JCPSLP Vol 23 No 3

Journal of Clinical Practice in Speech-Language Pathology Journal of Clinical ractic i Spe ch-L l

Volume 13 , Number 1 2011 Volume 23 , Number 3 2021

Creative clinical education

In this issue: Practical recommendations and insight about students transitioning to tele-delivered placements in both literacy and fluency Development of SuCEED—a model to optimise student learning while on clinical placement Perspectives about telesupervision in the new online world post-pandemic Simulation clinical learning; challenges and benefits? Adaptability of acute SLP services for patients from a CALD background during the pandemic Improving integration of consumers of health care in the clinical education process

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Kathryn McKinley Brooke Sanderson Alison Smith Bronwyn Sutton

JCPSLP Editor Co-Editors Dr Andy Smidt and Dr Katrina Blyth c/- Speech Pathology Australia

Editorial Committee Emma Finch Leah Hanley Lindy McAllister Rachael Unicomb

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Creative clinical education

From the editors Andrea Abel and Kelly Beak

Contents

W elcome to the are your guest editors for this issue—Andrea Abel and Kelly Beak. We would like to begin by thanking Andy Smidt and Katrina Blyth for their immense support and patience as we undertook the role of guest editors for this issue. This was our first foray into the editorial world, and we have thoroughly enjoyed the process November issue of JCPSLP . We

116 Speech pathology student perspectives of telepractice literacy placements during COVID-19 – Lisa Furlong, Tanya Serry, Kerry Ttofari Eecen, and Sharon Crosbie 122 The Playroom@USYD: How to SuCEED on an innovative community outreach clinical placement in lockdown – Annie Chan, Alison Purcell, and Donna Thomas 128 Clinical educators’ perspectives on transitioning to telesupervision: Experiences piloting a telepractice stuttering simulation placement – Catherine Easton, Claire Ellen Seaman, Narelle Patton, Melissa T. Nott, and Lisa Brown 134 How was it for you? University practice educators’ reflections on delivering a creative clinical placement during the COVID-19 pandemic in the UK – Lynsey Parrott, Esther Pettit, Alexandra Mallinson, Philippa Knox, Sally Bates and Jane Callard 140 Speech-language pathology management for culturally and linguistically diverse patients with COVID-19: A single-case report – Franziska Newman, Thomas Wilson, and Merridy Moore 146 Reflections on clinical education by students and new graduates: What can we learn? – Julia Hardy, Abigail Lewis, Joanne Walters, Anne E. Hill, Simone Arnott, Adriana Penman, Stacie Attrill, Ruth Nicholls, and Sally Hewat 151 Patients as teachers in speech-language pathology:Expert teacher and student perceptions – Alice Darragh, Philippa Friary, and Clare M. McCann 157 Exploring perceptions of involving tãngata whaiora in the education of health care professionals in New Zealand – Anton Spelman, Nadia Mantell, Shinhee Song, Philippa Friary, and Bianca Jackson 162 Ethical conversations. Eyes wide open: Key ethical issues for speech pathology students and their supervisors in a private practice setting – David Kinnane, Helen Smith, and Donna Dancer 165 Featured researcher: Dr Elizabeth Bourne 168 Around the journals – Elizabeth Bourne and Laura Loftus 171 What’s the evidence? The four components of contemporary evidence- based practice, Part 1: Practice contexts – Nicole McGill, Speech Pathology Australia 174 Top 10: Tips and tricks for creative clinical education – Simone Howells, Lucy Lyons, Rebecca Armstrong, and Anne Hill 176 Resource review – Jodie Connolly

From left: Andrea Abel and Kelly Beak

In recent years both of our careers have led us to work almost exclusively in clinical education, and we share a common passion for optimising and improving processes and models of clinical education for students, clinical educators, and organisations. For this reason, we were particularly interested in working on this issue which has a focus on clinical education. With that in mind, this issue was conceptualised midway through 2020 as we were emerging from the first wave of the COVID-19 pandemic, and it became clear that there were some incredible clinical education initiatives occurring. Throughout the pandemic, there has been a sense of collegiality between universities both across the country and internationally, and the creativity that was exhibited deserved to be highlighted and celebrated. We are therefore very proud to present an issue that demonstrates just some of the initiatives that were implemented in Australia and the UK to support clinical education at the height of a global pandemic. Our first group of papers discuss learnings from rapid transition of clinical education to telepractice. These papers provide some practical recommendations for education providers to support students in their transition to telepractice, and, with the development of the SuCEED model of clinical learning in Annie Chan and colleagues’ paper, support designers of clinical placements to optimise clinical learning environments for students. Moving into the perspectives of clinical educators on the effectiveness and applicability of telesupervision, the paper by Catherine Easton challenges educators to think more broadly about the use of telesupervision with students, beyond the constraints of a global pandemic. Lynsey Parrott’s paper from the UK includes an investigation into the use of computer-simulated learning environments to address a shortfall of clinical placements. The last COVID- 19-related paper is a case study from Thomas Wilson and colleagues who describe some of the challenges clinicians faced early-on in the pandemic when managing critically ill patients with swallowing and communication impairments. Moving away from COVID-19 specific modifications to clinical education, we have three papers about general considerations on how to optimise students’ experiences of and interactions with clinical education. The paper from Sally Hewat analyses the perspectives of both speech pathology students and new graduates on clinical education, and provides some key findings related to the importance of integrating clinical education into speech pathology curricula. Our final two papers focus on the role of patients as teachers. Both papers highlight the importance of increased patient involvement in overall clinical education systems for both speech pathology and the broader health care environment.

