Speak Out June 2020

SPEAKOUT JUNE 2020 THE MAGAZINE FOR AUSTRALIAN SPEECH PATHOLOGISTS

IT'S TIME TO RENEW YOUR MEMBERSHIP

Embracing new ways of working

RETURNING TO IN-PERSON WORK ETHICS AND TELEHEALTH

New feature: Member research Information for new graduates and more...

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Contents

June 2020

National Office Level 1/114 William Street Melbourne VIC 3000 T 1300 368 835 F 03 9642 4922 E office@speechpathologyaustralia.org.au Chief Executive Officer Gail Mulcair T 03 9642 4899 E execassist@speechpathologyaustralia.org.au Speech Pathology Australia Board Tim Kittel - President Chyrisse Heine – Vice President Communications Maree Doble – Vice President Operations

Feature story New ways of working p10

Brooke Sanderson – Director Bronwyn Sutton – Director Kathryn McKinley - Director Alison Smith - Director Follow Speech Pathology Australia via:

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From the President

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Copyright © 2020 The Speech Pathology Association of Australia Speak Out is the official bi-monthly magazine of The Speech Pathology Association of Australia Ltd. Speech Pathology Australia (SPA) owns the copyright to Speak Out and no part of this magazine may be reproduced without the explicit permission of SPA. Write to us Letters can be sent to publications@speechpathologyaustralia.org. au Letters may or may not be published in future issues of Speak Out magazine at SPA’s discretion. Advertisements Please refer to the “Publications” menu at www.speechpathology australia.org.au to view the 2020 Speak Out ad kit. Any queries may be directed to SPA Publications Manager T 1300 368 835 E publications@speechpathologyaustralia.org.au Advertising booking dates for August 2020 Speak Out . The official booking form must be received at national office by COB 9 July, 2020. Disclaimer To the best of The Speech Pathology Association of Australia Limited’s (‘the Association”) knowledge, this information is valid at the time of publication. The Association makes no warranty or representation in relation to the content or accuracy of the material in this publication. The Association expressly disclaims any and all liability (including liability for negligence) in respect of use of the information provided. The Association recommends you seek independent professional advice prior to making any decision involving matters outlined in this publication. Print Post Approved PP349181/01711 Print ISSN 1446-053X Digital ISSN : ISSN 2208-7125 We acknowledge the Traditional Custodians of lands, seas and waters throughout Australia, and pay respect to Elders past, present and future. We recognise that the health and social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples are grounded in continued connection to culture, country, language and community. Speak Out Branch Editors Please see the website for Branch Editor contact details.

It's time to renew your membership

Advocacy during the pandemic

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Participate in the inaugural Speechie Library Talks Campaign . New ways of working -Discover how some members adjusted during COVID-19 New series -Member research in focus

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The latest for new graduates

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Aboriginal and Torres Strait Islander Advisory Committee update.

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Professional Education

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National Conference news

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Ethics amid COVID-19

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In practice : Returning to in-person work

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Branch news

Cover pic: During COVID-19 student clinical placements at the University of Queensland changed to a telepractice model. Read more on page 18.

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From the President

One of Belinda Hill’s last duties as Vice President was to close the awards ceremony as a part of our first, completely online, Annual General Meeting (AGM). “On behalf of Speech Pathology Australia, I would like to thank you for your attendance this evening,” she said with a smile, handing back to the Online Facilitator. But if you waited right to the end, just before he turned off the audio, there was a laugh of relief, and you would have heard three final words: “We did it!” I’m not completely sure who it was who said that, but I suspect it may have been Nicole Pantalleresco, Board and Executive Assistant. Nicole had spent months of effort coordinating this new initiative. Working with Gail, Nicole had workshopped through all the possible risks and challenges involved. Having to hold an AGM online is something facing literally thousands of organisations, and not all have been successful. So, as a result, if it was Nicole, she absolutely deserved to utter these last words. And also because these words echo the experience that many speech pathologists are having right now. The ‘Embracing New Ways of Working’ feature article is a fantastic read, pulling together the experiences of speech pathologists across the nation, and the ways in which they moved swiftly and thoughtfully. While the stories are all distinct, the theme of “we did it” rings through each, and in particular the SP2030 aspirations of clients and communities driving service delivery. As a profession, we are uniquely placed to understand the irony behind the term social distancing. While we understand the health connotation behind keeping a physical distance to slow the spread of COVID-19, socially, we’re connecting more than ever. You’ll see in this issue that SPA’s social groups have increased both their memberships and engagement over the past few months. Indeed, some of the stories in our lead article cite that engaging with others over social media was vital in terms of gaining the resources and support needed to respond successfully. Also, now is exactly the right time to check out when your Branch is next meeting in your State or Territory. With all meetings

