JCPSLP Vol 21 No 2 2019 DIGITAL Edition

Group discussion

Screen share

Figure 3. Participant screen views

the need to manage technological requirements as well as facilitating the group added complexity. The clinician stated, “I was managing screen share for PowerPoint slides and video clips and talking simultaneously. Additionally, I was facilitating the session, so it was quite exhausting”. That telepractice delivery was manageable was attributed by the clinician to previous experience in delivering the HMTW content. It was suggested that telepractice delivery would be substantially harder if both the content and technology were less familiar. Telepractice delivery of group training content originally designed for face-to-face training required assessment and adaptation to the online condition. Additional time was needed to prepare and modify some activities and materials. For example, activities involving physical interaction between participants needed to be modified or substituted with alternative activities that would facilitate similar insights or experiences. Home practice plans, traditionally completed by hand during face-to-face sessions, needed modification to an electronic format that could be emailed to participants. This modification created subsequent benefit to the clinician, enabling thorough plan review and feedback. The process was considered superior to the quick plan check that occurs during face-to-face group training. When asked to provide a clinical opinion regarding telepractice delivery of the HMTW-based intervention, the clinician reported that all intervention components were able to be delivered effectively and that attainment of clinical goals and experiences for both parent participants appeared similar to those achieved during face-to-face delivery. Discussion This study aimed to identify suitable technology for telepractice delivery of HMTW and to determine the feasibility of delivering the HMTW program to parent groups via telepractice. The results demonstrated that HMTW content could be effectively delivered via telepractice to a small parent group using readily available technology. Selection of technology for telepractice-based group training involved consideration of factors that would support viability. Video-conferencing platforms needed to be reliable with standard internet connections, secure, reasonably priced, and easy to use. The ability to participate using commonly available devices was important to support access. Personal computers or tablets with integrated cameras, microphones and speakers, were generally adequate for participation and problems with audio or visual quality involved simple, readily available solutions such as headphones or external webcams.

Analysis of individual video-feedback sessions revealed challenges for the clinician in supporting live parent–child interactions involving children with high activity levels and difficulty following directions. Using fixed or inferior web cameras occasioned periods of poor visibility. Parent–child interaction was interrupted to alter web camera position when the child moved away, or the parent inadvertently blocked the camera. One child became distracted by the computer nearby; however, introduction of an external web camera, located on a shelf overlooking the interaction, solved issues of video quality and child distraction. Audio quality during live coaching was reduced when compared with group parent training sessions as parents were located further away from the computer when interacting with their children. Increasing microphone and speaker volume rectified this issue. Instances remained where the clinician had difficulty hearing verbal interaction between parent and child, particularly when child utterances varied broadly in terms of volume and clarity. Findings from participant interviews and ratings Parent participants reported comfort with telepractice and predicted online sessions would be more convenient than attending clinic-based group training. Benefits of not requiring childcare and feeling more confident in sharing opinions, doubts and ideas were expressed. P1 said, “Usually I don’t share my opinion when I am in a group, so I find this [online] small group discussion very helpful as there is no anxiety”. Parents felt able to develop relationships and help each other as the training sessions progressed. P2 stated that remote sessions allowed her to have better discussions with the clinician saying, “Here [on video], you are always in front of each other, [the clinician] can hear you all the time whereas in a room sometimes, it’s a bit hard to be heard”. Rather than having the clinician present during individual coaching sessions, one parent reported that the remote location of the clinician allowed her child to feel more comfortable engaging in activities. Both parents reported that their children interacted very naturally with them when the clinician was present online. Both participants thought that telepractice allowed easier scheduling of sessions at convenient times and re- scheduling if necessary. When asked to rate the helpfulness of group training sessions and individual coaching sessions, both parents rated them at the highest level 5 (“very helpful”). Clinician interviews revealed benefits and challenges with telepractice delivery. Strategies to support equal participation were required when parents were not equally confident to share experiences; however, it was noted that this also applies during face-to-face groups. Significantly,

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JCPSLP Volume 21, Number 2 2019

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