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national and local levels. Nicole highlights that there can be a conflict between evidence-based practice and reality. This inclusion of evidence from the practice context in the definition of evidence-based practice legitimises the challenges many of us face in real-world practice contexts, but particularly over the last two years as we all responded to a rapidly changing clinical and education landscape. In “Top 10” tips, the SPICE team share some very practical advice on optimising student learning opportunities, particularly when time and resources are limited. In the “Resource review”, Jodie Connolly reviews a new book on clinical education in speech pathology, which may be particularly useful for clinicians looking to embark on clinical education for the first time. Thank you to all of the authors who submitted their papers to this issue, and to the editorial committee and publications team who bring this journal together so seamlessly. It has been a pleasure being guest editors of this issue, and we hope you enjoy reading it as much as we enjoyed bringing it together. Andrea and Kelly

As well as these excellent papers, the J CPSLP editorial committee has put together columns that explore the topic of clinical education. In “Ethical conversations” David Kinnane, Helen Smith, and Donna Dancer discuss ethical issues for speech pathology students and their supervisors in a private practice setting. Their perspectives provide some thought-provoking ideas on speech pathology students as allied health assistants and highlight the differences between voluntary work and clinical placements. “Around the journals” this issue includes reviews of four key references in this area. We also have a new column— “Featured researcher”—which provides a profile of a researcher (relevant to the theme of the issue). This issue we have a profile of Elizabeth Bourne. You can read the profile in the issue or listen to the whole interview in an audio format. We hope you enjoy the option to read and listen to the interview. This issue’s “Evidence matters” column includes part 1 of a four-part series by Nicole McGill delving into the four sources of evidence. This article focuses on the addition of practice-based contexts to the sources of evidence-based practice, including at the international,

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National Conference 2022 Melbourne Convention and Exhibition Centre, Victoria, Australia

Save the date 22-25 May

JOIN US IN MAY 2022 A message from keynote speaker Dr Joanne (Jo) Watson

"In 2020 our world came to a standstill. Little did we know what was ahead. The COVID-19 pandemic has meant 2 years of connecting with our friends, families, and colleagues via endless and exhausting virtual meetings. Even the founder of Zoom, Eric Yuan, has admitted he’s “sick of endless virtual meetings”. The pandemic has halted our opportunities to connect face to face with one another. While virtual gatherings have benefits, in-person events are truly irreplaceable. In a time that has felt overwhelming and unpredictable for so many, one thing is certain. In May 2022, the Australian Speech pathology community will once again come together to reach “beyond borders”. Together, we will expand our knowledge, ask questions, find solutions, exchange ideas, share our passions, and knowledge, reignite and make all-important friendships. For me, May 2022 can’t come soon enough. I am thrilled to be welcoming friends and colleagues once again to my beautiful city, of Melbourne, after such a long time. I am honoured to be delivering several presentations throughout Quick links to the conference website The SPA National Conference website will be regularly updated and will provide you with all the information to attend the event. We recommend you check the website regularly.

the conference, providing me with an invaluable opportunity to not only share my research and practice, but importantly to receive feedback from my esteemed colleagues. There is something about face to face interaction in the same (non- virtual) space that is favourable to collaborative knowledge construction. It is within the context of this interaction, not only in presentations, but during afternoon teas, lunches and dinners where learning and collaboration is most optimal. I look forward to seeing you in person in May 2022." Dr Joanne Watson is presenting a number of sessions

during the Conference, to view these and other presentations, visit the conference website .