currently being held online, many Branches are experiencing increased attendee numbers, and the meetings I’ve been lucky to attend are filled with people sharing stories and laughing, as well as progressing the profession in a myriad of ways. It’s great to read that in Queensland, both pre-COVID and during the early days of the crisis, speech pathologists are getting together to share a story or two, and enjoy the collegiality of our profession. So there will be a lot of ways in which, once we start to re-establish what our profession and our wider society becomes in the years after the pandemic’s introduction. There will be some elements that return to us, some new ways of working that will continue to benefit us, and some things that absolutely must change. The Black Lives Matter movement has a particular resonance and importance within our country. Within this issue you will also read the significance of National Reconciliation Week, and meet Tania Harris, Eddie Ong, Louise Taylor, and Pauline Weldon-Bowen, who, with the Aboriginal and Torres Strait Islander Advisory Committee, the Board, and National Office, continue to drive our Reconciliation Action Plan into its Innovate phase. We cannot deny racism and discrimination throughout the world, and throughout our country, and ‘In This Together’ reinforces the commitment that we all share to eradicate this. I mentioned Belinda at the beginning of this introduction. Both Eddie and Belinda are stepping down from the Board, with Eddie continuing to work within the Aboriginal and Torres Strait Islander Advisory Committee, and Belinda moving on to her next challenge– the world of research. We thank them for their significant contributions to the Association. We also welcome Bronwyn Sutton and Alison Smith to the Board of Directors, who will also bring inspiring insights. Yes, we did it. We have proved that we can embrace “new ways of working”. Our next challenge is our “new ways of being”. Make yourself a hot chocolate, and join me, let’s get to it.

Tim Kittel

Tim Kittel National President

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Association news

Board report - May 2020 The second SPA Board meeting for 2020 was held with a condensed format, via virtual means, on Friday 8 and Saturday 9 May 2020.

o Waive the Administration Fee for Direct Debit payments ($15 per member); o Maintain 2020/2021 membership fees at 2019/2020 levels (not include the agreed 2% CPI increase); o Deferral of Direct Debit installment payments for a period of two months; and o Offer online professional education vouchers for members who pay their membership in full by the required date. The Association’s new Learning Management System (LMS), built on the Pointsbuild platform, has recently been launched. ‘The SPA Learning Hub’ gives members access to quality learning activities, developed and presented by leading educators, researchers and clinicians. Professional Standards for Speech Pathologists Following an extensive review process, the Board of Directors approved the final draft of The Professional Standards for Speech Pathologists (Version 16). This draft will be presented for legal review, prior to being disseminated to the membership. An implementation plan and transition period will apply. National and Branch Alignment Strengthening the alignment between the Board of Directors and Association Branches was discussed, with the 2020- 2022 Strategic Plan to be used as a vehicle to streamline priorities. Research Grants The SPA Board agreed to amend research grant guidelines to allow expenses associated with open access publication within Speech Pathology Australia research grant budgets. It was agreed that this is not only is open access beneficial to the researcher, it also provided the membership with further access to Association funded research. Fellowship and Awards Committee Life Member, C Bowen and Fellow Member, S Horton were appointed to the Fellowship and Awards Committee, for a three-year term. The Board will next meet on Friday 28 and Saturday 29 August 2020. Gail Mulcair Chief Executive Officer Other items addressed at the meeting include: Learning Management System

The Board of Directors welcomed incoming Directors, Alison Smith (QLD) and Bronwyn Sutton (QLD) to the meeting, as observers. Alison and Bronwyn will be formally appointed to the Board of Directors at the Association’s Annual General Meeting on 25 May 2020. As would be expected, much of the May 2020 Board of Directors meeting focused on the impacts of the COVID-19 Pandemic on the membership and the Association. The rapid and significant changes made by the Association in light of the COVID-19 pandemic, were acknowledged, with positive member feedback having been received. The Board approved a new Business Continuity Policy, which ensures the Association is able to address the needs of the membership in unforeseen circumstances, such as the current environment. Consideration is currently being given to how the Association can guide members as restrictions ease and face-to-face services are re-introduced. The newly formed COVID-19 Speech Pathology Advisory Panel, with broad representation from different sectors of the profession, met for the first time on 30 April, with approximately 30 in attendance. Input from this group will inform updates to the Speech Pathology Guidance Document as well as resources involving risk assessment and infection prevention and control. The recent member survey aimed to assist the Association in understanding the significant and wide-ranging impacts of COVID-19 on the membership. The feedback received will be used to inform the development of resources and provision of services, that meet the needs of the membership. The member survey results highlighted members’ concerns in relation to achieving the Professional Self -Regulation requirements including attesting to at least 1,000 practice hours in the past five years and meeting the required CPD points, in order to maintain Certified Practising Speech Pathologist status. Signatories to the Mutual Recognition Agreement (MRA) and the National Alliance of Self-Regulating Health Professionals (NASRHP) have endorsed that the Association offer members a twelve- month extension to meet the minimum practice hours and continuing professional development requirements. It was agreed this 12-month extension would be offered to members In recognising the impact of COVID-19 on members, the Board of Directors agreed to offer the following range of membership renewal incentives for the 2020/2021 membership period:

