Following the closure of schools across the UK in March 2020, many Speech and Language Therapy services had to deliver assessments and interventions remotely via telehealth. For the LIVELY project, adapting and developing assessments and interventions for remote delivery was an important consideration during the pandemic. Consequently, the team sought to investigate the suitability of selected platforms and technology; the feasibility of alternative delivery methods; how to adapt assessments so they remain reliable and valid and methods of supporting children, parents and educational staff to access and engage with the remote sessions.
The aim was to develop a telehealth option that was as effective as possible within the constraints of the LIVELY project (budget, timescales, and access to schools during the pandemic). We considered research questions that fell under two headings:
1. To what degree is it possible to develop a telehealth approach for pre-school child language assessments and/or intervention?
2. What are the characteristics of approaches that yield the best outcomes?
These questions formed a basis for whether it was possible to develop a telehealth approach that had high treatment fidelity and was reliable, valid and acceptable for therapists, parent(s)/caregiver(s), children and educational staff. As part of this, we wanted to explore how and why characteristics of approaches that yield the best outcomes vary across families, children and schools.
Following a review of research, professional guidelines and discussion with Speech and Language Therapists across eight regions of the UK, the key learning and considerations about telehealth as a service delivery model is summarised below:
Creation of a telehealth assessment and intervention protocol (RCSLT, 2020) (ASHA, 2020)
- The protocol should explain and document how the assessments and interventions will be conducted and adapted for remote use
- It will ensure high levels of treatment fidelity when delivering the interventions. Treatment fidelity ensures that the intervention is delivered in the same way, by different people, in different settings
Selecting a platform (RCSLT, 2020) (ASHA, 2020)
- The platform must ensure privacy and confidentiality
- A user-friendly guide should be created
- Trial the platform and check audio and video signals
- The LIVELY team piloted both Zoom and Microsoft teams as these had the functions of remote access and screen share. We also created set up instructions for these platforms and trialled with adults who were familiar and unfamiliar with these platforms
Facilitator role
Training sessions with facilitators in schools should focus on the following: (Grogan-Johnson et al, 2011) (Raman et al, 2019):
The LIVELY team created facilitator role sheets for various versions of the assessments and interventions. They were sent to qualified SLTs and feedback was given regarding the role sheets so they are as clear as possible for both parents and teaching staff
Feedback on the telehealth sessions (RCSLT, 2020) (ASHA, 2020)
- It is important to gather feedback on telehealth sessions. The LIVELY team created google forms for teachers and parents to evaluate the different telehealth options
- RAs kept reflective diaries regarding their experience with telehealth
For more information regarding the development of remote assessments and interventions during the LIVELY project, please see the presentation attached which was presented virtually at the Research Symposium 2021.
NESLT 2021 | Language Intervention in the Early Years | Newcastle University (ncl.ac.uk)
Authors: Emily Preston, Kate Conn, Christine Jack, Cristina McKean, Jenny Sandham
References
ASHA. “Telepractice.” Telepractice: Overview, ASHA, 2020, www.asha.org/practice-portal/professional-issues/telepractice/
Grogan-Johnson, S., Gabel, R. M., Taylor, J., Rowan, L. E., Alvares, R., & Schenker, J. (2011). A pilot exploration of speech sound disorder intervention delivered by telehealth to school-age children. Int J Telerehabil, 3(1), 31-42. doi:10.5195/ijt.2011.6064
Raman, N., Nagarajan, R., Venkatesh, L., Monica, D. S., Ramkumar, V., & Krumm, M. (2019). School-based language screening among primary school children using telepractice: A feasibility study from India. Int J Speech Lang Pathol, 21(4), 425-434. doi:10.1080/17549507.2018.1493142
RCSLT. (2020). Covid-19: Telehealth. Digitally transforming therapy – the what, why & how of telehealth in speech and language therapy. [PowerPoint slides]. https://www.rcslt.org/-/media/docs/Covid/Telehealth-webinar-final.pdf?la=en&hash=E5484323617F3C63CC3945328D3E9D8BB1D6FA1C
RCSLT. (2020) “Telehealth – Guidance.” Royal College of Speech and Language Therapists.www.rcslt.org/members/delivering-quality-services/telehealth/telehealth-guidance.