Diane Jacobs 2022 Conference Convenor Stephanie Gershon National Conference Coordinator

Conference Program Registration Social Sponsors & Exhibitors

Creative clinical education

Speech pathology student perspectives of telepractice literacy placements during COVID-19 Lisa Furlong, Tanya Serry, Kerry Ttofari Eecen, and Sharon Crosbie

Speech-language pathologists (SLPs) have an important role in the literacy domain because of the relationship between oral language and learning to read. This study explored the practicalities of student-led telepractice literacy placements in Australia during COVID-19 lockdowns in 2020. Data were collected from eight participants via an online qualitative survey. Participants were either studying to become an SLP or were new graduates, i.e., had completed their final year of study to become an SLP in 2020; and they had completed a placement experience where they saw at least one client for assessment and/or intervention for literacy via telepractice. Eight complete survey responses were analysed using thematic analysis. Findings identified that SLP students’ usual practices for literacy were modified in a telepractice environment; there was a heightened focus on communication skills for telepractice; and SLP students’ preparedness was mostly facilitated by practical learning opportunities with peers and supervisors. W hile the first pioneering applications of telepractice in speech pathology occurred in the 1970s (Houston & Ebsco, 2014), adoption of telepractice by speech-language pathologists (SLPs) has been slow (Grogan-Johnson et al., 2015). However, due to work-from-home requirements, social distancing and school closures during COVID-19, many SLPs rapidly adopted telepractice to maintain clinical services (Furlong & Serry, under review; Speech Pathology Australia, 2020). Likewise, many SLP students transitioned to telepractice clinical placements during COVID-19 lockdowns. This has occurred on the assumption that telepractice is pedagogically appropriate to supplement or replace onsite student placements (Bridgman, et al., in press). There is minimal evidence around how to prepare students for telepractice or what to include in training programs (Overby, 2018). A rapid review by Bridgman et al. (in press) identified only three studies evaluating the perspectives of allied

health students engaged in telepractice clinical placements; one involved SLP students (Bridgman et al., in press). The authors concluded that student perspectives of telepractice placements were generally positive. Students acknowledged benefits of telepractice, including access to services for clients in remote locations or with health or lifestyle conditions ordinarily preventing them from accessing onsite services. Students also identified barriers relating to observation and interpretation of the client’s face and body in telepractice sessions, differences in building rapport over telepractice, and technological limitations that impacted on assessment practices (Bridgman et al., in press). It has been reported that professional and interpersonal skills taught and developed over the course of students’ undergraduate training may not translate easily to telepractice (Overby & Baft-Neff, 2017). Additional interpersonal, clinical, and professional skills unique to telepractice include rapport building, non- verbal communication, and the technical skills required for providing assessment and intervention across web- conferencing platforms. Furthermore, there has been an identified need to be more animated in telepractice sessions, particularly when working with children (Overby & Baft-Neff, 2017). Recent SLP graduates placed value on being exposed to the literature associated with telepractice delivery and being taught about non-verbal communication in telepractice, how to solve technological issues, and how to address clients’ questions about telepractice (Overby & Baft-Neff, 2017). For many SLP students, the COVID-19 pandemic has provided their first experience of telepractice; however, as telepractice is a contemporary and emerging model of health care delivery, it is important that students receive sufficient education and practical experiences in telepractice so that they can provide clinical services in a future workforce that will most likely include evolving telepractice service delivery options (Grogan-Johnson et al., 2015). Exploring student experiences may help to identify the conditions that facilitate a successful telepractice placement which may inform student education and enhance student learning opportunities. In contrast to other areas of SLP practice, the evidence for telepractice literacy services is in its infancy in terms of both the quantity and quality of the evidence. The combined results of a small number of studies indicate that telepractice delivery of literacy services can be equally as effective as onsite delivery, and that children can make gains in their reading and spelling ability (Furlong et al.,

KEYWORDS CLINICAL PLACEMENTS

LITERACY SPEECH-

THIS ARTICLE HAS BEEN PEER- REVIEWED LANGUAGE PATHOLOGY STUDENTS TELEPRACTICE

Lisa Furlong (top) and Tanya Serry

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Research design We selected a qualitative research study as we sought to

