Dear   Missy,

I have recently been told that my four year old has difficulty communicating in her classroom, is often not understood by the teachers and or her peers. As a family we would agree that this is true, as we her parents have a difficulty understanding her much of the time.   She is frequently getting frustrated when we or they do not understand her.  We live out in the country and do not have easy access to a hospital or other facility that could offer help if needed and our current school district has the speech and language therapist position unfilled.  Looking on line I saw that some hospitals and school districts are starting to provide speech and language using the internet in what they call telepractice.  Would you recommend this, or would you recommend that we try the hospital an hour away from our home?

-Mom

Dear concerned Mom,

You bring up a really interesting question, I would consider not easily answered at this time.  While telepractice or teletherapy is a growing phenomenon across environments, it is still in its infancy as far research and standardization is considered.  Additionally, it comes with a wide range of variables that need to be addressed before feasibility and appropriateness can be measured.   At this time, our national governing body that standardizes treatment, ethics, and evaluation guidelines, identifies telepractice as an “ application of telecommunications technology for the delivery of professional services at a distance by linking clinician to client, or clinician to clinician for assessment, intervention, and/or consultation to overcome difficulties associated with distance, staff unavailability, and or impaired mobility.”  Their most important caveat is the importance of abiding by all ASHA policies and standards, health-care regulations, and state and national laws as the quality of service can by no means be sacrificed or compromised in comparison to face to face delivery methods.  Most past research has looked at quality control and effectiveness for adult patients with aphasia.  Currently, some school districts such as in Washington and California are implementing telepractice for economic reasons. Initially I would establish the diagnosis in a face-to-face session.  It would provide a better opportunity for careful observation, flexibility of assessment procedures as needed, and the ability to test out some therapy techniques if needed. If your child is then diagnosed with a disorder, I would ask the clinician whether they would recommend sessions face-to-face or if telepractice is a feasible.  Please consider the following information: Do you and the perspective healthcare facility have appropriate technology to deliver quality intervention, will your child be able to cooperate and participate in sessions over internet, and will your insurance provider reimburse for these types of services.  There are a whole slew of variables to consider, and it would be best to consider them with practitioners who are familiar with providing service in this way.  I hope this is a place to begin in your journey.

Missy

*Telehealth and Speech-Language Pathologists –Richard D. Steele, Ph.D.