Traveling SLP Magic: How to be in two places at once

Where are my itinerant clinician friends—those SLPs who pack up their therapy room in a weird rolling suitcase thing, make nice with administrative assistants all over town, eat in their cars, and find themselves constantly thwarted by conflicting building schedules? Yes, hello there! Let’s talk about how things could be different.

In a word… telepractice. As much as we value being physically present for our students and colleagues, we’re living in the age of Facetime, video conferencing, and working remotely. The whole realm of using technology to be a place that you’re not is now mainstream, and easier for people to accept and accommodate than even a few years ago. And after all, a 15-minute drive can easily mean 30 or 40 minutes of lost productivity, once you factor in packing/unpacking, parking, check-in, and everything else involved with a transition between buildings. This article takes the perspective that it’s not whether SLPs should be using telepractice, but how. There’s been plenty of research showing that telepractice can work (see our reviews on the topic), we just need to be smart about:

What job tasks we target for telepractice, and

How we go about it

The article lays out two case studies of SLP using telepractice for (1) direct service to high school students, (2) remote supervision of an SLPA, and (3) remote observations and consultations by a district AAC specialist. They include a lot of really helpful details about how they set these systems up, so definitely check out the article if you’re thinking about trying something similar. The authors studied the effectiveness of telepractice in these cases through a survey. The participants reported that:

  • Telepractice was effective and generally easy to implement for both direct and indirect services/supervision

  • The dreaded technical issues could be dealt with

  • It could be motivating to students, and

  • The SLPs had increased flexibility and decreased travel time

The downsides? Tech troubles did happen, and there were also some issues communicating and coordinating with sites. Choosing the right partners and laying down the groundwork is critical to making it work!

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The last part of the article lays out some very practical pro tips for other SLPs. For example, they recommend holding a team meeting upfront to demonstrate the systems you’ll use, answer questions, and secure buy-in from everyone involved. Also consider small but impactful steps like scheduling email reminders (with backup contact information and links to video sessions), or using two separate computers on the clinician end of thingsone for the audio/video, and one for all your other therapy “stuff.”  And if your admin needs any convincing? Remind them that you’ll be saving them time (from travel) and potentially money (from mileage reimbursements)!

Note: Not all states allow Medicaid billing of telesessions quite yet. So if you’re in the schools, that is an important thing to check first.

 

Boisvert, M. K., & Hall, N. (2019). Telepractice for School-Based Speech and Language Services: A Workload Management Strategy. Perspectives of the ASHA Special Interest Groups. doi:10.1044/2018_PERS-SIG18-2018-0004

And more...

Baylis and Shriberg found that 14 of 17 children (82.4%) with 22q11.2 deletion syndrome (aka DiGeorge syndrome and velocardiofacial syndrome) had comorbid motor speech disorders. Speech motor delay and childhood dysarthria were more common than CAS. These initial prevalence estimates add to a growing body of evidence that helps us better understand the profile of 22q syndrome.

Glover et al. found that young children (preschool through 3rd grade) had more negative attitudes toward stuttering than their parents. By 5th grade, those attitudes improved and were similar to attitudes of parents.

Hammarström et al. found that an intense treatment (4 sessions per week for 6 weeks) was effective for a 4 year old, Swedish-speaking child with a severe speech sound disorder. Treatment incorporated multiple approaches—integral stimulation, nonlinear phonology, and a core vocabulary approach. After therapy, the child produced more target words, word shapes, and consonants correctly.

Kraft et al. replicated an earlier study to find that effortful control (an aspect of temperament) was the most important factor predicting stuttering severity in children. They recommend addressing self-regulation as part of the holistic treatment of stuttering.

Lancaster and Camarata set out to explain the heterogeneity of language skills in kids with DLD. At this time, it’s looking like a spectrum model (think autism!) fits best, versus labeling kids by subtypes or chalking up the differences to unique, individual profiles; but lots more data is needed. For now, the evidence suggests we should assess and treat kids with DLD based on level of severity *and* individual needs—which is probably what you’re doing already. 

Lane et al. profiled the communication skills of children with Sotos Syndrome using a parent-report measure. They found that most of the children had a language impairment (with issues in both structure and pragmatics), with a relative strength in verbal vs. nonverbal communication and a weakness in using context. These children are likely to need support in peer relationships, too. 

Sutherland et al. found that a standardized language test (the CELF-4) can be reliably administered via telehealth to children with autism. The specific children they tested were between 9 and 12 years old and mostly mainstreamed.