2021). Many experienced SLPs implementing telepractice literacy services during COVID-19 highlighted that they felt underprepared to use telepractice, and faced numerous challenges within a telepractice model, mostly relating to technology and family engagement (Furlong & Serry, under review). SLPs saw fewer clients overall during the COVID-19 lockdowns and most provided individual sessions only and reported cancellation of group sessions. For most SLPs, their usual assessment and intervention practices for literacy changed in a telepractice model (Furlong & Serry, under review). Across peak body organisations worldwide, SLPs are recognised as having an important role in the literacy domain. This is driven by the reciprocal and cyclical relationship that exists between oral language and learning to read (Catts et al., 2003; Serry & Levickis, 2020; Serry et al., 2021). There has been a push for SLPs to make major contributions for children with literacy learning difficulties, including within school settings; however, many practising SLPs report feeling underprepared by their university training to work in the literacy domain. A survey by Serry and Levickis (2020) indicated that while 95% of SLPs agreed they have a role in supporting children with literacy learning difficulties, only 10% agreed that they had left university with the expertise to do so. Limited satisfaction with both academic and clinical training in written language disorders was reported by most of the 599 SLP participants in a US survey by Blood and colleagues (2010). In New Zealand, survey findings from Wilson, McNeill and Gillon (2015) indicated that student SLPs’ understanding of literacy constructs, including how orthography maps to spoken language, was inadequate. SLP graduates’ confidence and preparedness to deliver literacy services, particularly in the context of a telepractice placement, is unknown. Student SLPs can provide insight into the relative importance of interpersonal, clinical, and professional skills in relation to telepractice literacy services, which can help inform the training that is required in undergraduate programs. Furthermore, SLP students may also provide insight into what pedagogical strategies best support their learning. Method Objectives This study explored the practicalities of student-led telepractice literacy services in Australia to understand whether these clinical placements were easily or conveniently done from the perspective of student clinicians, and whether they were able to be implemented successfully. We sought to explore SLP students’ perceptions and experiences of preparedness, participation, and implementation of telepractice literacy services.

understand students’ subjective experiences of participation in telepractice literacy services.

The study received ethics approval from the Australian Catholic University Human Ethics Committee (HREC 2020- 159E). Data collection A survey administered online via Qualtrics was chosen as the primary method of data collection. For the current study, survey questions were developed in consultation with SLP academics with expertise in literacy and telepractice. Feedback on wording, relevance, structure, content, number of questions and ease of completion was included in the final survey version. The survey wasn’t formally piloted by members of the target population. The online qualitative survey contained three sections: (a) demographic questions, (b) practicalities of the literacy telepractice placement, and (c) experiences of telepractice literacy service delivery. There was a total of 16 questions (Appendix A, available by contacting the author). Participants Participants were selected using purposive sampling. To be eligible, participants had to be currently studying to become an SLP or have completed their final year of study to become an SLP at an Australian university in 2020; and have completed a placement experience where they saw at least one client for assessment and/or intervention for literacy via telepractice. The research participation opportunity was advertised via social media platforms and Speech Pathology Australia communications. Course/ student placement coordinators at 14 Australian universities were invited to advertise the research participation opportunity. The survey was open for 13 weeks. Seventeen people commenced the survey but only eight completed it. These eight responses resulted in 11 pages of data. Participant details are provided in Table 1. Data analysis A six-step process of reflexive thematic analysis was used by the first author to examine the survey data (Braun & Clarke, 2006, 2019). Results Thematic analysis identified three main themes in the data: (a) usual practices for literacy were modified in a telepractice environment; (b) a heightened focus on communication skills in a telepractice environment; and (c) preparedness for telepractice literacy placements was mostly facilitated by practical learning opportunities with peers and supervisors. These three themes, with illustrative data extracts, are described below.

Kerry Ttofari Eecen (top) and Sharon Crosbie

Table 1: Participant characteristics

State

Degree type

Current status

Duration of placement

Practice context*

Victoria

4 Bachelor:

5 New graduate:

3

≤ 20 days:

3 Primary school

5

Queensland

2 Masters:

3 Year 4 student:

3 21–30 days

3 Private practice

3

Western Australia

1

Year 2 student:

2 More than 30 days

1 Outpatient clinic

1

South Australia

1

Placement in progress

1

* Some student SLPs were in more than one practice context

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Theme 1: Usual practices for literacy were modified in a telepractice environment Two of the eight respondents perceived that literacy assessment and intervention transferred well to a telepractice model; however, all respondents described modifications to usual onsite practices. Modifications were required for two main reasons: (a) access to assessment tools and intervention resources, and (b) client characteristics. Access to assessment tools and intervention resources. Respondents used a wide variety of assessment tools via telepractice, e.g., CELF-5, SPAT-R, CAT and assessments available from the Macquarie Online Test Interface (MOTIf). Three of the eight respondents cited access to assessment tools for literacy as a barrier, in a telepractice environment. This included assessments not being available in digital format and universities not investing in digital versions of assessment tools (when available). For most respondents, usual assessment practices needed to be adjusted for administration via telepractice. They described administering subtests of standardised assessments that only required verbal responses or that did not require the stimulus book. Respondents modified the way in which clients responded to assessment items by asking them to use directional terms (e.g., left, right), labels (e.g., picture A, picture B) or mark-up tools. Some described scanning stimulus book pages and presenting them via Microsoft PowerPoint, using share screen functions to display freely available digital assessment tools, use of informal assessments, and more reliance on gathering information from others (e.g., teachers, parents). Limited access to appropriate resources for intervention meant that many respondents modified their usual intervention practices for literacy. They created videos (e.g., using iMovie), screenshared documents rather than using physical resources (e.g., flash cards), used the whiteboard in Zoom, and most frequently, delivered intervention using PowerPoint presentations. These PowerPoint presentations included positive reinforcement for the client (e.g., animations), images, activities, and links to external sites. Respondents commented on the benefit of PowerPoint presentations for delivery of back-to-back sessions. They also used online platforms or resources for their intervention including Vooks, Ultimate SLP, Wordwall and Extra Language Resources (eLR). One respondent commented on needing to be mindful of protocols and procedures when adapting resources for telepractice, e.g.: “I had to reconsider the way I presented activities and managed the session considering the technologies I was using and the protocols/procedures surrounding these” (P7). Modifying intervention resources and activities required technical skills and an understanding of the features of different teleconferencing platforms and software. Only one respondent reported that preparation for telepractice literacy services was more time-consuming than onsite services. Access to resources and activities for intervention was also identified as problematic due to respondents’ beliefs that literacy intervention needed to be multisensory, engaging, and interactive: Interventions had to remain interactive (as they usually would in face-to-face sessions) to ensure the children

