Orna Kempler- Azulay is the Founder RemoteSpeech.com, a subsidiary of Abington Speech Pathology Services; a multi-faceted Rehab company that’s provided therapy, speech staffing, and support throughout the country for more than 20 years. RemoteSpeech.com is a well-established telepractice, that combines crystal clear voice with the sharpest video to provide next-generation video calling and high-definition video delivery through live, face-to-face interactions between speech-language pathologists and their patients.

RemoteSpeech was initially launched by Kempler-Azulay to meet market demand.  For years, the demand for speech-language pathologists was far outpacing the supply of trained, certified professionals in cities nationwide (for both private practice and within school districts).  For years, RemoteSpeech has met this demand with streamlined services to provide quality treatment from the convenience and comfort of home. Orna Kempler- Azulay has ensured that RemoteSpeech is not the next best thing to in person treatment — but rather, it’s just as good, and in some cases, even better. With advanced state-of-the-art games, activities, and interactive screen sharing, students and adults actually look forward to their therapy sessions.

With the Covid 19 pandemic, RemoteSpeech found itself in a unique position to lend their experience for telepractice.  What was once a convenience is increasingly becoming a requirement, as telehealth emerges as a leading industry to respond to safety measures for social distancing.

Although RemoteSpeech is well-established in the delivery of telepractice for all treatments related to speech-language pathology, parents and patients alike have been forced to quickly acclimate to the concept of virtual treatment. With just a few months to adapt, many parents are left with a wide range of questions about their child’s care. Administrators are uncertain about remote alternatives to meet the demands of their district along with state requirements, and even therapists are catching up with adopting their methods for a virtual setting.

At RemoteSpeech.com and Abington Speech Pathology Services, we believe that knowledge is power. We want to assist parents, patients, therapists, and school districts to navigate the extensive research available regarding telehealth and speech-language pathology.

In this article, we are going to review the use of ASHA’s Evidence Map Portal for Telepractice– a free online portal that provides access to extensive research from around the world, specific to telepractice and speech-language pathology. Despite the spike in demand for remote therapy, virtual treatment is a long-established practice that is proven to be effective. It is our hope that this training tutorial will empower schools, therapists, parents and students alike, with adequate resources to answer any question and concerns as it relates to the new normal of speech-language pathology.

What is ASHA?

The American Speech Language Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 211,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students.

What are ASHA’s standards for telepractice?

According to ASHA guidelines, use of telepractice must be equivalent to the quality of services provided in-person and consistent with adherence to the Code of Ethics, audiology scope of practice, speech-language pathology scope of practice, state and federal laws, and ASHA policy.

What is the ASHA Evidence Based Map for Telepractice?

ASHA maintains an “Evidence Based Map” consisting of extensive research surrounding models that speak toward the efficacy of remote speech-language pathology with relation to telepractice.  The Telepractice Evidence Map provides pertinent scientific evidence, expert opinion, and client/caregiver perspective. It serves as a vital resource and guide for patients and providers.

How do I use ASHA’s Evidence Based Map for Telepractice?

First, Navigate to ASHA’s Evidence Map Portal for Telepractice by clicking HERE.

  SELECT CRITERIA FOR YOUR SEARCH:

Along the left-hand column, you will find a panel with various sections of search criteria. In each section, you can select more than one option to refine your search.  Sections are organized as follows:

PRACTICE AREA:

The research is organized by:

Assessment, Screening, Service, Delivery , and Treatment.

Again, you can opt to select one option, multiple options or leave the section blank.

DIAGNOSES:

This section provides a diverse range of conditions that can be selected, to locate telepractice research specific to your unique condition(s), including Autism Spectrum Disorders, Social Communication Disorders, Speech Sound Disorders, Spoken Language Disorders and beyond.

Select one or more conditions, or leave this area blank to search for general content and research related to telepractice.

POPULATION:

The Telepractice Evidence Map can be further refined by population.  Select “Adults”, and/or “children” to further refine your search to include research targeting specific age groups.

SETTING:

Next, refine your search by setting.

Select “healthcare” (for individual treatment) and/or “school-based” (for research associated with school districts). Leave this area blank if the setting is irrelevant.

TELEPRACTICE CONSIDERATIONS:

This section provides the opportunity to customize your search with a additional considerations.

Options include candidacy for telepractice (including additional diagnoses), documentation, and technological considerations (for a review of present technology available, it benefits and needs).

YEAR:

The default setting is set to “all.”  If searching for a specific year, slide the icon along the bar to select your year of preference.  Below the sliding bar is a checkbox to refine your search for “recently added articles.”  This is helpful if you use this portal frequently, and want to stay abreast of updated content.

FURTHER SEARCH CRITERIA:

Once you have completed your search, you will find a tab located at the top of the search results. This enables you to refine your results by External Scientific Evidence (research conducted by third parties), Clinical Expertise and Client Perspectives. The default setting for this search is set to “All” results.