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Association news

Upsurge in use of SPA resources

On the socials Members also flocked to the Association’s social media platforms and closed Facebook communities. There continues to be a steady flow of two-way communication with members sharing resources and providing collegiate support and advice. The most notable increase on the Association’s social media platforms was on the Facebook page where 300 more members joined in the conversations in March and April. The Instagram account also saw a huge rise in engagement. The number of posts increased by 131%, comments increased by 257% and overall reactions to posts increased by 405%. Linkedin and Twitter also welcomed many new followers with activity nearly doubling when compared to the months prior to COVID-19. Most popular posts While members largely logged on to find out about COVID-19 related resources in April, the Swallowing Awareness Day materials also proved popular and ranked in the top posts for March.

During the peak of the pandemic Speech Pathology Australia resources were utilised extensively by members. All of the Association’s business units received an upsurge in member enquiries and questions about how to navigate to new ways of working. The majority of questions related to telepractice and questions about how to transform from face-to-face interaction to digital interfaces. In response, the Association developed specific resources on telepractice, including podcasts and webinars, established a COVID-19 specific webpage, and continues to provide weekly updates to members. The Association’s website received 299,000+ page views in the five weeks between 23 March to 3 May representing a 45% increase in visitation compared to the same time last year. Top five web pages 23 March to 3 May 2020 COVID-19 News and Information 20,071 Telepractice Resources 15,476 COVID-19: Impacts on speech pathologists 9,655 COVID-19 Guidance for Service Delivery 9753 Find a Speech Pathologist 8,109 We are listening Across all parts of the Association our team have their eyes and ears open to find out about how they can support members at this time. We are pleased to say that many of you are appreciating our work. Here is what some members said: "The SPA head office Team have certainly had a busy time of it these past months, producing excellent resources & guidance on all its platforms, I thought that praise should be passed on to all those involved.” Mary “Where would we be without SPA more now than ever.” Renee “The resources from SPA have been amazing.” Stephanie

Facebook March: SAD 2020 video – 10,781 reach/ 272 reactions April: Genes linked to speech disorders – 8492 reach / 271 reactions. Top Tweets March: Letter - 8,491 impressions April: Leaning Hub launch – 6,382 impressions Linkedin Popular Posts March: SAD 2020 video – 5,117 impressions April: World Voice Day – 1843 impressions Podcast March: Kids behaving badly (1589 plays) April: Covid related stress (1166 plays) Instagram Top post Bulk billing MBS eligible telehealth services

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Speech Pathology Week 2020 earns Gold Quill Awards Over a number of Speech Pathology Week campaigns, the Speech Pathology Australia Communications and Marketing team has worked closely with the Melbourne-based public relations firm, Pesel and Carr. That partnership has again paid dividends in more ways than one. After helping the Association to refocus the purpose and aims of Speech Pathology Week, the 2019 campaign was rewarded with two International Association of Business Communicators 2020 Gold Quill Awards. Pesel and Carr’s success came for their work on the Association’s “Communicating with confidence” campaign. The awards came specifically in the ‘Marketing, Advertising and Brand Communication’ and ‘Non-profit Campaign categories’. “This was a highly rewarding campaign not just from a communications perspective, but for its social impact in highlighting something that affects so many Australians,” said Barbara Pesel, Managing Director at Pesel and Carr. “What’s pleasing is we did a lot of research to inform a strategy to improve on the previous year’s campaign and with the support of Speech Pathology Australia implemented our findings to achieve great outcomes.” The Association’s Communication and Marketing team were instrumental in implementing the engagement and communication strategy developed in consultation with Pesel and Carr. Highlights from the campaign included 51 pieces of media coverage, resulting in a reach of 1.27 million (with 98% of coverage including at least one key message) and theme recall almost doubling amongst members. In addition, the Association produced five video case studies (viewed more than 50,000 times), ran a highly successful and engaging social media campaign, which included one posting on Instagram securing over 4400 likes. The ‘eye-chart’ poster and graphic, initiated and designed in-house by the Association, encapsulated the campaign’s key challenge succinctly. That for most Australians, unfortunately, communication disability is out of sight, and out of mind.

