Clients In Speech Telepractice: Limitations To Consider

Now, more than ever, virtual services are increasingly touching the lives of clients, students, and their families. Never before has technology been able to help match clinician to client, with this level of speed. As technology continues to improve, Speech-Language Pathologists are taking their treatment success to new heights. Truly, there is no client we can't serve in 2019. But....WAIT. Is there?

There are many factors that may influence whether or not your client is a good fit for a virtual service model. Culture, physical limitations, and cognition, all play a part when predicting the success of treatment. The American Speech-Language Hearing Association (ASHA), has developed beneficial guidelines when selecting candidates for teletherapy. I have found these points very helpful, when working closely with student populations in both a school and home setting. If you have concerns about whether or not your client (or student) is a good candidate for this service model, consider the following questions, as recommended by ASHA:

1) Consider physical limitations.

• Does a client have the ability to use a touch screen, a mouse, or keys on the computer?

• What is the level of vision and/or hearing acuity with your client?

• Does your client have endurance for sitting for the length of the session?

2) Consider cognitive limitations.

• Is the client able to participate given his/her cognitive functioning?

• Does your client have the ability to maintain attention for an appropriate length of time?

3) Consider behavioral limitations.

• Is the client able to sit in front of the computer without excessive movement or desire to walk away from the setting?

• Is the client motivated to participate in therapy sessions?

• Does the client require excessive motivators to participate and engage with treatment material?

4) Consider communication limitations.

• Is the client able to respond to verbal directions or commands?

• Does the client exhibit speech that is intelligible without excessive need for clarification?

• Does the client or family require an interpreter for sessions?

• Is the client using an AAC device that requires different equipment or set up for teletherapy services?

5) Consider support limitations.

• Does the client have a support person in the home or school who can support them physically and behaviorally?

• Does the client have access to the necessary and proper equipment, or high speech internet services?

• Is the client's environment appropriate for treatment, with minimal distractions and noise?

As best practice, these questions should be considered prior to the onset of therapy services. However, as with many cases, sometimes treatment begins with the best of intentions, only to recognize that one (or several), limitations have surfaced.

In my personal experience, most clients CAN be serviced virtually, given the proper support. Obtaining proper support, however, can prove to be challenging. This is true when a client has a small support system, lack of resources, and/or poor access to basic needs.

My advice is always to attempt therapy first. During your sessions, make note of the strengths, and the challenges. After the first 3-4 sessions, bring your client and his/her support system back to the table! Have solutions to your challenges in mind, so that a proper plan can be created for client success. Ask that everyone be on board, so that the client can continue to benefit from a strong network of support.

However, it must be said, that even with the best of intentions, and attempted support systems in place, you may simply determine the client or student is not benefitting from the services as intended. It is your ethical responsibility to provide the BEST treatment possible, in all cases. If, in your professional opinion, you aren't able to provide that level of service to your client, using the telepractice delivery model, then it's best to refer that client to a face-to-face therapist instead.

If you must refer, make sure you have a list of possible options for your client, as a professional courtesy. Call ahead, and ask the clinic if they are taking clients, and what services may be available. Ask a school district if another SLP on site may be able to absorb your student on to her caseload, or if they might be willing to contract with an agency to bring another therapist in. Get creative with solutions, involving all team members and decision makers.

For further information regarding client selection and ethical considerations, please refer to ASHA's Telepractice Portal. There you will find the most up to date information about policy, changes in ethics, or issues for consideration.