REVIEWING YOUR SEARCH RESULTS:

Once you have completed your search, you will be presented with a series of articles, organized by title. When you select a title, you will be directed to a landing page with a summary of the research.  A helpful feature for therapists and administrators is the section titled “Indicators of Review Quality”, that provides responses of “yes,” “no” and “n/a” to the following conditions:

• The review states a clearly focused question/aim.
• Criteria for inclusion of studies are provided.
• Search strategy described in sufficient detail for replication.
• Included studies are assessed for study quality.
• Quality assessments are reproducible.
• Characteristics of the included studies are provided.

At the top of the summary landing page, you will find a link to the full report.

SAMPLE REPORTS:

Listed below, we have included five examples of research located using the ASHA Evidence Map for Telepractice.  We have included the search criteria used to locate the article, a link to the landing page with article summary (linked to the title of each study), and a link to the complete study (through the screenshot image of the full study) for your review.

Telehealth and Autism: A Systematic Search and Review of the Literature

Search Criteria

Practice Area: Screening

Diagnoses: Autism Spectrum Disorders

Description

This is a systematic review of experimental design studies investigating the outcomes of telehealth services in individuals with autism spectrum disorder (ASD). This article extends but does not replace a previous systematic review by Boisvert et al. 2010 (see the Notes on This Article section below for more details)

Questions/Aims Addressed This article aimed to review the following regarding telehealth services for ASD:

• the type of service delivered;
• the recipients of telehealth services; and
• the outcomes of the telehealth services provided.

Population

Individuals with ASD

Findings:

• “All studies reported high levels of programme acceptability and parent satisfaction with the telehealth component of the intervention or assessment. In addition, two studies that involved direct telehealth involvement with individuals on the [autism] spectrum … reported high participant satisfaction” (p. 333).
• “This review suggests there may be a range of benefits in using intervention using telehealth to individuals with [autism spectrum disorder] ASD, their families and teachers” (p. 335). Results indicated overall positive outcomes for intervention delivered via telehealth sessions. Due to low study quality, however, results for telehealth to provide diagnostic assessments suggested that telehealth for diagnostic assessments can not yet be considered an established practice.
• The majority of included studies (9/14) investigated parent satisfaction of telehealth services. “All studies reported high levels of programme acceptability and parent satisfaction with the telehealth component of the intervention or assessment. In addition, two studies that involved direct telehealth involvement with individuals on the [autism] spectrum … reported high participant satisfaction” (p. 333).
• “This review suggests there may be a range of benefits in using intervention using telehealth to individuals with [autism spectrum disorder] ASD, their families and teachers” (p. 335). Results indicated overall positive outcomes for intervention delivered via telehealth sessions. Due to low study quality, however, results for telehealth to provide diagnostic assessments suggested that telehealth for diagnostic assessments can not yet be considered an established practice.

The Efficacy of Telehealth-Delivered Speech and Language Intervention for Primary School-Age Children: A Systematic Review

Search Criteria Practice Area: Treatment Diagnoses: Speech Sound Disorders Description This is a systematic review of intervention studies investigating the effects of telehealth-delivered speech and language intervention in elementary students with speech and language disorders. Questions/Aims Addressed “This systematic review evaluated the present literature to determine if telehealth-delivered [speech-language pathology] SLP interventions are as effective as traditional in-person delivery for primary school-age children with speech and/or language difficulties” (p. 56). Population School-aged children, four to twelve years of age, with speech and/or language disorders Intervention/Assessment Speech and language interventions delivered via telehealth Findings – Telepractice:

• “The conclusions found … on the effectiveness of telehealth-delivered intervention are dependent on the selected outcome measure. Outcomes for telehealth were more consistently positive when standardized assessments, such as the [Goldman Fristoe Test of Articulation – Second Edition] GFTA-2, were used for the pre- and post-intervention testing” (p. 63).
• “The findings from the seven reviewed studies revealed that telehealth is a promising method for treating children with speech and/or language difficulties” (p. 63). Results are limited, however, due to the variable methodological quality and the predominant focus on speech sound intervention among the included studies.
• “The conclusions found … on the effectiveness of telehealth-delivered intervention are dependent on the selected outcome measure. Outcomes for telehealth were more consistently positive when standardised assessments, such as the [Goldman Fristoe Test of Articulation – Second Edition] GFTA-2, were used for the pre- and post-intervention testing” (p. 63).