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Association news

Current government inquiries The two major advocacy projects underway prior to COVID-19 (Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability; and Royal Commission into Aged Care Quality and Safety), although having suspended public hearings due to the pandemic, continue to release issues papers requiring a response. The SPA advisors responsible for these portfolios continue to contribute expert input to ensure the perspective of the profession and their clients is considered. Of course, many other advocacy activities continue, notably the Australian Government’s Senate Select Committee into Autism, which many SPA members are generously providing assistance with SPA’s response to this major review. COVID-19 related activities A great deal of work has been undertaken on many fronts, but here is a summary of the main issues. Telehealth: An urgent focus was the potential to introduce telehealth due to the virus, so we quickly provided strong arguments to the various funders (e.g.., Medicare, DVA, private health funds and compensable bodies – further detail on the status of individual funders is available on the SPA COVID-19 Telepractice webpage) to support the need for, and efficacy of, telehealth practices for speech pathology. (Many thanks to Deb Theodoros for her valuable assistance at very short notice!) I am pleased that many of these funding bodies moved very quickly to introduce processes for telehealth. We are preparing to re- establish contact with the various funders before their temporary arrangements end, with a view to permanent acceptance of speech pathology services provided via telehealth post COVID-19. We are now collaborating with several other allied health professions and University of Melbourne on an evaluation framework to analyse the introduction of telehealth during this period. We also provided strong support to AHPA which led to the removal of the need to bulk bill for Medicare telehealth services. PPE: SPA advocated strongly and was successful in having speech pathology listed as one of the high priority professions for Advocacy during the pandemic

PPE from the National Medical Stockpile. This was due, in part, to the work undertaken to articulate the aerosol generating issue of speech pathology work, but also through the eventual acceptance of speech pathology as an essential service AHPRA-related deals: We have been contacted by a number of members disappointed that some businesses have, in response to COVID-19, been offering special deals for health professionals on the basis that individuals provide their AHPRA registration number. We have followed up with these companies to explain that most health professions, like speech pathology, are not part of the national registration scheme, but some, like speech pathology, do have processes in place (through NASRHP) to ensure the same protection of the public provided by AHPRA, and we have offered to facilitate the same verification process from the SPA database that AHPRA’s register allows. One business response to our offer noted that they agreed that their process was “not perfect” but declined to do anything further. (We have written back to Optus a second time but still awaiting a further response). We understand that it is frustrating to some of you that speech pathology is not regulated through AHPRA, but the Australian Government has articulated that there is no appetite to extend AHPRA to cover any further health professions at this time. These are just the major issues during this challenging time. A significant amount of advocacy and lobbying has been done by various members of the SPA team, and through our strong connection with and participation in Allied Health Professions Australia. Mark Smith Manager, Policy and Advocacy Speech Pathology Australia is aware that with government announcements regarding easing of COVID-19 restrictions many members will be returning to face-to-face work. The Association has developed a dedicated page with resources and information to support and guide members. Information on this page should also be read in conjunction with the Association’s Guidance for Service Delivery document. New member resources Returning to work page

Go to the return to work page

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Association news

Speechie Library Talks A new campaign to help you connect with your community and local library

How you can get involved… You are invited to register your interest in holding a Speechie Library Talk in November at your nominated school or public library. The talk will include a reading of one of the winning books and will also be an opportunity for you to talk about your role in helping children's language and literacy. You will be asked to nominate the ALIA member library of your choice and also a tentative date in November. The Association will make the connection with the library and assist with the arrangements. To register you interest, click on the 'register here' button below. You can also find out more about the campaign here or www. speechpathologyaustralia.org.au/library. If you'd like more information about the Speechie Library Talks campaign please contact Publications Manager, Rebecca Faltyn, rfaltyn@speechpathologyaustralia.org.au.

The role of speech pathologists in children’s language and literacy development will be the feature of Speech Pathology Australia’s inaugural Speechie Library Talks campaign. Speechie Library Talks will facilitate connection between speech pathologists and their local public or school library in a series of events to be held in November 2020 to coincide with the Association’s Book of the Year celebrations. By connecting speech pathologists with their local public or school library, and their broader community, the aim of the campaign is to raise awareness of speech pathologists' role in developing children’s language and literacy, the Association’s Book of the Year Awards, and how library resources can play a part in building language and literacy. The Association will collaborate on the campaign with the Australian Library Information Association (ALIA). Parents, carers and those interested in children’s language and literacy development will be invited to attend a talk to find out more about how speech pathologists can help their child’s language and literacy development and the resources available at their local library. Members will be supported by the Association's Communications and Marketing team with resources to assist with promoting and conducting the library talks.

Register here

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New ways of

working

FOR MANY MEMBERS THE IMMEDIATE WEEKS AFTER THE ONSET OF THE COVID-19 PANDEMIC WAS CHALLENGING AND CONFRONTING. THERE WAS A MONUMENTAL SHIFT IN THE WAY SPEECH PATHOLOGISTS APPROACHED THEIR WORK AMID CONCERNS FOR PERSONAL SAFETY AND THAT OF THEIR FAMILY, TEAMS, STAFF AND CLIENTS. SO HOW DID MEMBERS FACE THE ADVERSITY?

A recent Association member survey showed that more than 80% of members changed the way they work in response to the community restrictions – most moved from face-to-face to telepractice. For some the pandemic and the resulting restrictions ignited innovative ideas and new ways of working that will have a lasting impact on the profession. The Association was privileged to receive a number of insights from members on their approach to their new ways of working, revealing how their adaptability and resilience shone amid the chaos. The early days For many members the early days of the pandemic were full of confusion and uncertainty. After all who has a crisis or business continuity plan for a pandemic?

