2016 mi audiology consortium final · n auditory -verbal therapy/parent coaching n adult aural...
TRANSCRIPT
10/16/16
1
+
Connecting to Communicate: Serving Children with Hearing Loss & Their Families Through Telepractice
K. Todd Houston, PhD, CCC-SLP, LSLS Cert. AVTSchool of Speech-Language Pathology & Audiology
The University of Akron
+Disclaimers
Dr. Houston is currently the author or co-author/editor of three books published by Plural Publishing:
Telepractice In Speech-Language Pathology (2014)
Assessing Listening and Spoken Language In Children with Hearing Loss (2015) – with co-author/editor, Tamala S. Bradham, PhD, CCC-A
Telepractice In Audiology (2016) – with co-author/editor Emma Rushbrooke, MA, AuD
Dr. Houston does not receive any monetary compensation from any of the manufacturers/companies of the technology discussed during this presentation.
2
+Learning Objectives
At the end of this presentation, participants will be able to:
n Identify current distance technology that is impacting early intervention and the education of children with hearing loss;
nDiscuss the role of parent coaching in telepractice; and
nDefine the use of telepractice as a service delivery model for children with hearing loss and their families.
3 + Terminology4
+History of Telehealth
5 +Evolution Leading to Revolution
6
5 Mb of Storage Being Loaded: 1956
10/16/16
2
+Evolution?
7 +Adopting New Technology
8
+Healthcare Access of the future
According to the
American Medical Association,70% of doctors visits and
40% of ER visits
could be avoided through telemedicine.
Increasingly, speech-language pathologists, audiologists, and other educators are adopting
models of telehealth & telepractice to serve more children with speech, language, hearing, and/or
learning needs.
9 +Wearables, mHealth, & the Quantified Self
10
+mHealth: Quantified Selfn Handheld & wearable devices will allow us to have our own
personal “health” dashboard.
n Individuals with hearing loss will be able to monitor their hearing technology’s response to sound, spoken language, or their environment – in real time.
11 + mHealth = Community-Based Interventions
12
Using smartphones, tablets or laptops to connect in meaningful situations/contexts – just in time learning, contextual learning & coaching
10/16/16
3
+Smart Phones to Smart Houses
13
The Internet of Everything
The Internet of Things
+Smart Phones to Smart Houses
nCaregiver alerts, alarms
nVoice prompts
nSmart beds to monitor sleep cycles, other health related conditions
nVital sign monitoring
nAuditory access/background noise
nTelevisions with built-in Internet access & webcam ~ “Telepractice” ready
14
15 + Convergence of Technology, Healthcare, & Education
Technology: Smartphones,
Tablets, Notebooks
Broadband Internet
Lowering Costs:ACA, Market
Pressures
Social Media/Networks:
Connections
Increased Demand for Telehealth Any Service,
Any Place,Any Time
16
+An Audiologist’s Perspective
“Telehealth has taken many years to become an “overnight” sensation…and now we have…a convergence of telecommunications and health care finally becoming a reality.”
--David Fabry, PHD
17
+Defining Telepractice
18
10/16/16
4
+Defining Telepractice
nAmerican Speech-Language-Hearing Associationn The application of telecommunications technology at a
distance by linking a clinician to client or clinician to clinician for assessment, intervention, and/or consultation.
nTelepractice is an appropriate model of service delivery for the professions of Speech-Language Pathology & Audiology.
nThe quality of services delivered via telepracticemust be consistent with the quality of services delivered face-to-face.
19 +Telepractice
nTelepractice is the application of telecommunication technology for the delivery of services at a distance (ASHA, 2013).
nTelepractice has become more widely used and is an emerging area of service delivery in Speech-Language Pathology (…and Audiology!) (Theodoras, 2011).