Systematic Review of School Telehealth Evaluations

Search Criteria Practice Area: Treatment Diagnoses: Speech Sound Disorders Description This is a systematic review of peer-reviewed studies investigating the use of telepractice in school-based settings. This review included telehealth services addressing a variety of healthcare needs (e.g., asthma, diabetes, speech language impairments). The following summary identifies conclusions regarding speech-language pathology telepractice services. Questions/Aims Addressed “The purpose of this review is to provide an updated evidence synthesis focused on the evaluation of school-based telehealth clinical programs reported in the literature … regarding the value of school telehealth” (p. 61). Population School-aged children identified for school-based speech-language services Intervention/Assessment School-based speech-language pathology services provided via telepractice Number of Studies Included: 20 Findings – Telepractice

• “One study investigating stakeholder perspectives on the use of telepractice for the provision of speech-language services in a school setting found “low levels of awareness and engagement from classroom teachers and generally positive attitudes but still low knowledge from principals” (p. 70).
• “Three studies evaluating telehealth treatment of speech sound disorders found that telehealth outcomes were equivalent or somewhat better than traditional treatment, depending on outcome measurement” (p. 67). Additional research regarding service utilization and cost-effectiveness is needed.

A Systematic Review of the Use of Telehealth in Speech, Language and Hearing Sciences

Search Criteria Practice Area: Assessment Diagnoses: Voice Disorders Description This is a systematic review of the literature on speech, language, and hearing assessment and treatment via telehealth. Domains addressed include hearing, language, speech, voice, swallowing, orofacial myology and reading/writing disorders. Various populations are included. Benefits and barriers of telehealth are discussed. Questions/Aims Addressed “The aim of this paper is to provide a systematic literature review that investigates telehealth applications within the domain of speech-language and hearing sciences” (p. 2). Population Any population related to speech-language and hearing services Intervention/Assessment The use of telehealth to provide any intervention related to speech-language and hearing services Number of Studies Included 103 Findings – Telepractice:

• Out of thirty-three studies investigating the benefits of telehealth to identify the presence of hearing loss in individuals, 93.9% reported improved access to care and 21.2% reported cost-effectiveness.
• Three studies supported the cost-effectiveness and viability of using telehealth for assessment, diagnosis, and telemonitoring of voice disorders in individuals with Parkinson’s disease.
• Nine studies examined use of telehealth in voice disorders. Most addressed assessment and screening of voice, and “results showed that remote voice assessment was considered reliable and viable” (p. 19). One study compared face-to-face intervention with intervention via real-time remote videoconferencing, and found no significant differences in outcomes (perception of voice quality, acoustic changes, patient satisfaction, laryngeal changes). Access to services and cost-effectiveness were mentioned as benefits of telehealth. Barriers included internet/computer access, internet speed, and individual skills in using telehealth.
• One study found positive results of a children’s literacy assessment administered over the internet via videoconferencing. Further research was suggested to address technology issues with the audio
• Six papers were found comparing telepractice to face-to-face assessment for dysphagia. Most of the studies reported both improved access to and quality of care. Early diagnosis and treatment for dysphagia was emphasized. Barriers to implementation included internet speed, individual computer skills, and accessing patient health data. It should be noted that of the studies included, four were authored by the same or similar group of individuals, and two of those studies appear to share at least some portion of participants; and
• two are pilot studies, one of which used simulated patients.

Search Criteria Practice Area: Treatment Diagnoses: Fluency Description This is a systematic review of peer-reviewed studies investigating the use of telehealth applications for the assessment and management of stuttering in children and adults. Questions/Aims Addressed “The aim of this article is to review telehealth applications to stuttering management” (p. 223). Population Children and adults with fluency disorders Intervention/Assessment Assessment and treatment of stuttering via telepractice Number of Studies Included 11 Findings – Telepractice:

• “The efficacy and reliability regarding the assessment of stuttering across the age groups is currently unknown. No research has comprehensively evaluated the cost-benefit or economic health benefits of stuttering interventions using telehealth modalities. It is clear that there is need for vigorous research in this area to refine procedures and improve efficiency, particularly for young children who stutter” (p. 233).
• Five studies investigating the delivery of fluency treatments via telephone for children and adults who stutter found this low-tech option to be a viable telehealth service delivery model. Benefits of fluency treatment over the phone include convenience, cost-effectiveness, portability, and reliability as a standby alternative in the event of service interruption or equipment failure.
• The efficacy and reliability regarding the assessment of stuttering across the age groups is currently unknown. No research has comprehensively evaluated the cost-benefit or economic health benefits of stuttering interventions using telehealth modalities. It is clear that there is need for vigorous research in this area to refine procedures and improve efficiency, particularly for young children who stutter” (p. 233).

The response to the COVID-19 virus is unprecedented. Because of our unique role in children’s K-12 education, we feel a responsibility to do what we can to assist schools, therapists and students with this transition to online learning and seclusion. To ensure that our clients remain engaged and supported, our therapists will be providing complimentary “Support Sessions” to the country’s youth. We will also be assisting schools by training therapists for remote therapy.

Click here to schedule a complimentary assessment by one of our licensed partners.