 

Baylis, A. L., & Shriberg, L. D. (2018). Estimates of the prevalence of speech and motor speech disorders in youth with 22q11.2 deletion syndrome. American Journal of Speech-Language Pathology. doi:10.1044/2018_AJSLP-18-0037

Glover, H. L., St Louis, K. O., & Weidner, M. E. (2018). Comparing stuttering attitudes of preschool through 5th grade children and their parents in a predominately rural Appalachian sample. Journal of Fluency Disorders. Advance online publication. doi:10.1016/j.jfludis.2018.11.001

Hammarström, I. L., Svensson, R., & Myrberg, K. (2018). A shift of treatment approach in speech language pathology services for children with speech sound disorders – a single case study of an intense intervention based on non-linear phonology and motor-learning principles. Clinical Linguistics & Phonetics. Advance online publication. doi:10.1080/02699206.2018.1552990 

Kraft, S. J., Lowther, E., & Beilby, J. (2018). The Role of Effortful Control in Stuttering Severity in Children: Replication Study. American Journal of Speech-Language Pathology. Advance online publication. doi: 10.1044/2018_AJSLP-17-0097

Lancaster, H. S., & Camarata, S. (2018). Reconceptualizing developmental language disorder as a spectrum disorder: Issues and evidence. International Journal of Language and Communication Disorders. Advance online publication. doi:10.1111/1460-6984.12433

Lane, C., Van Herwegen, J., & Freeth, M. (2018). Parent-Reported Communication Abilities of Children with Sotos Syndrome: Evidence from the Children’s Communication Checklist-2. Journal of Autism and Developmental Disorders. Advance online publication. doi:10.1007/s10803-018-3842-0

Sutherland, R., Trembath, D., Hodge, M. A., Rose, V., & Roberts, J. (2018). Telehealth and autism: Are telehealth language assessments reliable and feasible for children with autism? International Journal of Language & Communication Disorders. Advance online publication. doi:10.1111/1460-6984.12440

And more

Boyce et al. found that school-aged children with cleft lip and/or palate had receptive and expressive language skills within the normal range, similar to their typically developing peers. Note that children with clefts in this study did not have a co-occurring syndromic diagnosis or other major medical condition. The findings remind us to evaluate all students individually, and without making assumptions based on diagnoses.

Caron et al. found interventions using AAC software with Transition to Literacy (T2L) features increased sight word recognition accuracy for kids with autism. T2L, currently available on a few speech generating devices/apps, is designed to make orthographic and phonological cues more salient for people who use AAC. Check out the full article for pictures that show how the app draws attention to the words—and be on the lookout for these features to make their way into more dynamic AAC systems.  

Guiberson & Crowe, recognizing that we have a limited evidence base for intervention with multilingual children with hearing loss, reviewed interventions designed for multilingual children only, children with hearing loss only, and multilingual children with hearing loss— specifically audition, speech, language, and literacy interventions. You’ll need to use your clinical judgment to apply the findings, but it’s a starting point if you find yourself supporting students with similar needs. 

Morin et al. evaluated the quality of research on the use of high-tech AAC to teach social-communication skills. They found that using high-tech AAC to teach social-communication skills to individuals with ASD or ID can be considered an evidence-based practice. Their review also indicated that high-tech AAC was not significantly better than low-tech AAC when teaching social-communication skills to this population.a

Ring et al. studied the efficacy of the Take Flight reading intervention, an Orton-Gillingham based approach with and added focus on phonological awareness, reading rate, and comprehension. Their results support previous findings on the effectiveness of the individual treatment components (synthetic phonics, etc.), including the benefit of adding comprehension work.

Sutherland et al. completed a systematic review of telehealth assessment and intervention for children and adults with ASD. They found that services delivered via telehealth were equivalent to those delivered face-to-face, however, the recipients of the majority of the interventions were parents, carers, and/or teachers. Those that did include individuals with ASD interacting with the interventionist were predominantly adults and older children with ASD. The authors emphasized that future research must look at telehealth services when providing direct services to people with ASD, especially young children.

We know it helps to leverage L1 when we teach English vocab (see our review of Méndez et al.), but how do you actually DO that if you're not bilingual yourself? One possible avenue might be computer-based bilingual vocabulary lessons tied to e-books. Wood et al. found that Kindergarten–1st grade English Learners who read e-books with embedded vocab instruction in Spanish and English made greater gains in vocabulary than those who only read the books.

Wood et al. found that electropalatography (EPG) could be an effective way to help people with Down Syndrome (DS) improve their articulation, and that the visual feedback EPG provides capitalizes on a strength of many people with DS. The authors emphasize that their findings, combined with others’, shows that individuals with DS can keep improving their speech and intelligibility into their teen years and beyond.

 

Boyce, J. O., Kilpatrick, N., Reilly, S., Da Costa, A., & Morgan, A. T. (2018). Receptive and Expressive Language Characteristics of School-Aged Children with Non-Syndromic Cleft Lip and/or Palate. International Journal of Language and Communication Disorders, 53(5), 959–968.

Caron, J., Light, J., Holyfield, C., & McNaughton, D. (2018). Effects of Dynamic Text in an AAC App on Sight Word Reading for Individuals with Autism Spectrum Disorder. Augmentative and Alternative Communication, 34(2), 143–154.

Guiberson, M., & Crowe, K. (2018). Interventions for Multilingual Children with Hearing Loss. Topics in Language Disorders, 38(3), 225–241.

Morin, K. L., Ganz, J. B., Gregori, E. V., Foster, M. J., Gerow, S. L., Genç-Tosun, D., & Hong, E. R. (2018). A systematic quality review of high-tech AAC interventions as an evidence-based practice. Augmentative and Alternative Communication, 34, 104–117.