20
+Telepractice & Speech-Language Pathology
n Around the world, SLPs are using telepractice to delivery direct and indirect services for the following areas of practice:n Assessmentsn Speech and language delaysn Articulation & phonological disordersn Voice & fluencyn Non-verbal/AACn Traumatic brain injuryn Aphasia/Stroken Auditory-Verbal Therapy/Parent Coachingn Adult Aural Rehabilitationn Supervision, mentoring, & consultation
21
Boisvert, M. (2014)
+Telepractice & Audiology
nPatient Counseling
nHearing Screenings
nAudiological Diagnostics
nHearing Aid Fittings
nCochlear Implant Mapping
nAdult Aural Rehabilitation
22
+
Telepractice is not a different service but rather a different method of service
delivery.
-- Janet Brown, 2010
23 + The Need for Telehealth/Telepractice
nClinician/specialist shortages
nMisdistribution of providers
nRural/urban underserved
nTravel time, cost & hardship
nDelayed treatment, intervention or rehabilitation
24
10/16/16
5
+ 25
…so what about audiologists and speech-language pathologists?
+Benefits of Telepractice
More Patients Served
Telepractice: Force
Multiplier
26
Boisvert, M. (2014)
+ Telehealth Benefits
n Reduces barriers to accessn Reduces travel, time constraintsn Reduces overall healthcare costsn Reduces delays in caren Improves quality of care, collaboration, &
coordination
More consistent therapy & intervention leads to improved speech, language, and learning outcomes for the children served.
27 +The Question for the Day
With the convergence of communication technology and healthcare, how will telepractice service delivery models impact the provision of audiological and speech-language intervention to children with hearing loss & their families?
28
+Technology & Service Delivery Models
29
+What is the Technology
Principal components
nEquipment (dedicated & software)
nConnectivity
Two Technology Approaches
nLive Interactiven Audio/Videon mHealth
nStore and Forwardn Audio/Videon mHealth
30
10/16/16
6
+Determining Technology & Equipment Needs
Goals & Clinical Population Setting & Delivery Model
Security Requirements Resources Available
SuccessfulProgram
31
Boisvert, M. (2014)
+Determining Technology & Equipment Needs
n Key Questions:n What is to be accomplished? (direct service, supervision,
mentoring, etc.)n What is the clinical population? (e.g., speech/language delay,
voice, fluency, articulation/phonology, AAC)n What is the setting of the services? (e.g., 1:1, small group,
classroom based, training)n What is the delivery model? (e.g., direct FtF, Store/Forward,
hybrid)n What are the security requirement?n What are the resources that are available? (i.e., existing
equipment, budget, IT support, administrative support, bandwidth)
32
Boisvert, M. (2014)
+
Technology: Things to Consider
§ Transmission methods and speeds
§ Types of technology§ Uses of technology§ Technical support§ Privacy/Security§ Funding Issues§ Applications
33 +Transmission Methods
nISDN (Integrated Services Digital Network)nT1-T4 lines
nBroadband/IP (Internet Protocol)nMobile/CellularnDSL (Digital Subscriber Line)nCablenSatellite
34
+Bandwidth is the KEY Technological Issue
nAll technology systems, regardless of cost, are effected by bandwidth
nBandwidth is an issue in all geographical locations (urban and rural)
nBandwidth is traffic dependent
nTraffic is dependent on time of day, weather, location
nBandwidth is increasing dramatically nation-wide, but so is traffic (thanks, Netflix and youtube!)
35 + 36
10/16/16
7
+ + 38
+Dedicated systems
nHigh quality audio and video
nTeacher can control family’s camera remotely
n IT support can be provided to family remotely
nProvides more secure connection
nNeed compatible equipment at both ends
nCan be expensive
nUsually remains in one location
Pros Cons
39 +Dedicated systems
Basic equipment
nHardware/software
nCamera
nMonitor
nMicrophone
nSpeakers
Looks like….
nPolycom, Cisco
nPTZ camera
nTelevision
nSeparate and/or internal
nThrough monitor
40
+Web-based systems
nHardware/software
nCamera
nMonitor
nMicrophone
nSpeakers
nSkype, facetime, etc.
nInternal or external webcam
nComputer screen/tablet
nHeadset or built-in
nHeadset, built-in or external
Basic equipment Looks like….