board games, using animations on rhyming words). Additionally, if there were activities which weren’t very interactive, I was sure to include activities the children could participate in a reward activity and in some cases to get the children moving physically instead of just sitting at the desk (e.g., online dress-up Barbie game, dance challenge with YouTube videos). (P7) Two respondents also acknowledged that families sometimes had limited access to physical resources in the home to use in therapy: “I was unable to provide parents with tangible resources besides things they could print and not having appropriate toys etc in the home to assist in facilitation of therapy (e.g., Magnetic letters and playdoh)” (P3). While access to appropriate resources for telepractice was described by all respondents, one commented that access improved over the course of the lockdowns as more online tools became available. Others described being provided with resources for telepractice literacy sessions which they found particularly helpful when they aligned to schools’ approaches to teaching literacy. Two of the eight respondents’ intervention practices followed the literacy program of their client’s school. One respondent’s rationale for this was that their clients needed “more in-depth exposure that [sic] what was being provided in class” and that with a limited number of intervention sessions available to the child, they chose to “continue with what he was learning at school” (P8). Client characteristics Respondents identified challenges relating to client engagement and identified that telepractice may not suit all client profiles. Two commented that it may not suit children who need to physically move in sessions, or children who need multiple, changing activities to stay engaged. Other client profiles that were perceived as less suited to telepractice were children with additional sensory needs, attentional difficulties, and those who were non-speaking. Communication via telepractice with children who had oral language difficulties was also perceived as more difficult compared to children with typical language. One respondent commented that some of their clients “could not tolerate telepractice” or “focus their attention on a screen for an extended period of time” (P2). As a result, many respondents modified their intervention to meet clients’ needs. They reported needing to be more “creative” (P2) to keep clients engaged which included making session activities more interactive, including activities that incorporated movement, providing reward activities, and using digital animations. They also reported relying more on parents and school staff, to keep children focussed during their sessions. Theme 2: A heightened focus on communication skills in a telepractice environment All respondents acknowledged the importance of increased attention to their own communication skills in a telepractice environment. This included clear instructions and feedback provided to clients, and the value of this being timely, specific, and clearly articulated. A perception of needing to be more animated in telepractice sessions to keep clients engaged was reported by some respondents: “It required me to become extremely more animated to keep the student engaged through the screen” (P3). Some respondents also commented on the benefits of clear communication with clinical educators, parents,

remained engaged (e.g., dragging and dropping pictures, rearranging letter tiles, making online

