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Introduction to Telepractice

Telepractice (AKA telemedicine, teletherapy, telehealth, telespeech, telerehabiliation, virtual speech therapy) is the delivery of health services via a telecommunications system. This service model is becoming increasingly more popular in the fields of speech-language pathology and audiology. Large factors that have driven the use of telepractice are reducing travel time for the client and/or professional and expanding the reach of services. Telepractice is becoming a more widely used and accepted method of providing speech-language pathology and audiology services. However, many families are skeptical that the services provided through a computer could be beneficial or equally as productive as those provided face-to-face. Despite family reservations, researchers (e.g., Gorgan-Johnson and colleagues) have found that children receiving virtual speech therapy do as well as those receiving services in person.

Benefits of Telepractice

  • Decreases the rate of cancelations or no shows
    • Sessions can still occur in bad weather or when the speech-language pathologist (SLP) or client are sick.
  • Allows underserved populations to receive evaluations and treatment
    • Individuals living in rural towns may struggle to find local in-person services for their needs. Furthermore, individuals from culturally or linguistically diverse backgrounds may struggle to find appropriate services in their area. By using telepractice, these clients are able to receive the services they deserve.
  • Increases family involvement in the sessions
    • Family members can have a more active involvement by assisting clients with the session activities.
  • Increases interest or attention with clients that are motivated by and/or more comfortable in front of computers
    • Clients may be more engaged during their sessions because they enjoy being on the computer. They may also feel more comfortable asking and answering questions and performing difficult tasks with the computer screen as a safety net.
  • Allows clients to connect with professionals who specialize in their disorder or disability and/or can provide services in their native language
    • Speech-language pathology is a broad field. Although all SLPs receive some degree of training in all aspects of speech, language, and swallowing disorders, most  specialize in certain areas over areas.  For example, some SLPs may specialize in working with children with autism while others may have extensive training in treating adults who have aphasia. In addition, the majority of SLPs are monolingual and/or do not have the training to provide appropriate services to a bilingual client.
  • Makes sharing information easier
    • Clients and SLPs can share their computer screens and upload files to enhance the therapy session.
  • Helps clients and families to remember and understand what occurred during the session
    • Virtual therapy sessions can be recorded (with permission) and used for later review. By recording the sessions, clients and family members can watch what occurred. Watching the recordings assists clients with practice and carryover of skills. Moreover, watching previously recorded sessions allows everyone to observe the progress that has occurred.

How can we help?

At Liberty Speech Associates LLC, we provide telepractice sessions for the following purposes: accent modification, counseling, speech-language evaluations and treatment, speech-language screenings, and collaboration with related professionals. For more information on our telepractice services, contact us today.

References

  1. Grogan-Johnson, S., Alvares, R., Rowan, L., & Creaghead, N. (2010). A pilot study comparing the effectiveness of speech language therapy provided by telemedicine with conventional on-site therapy. Journal of Telemedicine and Telecare, 16(3), 134139.
  2. Grogan-Johnson, S., Gaebel, R., Taylor, J., Rowan, L. E., Alvares, R., & Schenk er, J. (2011). A pilot exploration of speech sound disorder intervention delivered by telehealth to school-age children. International Journal of Telerehabilitation, 3(1), 3141.
  3. Grogan-Johnson, S., Schmidt, A. M., Schenker, J., Alvares, R., Rowan, L. E., & Taylor, J. (2013). A comparison of speech sound intervention delivered by telepractice and side-by-side service delivery models. Communication Disorders Quarterly, 34(4), 210220.

Understanding Eligibility Criteria for School-Based Speech Therapy

Children (age 3 and up) are allowed to receive speech-language therapy and related services through their local public school district. However, students must meet specific criteria in order to be eligible for these services. The eligibility criteria vary from state to state. Because my practice is based in New Jersey, the purpose of this post will be to discuss the eligibility criteria for speech-language therapy in NJ Public Schools.

 

Speech-language therapy and related services in NJ Public Schools is mandated by Chapter 14 of the New Jersey Administrative Code. If you have a child in need of services or already receiving services, it’s important that you read and familiarize yourself with the Code to ensure your child is getting the services s/he deserves.

