – there are technology instructions for each specific slide and references to the Making Hanen Happen Leader’s Guide so you can cross check your resources.

We have outlined the technology requirements for both you and the families in your program, so you’ll know exactly what you need and what to look for in the software you will be using. Although internet connection may be out of your control, we share tips on how you can make the most of your connection. We also share tips on the bandwidth size you will require and how to check this.

When it comes to the issue of observing subtleties in the child’s behaviour, it is true that is may be difficult to observe everything through your screen. However, as we help parents to closely observe their children, they become more tuned in to their child’s interactive behaviours and they identify things that we may not see.


Using resources and technology during your Hanen Program via telepractice

  • We recommend having a hardwired internet connection rather than relying on Wi-Fi. This will help establish a stronger connection and avoid cutting out.
  • We conduct a “tech check” prior to the Orientation session to ensure everything is working properly and encourage families to do the same. This makes a big difference because it allows us to work out any issues before the session itself.
  • We recommend using two monitors during the sessions. This allows us to see our participants and notes on one screen and share our PowerPoint with the families on the other screen.
  • We encourage you to practice using the software (i.e., sharing your screen, filling out a flip chart, making breakout groups) beforehand with friends, family members or coworkers. This will help you feel more confident during your session.
  • In our Hanen Program Manual for Telepractice, we created session modification documents to outline anything from the in-person program that has been changed in the telepractice version so it’s easy for you to identify the modified aspects of the program and familiarize yourself with them.


Access to support

The SLPs in the study indicated that initially they felt worried about navigating the technology, but found that they learned how to use the platforms quite quickly. They shared several ways in which they were able to learn: receiving informal training, practicing using the platforms prior to their sessions, observing telepractice sessions and having discussions with other SLPs who were experienced in telepractice. With everything currently happening at such a rapid pace, you may be feeling concerned about learning the ins and outs of telepractice.


Addressing support for clinicians during a Hanen Program via telepractice

We want your transition to telepractice to be as smooth as possible. So, we created our Hanen Program Telepractice manual to support you. It includes important tips, such as how to fill in online flip charts and what communication to send to families before and after each session (with sample emails). We’ve trialed everything in our own pilot programs to make all the tweaks and adjustments necessary so you can have a streamlined program right from the start!

As part of the telepractice license, you are also granted access to a tutorial that shows how to use the different aspects of a video conferencing platform. This tutorial will give you an idea of what it looks like to run a Hanen Program online. As a Hanen member, you have access to our discussion forums – this is a great place to reach out to other clinicians who may have previous telepractice experience.


Accessing support during your Hanen Program via telepractice

  • We have a discussion forum on the Hanen members website which is a great way to connect with other clinicians running Hanen Programs via telepractice to ask questions or share tips.
  • We recommend making use of tutorials and trainings offered by teleconferencing platforms. For example, Zoom offers free live training webinars to help get you started.
  • We welcome you to reach out to us – we are always happy to answer your telepractice questions!
We know you have a lot on your plate right now. We hope that this information will be helpful and provide you guidance and confidence as you navigate the world of telepractice. Good luck!

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References

Hines, M., Lincoln, M., Ramsden, R., Martinovich, J., & Fairweather, C. (2015). Speech pathologists’ perspectives on transitioning to telepractice: What factors promote acceptance? Journal of Telemedicine and Telecare, 21(8), 469-473.

Erdmann, J., Weitzman, E., McDade, A., Boaden, D. (2019). The Hanen Program® Manual for Telepractice for the More Than Words Program.