how to know what works...how to know what works evidence for teletherapy and beyond meredith harold,...
TRANSCRIPT
How to Know What Works
Evidence for Teletherapy and Beyond
Meredith Harold, PhD, CCC-SLP
www.meredithharold.com
www.theinformedslp.com
Introduction & Disclosures
Financial Disclosures
• Salary from and owner of The Informed SLP
• Adjunct faculty at the University of Kansas
Non-Financial Disclosures
• President-Elect of Kansas Speech–Language–Hearing
Association
• Board member of ASHA CRISP Committee
• More at www.meredithharold.com
What’s the evidence for telepractice?
Is there research to suggest it works?
Broad take-homes
• Quantity: There’s just not a lot of telehealth research in our field
• Pace: Telehealth (technology and practice) has moved faster than either policy or science for it
• Populations: Research available is with likely-to-be-compliant populations
• Parents (parent coaching)
• Older children (> 5)
• Adults (over half of studies; Molini-Avejonas et al., 2015)
• Some areas have more evidence. e.g. telehealth can be as effective as in-person services for:
• TBI
• Autism– but mostly older children in mainstreamed classrooms
• Hearing loss
• Dementia
• Fluency disorders
• Speech sound disorders [treatment]
• Less evidence for:
• Dysphagia
• Pediatric speech–language assessment
• Language disorders in school-age children
Broad take-homes
from ASHA’s Evidence Maps
• PROS: When looking across studies…
• improved access to care
• fewer missed appointments
• cost-effectiveness
• and patient satisfaction
… are primary benefits (Covert et al., 2019; Molini-Avejonas et al., 2015; Sutherland et al., 2018)
• CONS: Very little research on telehealth best-practices; no great answer to the question of, “What’s the right way to do telehealth?”
Broad take-homes
Teletherapy success dependent on things like clinicians’:
• Nonverbal communication skills
• Knowledge of EBP
• Comfort and problem-solving skill with technology
• Ability to calm own, and clients’, fears of telepractice
Hines et al. (2015)
Overby & Baft-Neff (2017)
Broad take-homes
Early intervention research
• More treatment research than assessment:• But clinicians who do telehealth assessment report feeling
very confident about it (Blaiser, 2016)
• All* treatment research is on parent coaching. Everything from:• 10 minutes per week w/ SLP (Peter et al., 2019)
• … to pre-recorded modules that parents watch on their own time (Douglas et al., 2018)
• … to weekly coaching sessions, with a variety of kids, e.g. parents of kids with autism (Meadan et al., 2017)
Early intervention research
• Results comparable to good parent coaching:
• e.g. improved initiations and responses between parent and child (Baharav & Reiser, 2010)
• also Blaiser et al. (2013) & Behl et al. (2012)
• With some things even better than face-to face:
• e.g. parent practice with feedback (Inbar–Furst et al., 2019)
• “.. a by-product of this increasingly accessible service delivery platform may be that parents receive the type of therapy that has been found to support successful outcomes for children.”
Why aren’t more states doing it?
• A survey of coordinators across 26 states indicated that they’re most concerned about:
• security
• privacy
• quality of services
.... in the use of telehealth for IDEA Part-C services
(Cason et al., 2012)
SLPs are the ones equipped to make decisions about what
can be adequately provided via telehealth and what can’t; and increased trust in SLPs’
clinical decision making
and less fear of the unknown will allow us to make good, responsive decisions for clients.
Preschool & school-age research
• More research on older children• Difficult to find papers on ages 3–4; 5+ easier; 8+ even
easier.
• Assessment research. Taylor et al. 2014 found:
• Strongest evidence: screenings• Some evidence: speech, and language assessments
• Some newer assessment research too; e.g. CELF-4 can be reliably administered via telepractice (Sutherland et al., 2018)
• Difficulty with assessment comes mostly from things that are just plain harder to hear via digital audio, including:• judgement of individual speech sounds
• detection of pluralization
• discriminating between similar sounding words
Preschool & school-age research
• More treatment research than assessment
• telehealth equivalent to face-to-face treatment,
• communication outcomes similar,
• and better than no-treatment conditions
(Coufal et al., 2018; Grogan-Johnson et al., 2013; Sutherland et al., 2018; Wales et al., 2017)
Adults research
Caughlin et al., 2019:• efficacy and cost of telerehabilitation same as face-to-face
• patients satisfied with telehealth
• clinicians prefer face-to-face, but will use telerehabilitation when face-to-face not feasible
Weidner & Lowman, 2020 (systematic review):• “Overall, results… support the use of telepractice as an
appropriate service delivery model in speech–language pathology for adults. Strong research designs, including experimental control, across multiple well-described settings are still needed to definitively determine effectiveness of telepractice services.”
Is there….. any more in the literature?
Telepractice How-To and Tips
Lean on clinical experts
Best Practices for Assessment and Treatment
(within telepractice; regardless of service delivery model)
Lean on the research
Autism
Speech
Sound
Disorders
Fluency Language Pragmatics Feeding
And
everything
else we
work with!
Is there….. any more in the literature?Expert Opinion, Tutorials, and Perspective Pieces
Is there….. any more in the literature?Expert Opinion, Tutorials, and Perspective Pieces
Is there….. any more in the literature?Expert Opinion, Tutorials, and Perspective Pieces
Is there….. any more in the literature?Expert Opinion, Tutorials, and Perspective Pieces
Is there….. any more in the literature?Expert Opinion, Tutorials, and Perspective Pieces
How do I know what’s evidence-based?For other topics?
In a way that’s efficient?
EBP
It’s what worksWhat we’re supposed to be doing (Code of Ethics)And what our clients need from us…
SLPs: what this feels like
Research Clinical Practice
Leadership Businesses
“Just read the
research!”
“No worries;
we got you!”
cost
time
clinical utility
format
culture
“You don’t need
the research.”
“There is a well-established disconnect between EBP and the
realities of clinical services provision…” (Douglas, 2016)
Our field is starting to correct for this,
with solutions that didn’t exist just a handful of years ago.
but also…
Current solutions for SLPs
Research Clinical Practice
Leadership Businesses
Evidence
Evidence-based
Not evidence-based
Journ
al arti
cles
Filtere
d and analyzed
articles &
reviews Pseudoscience
Courses (including ASHA CEUs)
Products, Tools, Handouts
Websites, Blogs
… that range from highly evidence-based
To somewhat evidence-based
To not evidence-based (and even entirely
misaligned with what the data shows works)
Filtered and analyzed articles & reviews
Research Clinical Practice
“the blue section”
Speech
BITE
ASHA’s
Evid
ence M
aps
The In
form
ed SLP
• Free
• Treatment research
• Quality appraisal
• Free
• Assessment & treatment
research: systematic
reviews & guidelines
• Quality appraisal
• Brief take-homes
• Members-Only
• Assessment & treatment research
• Editorial review/descriptions
• Web, print, and audio formats
Journ
al arti
cles
ASHA’s Evidence M
aps,
The Info
rmed SLP &
SpeechBITE
Pseudoscience
Courses, Products, Tools, Handouts, Websites, Blogs
Highly
evidence-
based
Not EBP
Finding more journal articles
• PubMed
• (ERIC)
• (Google Scholar)
“the purple section”
Obtaining free copies of journal articles
• UnPaywall
• Google search of title
• Email the author
Meredith Harold, PhD, CCC-SLP
www.meredithharold.com
Thank you all for learning with me!
See accompanying document for references.