Ring, J.J., Avrit, K.J. & Black, J.L. (2017). Take Flight: The evolution of an Orton Gilingham-based curriculum. Annals of Dyslexia, 67, 383–400.

Sutherland, R., Trembath, D., & Roberts, J. (2018). Telehealth and autism: A systematic search and review of the literature. International Journal of Speech-Language Pathology, 20, 324–336.

Wood, C., Fitton, L., Petscher, Y., Rodriguez, E., Sunderman, G., & Lim, T. (2018). The effect of e-Book vocabulary instruction on Spanish–English speaking children. Journal of Speech Language and Hearing Research, 61, 1945–1969. 

Wood, S. E., Timmins, C., Wishart, J., Hardcastle, W. J., & Cleland, J. (2018). Use of electropalatography in the treatment of speech disorders in children with Down syndrome: a randomized controlled trial. International Journal of Language & Communication Disorders / Royal College of Speech & Language Therapists. Advance online publication. doi: 10.1111/1460-6984.12407

And more...

  • Boyle et al. propose a way to program digital books for students that could have benefits for their language and literacy skills, using visual scene display apps that allow for dynamic presentation of text (e.g. Tobii-Dynavox’s Snap Scene). Their pilot study showed that this might be an effective strategy to help young children with language disorders learn new sight words.
  • Coufal et al. show “comparable treatment outcomes between traditional service delivery and telepractice” for children ages 6–9 ½ with speech sound disorder only.
  • Lundine et al. share some preliminary evidence suggesting that junior- and high-school aged students who have suffered TBIs and are struggling academically might have particular challenges with expository discourse (understanding and producing informational, rather than narrative, passages) that don’t show up on typical language assessments. As always with older students, consider throwing an expository language sample into your testing routine!
  • Szumski et al. compare the outcomes of two social skills programs (“Play Time/Social Time” and “I Can Problem Solve”) in preschool-aged children with ASD in Poland.  “Play Time/Social Time” was more effective in improving interaction skills, while “I Can Problem Solve” was more effective in improving children’s ability to take others’ perspective. Both curricula were developed for implementation in the preschool classroom with children with and without special needs.
  • Wittke & Spaulding found that teachers perceived preschool children with developmental language disorder (DLD) who were receiving services as having poorer executive functioning (e.g. inhibition, working memory, and task shifting) as compared to preschoolers with DLD who were not receiving services. Because we know the challenges of differentially diagnosing DLD, SLPs should be aware that children who have poorer executive functioning skills are more likely to be referred for services than peers with higher executive function skills who also meet criteria for DLD.

 

Boyle, S., McCoy, A., McNaughton, D., & Light, J. (2017). Using digital texts in interactive reading activities for children with language delays and disorders: a review of the research literature and pilot study. Seminars in Speech and Language, 38(4), 263–275.

Coufal, K., Parham, D., Jakubowitz, M., Howell, C., & Reyes, J. (2017). Comparing traditional service delivery and telepractice for speech sound production using a functional outcome measure. American Journal of Speech-Language Pathology. Advance online publication. doi:10.1044/2017_AJSLP-16-0070

Lundine, J. P., Harnish, S. M., McCauley, R. J., Zezinka, A. B., Blackett, D. S., & Fox, R. A. (2017). Exploring summarization differences for two types of expository discourse in adolescents with traumatic brain injury. American Journal of Speech–Language Pathology. Advance online publication. doi:10.1044/2017_AJSLP-16-0131.

Szumski, G., Smogorzewska, J., Grygiel, P., & Orlando, A-M. (2017). Examining the effectiveness of naturalistic social skills training in developing social skills and theory of mind in preschoolers with ASD. Journal of Autism and Developmental Disorders. Advance online publication. 10.1007/s10803-017-3377-9. 

Wittke, K. & Spaulding, T. J. (2017). Which preschool children with specific language impairment receive language intervention? Language, Speech, and Hearing Services in Schools.

Teletherapy for CAS using Rapid Syllable Transitions

This article is a good one, not only because it’s a nice example of telepractice via online video conferencing (not many of those!), but also because it uses a treatment technique that you should know about, as well. Rapid Syllable Transitions (ReST) has been studied before, here and here, among others. It is “a relatively new treatment for CAS [childhood apraxia of speech] that uses pseudo-word targets with varying lexical stress patterns to target... articulatory accuracy, fluent transitions between syllables, and lexical stress” (Thomas et al., 2016).
The current study is small (five kids, age 5–11) and the first of its kind (so interpret with caution), but demonstrates “significant… generalization of the treatment effect to untreated imitated pseudo-words and real words”. Therapy was delivered four times per week for three weeks, so high intensity and short duration. The authors point out that ReST doesn’t require hands-on cueing and tends to work best for clients with milder forms of CAS, and thus may be well-suited for teletherapy.
See: Thomas, D. C., McCabe, P., Ballard, K. J. and Lincoln, M. (2016), Telehealth delivery of Rapid Syllable Transitions (ReST) treatment for childhood apraxia of speech. International Journal of Language & Communication Disorders. doi: 10.1111/1460-6984.12238