41 +Web Based Systems
n Quick and easy to set up
n Can be accessed from any computer with internet
n Inexpensive
n May have screen sharing
n Could be portable
nLimited camera angle
nTeacher can’t control the family’s camera
nRelies on family’s/school’s internet connection
nFamily must provide own IT support
Pros Cons
42
10/16/16
8
+Types of equipment
nHardware/software
nCamera
nMonitor
nMicrophone
nSpeakers
43 +
nDesktop or Laptop computer
nWebcamnHeadset with Mic; integrated
microphone & speaker
nPrinter & scannernPhones
nDirect line to Internet (no wi-fi)
nTeleconferencing PlatformnEmail
Clinician/Contractor Equipment44
+ Software
§ Price§ Features§ Necessary Downloads§ Compatibility§ Size§ Internet Access
+Web-Based Telepractice Platforms
nSKYPE (Free…No!)
nSKYPE for Business
nInfinite Conferencing
nAdobeConnect
nMegameeting
nGoToMeeting
nMicrosoft Office 365
nCisco WebEx
niLinc
nBlackboard Collaborate
nZoom
46
+WEBEX
DocumentSharing ApplicationSharing
47 +Additional Peripheral equipment
nDocument Reader
nConnect a laptop to the camera
nIndustry specific tools
nRecording devices
48
10/16/16
9
+Technology Considerations
n Up-front Costs
n Ongoing Service Fees
n Bandwidth & Reliability
n Technology Maintenance &
Support
n Quality of Equipment (video, image size, camera pan, & zoom)
n Recording telepracticesession
n Security, Firewalls
n Ease of Use
49
+
PhysicalSet-up
50
+Presenter’s space
nRoom size
nRoom location
nLighting
nAcoustics
nFurniture
nStorage
51 +Client’s / School’s Space
nAdequate work space?
nAppropriate furniture?
nAccess to floor space?
nRoom size?
nCamera placement
nDistractions
52
+Privacy, Security, & Licensure Considerations
53
+Security vs. Privacy
n Security is about firewalls, hacking, viruses and wormsn Location and hardware/software dependent
n Targeted use technologies (e.g., umi, xbox, videophone) are typically less susceptible to security issues
n Home locations are likely to be more susceptible to security issues than locations that invest in IT)
n Privacy is about protecting the rights and privacy of individuals per HIPAA and FERPA
n Standards-based technologies and Federal laws, particularly FCC regulations, help protect privacy
n There is no regulatory agency for the Internet—currently, ”Net Neutrality” means Internet use is unrestricted
54
10/16/16
10
+Privacy Considerations
nPrivacy rights are just as important through telepacticeservices as they are in traditional services
nPrivacy procedures must be in congruence with federal regulations:
nApplying privacy regulations:nObserving “live” telepractice sessions- informed
consent must be obtained before anyone observesnRecording telepractice sessions- permission from
family to record
55 +Licensing Issues
n ASHA requires the SLP to be licensed in every state that services are provided and purchase the license at own expensen Regulations may change as telepractice become more popularn New licensure standards may come about for medical services delivered
through telehealth
n Limited licensure is another point of discussionn Would allow states to monitor tele-practitioners who are providing services in
multiple states without restricting their practice
n Currently, no licensure/certification requirements for telepracticeprovidersn Require telepractitioners to have same credentials as traditional service
providers and stress importance of privacy regulations
56
+
Critical Skills of Practitioners
57
+General Clinical Skills & Procedures
n Telepractice is not about technology…rather it is another service delivery model.
n Telepractice is really about clinical interactions, rapport, and forming a strong working relationship with the client, family, and/or other practitioners.
n Telepractice does not remove existing responsibilities in service delivery.
n Telepractice must be the same quality as those delivered in-person.
