JCPSLP Vol 21 No 2 2019 DIGITAL Edition

positive interaction models during subsequent parent training sessions. Laboratory-based testing was conducted at the Institute for a Broadband-Enabled Society, School of Engineering, University of Melbourne. The researchers, a collaboration of speech pathologists and network engineers, provided clinical and technological expertise required for the project. Potentially suitable telepractice hardware and software configurations were identified with consideration to privacy and security, public availability, and realistic internet capability in home and clinic environments. The aim of testing was to maximise accessibility and optimise the teleconferencing experience for both the clinician and participants. Scenarios were evaluated for effectiveness of video and audio quality, functionality and ease of use. Technology configurations identified as potentially suitable during laboratory testing were then tested at the clinic of the first author, simultaneously with up to four people located remotely. Clinical testing confirmed technology configurations of choice for the telepractice intervention delivery phase. The intervention was delivered using VSee Telemedicine Video-conferencing Platform (VSee, 2014). Group training sessions were delivered using the clinician’s personal computer with dual screens and video footage was shared using the VSee screen sharing application and a media player. Participants received the group training and individual video-feedback sessions via internet connection to their laptop computers using internal or external fixed web camera, microphone and speakers. Video feedback sessions were recorded using Camtasia Screen recording software to enable shared video review and feedback (Techsmith Corporation, 2017). Phase 2: Telepractice delivery of Hanen More Than Words ® based intervention The purpose of piloting telepractice group intervention was to determine the feasibility of the delivery method considering design implications, participant perceptions and potential application to larger parent training groups. Ethics approval was obtained from the University of Melbourne Human Research Ethics Committee (Reference number: 1238764). Participants Two women who were parents of a child with autism received the pilot training. One was born in Australia, the other in Ireland; both with minimum Year 12 level education. Each had a male child with an ASD diagnosis aged 46 months and 52 months, respectively, at commencement. The diagnosis was confirmed by eligibility to receive Helping Children with Autism funding, an Australian Government initiative providing support for young children with autism. The participants resided in an inner regional area in Australia and were recruited via local early childhood intervention services. Both parents had previously received face-to-face intervention; however, neither had experienced telepractice services prior to participation. Each had basic computer skills, access to a personal computer and reliable internet connection at home. Intervention Prior to commencing the telepractice HMTW-based intervention, a home-based consultation was provided to each family including parent–child observation and discussion of the technology set up for future telepractice sessions. During the telepractice intervention period,

parents participated in eight online, 2.5-hour training sessions interspersed with three individual video-feedback sessions, approximately 1.5 hours each. All sessions were delivered via telepractice by the first author, a certified Hanen More Than Words® trained speech pathologist. Parents completed both the group intervention training and individual video-feedback sessions at home using their personal computers. All group and individual sessions were delivered from a clinical setting by the first author and online, real-time observation of approximately two-thirds of the sessions occurred at an additional remote location by a secondary researcher (figure 1).

Parent 1

Parent 2

Video-conference connection

Observer

Clinician

Figure 1. Parent training session

During delivery of group training the clinician used a desktop computer with two screens. The first screen had an integrated web camera and was used to video- conference and share PowerPoint slides and video files. The second screen was used to collect and annotate participant feedback on editable slides. Parent computer screens displayed individual windows for each participant and the active application. During individual video-feedback sessions, laptop computers with integrated or external webcams were used, displaying individual windows for each person and a window for the captured parent–child interaction video. Data collection Data was collected via observation of intervention sessions, participant interviews and parent ratings. • Session observations Online and captured training sessions were reviewed by a secondary researcher. Fieldnotes were created during observation, extended via discussions with the primary author and coded iteratively to capture emerging ideas and trends regarding the telepractice intervention. • Participant interviews Information regarding experiences with technology and delivery method was collected from participants using semi-structured interviews by the secondary researcher. Pre- and post- program interviews occurred with both parents. The clinician and parent 1 (P1) completed two interviews during the program period and parent 2 (P2) completed three interviews. All interviews occurred via telephone or video-conference and were audio recorded and transcribed for analysis. • Parent ratings Parents were asked to rate both group training sessions and individual coaching sessions post

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JCPSLP Volume 21, Number 2 2019

Journal of Clinical Practice in Speech-Language Pathology