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because as a student clinician, I was in an environment where I could make mistakes and learn from them” (P2). For four students, a feeling of being unprepared was related more to the literacy aspect of the service rather than the telepractice aspect: “I felt that my assessment sessions could have been more direct had I known more about literacy skills and approaches to learning literacy. If I were to complete the placement again, I would [sic] I felt that telepractice was not as much of a barrier to providing literacy services as I had thought” ( P8) . “I felt completely lost in where to begin and felt I hadn’t covered literacy treatment delivery/supporting reading skills in depth within my degree. I wasn’t up to date with the then current evidence-based programs for literacy intervention” (P3) . Discussion In this study, we explored SLP student and recent graduates’ perceptions and experiences of preparedness, participation, and implementation of telepractice literacy services within university placements. While the sample size for this study was small, the data provide preliminary information around experiences of telepractice literacy placements including the competencies, skills, infrastructure and supports required, from the perspective of students and recent graduates. Findings identified that SLP students’ usual practices for literacy were modified in a telepractice environment, there was a heightened focus on communication skills for telepractice and SLP students’ preparedness was mostly facilitated by practical learning opportunities with peers and supervisors. In this discussion, we compare our findings to previous research and provide recommendations for educators and clinical supervisors working with SLP students in telepractice literacy placements. Our respondents indicated that their usual clinical practice for literacy was modified for telepractice. This was mostly due to issues accessing appropriate assessment tools and intervention resources for online delivery, and to individual client characteristics. In a recently published rapid review by Furlong et al. (2021), only two studies were identified that evaluated reading and spelling assessments via telepractice. In both studies, assessment materials were scanned and digitised for online use, with the test developers’ permission. Of these assessment tools, and those reported to be most used by Australian and New Zealand SLPs working in the literacy domain (Furlong & Serry, under review), few are available in digital format. Like our respondents, practising SLPs have similarly reported modifications to their assessment and intervention practices for literacy in a telepractice context during COVID-19 (Furlong & Serry, under review). The availability of intervention resources for telepractice, and an ability to select, adapt and create resources for online use, have been recognised in numerous studies as important considerations for SLPs and SLP students (Furlong & Serry, under review; Hines et al., 2015; Overby, 2018). Intervention resources and activities used in telepractice may need to be more interactive to keep clients engaged (Hines et al., 2015; Overby, 2018) with some SLP students perceiving that this is particularly important for younger children, who may be less able to attend in a telepractice environment (Overby, 2018). Supporting SLP students to determine clients’ suitability for telepractice is therefore an important

and school staff in a telepractice placement. This was sometimes perceived as challenging when student SLPs were not in the same physical space: “It was very difficult to contact teachers as we had to have email correspondence through only one person from the school—consequently, it was very difficult to determine if the literacy interventions were making positive impacts in the classroom ... additionally, considering the context of the service it was difficult to contact parents...” (P7) . While there was a heightened focus on communication skills in a telepractice environment, some respondents felt this environment made it easier to reflect on their communication as they had the opportunity to review the session recordings and adjust their practice accordingly: “...I was able to review my professional and interpersonal skills and found that I often gave longer/ complex instructions. As I became more aware, I was able to provide instructions that were direct, which resulted in better results from my clients” (P8) . Theme 3: Preparedness for telepractice literacy placements was mostly facilitated by practical learning opportunities with peers and supervisors Perceived preparedness for telepractice services was evenly split, with four respondents feeling unprepared to deliver telepractice and four feeling adequately prepared. Of those who felt adequately prepared, they described completion of workbooks prior to telepractice placements, access to information about different videoconferencing platforms, access to webinars about telepractice, and involvement in telepractice simulation clinics. They also described how their own experiences of learning online during workshops, tutorials and lectures helped them feel confident to work online. Those who were further through their degree and therefore had completed more clinical placements also appeared more confident in their clinical skills and less concerned about how these would translate to a telepractice environment, e.g., “I also felt that my clinical skills were at the level that providing therapy services via telepractice would not be exceeding challenging [sic]” (P8). Most respondents acknowledged the value of either rehearsing telepractice delivery with another student ( n = 2) or observing live or recorded sessions ( n = 5) of other SLPs or students delivering telepractice. One commented that it was challenging to have a supervisor without any telepractice experience: “My supervisor did not have any background in telepractice so it was really challenging for her to provide me with suggestions on what I could do during sessions” (P2). Learning opportunities and supports mentioned less frequently by respondents included being provided with journal articles to read about telepractice delivery, having a set timetable for the duration of the placement, having a supervisor to problem-solve with and having supervisors access sessions remotely. The presence of a supervisor in telepractice sessions meant student SLPs felt supported, particularly when they could “signal them in” (P7). Those who reported an open and positive relationship with their supervisor felt that placement was a safe place to trial new things and make mistakes: “Although telepractice was really challenging for me, I thoroughly enjoyed the process