58
Adapted from Boisvert, M. (2014)
+General Clinical Skills & Procedures
nTelepractitioners should know how to troubleshoot the teleconferencing system:n Downloading & updating software
n Scheduling a meeting/session
n Inviting participants
n Screensharing with patients/others
n Annotation features
n Data collection/goal monitoring
59
Adapted from Boisvert, M. (2014)
+Skills Checklist for Providers of Telepractice
nHas basic knowledge of computers and other equipment being used
nCan troubleshoot video and audio equipment
nAttends to technology while conducting the session
nOrganizes materials for activities ahead of time based on naturally-occurring routines
nConducts activities that involve materials and actions that are easily depicted over video/audio
60
10/16/16
11
+Telepractice: Summary
Benefits
n Access to SLP/AuD services
n Individualized Programming
n Service Delivery Options
n Access to specialists
n Increased learning
n Acceptance by students
n Collaboration
n Benefits for families Benefits for the SLP, AuDs
n Ease the shortage of SLPs, AuDs
Barriersn Technology failures
n Lack of training
n Lack of procedures
n Nature of the environment
n Lack of physical contact
n Establishing therapeutic/clinical relationships
n Ethical concerns
n Dissatisfaction
n Lack of research
61 +
Telepractice & eLearning Laboratory (TeLL)
+ Telepractice & eLearning Lab (TeLL)School of Speech-Language Pathology & Audiology
n The University of Akron serves children with hearing loss and their families as well as adults with hearing loss
n Pediatric therapy focuses primarily on listening and spoken language & Auditory-Verbal Therapy
n Adult aural rehabilitation with a direct, patient-centered focus
n Training of future SLPs in telepractice service delivery models
63 +Why Telepractice?
nDistance
nLack of specialists
nReduced travel
nClient/family motivation
nFlexibility of scheduling, fewer cancelations = more consistent intervention
nFunctional “natural” environment – child & parents are more comfortable
nCrucial for Auditory-Verbal intervention: Parent participation is “built in”
64
+ Adult Learning Theory: Adults [Parents] like to…
nbring knowledge, skills, attitudes
nbring experiencenlike to solve
problems
nlike to apply what they learn to real situations
nlike to have choices
n like to share in the setting learning objectives
nhave variety of learning styles/preferences
ndo best in an environment where they feel safe, accepted, and respected
nwant and need feedback
nneed to have their abilities and achievements honored
65 +Types of Adult Learners
Do you prefer: hands on, risk taker, trial by error? ü Dynamic Learner...asks What if?
Do you prefer: experts’ opinions, directions?ü Analytic Learner…asks Why?
Do you prefer: learn the facts, then experiment?ü Common Sense Learner…asks How?
Do you prefer: listen, discuss, consult with others?ü Imaginative Learner…asks Why not?
66
10/16/16
12
+ Coaching and Adult Learning Theory
Joint Planning
Observation
Action
Reflection
Feedback
Generalizing knowledge and applying to other situations
67
Sequence Of Therapy Preparation
1. Referral to clinic
2. In-person visit for full evaluation
3. Completion of home inventories
4. Technology test session
5. Lesson plans emailed at least 48 hours prior to session
6. Parent gathers materials and prepares by collaborating with clinicians by email or phone
7. Session begins
68
+Conducting A Session
69
1.Reviewing goals and activities-Reviewing goals from previous week, new updates, review goals for current session, check hearing devices
2.Conducting the lesson/activity-Demonstration of new strategies/techniques, coaching the parent or adult, discuss integration of goals into daily home routines, strategies for improving/controlling communication opportunities (adults)
3.Debriefing-Allow questions from parents, discuss continuation or selection of new goals, summarize session and goals for the coming week
+Nancy & Alex
70
+Nancy & Alex
71 +Nancy & Alex
72
10/16/16
13
+Nancy & Alex
73 +Alex – the Super HEAR-O
74
+Alex…getting ready for school
75 +Future Directions
nTelepractice can offer a viable solution to meet the increased demand for services
nThere are tremendous advantages for clinicians and their patients when telepractice is utilized
nClinicians/programs should plan carefully before implementing a telepractice program
nTelepractice service delivery models will continue to expand & will be a regular fixture in health care
76
Questions?
Comments?
Ideas?