 

Preschool child with a disability” is the classification used for children between the ages of 3 and 5, who present with developmental delays. A developmental delay is described as a 33% delay in one area of development or a 25% delay in two or more areas of development. Areas of development include: physical (gross and fine motor), intellectual, communication, social-emotional, and adaptive/self-help. A child may also qualify for speech-language therapy and related services under this classification if s/he has a diagnosed disabling condition that could impact education.

 

 

Communication Impaired” is a classification used for children older than 5. A child receives this classification if s/he presents with a language disorder that negatively affects his/her ability to learn. A child may have difficulties in any or all of the following areas: morphology, syntax, semantics, pragmatics. To determine if a child falls under the “communication impaired” classification, s/he should undergo functional assessment outside of the testing situation and participate in at least two standardized language tests (when appropriate). If the child’s performance is more than 1.5 standard deviations below the mean, s/he is eligible for speech-language services.

 

 

In addition to the two aforementioned classifications, a child may also qualify for speech-language therapy as a result of a speech disorder. A speech disorder is a disorder in any or all of the following areas: articulation, phonology, fluency, voice. Difficulties in any of these areas should be considered unrelated to dialectal or cultural differences or influences from a foreign language. Criteria for classification of a speech disorder are listed below:

 

  • Articulation/phonology: Using a standardized articulation or phonology test, a child must present with one or more sound production errors on sounds that 90% of children of the same age have reached mastery. A child must also consistently produce the errors in a speech sample.
  • Fluency: A child must display a mild rating or higher on a fluency rating scale and in a speech sample. A child must also exhibit dysfluencies on at least 5% of words spoken.
  • Voice: A child must perform below the expected level for vocal quality, pitch, resonance, loudness and/or duration using a voice rating scale. The voice difficulties must be present on two separate testing sessions held at least three sessions apart.
 
This post is only a short summary regarding the eligibility criteria for speech-language therapy for preschool and school-aged children. It is solely meant to be an informational resource for parents and should not be considered a replacement for carefully reviewing the complete Code and speaking with relevant Board of Education personnel.

 

Stimulating Communication Without Spending a Dime

I often get asked about the best toys and gadgets to stimulate communication in children.  And, although I do have some favorites, communication occurs everywhere, everyday (#CommunicateEverywhere).  No special gadgets or gizmos are needed.  So keep your money in your pocket and use your everyday routines to work on your child’s speech and language skills.  There are numerous ways that you can help your child learn and stimulate his communication without spending a dime…or leaving the house.  Here 9 tried and true activities for communication development:

Speak to Your Child

Children understand a lot more of what we’re saying than we think.  Speak to your child even if you think s/he doesn’t understand or isn’t listening. You can describe activities as they’re happening (e.g. Mommy’s making dinner), model words and phrases, ask questions, and so on…

Read Books and Look at Pictures

If you have children’s books at home or have access to books from the library, read them to your child. Or if your child won’t sit and listen to the story, you can make the activity more interactive by asking him to find, name, or describe certain pictures. You can also take turns “reading” the story. You can read or describe the story to your child and then pass the book along and allow him to re-tell the story using the pictures for support. If you don’t have access to books, or are interested in trying something else, use your own photos to make a book. Children are sometimes more engaged when they see pictures of themselves or people they know

Invite Your Child into the Kitchen

Some families are hesitant to bring kids into the kitchen because it’ll lead to a mess. But the benefits of bringing your child into the kitchen should outweigh the mess. You can teach your child various skills, such as sequencing and counting.

Let Your Child Participate in Chores

Not only does this help children learn, it also helps you gets the chores done! Talk about a bonus! If you are doing laundry, have your child match up the socks. Doing this one activity, your child can learn the skill of matching similar objects, can learn colors (if you have socks with different colors or designs), and can practice counting (among other things).

Do Arts and Crafts

There are millions of websites (and Pinterest boards) out there with arts and crafts activities that can be done with children of all ages. Arts and crafts that are particularly beneficial are those that can be used multiple times, such as homemade dough, masks, or puppets.Watch this video about a simple bunny puppet craft that can be used to stimulate communication.  The list of skills a child can learn from one craft is endless.

