Researching the acceptability of Skype mediated SLT for language impaired children? Rebecca Matthews Speech & Language Therapist Supervisors: Professor Bencie Woll & Dr Michael Clarke Speech Sort

Presentation will provide 1.SLT service pressures and use of tele- technology to provide SLT services 2.Describe & show what the SLT service set up using Skype looks like 3.Data collected and findings

UK SLT Service delivery issues Increased demand 2.5 million estimated to need SLT in the UK Increasing demand from an older population Increasing number of complex cases 7% of children entering school need SLT Shortage of qualified SLTs 13,000 registered SLTs Shortage profession More effective delivery of SLT services is vital to meet the need

Service delivery solutions Traditional approaches face-to-face individual/paired/group weekly/fortnightly/monthly Alternative approaches Programmes of work specifically designed Training with general work e.g.Elklan, Hanen Standardised programmes e.g. Lidcombe, Lindamood, LSVT Alternatives not suited to everyone Could tele-technology provide another approach?

Tele-health is The use of telecommunications technology to provide a link between health care professionals or between health care professionals and patients ASHA, 2005

Service activity using tele-technology The same service activity as face-to-face: 1.Liaison 2.Assessment 3.Treatment ASHA, 2005 Store & forwardAsynchronous or real time Face-to-FaceNo sight of each other

SLT services using tele-technology First SLT service set up in 1976 Only 45 papers published about SLT services using tele-technology Majority in North America, fewest in Europe Range of tele-tech systems used Investigated feasibility, costs and user satisfaction

SLT tele-technology research findings 1.Feasibility demonstrated a)liaison, assessment & providing service b)Adults and children c)Voice, AAC, dysfluency, dysphasia, dysarthria, dysphagia 2.Costs a)Tele-technology equipment costs high b)Running costs lower 3.Acceptability a)Satisfaction for clients/users b)Not acceptable to therapists

Limited use of tele-technology to provide SLT Despite positive research findings therapists do not find this way of working acceptable 1212 No professional guidelines Ethical & malpractice issues Professional 3434 Expensive set up equipment costs Reimbursement Costs Clinical Effectiveness Change to work practice Loss of interaction & rapport with clients Clinical 8989 Training to use the technology Managing the client’s technology Technology ASHA Survey, 2002

Speech Sort Skype SLT Service 1.Costs low cost desktop videoconferencing = Skype = free to use 2.Technology ‘off the shelf’ peripherals inexpensive training & taking advice from others Manual for clients + trial session 3.Professional Issues ASHA professional guidelines 4.Interaction Both face-to-face & SKYPE 5.Changes to work practice Prep Routine Administration Equipment

The computer with Skype

The child’s view

Pilot Study Aims 1.Trial the Skype SLT service – Setting up the Skype technology – Equipment – Administration 1.Trial data collection

Research question Is SLT provided through Skype acceptable? 1.Clinical Activity 2.Technology 3.Interaction 4.Costs to provide (American Speech Hearing Association, 2002)

Data Collection 1. Session profile – activity, costs & technology performance 2. Discourse analysis – interaction (Video recording of both session formats for each participant) 3. Questionnaires – adult views 4. Interviews – child views

Participants recruited 11 participants 7 boys and 4 girls 1 infant, 6 junior and 4 senior school 6 Autism/ASD diagnosis 2 dyslexia 2 specific syndromes 1 dyspraxia 6 familiar to me and 5 new referrals

Participants not recruited 2 asked but did not participate Both girls One in Year 2 and the other in Year 3 Internet connection seen as problematic Bilingual family felt that they would not gain as much from SLT Reduced costs not a factor in their decision

Data collected 110 session record cards 17 hours of video recording 12 sets of questionnaires 10 child participant interviews

Results 1.Clinical Activity  More goals completed in Skype SLT  Fewer turns used to complete the same activity  Working harder - children using more Requests 2.Technology  Positive change in adult participant views on technology  Equal turns and fewer clarifications suggest minimal disruption from the technology 3.Interaction  Same pattern of turns, moves and providing utterances in both session formats for therapist and child  Fewer interruptions in the Skype session 4.Costs to provide  £1.68 for Skype and £2.97 for F2F per minute

Conclusion 1.Session more task focused 2. Technology affordable intuitive design 3. Therapeutic tool using the observed differences 4. Solution to service delivery dilemma increased demand for service reduced resources

For further information contact …… Rebecca Matthews Heathercote House, Silchester, Reading, Berkshire, RG7 2PG. Tel: