1. Supervision and Telepractice Colette Edwards, M.A., CCC-SLP The University of North Carolina at Greensboro

2. 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 presentation  Basic background information  Supervisory skills needed  How to become trained

3. Overview continued  How to train graduate students and facilitators  How does telepractice work with videos  What are the similarities and differences in the supervisory process  What are the implications for the future

4. 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?

5. 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.

6. 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

7. 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

8. Ethical & Legal ASHA’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).

9. Knowledge and Skills Needed Knowledge  In-person observation of service delivery through telepractice  Familiarity with the literature (binder of articles)  Equipment training, HIPPA training, Licensure training, Responsibilities and forms training

10. Knowledge and Skills Skills  Clinical skills with school-aged population  Multi-tasking skills  Problem-solving skills  Interpersonal skills  Administrative skills  Collaborative skills  Supervisory skill

11. 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

12. Training Graduate Students and Facilitators

13. 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.

14. 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.

15. 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.

16. Short Video

17. Equipment Options Videoconferencing o High-end videoconferencing systems o Videoconferencing software o Free chat programs (e.g., Microsoft Live Meeting) o Company developed systems Peripherals o Speakers o Microphone o Computer o Document Camera o Content server or DVD Recorder o Secondary Video Camera

18. Set-Up Options Desktop Version Cart Mounted

19. Peripheral Options

20. System in Use

21. Therapy Video

22. Similarities and Differences in the Supervisory Process

23. Future Implifications

24. Innovative Outcomes Animal-Assisted Therapy-Colin Drolet & Ashley Scott (see July 2013) ASHA Leader article) A Telepractice Paraprofessional Manual by Cristina Garcia

27. References