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SLP students will continue to participate in telepractice literacy placements for the foreseeable future. It is therefore important that SLP students leave university with the requisite knowledge and skills to work not only in the literacy domain, but in telepractice, as a continuing model of service delivery. Scope of practice documents and clinical guidelines from speech pathology organisations outline the competencies that are required to work both in literacy and telepractice; however, we need to understand the perspectives of students engaged in placements involving both literacy and telepractice to understand what is important to students and to help inform the best pedagogical strategies to support them in delivering a successful service. The findings of this study have contributed to filling this gap in knowledge, and to the set out below recommendations. Recommendations 1. Support access to appropriate online assessment tools for literacy (e.g., resources from MOTIf) and intervention resources (e.g., subscription-based resources and online platforms). SLP students could be supported to develop the skills required to create and adapt assessment and intervention resources. It is important to be mindful that selecting and creating resources for intervention can be time-consuming, and this should be considered alongside SLP students’ usual caseload requirements. Copyright also needs to be considered. Some standardised assessment tools are now available in online versions and where these are available, it is important that universities invest in these resources. Where resources have not been converted to online versions by the authors or publishers, it is important for permission to be sought before adapting these resources. 2. Provide explicit teaching and opportunities for practice around communication skills in a telepractice environment, including how these differ to onsite contexts. Teaching and practice opportunities could focus on the antecedent and feedback components of the teaching moment with clients, and considerations for clients with sensory needs (e.g., vision impairment, hearing impairment). 3. Provide SLP students with practical learning opportunities in telepractice literacy services. The most effective telepractice pedagogy, from the perspective of SLP students, may include simulated learning environments, role-playing with peers and supervisors, and observation of peers and supervisors delivering telepractice literacy services. 4. Support students to determine which clients are best suited to telepractice and to reflect on the evidence base, particularly for literacy where research evidence is limited. Encourage students to explain the limitations and benefits of telepractice to clients and families, so that they can make informed decisions. 5. Ensure that all speech pathology courses adequately prepare students to work in the literacy domain. Limitations The sample size for this study was small; however, the richness of participants’ responses was adequate to address the research questions and allow for meaningful analysis. The lack of data from New South Wales may be a limitation given the number of well-established speech pathology courses run in this state. It is a limitation of the study that no third-year speech pathology students participated in the survey.

consideration. Furthermore, SLP students need support to understand how to tailor intervention approaches, resources, and activities for literacy to meet individual client needs in a telepractice context. Our respondents reported a heightened focus on their own communication skills in a telepractice environment. This included attempting to be more animated, and providing timely, specific, and clearly articulated instructions and feedback to clients. In Overby’s study (2018), interpersonal engagement was identified by all stakeholders (SLP faculty, graduate students, and telehealth clinicians) as important for telepractice services, with SLP students identifying this as the most important telepractice clinical skill. In a telepractice placement context, differences compared to face-to-face service delivery have been reported by allied health students relating to observation and interpretation of clients’ non-verbal communication (Bridgman et al., 2018; O’Hara & Jackson, 2017) with some recommending this as an area for explicit teaching within academic training programs (Overby & Baft-Neff, 2017). For our respondents, the importance of presenting clear and concise instructions and information to clients may have been heightened due to these perceived challenges in an online context relating to non-verbal communication. Despite this, the real-time visual feedback afforded by telepractice, and the ability to view session recordings means that telepractice can provide an opportunity for SLP students to reflect on their own performance, including their interpersonal skills, and adjust their performance accordingly (Bridgman et al., 2018). Like the perspectives of stakeholders in Overby’s study (2018), our respondents indicated that practical learning experiences with peers and supervisors were most beneficial for preparing them to deliver telepractice literacy services. These experiences included observation of supervisors or peers delivering telepractice literacy services, role-playing and participation in simulation clinics. It is thought that practical experiences such as these provide familiarity with technology and its capabilities, examples of the types of difficulties that might be encountered and an opportunity to analyse the strategies used by other clinicians in telepractice (Overby, 2018). Interestingly, our respondents reported feeling more confident with the technological aspect of their telepractice placement rather than the literacy aspect. This is consistent with the findings of Overby (2018), where fear and anxiety about technology failure did not emerge as a theme from their SLP student data. In the current COVID-19 climate, many tertiary institutions have rapidly transitioned to online learning and therefore, our respondents’ own experiences of learning online may have contributed to their confidence with the technological aspect of telepractice. Half of our respondents commented on their lack of confidence working in the literacy domain as being a barrier to delivering a successful telepractice literacy service, despite literacy being recognised as within SLPs’ scope of practice (Serry et al., 2021; Speech Pathology Australia, 2011). Some SLP students reported an intention to seek additional professional development in literacy following graduation, consistent with the findings of Serry and Levickis (2020) who reported that much of the knowledge and skills SLPs gain for working in the literacy domain are obtained through post-university training. Given the expected long-lasting effects of the COVID-19 pandemic, along with an appreciation of the benefits offered by telepractice relating to cost and service access, many

