JCPSLP - March 2018

convenient to conduct telehealth sessions both for the “ease for clients” and also because there was less need “to have space organised and neat” as is required in a traditional clinic session. Student SLPs also appreciated that telehealth service delivery made it more convenient for the clients to access services as they did not have to travel to the clinic. One student noted that telehealth made it possible to offer “services to people who otherwise would not have access”, while another recognised the potential of the model to “give increased access to clients”. The students considered the ability to treat a diverse range of clients an advantage of telehealth with students valuing the possibility of “Being able to treat clients all over the world” and “treat[ing] clients regardless of where they are”. This included providing treatment to clients based overseas and in different time zones. Theme 5: Clinical considerations with telehealth: Pros and cons Student SLPs commented that using telehealth to treat clients in their own environment may facilitate transfer of fluent speech skills into a client’s everyday communication environment as it “allows you to see a client in an environment that they need transfer to occur so it almost accelerates fluency stages” and “transfer of their skills”. In terms of disadvantages, almost all students (5 out of 6) reported that technical issues affected the quality of at least one therapy session with “glitches in the sounds”, “poor internet quality affecting session/noise” and “one instance of bad internet making [the] session difficult” being the most pervasive issues. Students reported speaking louder than they normally would during telehealth sessions and felt that identifying stuttering was easier in the in-clinic sessions as compared to telehealth because it they could “notice secondary characteristics in fluency” and “clearly

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6

5

4

3

2

Number of students SLPs

1

0

beginning

mid

end

I prefer telehealth

I have no preference

I prefer in-clinic

Figure 1. Student attitudes towards telehealth during placement

receive “online feedback from the clinician without disturbing the session”. In contrast, they felt that real-time feedback during in-clinic sessions had a greater propensity to interrupt the flow of the session. This may reflect the client having more direct visual access to the clinician during in-clinic sessions compared to telehealth. Further, telehealth allowed the student SLP to see themselves. This provided real-time visual feedback to the student about how they were performing and was perceived by most as “a benefit is that you can see yourself and how you look when working”. While this was mostly helpful in facilitating online adjustment of manner and delivery, one student found this disconcerting and stated that the“worst thing about telehealth? [is] seeing myself on screen”. Theme 4: Ease of service access Student SLPs reported that telehealth increased convenience for both clients and SLPs. They found it more

Student perspectives on managing anxiety, self-consciousness and pressure to perform

Challenges of working from a “virtual” environment

Differences in the approach to student learning

Clinical considerations with telehealth

Ease of access to services

Telehealth has the ability to provide more seamless “online” feedback

Telehealth provides increased access to services

Technical difficulties can impact on clinical aspects of the session

Changing dynamics of the clinician-client interaction

Student anxiety and self- consciousness

Telehealth provides increased

Understanding the boundaries of working from a different “environment”

Student self-monitoring and visual feedback

Telehealth allows for more flexibility and transfer of skills

Pressure to perform

convenience for both clients and clinicians

Telehealth makes it more difficult to provide sensory feedback to clients and to use physical resources as part of the session

In-clinic sessions are still necessary

Figure 2. Themes and subthemes

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JCPSLP Volume 20, Number 1 2018

Journal of Clinical Practice in Speech-Language Pathology