77 +References
n Boisvert, M. (2014). “Telepractice for School Based Speech & Language Services.” A paper presented at the Ohio Speech-Language-Hearing Association Annual Convention.
n Boisvert, M., Chacias, J., & Andrianopoulous, M.V. (2013). “Prerequisites to implementing telehealth in schools: The role of needs assessment.” Paper presented at the 2013 Convention of the American Speech-Language-Hearing Association, Chicago, IL.
n Boisvert, M., Hall, N., Andrianopoulos, M., & Chaclas, J. (2012). The multi-faceted implementation of telepractice to service individuals with autism.International Journal of Telerehabilitation, 4(2).
n Eastmond, N. (1994). Assessing needs, developing instruction, and evaluating results in distance education. Distance education: Strategies and tools, 87-106.
n Grogan-Johnson, S. (2012). Providing School-Based Speech-Language Therapy Services by Telepractice: A Brief Tutorial. Perspectives on Telepractice, 2(1), 42-48.
78
10/16/16
14
+References
n Jennett, P., Yeo, M., Pauls, M., & Graham, J. (2003). Organizational readiness for telemedicine: implications for success and failure. Journal of Telemedicine and Telecare, 9(suppl 2), 27-30.
n Juenger, J. M. (2009). Telepractice in the Schools. The ASHA Leader, 14(12), 20-21.
n Lemke, H. U., & Berliner, L. F. (2008). U.S. Patent Application 12/213,979.
n Martin (2011). TeleHealth Resource Center.
n McCawley, P. (2009.). Methods for Conducting an Educational Needs Assessment. University of Idaho Extension.
n Polovoy, C. (2008). Audiology telepractice overcomes inaccessibility. ASHA Leader, 13, 20-2.
79 +References
n Schmidt, H. A. The National Strategy for Trusted Identities in Cyberspace and Your Privacy, April 26, 2011. White House blog post.
n Tucker, Segal, & Hyler (2001). Psychiatric telemedicine for rural New York. Journal of Psychiatric Practice®, 7(4), 279-281.
n Tucker, J. K. (2012a). Perspectives of Speech-Language Pathologists on the Use of Telepractice in Schools: Quantitative Survey Results. International Journal of Telerehabilitation. 4(2).
n Tucker, J.K. (2012b). Perspectives of Speech-Language Pathologists on the Use of Telepractice in Schools: The Qualitative View. International Journal of Telerehabilitation. 4(2).
80
+Resources
nAmerican Telemedicine Association n www.americantelemed.org
nAmerican Speech-Language-Hearing Associationn www.asha.org/telepracticen SIG 18: Telepractice
nBroadbandUSAn http://www2.ntia.doc.gov/iowa
nCheck with your professional organization for additional white papers, position statements, & preferred practices
81 +Resources
n National Center for Hearing Assessment and Management (NCHAM). A Practical Guide to the Use of Tele-Intervention in Providing Listening and Spoken Language Services to Infants and Toddlers Who are Deaf or Hard of Hearing. Available from: http://www.infanthearing.org/ti-guide/index.html
n American Telemedicine Association’s A Blueprint for TelerehabilitationGuideline. Available from: http://www.americantelemed.org/files/public/standards/ATA%20Telerehab%20Guidelines%20v1%20(2).pdf
n Center for Telehealth and E-Health Law (Ctel):
http://www.telehealthlawcenter.org/
n International Journal of Telerehabilitation: http://telerehab.pitt.edu/ojs/index.php/telerehab
n Journal of Telemedicine and Telecare: http://jtt.rsmjournals.com/
82
+ Telepractice & Listening & Spoken Language
Monograph available from the Alexander Graham Bell Association for the Deaf & Hard of Hearing
83 +
Available from Plural Publishing:
www.pluralpublishing.com
Published: 2014
84
10/16/16
15
+ 85
Available from Plural Publishing
www.pluralpublishing.com
Published 2016
+
Put in all logos
Assistance Is Available!
Federally Designated
Telehealth Resource Centers
86
+Thank You for Listening!
K. Todd Houston, PhD, CCC-SLP,
LSLS Cert. AVT
Email: [email protected]
Office: (330) 972-6141
Facebook: K Todd Houston
Twitter: ktoddhouston
LinkedIn: www.linkedin.com/in/toddhouston
LinkedIn Group: 6 Sound-Off
87