Alissa Gargano is a private sole clinician working in Sydney, and pre-pandemic, was working primarily with children at school, some parent coaching, and a limited caseload of adults living with developmental issues. March saw a rapid and severe decrease in Alissa’s clients’ ability to access and engage in her service. “My March income was less than half of my income compared with February. So I had to hustle!” Before the pandemic Amelia Bayliss provided speech pathology services for adults at a clinic at Burwood in Sydney where she would travel to see clients within their homes, nursing homes and consult within hospital settings. “Prior to COVID-19, my caseload was 100% face-to-face services. Something I have always enjoyed about my work has been being able to provide therapy in the comfort of the client’s home. It’s allowed me to better understand each client, to individualise their therapy and make sure it was relevant to what they really needed. It

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also meant they were typically more comfortable in their familiar environment, which created a more collaborative approach towards therapy. “In the early days, for a short period my work continued as usual. However, as the pandemic started to increase my concern for my family’s health and wellbeing became my priority. I live with someone who is in the higher risk population so it was my preference to limit as much face-to-face contact. Thankfully my manager was very supportive of this decision and my adventure into telehealth began.” Carly Veness in her practice located in Melbourne’s outer northern suburbs, is primarily focused on supporting infants and children with feeding and swallowing difficulties. “Before the COVID-19 pandemic we provided about 99% of our services in a face-to-face context. “Like all our colleagues, we had to adapt and adapt quickly! We made the decision relatively quickly to shift entirely to Telehealth services and for all our team to work from home. This was a completely new experience and a challenge for our team as we had not provided this model of service before. ‘Jumping in the deep end’ and ‘rapid learning curve’ are phrases that come to mind!! I was also worried about how the transition into Telehealth would go and how we could adapt our current assessments and therapies to the Telehealth setting. Would families be keen to engage in Telehealth? Could we still keep our practice open and running? How would it all work?” Making the transformation The move to telepractice and other ways of working was a steep learning curve for many practitioners. For some the pandemic fast-tracked digital transformation of their business practices and for others the need to change advanced their personal skill sets. Genuine concerns about being able to adapt to meet the needs of clients was matched by concerns for health and safety of teams and staff. Karina Quince Mobile private practice McDevitt Speech Pathology Adelaide Before the pandemic Karina serviced clients via school and home visits. A previous role as the lead speech pathologist involved in the development of tele-rehabilitation in the Southern Adelaide Local Health Network at SA health gave her extensive experience in telehealth and she was able to draw on this to support her team to adapt to the changing landscape. “My early concerns were for my team and their clients, rather than being concerned about being able to deliver telepractice services myself. I was concerned about my colleagues losing income and their clients not being able to access services and the repercussions for their clinical outcomes. “I was confident in the quality of telepractice as a service delivery option for many clients, I had transferrable knowledge and skills, and I was able to quickly prioritise the most important actions necessary to shift to telepractice clinical services. I was also fortunate that I was on maternity leave, I had time on my hands, which enabled me to be proactive and help to prepare my team early. “I firstly sought to reassure my team about the efficacy of telepractice and shared my positive experiences from my prior work with them. I investigated recommendations made by both SPA and ASHA. I investigated and trialled various video conferencing platforms. I invested in a headset with a microphone, document camera and second computer monitor. I

developed a telepractice consent form and user guides for both our team and clients. I accessed online webinars relevant to telepractice. I learned how to digitalise my existing resources via PDF documents, PowerPoint and Boom Cards and also began creating new documents. I completed training sessions with my colleagues via video conference calls using screen sharing functions. “I was worried about my colleagues and others in the profession. Personally, I was excited to be engaging in the telepractice service delivery model again and I found that the situation hastened my return from maternity leave. I was also very inspired by the camaraderie of the profession, the generosity of those who shared information and resources, and I was able to see how our profession and my own clinical practice were advancing as a result of this terrible situation.” “I believe that my clinical practice has changed forever. I will continue to use personalised, interactive digital resources wherever possible, so as to engage my clients and also so as to minimise the environmental impacts of printing and laminating. I will continue to use digital practice management software, including digital forms, for the convenience of the families that I work with. I will continue to offer telepractice as a mode of service delivery where clinically appropriate. I will also offer it as a means of communicating with families and as a method to increase communication with my mobile practice team mates. Kate Lalor Community Health Paediatrics Northern Territory Kate Lalor and her team in the NT began by exploring and upskilling in various telepractice options early on to prepare if community spread was reported in the NT. “We began gathering data from new clients at assessment to determine their capacity for using telepractice should we suddenly need to cease face-to-face sessions. As the pandemic escalated we took more steps to reduce face-to-face sessions and began trialling telehealth sessions with families. We completed screening questions at the time of booking clients and the day before or day of appointments to ensure clients were safe to attend. Our main concerns related to our rural clients and those unlikely to have access to internet or data should telehealth become the only option and the potential impacts on some of our more vulnerable clients who can be difficult to engage with even without the new barriers. We also worried about our waitlist growing as our ability to see clients slowed. We have been lucky enough not to reach the point of community spread in the NT, therefore in-person visits never actually ceased. In saying that, certainly high-risk client and/or staff did cease face-to-face visits and in these instances telepractice was a successful alternative. “Since we have no community spread in the NT, we have been able to return to a relatively ‘normal’ way of operating, with additional measures including: social distancing within sessions, restricted number of people in rooms, not running groups, completing strict health screening calls prior to sessions. Our main changes include now having access to (and confidence to use) the technology required for providing services via telepractice. “I think one of the biggest challenges has been keeping abreast of the frequent changes and messaging from our managers and changing our practice accordingly. Keeping our clients and families informed and ensuring we are communicating our service changes and reasons for changes clearly has also been very important. “Most of our clients have been very understanding of changes to our service. We have found we have been seeing fewer