Keep Your Used Toilet Paper/Paper Towel Rolls

After you’ve used up all the paper, use the rolls for a variety of functions: to make binoculars, to use it as a microphone, to use it as a telescope…Oh the fun your child can have with that. If using it as a microphone, take turns making silly sounds (and then eventually words or phrases) into it. Your child will be encouraged to try and speak and imitate you during this fun and interactive game. If using it as binoculars or a telescope, your child can become an adventurer, looking for people and objects that are around the house or in pictures.

Have a Scavenger Hunt

You can do this by hiding pictures or objects around the house and having your child find them. Your child can work on skills, such as identifying specific objects (e.g. Johnny, where’s the ball?), naming objects (ball!), describing objects (big ball), using location phrases (on the table), and so on.

Sing songs

Singing is a great way to engage your child and encourage sound or word imitation. Try using songs that have accompanying hand movements, such as the Wheels on the Bus. Children typically imitate movements before they imitate words. After you’ve sung the same song multiple times, pause at key parts in the song to see if your child will fill in the blank.  For example, you would say, “The wheels on the bus go….” and your child would finish “round and round.” Depending on your child’s age or developmental level, he may not be able to say or pronounce the appropriate words, but may be able to produce a sound (e.g. “ah”).

Play I Spy

You can work on various concepts with your child by playing this typical children’s game. Concepts could include: colors (I spy something yellow), sizes (I spy something large), shapes (I spy a circle), etc. Your child can practice identifying objects based on your descriptions and/or your child can practice describing objects for you to find.

 

I think this list is good enough to get you started and demonstrate the point that expensive toys or contraptions are not needed to have fun, learn, or speak. So spend some much-needed time at home with your child relaxing and doing some of these fun activities. Keep in mind that all of the activities can be made simpler or more complex depending on your child’s age or skill level.

Check back for more activities in upcoming posts!

Bilingualism: Separating Myths from Truths

About two years ago, I wrote an article entitled To Be Bilingual: That is the Answer, Not the Question for in the NJ Speech-Language-Hearing Association’s publication VOICES. This article aimed to debunk myths about bilingualism that are spreading like wildfire around the U.S. The article was primarily seen by speech-language pathologists and audiologists in NJ, but the unfortunate truth is that it’s not just NJ speech-language pathologists and audiologists that are spreading these myths; it’s doctors, physical therapists, teachers, social workers, families…The list goes on and on.

 

At least once per day bilingual families tell me that they’ve been told by another professional to use only English in their households due to the dangers of bilingualism. Who knew bilingualism could be so dangerous? It’s truly crazy when you think about it. I spend hours each day listening to ludicrous, unfounded myths about bilingualism. So I’m going to take the time now to provide the research-based truths. It’s my hope that by sharing the information in this blog, rather than in an article like I did the first time around, it’ll reach more people nationwide and across the world.

 

 

The dreaded myths:

Bilingualism confuses children.

Bilingualism causes delayed speech and language development.

Code-switching is indicative of a delay or problem.

Children with delayed speech and language skills should only learn English.

Individuals with developmental disabilities (e.g. autism, down syndrome) cannot become bilingual.

 

These myths couldn’t be further from the truth and yet they continue to be spread around. Why they continue to be spread is beyond me. I don’t know if it’s a lack of awareness and knowledge or what, but it bears repeating (a million times over) that these myths are NOT in any way true.

 

 

The research-based truths:

Bilingualism DOES NOT lead to delays or confusion.

Code-switching is a normal part of development in bilinguals.

Parents and family members should speak their native language at home with their children.

All children, regardless of whether or not they have a disability, can become bilingual.

 

References:

Bird, E. K., Cleave, P., Trudeau, N., Thordardottir, E., Sutton, A., & Thorpe, A. (2005).      The language abilities of bilingual children with down syndrome. American Journal of Speech-Language Pathology, 14, 187-199.

Genesee, F., Paradis, J., & Crago, M. B. (2004). Dual language development and disorders: A handbook on bilingualism and second language learning. Baltimore: Paul H. Brookes Publishing Co.

Kremer-Sadlik, T. (2005). To be or not to be bilingual: Autistic children from multilingual families. Paper presented at the 2003 at the ISB4: Proceedings of the 4th International Symposium on Bilingualism. Retrieved October 20, 2011, from www.cascadilla.com/isb4.html

Macnamara, J. (1966). Bilingualism and primary education. Edinburgh, Scotland: Edinburgh University Press.