Perspectives of Speech-Language Pathologists on the Use of Telepr actice in Schools: Quantitative Survey Results

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1 Perspectives of Speech-Laguage Pathologists o the Use of Telepr actice i Schools: Quatitative Survey Results Jaice K. Tucker, SLP.D. Speech Laguage Support Progr ams, Licol Itermediate Uit #12, New Oxford, PA Abstr act This research surveyed 170 school-based speech-laguage pathologists (SLPs) i oe ortheaster state, with oly 1.8% reportig telepractice use i school-settigs. These results were cosistet with two ASHA surveys (2002; 2011) that reported limited use of telepractice for school-based speech-laguage pathology. I the preset study, willigess to use telepractice was iversely related to age, perhaps because youger members of the professio are more accustomed to usig techology. Overall, respodets were cocered about the validity of assessmets admiistered via telepractice; whether cliicias ca adequately establish rapport with cliets via telepractice; ad if therapy coducted via telepractice ca be as effective as i-perso speech-laguage therapy. Most respodets idicated the eed to establish procedures ad guidelies for school-based telepractice programs. Keywords: speech therapy, telepractice, schools Telepractice is receivig icreasig attetio i the field of speech-laguage pathology (America Speech-Laguage-Hearig Associatio [ASHA], 2005c, 2010; Jueger, 2009a). ASHA coducted a survey of its membership i 2002 ad foud that oly 11% of respodets were egaged i the use of telepractice, with lack of kowledge about telepractice emergig as the greatest barrier. A membership survey coducted by ASHA i 2011 icluded two questios pertaiig to telepractice. The 1455 respodets idicated a 2.3% utilizatio of delivery of ay service via telepractice i speech-laguage pathology; for the school populatio this yielded a icidece rate of 1.6%. The cliet populatios icluded (preseted from greatest to least served): childre i homes, childre or adults i satellite cliics/hospitals, childre i schools, adults i home or work eviromets, ad adults i military/va. The potetial beefits of telepractice are substatial (ASHA 2005c, 2010; Hou & Trottier, 2006; Mashima & Doar, 2008) ad could iclude: greater access to speech-laguage pathology services for uderserved populatios (e.g., rural ad ier city studets); improved access to services for cliets with cultural ad liguistic diversity, (icludig those who require biligual cliicias); idividualized therapeutic programmig; greater access to dysphagia experts; icreased ease of collaboratio amog team members; ad savigs i travel time ad costs for providers (ASHA, 2005c, 2010; Polovoy, 2008). Service delivery i public schools via telepractice could also support free ad appropriate educatio for studets ad icrease studet learig (Jueger, 2009b). However, much still eeds to be leared about how speech-laguage pathologists view telepractice (ASHA, 2010; Hill et al., 2006; Torres, 2004), especially i light of evidece that providers perceptios are less tha ethusiastic (Whitte & Holtz, 2008a, p. 952). A ehaced uderstadig of SLPs perceptios cocerig the use of telepractice i schools could help idetify reasos for its limited adoptio, ad iform the developmet of a framework from which to build acceptace ad cofidece (ASHA 2010; Torres, 2004; Whitte & Holtz, 2008a, 2008b). Methods Survey Costructio A web-based survey was costructed, based i part o the ASHA Telepractice Survey of 2002 for Audiologists, SLPs, ad Speech, Laguage, ad Hearig Researchers. The ASHA 2002 istrumet cosisted of closed-eded questios regardig the amout of use of telepractice, type of cliet services, settigs, techologies, ad reimbursemet of telepractice services. This tool also surveyed the participats educatio or traiig ad reasos for utilizig telepractice (itervetio or research purposes). Iteratioal Joural of Telerehabilitatio Vol. 4, No. 2 Fall 2012 ( /ijt ) 61