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clients over the past couple of months due to an increase in difficulty contacting some clients, increase in cancellations and rescheduling due to illness and other family circumstances. Given we are a government service, we have been able to be flexible with following up these clients. “I think we have also been lucky in that we have been able to follow the lead of many of the other states and certainly our changes have been less significant in comparison. For the most part we will return to pre-COVID ways of working. I expect we will continue to use telepractice as an alternative when the need arises. We have had many positive experiences via telehealth as a team and have received positive feedback from clients, and will likely continue to be a part of our service.” "Telehealth was also the push we needed to get all of our systems integrated online." “My business partner, Jess, and I were due to open a brand new practice, Protea Therapy, at the end of March. Our target population was children aged 0-18 but with a special interest in speech sound disorders, feeding and medically complex children (the focus of my PhD), and children with cleft lip and/or palate (the focus of Jess’ PhD). We already had a few referrals, and were looking forward to starting to see clients in our lovely room in a GP clinic in Carlton North. "Luckily, we both also have other strings to our bows—Jess as a lecturer and postdoctoral researcher, and me as a writer/editor and postdoctoral researcher." Moving her practice to telehealth provided professional and personal challenges for Katherine Sanchez. Her learning curve into telehealth was steep, but says it was the push they needed to get all of the business systems integrated online. “Telehealth was an innovation for us, although I know many speech pathologists have been effectively practising this way for years. I’ve also shifted more intensively towards parent coaching, which I’ve really been enjoying. “Getting the right hardware was key! A second monitor, a good webcam, and a headset have all helped me to deliver services smoothly. I also got my license to deliver Hanen: It Takes Two to Talk via telepractice, and I have been using these resources individually with families. “In terms of my own learning, I was involved in writing about telehealth resources, so I had an opportunity to familiarise myself with the literature and see what resources other writers found too. I also loved SPA’s webisodes on telehealth and joined a lot of telepractice Facebook groups for ideas. Katherine Sanchez Private Practice and Postdoctoral researcher, Melbourne

“Telehealth was also the push we needed to get all of our systems integrated online. Our patient forms are now online, we take online payments, and we’ve got our telehealth platform talking to our practice management software. I haven’t used any paper yet! It’s been a learning curve, but it’s great to have a new way of working that makes our services more accessible for some families." Kristin Bayley Clinical Director, To the Moon and Back, Sydney For Kristin the key to making a smooth transition was to start preparations early. The practice with four speech pathologists in Sydney works primarily with children and some adults diagnosed with ASD and related disabilities. As the gravity of the situation became more obvious to Kristin and the team they realised they needed a plan. “I felt that the better prepared our staff and families were, the smoother and the more successful the transition would be. We also needed a clear plan for how and when we would make the decision to shut down. We developed a three phase plan- and we will return to a similar three-phase plan when we start to think about making a slow, measured move back to ‘normal’. “Once we decided that we would go to 100% telehealth, we conducted a number of risk assessments of clients to access this telehealth model. We were very fortunate that all of our families had a device they could access a telehealth and had adequate internet access. Some families were concerned about privacy and so we had to do a lot of research into the ins and outs of safety and security on telehealth, and of course turn around consents very quickly! “All of this occurred before we could even consider how the clients would benefit from telehealth. We needed to identify those clients that likely wouldn’t benefit from 1:1 client/therapist sessions. For these clients, we offered a parent coaching model. Other clients moved seamlessly into 1:1 telehealth. Because we were likely in this for the “long-run” we felt it would be worthwhile to ‘teach’ telehealth skills just like we’d teach any other type of skill and developed a checklist of telehealth skills that could be used quickly to assess what skills were needed and whether it would be possible to teach these skills. “We were aware that some families would be dubious of the benefits of telehealth and wanted to allow them to try before they committed. We offered a set up session at no charge which allowed us to talk them through the process and for us to see how their child would go with accessing telehealth. “Honestly, I was worried this would be the end of my business. Given the complexity of some of our clients, I was not sure telehealth would be feasible. But that worry only lasted for a brief time. I have an amazing team and I could quickly see how they would rise to the challenge, think creatively to make telehealth work for our clients. We had a 90% retention rate of clients over the COVID period. “My worries then turned to our staff. We work very much as a team at TMB. Many of our clients see more than one team member – e.g. one for speech and another for behaviour. We have many opportunities for team collaboration and peer supervision. I was conscious that part of our culture was the incidental chats, quick clinical debriefs that occurred in the staff room between sessions. We needed to find a way to replace these chats with an online format. I knew long email chains just wouldn’t do. “After reaching out to the Speech Pathology Private Practice Facebook Group – I got some really great ideas. We all joined Microsoft Teams as a group sharing space. This has been

