JCPSLP Vol 21 No 2 2019 DIGITAL Edition

program on a scale from 1 (“not very helpful”) to 5 (“very helpful”). Data analysis Qualitative analysis was based on grounded theory (Strauss, 1998). The secondary author manually coded observational and interview data into themes, noting emerging trends in both delivery and receipt of telepractice intervention. Emerging themes were discussed with the first author to provide feedback on program delivery and reflect on observations and analysis. Affinity diagrams were used by the secondary author to structure key ideas (Aggarwal et al., 2015). This involved recording individual ideas and subsequent organisation of ideas into subgroups with common themes. Results Phase 1: Telepractice technology assessment and trial Four potentially suitable video-conferencing platforms were assessed for security, reliability of connection at different bandwidths, cost, and ease of use. Security was assessed against stated compliance with the Health Insurance Portability and Accountability Act (Centers for Medicare and Medicaid Services, 1996). Reliability of audio and video quality was assessed during simulated telepractice delivery under both training and video-feedback conditions. Under cost, the affordability for individual practitioners was considered. Ease of use was determined on the basis of whether the platform could be used without training by someone with basic computer competencies such as ability to open, close and resize applications, edit and save simple documents, access the internet and use email (figure 2). A variety of hardware and software configurations were tested for group training and individual feedback sessions. Each scenario was graded by up to four testers who provided quality ratings. Test scores were averaged to create results (table 1). Clinic-based testing determined that a minimum of ADSL2 broadband (typically 1 megabit upstream and 3–15 megabits downstream) internet connection was sufficient for successful group training. Wireless network transmission resulted in poorer quality video sharing, particularly with low signal strength. Hardwired internet connection was deemed superior. Technology testing confirmed that delivering the telepractice intervention was viable. It was determined that the pilot would be conducted using VSee Telemedicine

Video-conferencing Platform (VSee, 2014) and that group training would be best delivered using the clinician’s personal computer with dual screens. Video footage would be shared using the VSee screen sharing application and a media player. Participants would receive both the group training and individual video-feedback sessions via internet connection to their laptop or personal computer using internal or external fixed web camera, microphone and speakers. Headsets could be used to alleviate background noise. Individual coaching sessions would be recorded using Camtasia Screen recording software for evaluation purposes (Techsmith Corporation, 2017) . Phase 2: Telepractice delivery of Hanen More Than Words ® based intervention. Telepractice intervention delivery and collection of observational and interview data enabled analysis and evaluation of the applied technology, user experience and design implications. Findings from session observations Fieldnotes from session observations enabled organisation of data into themes including interaction of participants with the technology, interaction between participants and system usability (Aggarwal et al., 2015). Participants were required to interact with the technology to ensure adequate internet connection and appropriate audio and visual settings to access the intervention. Flexibility in arrangement of windows on computer screens allowed participants to personalise the experience to meet their individual needs (figure 3). Individual windows could be moved and resized allowing participant manipulation of screen set-up to manage issues such as discomfort at seeing themselves and ability to see training materials. Participants personalised individual interaction by reducing non-active screen sizes and enlarged participant screens to enhance group participation for general discussions. Fieldnotes confirmed that dialogue occurred frequently between participants during training sessions and ranged from sharing personal experiences to analysing video examples, to intervention planning. Non-verbal turn-taking cues that occur naturally in face-to-face settings required more explicit facilitation during telepractice sessions to ensure parents understood when to take a turn and to keep turns balanced. Participants needed to remain aware of their position in relation to the webcam throughout training sessions, particularly during activities that required vision of their physical movements and gestures.

Accept Vendor 3 (VSee)

Yes

Yes

Yes

Useable?

Vendor 3

Affordable?

Yes

Vendor 2 Vendor 3

Reliable?

No

Video- conferencing platforms

Yes

Vendor 2

HIPAA compliant?

Vendor 1 Vendor 2 Vendor 3 Vendor4

No

Reject Vendor 1 Vendor 2 Vendor4

Vendor 1 Vendor 4

Figure 2. Video conferencing platform selection process

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JCPSLP Volume 21, Number 2 2019

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