2 With permissio from ASHA, 11 out of 21 questios from the 2002 survey (Questios 1, 2, 5, 6, 7, 9, 10, 14, 15, 16, ad 20) were used with revisios made for the purposes of this preset study to reflect a school focus ad SLP respodets, (as opposed to both SLPs ad audiologists who iformed the origial 2002 survey). This preset study s survey icluded two items pertaiig to demographics of all respodets ad 12 questios relatig directly to specificity of the use of telepractice i school settigs ad the kowledge ad skills of oly those SLPs ivolved i telepractice. The subsequet 17 item sectio of this quatitative istrumet icorporated the themes ad commets that emerged from the qualitative iterviews i the first phase of this mixed methods study ad cetered o all respodet SLPs attitudes ad beliefs with regard to the use of telepractice i speech-laguage pathology. Four remaiig opeeded questios allowed SLPs to list their reasos to use or ot use telepractice ad for ay additioal commets they wished to provide. The survey cosisted of a total of 35 items ad required less tha 20 miutes to complete (Creswell, 2008). Approval to coduct the research was grated by the Istitutioal Review Board (IRB) of Nova Southeaster Uiversity. Pilot Testig To provide a measure of iteral clarity, cotet ad costruct validity, the revised ASHA Telepractice istrumet was pretested via a survey with 10 SLPs; each had more tha 5 years of experiece with school-based speech therapy i the target state (Creswell, 2008). The pilot group was asked to review the questios for ambiguity, termiology, ad ease of admiistratio. Mior adjustmets were made to spellig ad word order based upo their recommedatios. Survey Admiistr atio The survey was placed i a password protected Google accout, a web-based survey system ad dissemiated to the 1900 members of the state s speech-laguagehearig associatio membership listserv. [The researcher did ot have access to or kowledge of the membership s ames or addresses.] Each ASHA certified SLP received the quatitative data collectio istrumet, alog with a Participatio Letter ad itroductory briefly explaiig the purpose of the study, risks ad beefits of participatig, ad iformatio cocerig cofidetiality ad the right to withdraw from the study. A remider was set to the membership via the associatio s listserv two weeks later to ecourage participats to respod (Creswell, 2008). Selectio bias was limited by icludig the etire speech-laguage-hearig associatio membership of SLPs i the targeted state. Participats The quatitative survey was ed to members of the state s speech-laguage-hearig associatio via that associatio s listserv of 1900 ASHA-certified SLPs. Accordig to statistics from the Natioal Ceter for Educatio Statistics (NECS), the populatio of public school-based therapists certified to teach the speech ad laguage impaired i the selected state cosisted of over 3200 idividuals (NECS, 2008). Therefore a subset of 1900 ASHA-certified SLPs i this state should provide represetatio of SLPs providig services i school settigs ad afford a adequate respose rate (Creswell & Plao Clark, 2011; Fik, 2003). Additioally, the associatio s listserv membership icluded those SLP professioals that provide telepractice services to charter or cyber schools. Olie public cyber school erollmet i this ortheaster state has icreased approximately 760% from (Beefield & Ruk, 2008), ad studets with Idividualized Educatioal Plas (IEPS) costitute 14% of the erollmet i these cyber schools (Müller, 2009). Telepractice i speech-laguage pathology may be utilized more i these school settigs due to existig distace educatioal techologies, ad as such, the viewpoits ad data from SLPs providig the telepractice services to these educatioal eviromets were icluded i this study (Alverso et al., 2008; ASHA, 2010; Chumbler, Kobb, Brea, & Rabiowitz, 2008). RESULTS Rate of Retur Of the 1,900 surveys that were set to the ASHAcertified SLPs i the selected ortheaster state, 170 were retured, a respose rate of 9%. Descriptive statistics were employed for items relatig to respodet demographics, use of ad kowledge ad skills of SLPs utilizig telepractice, ad SLPs attitudes toward telepractice. The most frequet resposes ad outlier commets were tabulated for the fial four ope-eded questios. Respodet Demogr aphics Years of employmet raged from 1 to 25+ years with the majority of survey respodets i the 25+ years category (43.53%). Resposes came from all four geographical regios across the state but predomiatly from easter (48.82%) ad souther (27.06%) locatios, with 21.76% from the west ad 2.35% from the orth. These regioal percetages correlate with the curret distributio of the populatio i this state. 62 Iteratioal Joural of Telerehabilitatio Vol. 4, No. 2 Fall 2012 ( /ijt )