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amazing for incidental back and forth conversations. We were able to share the huge amount of free resources that were coming our way from everywhere, and to provide reviews/ commentary on different websites/activities we had tried. “We also recognised that we had to look/change to a new way of working, away from the traditional 8hr day with a lunch break. We gave staff flexibility in the way they managed their day to ensure that they were incorporating enough breaks, getting outside and time away from screens.”

children with ASD) have had a more negative experience, as adapting to online learning is an entire devastating lifestyle change for them. I have found myself being more of a support to those children and their parents (rather than a speech pathologist) by giving strategies on how best to cope with the online learning experience. I think we are all trying to ‘survive’ the best we can in these times, so I’ve been trying to support each child individually according to their immediate needs. I’m actually really thankful that I had this experience as it made me think outside the box. I have been operating as a speech pathologist for nine years now, so it was a fantastic opportunity for me to extend my skills and prove to myself that I can operate as a Teletherapist if I need to! Jonathon Rafols Manager Speech Pathology Bentley Hospital Perth For Jonathon and his team at Bentley Hospital in Perth the pandemic meant significant changes to services and to staff. The team sees inpatients and outpatients with swallowing and communication disorders. Pre-COVID they mostly worked with clients face-to-face. We see adults over the age of 16. Areas of specialty include stroke and geriatric rehabilitation, Parkinson’s, voice and videofluoroscopy. “We have a business continuity plan but it did not include a pandemic. Despite it being talked about by the likes of Bill Gates and others our focus had been on fire prevention and other emergencies. The risk of viral infection (not just corona) is significantly greater and yet we were all very under prepared. “In the first phase of the pandemic pregnant hospital staff took unplanned leave due to fear of infection and replacement staff were required and telehealth for outpatient visits was adopted. “Our group therapy ceased, videofluoroscopy ceased for outpatients. There was increased use of PPE. Dysphagia assessments were considered high risk for aerosolisation so new PPE guidelines for SPs had to be developed. We had lots of training on the correct technique for donning and doffing of PPE. “We had to cease a research study due to some of the procedures being considered aerosol generating procedures (e.g., EMST) and cease commencing another project. “One of the main concerns was staff becoming infected and not having sufficient human resources to provide a SP service. “We feared the hospitals would be inundated with COVID patients and that we would not be able to provide rehabilitation to our regular patients such as those with stroke and other neurological conditions. “We had to adopt our outpatient service for use with telehealth. We had some webcams but not enough and the shops had sold out so it meant a lot of swapping computers with cameras. We also did not have enough PPE in the hospitals. There was not enough PPE for training purposes, and we had to improvise by using cloths with elastic bands as masks. “We have discovered the benefits of using telehealth with outpatients. Aphasia therapy works well when delivered via telehealth. We have recently started running an aphasia group via telehealth. Therapies for other disorders such as dysarthria and dysphonia are more difficult. “Inpatient numbers have increased by 20% as we are taking more subacute patients from the tertiary hospitals. We also have active (as at 15 May 2020) COVID-19 patients in a dedicated COVID-19 ward for mental health patients. We have so far not

Felicity Conlan Speech Pathologist, Penleigh and Essendon Grammar School, Melbourne. Felicity works at a primary school

and her main concerns centred on keeping students engaged in an online environment. “The idea of keeping my students engaged online for an entire term, running out of online resources to use, and my limited IT knowledge and experience in regard to Teletherapy.” There are a couple of children who weren’t able to continue speech therapy online. We discovered that they were feeling overwhelmed and weren’t keeping up with the academic side of online learning. So instead of conducting another online session, I found it more useful to provide their parents with strategies to help support their child in their online learning environment at home. As my screening process has now ended for the kinder children, I had to think of a way I could connect with them online to stay present in their learning. I’ve had great success with posting daily speech and language activities on my Instagram page for their parents to try at home with their children. The timing of my sessions has also been important for student engagement. All of my online sessions with students are scheduled in the mornings as I found that I lost most of the children by the time the afternoon comes around. My speech sessions are also much shorter, as learning from a screen is incredibly draining. “I discovered that I am able to operate Teletherapy successfully. I can now turn any face to face lesson into an online one. It took a lot of trial and error, speaking to other speech pathologists, and watching lots of online tutorials, but I got there! “Most of my students have been able to adapt tremendously well to online learning. However, some of them (in particular