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Conclusions In our investigation of the practicalities of student-led telepractice literacy services, we conclude that participants in our sample needed the following: (a) adequate access to evidence-based assessment tools and intervention resources that transfer easily to online delivery; (b) a heightened focus and self-awareness of their clinical communication skills in telepractice and; (c) opportunities to practice delivering telepractice services with peers and/or supervisors. Above all, speech pathology courses need to privilege the teaching of literacy as an area of practice so that students are adequately prepared to work in the literacy domain regardless of the service delivery model. Acknowledgements The authors gratefully acknowledge the funding received for this study from a Learning and Teaching Grant from the Australian Catholic University. The authors would like to thank the SLP students and graduates who took part in this study. References Blood, G., Mamett, C., Gordon, R., & Blood, I. (2010). Written language disorders: Speech-language pathologists’ training, knowledge, and confidence. Language, Speech & Hearing Services in Schools (Online) , 41 (4), 416–428A. https://doi.org/10.1044/0161-1461(2009/09-0032) Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology , 3 (2), 77–101. Braun, V., & Clarke, V. (2019). Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health , 11 (4), 589–597. https://doi.org/10.1080/21596 76X.2019.1628806 Bridgman, K., Erickson, S., Furlong, L., & Bird, A. (in press). Allied health student engagement in telehealth clinical placements: A rapid review. Internet Journal of Allied Health Sciences and Practice . Bridgman, K., Pallathil, K., Ford, N., Tran, J., Lam, D.-L., Wee, E., & Kefalianos, E. (2018). Attitudes and experiences of SLP students from a pilot telehealth stuttering clinic. Journal of Clinical Practice in Speech-Language Pathology , 20 , 14–20. Catts, H. W., Hogan, T. P., & Fey, M. E. (2003). Subgrouping poor readers on the basis of individual differences in reading-related abilities. Journal of Learning Disabilities , 36 (2), 151–164. https://doi. org/10.1177/002221940303600208 Furlong, L., & Serry, T. (manuscript under review). An exploratory study of speech-language pathologists’ clinical practice in the literacy domain: Comparing onsite practices with telepractice services during COVID-19. Furlong, L., Serry, T., Bridgman, K., & Erickson, S. (2021). An evidence-based synthesis of instructional reading and spelling procedures using telepractice: A rapid review in the context of COVID-19. International Journal of Language and Communication Disorders . https://doi. org/10.1111/1460-6984.12619 Grogan-Johnson, S., Meehan, R., McCormick, K., & Miller, N. (2015). Results of a national survey of preservice telepractice training in graduate speech-language pathology and audiology programs. Contemporary Issues in Communication Science and Disorders , 42 , 122–137.

Hines, M., Lincoln, M., Ramsden, R., Martinovich, J., & Fairweather, C. (2015). Speech pathologists’ perspectives on transitioning to telepractice: What factors promote acceptance? Journal of Telemedicine and Telecare , 21 (8), 469-473. https://doi.org/10.1177/1357633X15604555 Houston, K. T., (2014). Telepractice in speech-language pathology . Plural Publishing. O’Hara, R., & Jackson, S. (2017). Integrating telehealth services into a remote allied health service: A pilot study. Australian Journal of Rural Health , 25 (1), 53–57. Overby, M. S., & Baft-Neff, A. (2017). Perceptions of telepractice pedagogy in speech-language pathology: A quantitative analysis. Journal of Telemedicine and Telecare , 23 (5), 550–557. https://doi. org/10.1177/1357633X16655939 Overby, M. S. (2018). Stakeholders’ qualitative perspectives of effective telepractice pedagogy in speech– language pathology. International Journal of Language and Communication Disorders , 53 (1), 101–112. https://doi. org/10.1111/1460-6984.12329 Serry, T., & Levickis, P. (2020). Are Australian speech- language therapists working in the literacy domain with children and adolescents? If not, why not? Child Language Teaching & Therapy (Special issue: Language and literacy), 1–15. https://doi.org/10.1177/0265659020967711 Serry, T., Seiler, T., Leitao, S., Westerveld, M., Furner, R., Morrish, S., Neilson, R., Snow, P. C., Schambre, M., Brown Walmsley, K., Jones, E., Atherton, M., & Baldac, S. (2021). Practice guidelines for speech pathologists working in childhood and adolescent literacy: Revised . The Speech Pathology Association of Australia Limited. Speech Pathology Australia. (2011). Position statement: Literacy . Speech Pathology Australia. (2020). New ways of working. Speak Out , 10–16. Wilson, L., McNeill, B., & Gillon, G. T. (2015). The knowledge and perceptions of prospective teachers and speech language therapists in collaborative language and literacy instruction. Child Language Teaching and Therapy , 31 (3), 347–362. https://doi. org/10.1177/0265659015585374 Dr Lisa Furlong is a speech-language pathologist. She is an adjunct research fellow in the School of Education at La Trobe University and a senior lecturer at the University of Canterbury in Christchurch. Associate Professor Tanya Serry is a speech- language pathologist currently working in the School of Education at La Trobe University. She is the co-director of the SOLAR Lab (Science of Language and Reading). Dr Kyriaki (Kerry) Ttofari Eecen is a lecturer in speech pathology at the Australian Catholic University in Melbourne and is the coordinator of a student mentoring program. Dr Sharon Crosbie is a speech-language pathologist with Brisbane Catholic Education and a senior lecturer at the Australian Catholic University in Brisbane.

Correspondence to: Lisa Furlong La Trobe University phone: +64 225 145 610 email: l.furlong@latrobe.edu.au

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