Supervision and Telepractice

Colette Edwards, M.A., CCC-SLPThe University of North Carolina at Greensboro

Overview of Presentation

• Assuming that you have some knowledge of telepractice, telemedicine, or telehealth

• Focusing on the supervisory aspects of my experience with Telepractice

• Discussing in this presentationBasic background informationSupervisory skills neededHow to become trained

Overview continued

How to train graduate students and facilitatorsHow does telepractice work with videosWhat are the similarities and differences in the

supervisory processWhat are the implications for the future

Supervision

• It is often said that “Clinical supervision is more than being a competent clinician.”

• ASHA’s 2008 position statement suggested that “ Clinical supervision is also a collaborative process, with shared responsibility for many of the activities throughout the supervisory experience.”

• How does this work in telepractice?

Tele-supervision

• I propose that Tele-supervision is more than being a “competent supervisor.”

• It’s a combination of being a competent supervisor of both graduate students and facilitators and a competent clinician at the same time.

• This is different from Tele-supervision as described in “Focusing in on Tele-Supervision” by Carol C. Dudding who writes about clinical instructors providing supervision at a distant site, geographically remote from the university campus.

History of School-Based Telepractice

• Nationally– 1999: INTEGRIS Health in Oklahoma City– 2005: ASHA documents– 2006: Kent State implemented telepractice project and completed

outcomes study

• In NC– 2008: UNCG started as pilot project

• Served 4 school districts thus far• Over 200 students, ranging from PreK to Middle School

– 2010: Telepractice rule added to licensure law for SLPs and AUDs– 2011-12: added a part-time (two mornings a week) “supervisor

clinician” delivering speech-language services to a remote NC mountain elementary school

Tele Terminology

• Telepractice, telespeech, telehealth, telemedicine, telerehabilitation, telecare, e-health

• Facilitator, paraprofessional, e-helper, telehelper

• Synchronous versus Asynchronous• Hub versus Remote Site• Face-to-Face, In-Person

Ethical & LegalASHA’s Position Statement on Telepractice

“The use of telepractice does not remove any existing responsibilities in delivering services, including adherence to the Code of Ethics, Scope of Practice, state and federal laws (e.g., licensure, HIPAA, etc.), and ASHA policy documents on professional practices. Therefore, the quality of services delivered via telepractice must be consistent with the quality of services delivered face-to-face” (2005b).

Knowledge and Skills Needed

• KnowledgeIn-person observation of service delivery

through telepracticeFamiliarity with the literature (binder of

articles)Equipment training, HIPPA training, Licensure

training, Responsibilities and forms training

Knowledge and Skills

• Skills Clinical skills with school-aged populationMulti-tasking skills Problem-solving skillsInterpersonal skillsAdministrative skillsCollaborative skillsSupervisory skill

Supervisory Training

• Lead SLP in a small rural school system• Supervisor on campus with child and adult

individual clients and groups of clients (FAM and Transgender Voice & Communication)

• Supervisor for numerous CFY SLPs• Coordinator of Innovative summer camps• Supervisor for a Clinic Team

Training Graduate Students and Facilitators

How Does it Work

• Students and Supervisor Clinician arrive 30-45 minutes before session with a therapy agenda ready for each child, data sheets, and therapy materials.

• Equipment is turned on and checked at hub.• Facilitator arrives turns on equipment at her site,

chats with SLP and graduate student about up-coming sessions and/or responsibilities/changes in session.

• Facilitator goes to classroom to get the first child. Student and supervisor discuss any last minute planning.

How Does it Work

• Therapy is conducted by the Supervisor-Clinician, the graduate student or both.

• Children are shown the agenda for the day and participate in 2-3 therapy activities.

• Data is collected on a one page SOAP note.• The Facilitator follows the Supervisor’s

directions during therapy and often participates in the reward time at the end of the session.

How Does It Work

• Supervisor-clinician and student collect data separately during the session (discuss discrepancies later). Supervisor writes feedback notes for student.

• After the session, the Supervisor and student talk with the Facilitator (ask for feedback about the session, discuss behavior management issues or questions and make assignments regarding parent or teacher contacts, organizing paperwork, and conference reminders.

• Student remains to complete A and P on SOAP note or schedules an appointment to complete the work.

• The Telepractice sessions are discussed in the Clinical Team meeting.

Short Video

Equipment Options• Videoconferencing

o High-end videoconferencing systemso Videoconferencing softwareo Free chat programs (e.g., Microsoft Live Meeting)o Company developed systems

• Peripheralso Speakers o Microphoneo Computero Document Camerao Content server or DVD Recordero Secondary Video Camera

Set-Up Options

Desktop Version

Cart Mounted

Peripheral Options

System in Use

Therapy Video

Similarities and Differences in the Supervisory Process

Future Implifications

Innovative Outcomes

• Animal-Assisted Therapy-Colin Drolet & Ashley Scott (see July 2013) ASHA Leader article)

• A Telepractice Paraprofessional Manual by Cristina Garcia

References