JCPSLP Vol 23, Issue 1 2021

Staley, B., O’Boyle, J., Armstrong, E., Coonan, E., Taylor, L., & Dutton, J. (2020). The impact of COVID-19 on professional practice in the Northern Territory, Australia. Perspectives of the ASHA Special Interest Groups , 5 (6), 1789–1792. https://doi.org/10.1044/2020_PERSP-20-00090 Dr Bea Staley (PhD) is a paediatric speech pathologist and senior lecturer in special needs and inclusive education in the College of Education at Charles Darwin University. Bea’s teaching and research interests include language and literacy development in multilingual and multicultural contexts. Jenny Lethlean “Shifting sands” is a phrase used to emphasise something that changes very frequently, making it difficult to deal with or make plans for. The “shifting sands” of health care is how I would describe my experience of working as a speech pathologist and clinical educator in an outpatient rehabilitation tertiary hospital context in the early months of responding to the COVID19 pandemic. The outpatient aphasia group which had been running weekly for more than 12 years had to be cancelled at short notice in March 2020. Participants had been coming for many years—already isolated in the community due to their communication challenges. The group provided them with regular conversation practice and psychosocial support which had now been suddenly taken away with associated uncertainty as to when the group would resume. My two University of Queensland Graduate Entry Masters students were early on in their sessional clinical placement with key learning goals including developing communication partner skills and facilitating the aphasia group. What was I to do? How could I rapidly transition the aphasia group to a video-teleconferencing (VTC) platform and supervise students in this context with my own limited telehealth skills and resources? Would the group members have the resources and skills to engage with the group via VTC? Would the available resources be aphasia-friendly and accessible to the group members? How could we continue to provide a safe space, facilitate communication interactions and support individual communication needs in this new environment? How would we put plans in place to support the group members who were unable to participate? How could I manage my anxiety and minimise the risk of COVID19 infection—for myself and my students who were continuing their clinical placement? The sands had well and truly shifted! Thankfully, I had wonderfully resilient, hard-working, tech-savvy students and together we worked out a project plan—starting with the basics. We gathered information from the group members to determine whether they had the interest and/or resources to access a telehealth platform. Did they have adequate wifi/internet access? If they had a computer, did it have a camera and microphone? Did they know how to use it? Did they have an email address to which the telehealth link could be sent? If they had access to an iPad, did they know how to download an app? Could they access their emails on the iPad so they could click on a link? Did they have the software to open a Word or PDF document with conversation topics? Was there someone at home to support access? There were so many questions which had to be asked in an aphasia-friendly way! The next step was to investigate which VTC platforms were recommended by Queensland Health and determine which would be the simplest for us and for people with

aphasia to use independently to also enable the translation of skills to connect with family and friends. The Zoom platform was being widely used in the community and the students had already had some experience with Zoom so we initially went with this popular option. A month later, the sands shifted again when security concerns with Zoom were raised so we proceeded to transition to the Microsoft Teams platform—inviting the group members as guests! The first few weeks of transitioning to VTC were very challenging but gradually, one by one, the students and I managed to assist group members to problem solve their access issues. The learning curve was enormous, and my IT-related knowledge was well and truly stretched. The group participants and students showed incredible patience and tenacity. VTC links were sent out and telehealth etiquette was promoted to ensure everyone felt safe to participate, could hear each other, and had a turn to talk. Screen sharing enabled “key-wording” to check and clarify conversation content, the use of images to support those with comprehension challenges and provide choices for word-finding difficulties. The students developed aphasia- friendly resources to support aphasia group members to access the VTC platforms. They also developed a “How to run a Teams group?” guide for other clinicians and students with useful tips, and evaluated the group members’ experience of using the telehealth platform via a survey. At the time of transition to a VTC platform, the face-to- face aphasia group had a maximum of 13 participants. Seventy percent (9/13) of the group reported that they had the resources and support to enable them to access the telehealth aphasia group and provided positive feedback of the VTC experience. In response to our survey, one group member responded: “The online group has made it possible for us all to stay connected in what has become a very important part of our week”. Unfortunately, 30 per cent (4/13) of the group reported they either did not have the technical resources (e.g., no computer/iPad/wifi) to support access or declined engagement with the VTC platform. Regular phone contact and a buddy system with other group members was set up to support those who were unable to access the group in this new format. Thankfully, Queensland has fared well and the impact of COVID19 on our community and health systems has been relatively low compared to other places. The sands have started to settle. As a health service, we are now looking to the future to ascertain what telehealth services we want to continue especially now that we have access to more resources, training and expertise. In 2021, the aphasia group resumes face-to-face meetings once a month (in a COVID safe way) and will continue to meet on the other weeks via VTC. Together with the students and aphasia group members, we will continue to support each other should the sands shift once again. Dr Jenny Lethlean (PhD) is an advanced speech pathologist and clinical education support officer (rehabilitation) in the Speech Pathology Department of Princess Alexandra Hospital, Queensland. Paul and Pat Cheetham I (Paul) began attending weekly aphasia group meetings at Prince Alexandra Hospital, Queensland after suffering a haemorrhagic stroke in 2014. From the very beginning I was made to feel that I was part of a very friendly and caring group of people who understood the difficulties I now faced after my stroke.

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JCPSLP Volume 23, Number 1 2021

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