JCPSLP Vol 23, Issue 1 2021

Speech pathology: An agile and responsive profession

Speech-language pathologist practice changes in telehealth speech-language therapy for rural children Jessica Campbell, Deborah Theodoros, Trevor Russell, Nicole Hartley, and Nicole Gillespie

The purpose of this study was to understand practice changes made by speech-language pathologists and parents when shifting from in-person to telehealth delivery of paediatric speech-language therapy in a rural context. Participants in this qualitative exploratory study were two speech-language pathologists (SLPs), six managers, and 17 parents within BUSHkids, a not-for-profit organisation. Fieldnotes written during observations of in-person and telehealth therapy and clinician interview transcripts were analysed with an inductive thematic analysis approach. Two major practice change themes emerged from thematic analysis. These were extending parent roles (parents taking on a co-therapist role, including presenting therapy stimulus and instructions, delivering cues, supporting child posture, and judging speech accuracy), and preparing and adapting resources (clinicians creating or locating electronic stimuli or rewarding turn-taking games, and experiencing the lack of tactile cues in a telehealth modality). Telehealth with young children requires expanding parent roles to that of co-therapists. Increased support for clinicians and parents during the initial increased demands of telehealth practice could include providing ready-to-use electronic stimuli, explicitly discussing roles and responsibilities, and providing administrative support and telehealth room preparation. This study highlights the importance of understanding telehealth practice through the perspective of multiple stakeholders. R ural residents have less access to speech pathology compared to peers in major cities as only 3.9 percent of Australian speech-language pathologists (SLPs) are primarily employed in rural and remote areas

(Fairweather et al., 2016). Fewer practitioners means patients travel considerable distances for services and experience longer waiting times (Dew et al., 2013). At the same time, the Australian Early Development Census (AEDC) has found that a higher proportion of Australian children outside major cities are more developmentally vulnerable than their city-dwelling peers (Commonwealth of Australia, 2019). Employing telecommunications technology to enhance health care delivery and support (telehealth) is an important option for improving access to SLP services. In a systematic review of the efficacy of telehealth speech and language therapy in primary school-aged children (Wales et al., 2017), the authors found that there is some evidence to support the efficacy of telehealth approaches in such a population, although a limitation identified was the small sample size of most of the studies and overrepresentation of speech sound disorder therapy in the included studies. The highest level evidence identified by the authors were two randomised controlled trials (RCTs) for speech sound disorder therapy (Grogan-Johnson et al., 2013) and childhood apraxia of speech therapy (Parnandi et al., 2015). Non-RCT evidence has suggested the potential efficacy and acceptability of school-based speech-language therapy (Coufal et al., 2018; Gabel et al., 2013; Grogan-Johnson et al., 2010; Grogan-Johnson et al., 2011; Thomas et al., 2016; Wales et al., 2017). In school- based therapy, clear lines of communication with teachers and parents (Lincoln et al., 2014) and the use of therapy assistants and engaging children with their interests (Hines et al., 2015) have been reported as supportive factors. There are few studies that examine supportive factors for telehealth speech-language therapy in children younger than school-age. In a single qualitative study of play-based teletherapy with young children, SLPs found alternatives to children interacting with objects, such as interacting with the object on the client’s behalf (Ekberg et al., 2018). We have not identified other studies that have reported in a detailed way how clinicians adapt their practice to telehealth modalities with young children. It is known that parents are key stakeholders in the therapy of young children. Parents of children with developmental disabilities hold multiple specific expectations about therapy, including the likelihood of receiving a diagnosis, potential child achievements, service availability, therapist knowledge, skills, relationships and communications and parent’s own attendance and roles in therapy and home practice (Phoenix et al., 2020). Rather

THIS ARTICLE HAS BEEN PEER- REVIEWED KEYWORDS PAEDIATRIC RURAL SPEECH THERAPY TELEHEALTH VIRTUAL HEALTH

Jessica Campbell (top), Deborah Theodoros (centre) and Trevor Russell

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JCPSLP Volume 23, Number 1 2021

Journal of Clinical Practice in Speech-Language Pathology