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guides were in place as we were trying to stay on the ‘front foot’. Some families opted to self-isolate from this time so we began Telehealth sessions. Due to our open communication with our clients from an early stage in the pandemic and our preparation of our clinicians to move to Telehealth when needed, we were able to move to 100% Telehealth by the end of March, which we are currently continuing in order to protect both our employees and clients. We have completed assessments and therapy online since. “As a business owner my main concerns were making sure my staff were happy, healthy and felt supported and safe. I wanted to make sure our clients’ needs were being met and that we were able to prioritise high need families and find a suitable alternative to face-to-face therapy to continue their necessary progress. From a financial point, I was worried that if we were to lose too many clients due to COVID and the need to transition to Telehealth we would struggle to survive financially.” For us the main challenge has been the retention of clients due to the needs to transition to Telehealth although, through education of parents and a ‘give it a go’ attitude we have managed to maintain the majority of our clients. For those clients who are unable to continue therapy due to difficulties accessing therapy via Telehealth or financial strains placed on the family, we have implemented home programs and follow up procedures. “Through some word-of-mouth referrals we are now seeing a handful of clients in regional/rural areas (including locations such as Broke, NSW and as far as Karratha, WA). All thanks to our adaption to digital services and using Telehealth. Additionally, we effectively marketed to our loyal customers a financial incentive to continue therapy in term 2. We called this our COVID 19 Loyalty Discount. Going forward we definitely see the value of adapting and providing different approaches to therapy including reaching a broader area of Australia – who knows, international clients? Something to ponder. “We will certainly continue to use many of the new and improved systems that facilitate a better customer experience, like online intake forms, customer feedback forms, streamlining online payment systems and reducing taxing administration tasks. Valerie Gent Let’s Eat Paediatric Speech Pathology, Newcastle “The week the virus was declared a pandemic we immediately put in strict hygiene principles around cleaning. Clients were either spaced out immediately or told to wait in their car until "As a business owner my main concerns were making sure my staff were happy, healthy and felt supported and safe."

received referrals from this ward. “One of the most significant challenges has been managing staff anxiety. Most staff are coping well; however, we have had some staff who were anxious about contracting the disease from patients or the public. It is also difficult to socially distance when working on a busy ward where there are lots of staff and patients” Alissa Gargano Sole clinician Sydney Alissa transitioned as many clients as possible to videoconference. “I already felt competent with video- conference service delivery with this program, so I was ready to hit the ground running with new families in this space. One thing that has been a struggle is for new families to make the switch to video-conference as a viable alternative, but this can be so useful for clients, particularly those who are faced with barriers that prevent ongoing in-person attendance, such as time and geography. As far as these sessions go, I can honestly say that the sessions are exactly the same whether it is in-person or via zoom.” “What has been great is that parents that would otherwise not see the therapy in-person, as is the case with many clients I see in their school, parents have been able to be a part of it. I will be offering this as a service ongoing during the holidays for any parent who wants to attend in-person to do it via Zoom, and to be a part of it.” “I also had a long-standing client prioritise intensive therapy to support literacy acquisition. I have significantly reduced my fees to meet with the family’s capacity (as I have done with all clients right now). This intensive instruction is sustainable for the client in the short term while they are at home, and has meant that the client has now gone from reading single letters and single sounds, to reading chapter books and writing self-constructed full sentences, in the space of one month “I have been able to branch out with support of a colleague who runs a centre overseas. They were required to transition over to video sessions only with only a few days warning. Since I had been working with video sessions for my parent coaching for a few years now, and then had a few more weeks experience with direct therapy via video, I was engaged to conduct some training for the therapy team in that centre. This has now been expanded in to a long standing engagement, including writing a parent training program that we will roll out within that team. Further to this, there is interest from other centres in the region who will also be signing up for training in the program to be delivered via Zoom. So at the moment, with things being very different, and with direct client work having certain limitations at the moment, this training program has turned in to my bread and butter, and I’m hoping, something that will see me through for the next six months and allow me to keep my business running till the landscape stabilises and things go back to normal.” Samantha Carr Director Speak and Write, Sydney For Samantha Carr, owner of Speak and Write Speech Pathology operating two clinics in Sydney, in the early days of the pandemic communication was key. “Prior to COVID-19 we mainly saw clients at our clinics or at schools in our local area. However, we also offered a few Telehealth appointments for clients out of area (but only a few!) “Initially we communicated with parents to remind them of our Infection Control Policy and our plan to move to Telehealth as a way to continue therapy if that became necessary. This was sent at the beginning of March before any social distancing

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