JCPSLP Vol 23 No 3

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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JCPSLP Volume 23, Number 3 2021

Journal of Clinical Practice in Speech-Language Pathology