3 Telepractice Usage Survey Questios 4 14 pertaied to kowledge, skills, ad experieces of those SLPs who have provided telepractice i school settigs. The use of telepractice i school settigs i the ortheaster state was reported by 10 SLPs out of the 170 respodets (6%), with four reports of telepractice use outside the state. [Three of these SLPs were supervisors of telepractice programs ad did ot maitai a telepractice caseload. Two of these idividuals worked i the wester side of the state while oe came from the easter side.] Seve SLPs provided telepractice, but four idicated that this was previous work ad ot curret practice. Thus oly three SLPs reported curret provisio of service via telepractice. All seve SLPs reported legth of time, umber of studets, ad percetage of work week devoted exclusively to telepractice. This varied from less tha oe year to more tha three years i legth, for oe to up to 30 studets. Telepractice service for all but oe SLP ivolved less tha 25% of their work week; oe SLP reported 26-50% of the workweek for studets. Locatio of Telepr actice Services The locatio of telepractice services, for both the studets ad the SLP deliverig the therapy, was also reported. Telepractice delivery to studets i a elemetary school locatio was reported by all respodets, with middle through high school also listed for 5 of the 10. Three respodets idicated that they provided telepractice i a private or cyber school ad two practiced i a special educatio ceter. The oe SLP providig telepractice i the easter regio of the state delivered telepractice to studets homes. The most frequet SLP locatio from which to deliver telepractice was a special educatio ceter (five) with elemetary school reported by four. The SLP i the souther part of the state was the oly oe who provided telepractice from home. Service Types Seve SLPs ad three SLP supervisors cotributed data o the types of services provided via telepractice. The SLPs idicated which types of therapy services were provided, i terms of screeig, assessmet, treatmet, ad cosultatio. I additio, the three SLP supervisors who had experiece with telepractice idicated that they had provided cosultatio ad oe provided assessmet via telepractice. The SLPs with a curret or past telepractice caseload idicated that the predomiat service was treatmet (85.7%), followed by cosultatio (42.8%), ad screeig (28.6%). Similar to the SLP supervisor group, oe treatig SLP listed assessmet as a service provided. Oe SLP specified cosultatio to teachers, parets, ad others as the oly telepractice service provided. The SLPs were also asked to idicate studet areas of impairmets from a o-iclusive list. The results revealed, i order of frequecy served: Laguage Disorder (71.4%); Articulatio/Phoology (1%); Fluecy (28.6%); with oe each for Learig Disabilities; Autism Spectrum Disorders, ad Attetio Deficit (14.2%). The SLPs were questioed o what speech-laguage areas they believed were ot appropriate for telepractice therapy, usig the same list of o-iclusive areas. The results were mixed ad are listed here i order of frequecy of respose: all areas are appropriate for telepractice (71.4%); Birth to three, Dysphagia, or Motor Speech Disorders (57.1%); Articulatio/Phoology, Autism Spectrum Disorders, Fluecy, or Preschool (42.8%), Hearig Impairmet, Metal Retardatio, Psychiatric/ Emotioal Disturbaces, or Voice (28.6%); Learig Disabilities (14.2%). Telepr actice Assistats The use of a telepractice assistat was reported i questio 12. Three of the seve SLPs experieced i telepractice did ot have a telepractice assistat. Four of the remaiig experieced SLPs i this group idicated that the duties of these assistats icluded assistig studets to remai o task ad providig some degree of techology support. Three of the four revealed that the assistats commuicated with teachers or other school staff, copied ad/or collected materials, ad helped get the studets to ad from class. Oe SLP reported the assistat, i additio to the aforemetioed duties, atteded Idividualized Educatio Program (IEP) meetigs ad worked directly with studets durig therapy sessios. Prior Tr aiig Traiig was questioed i items 13 ad 14. First, the SLPs experieced i telepractice were asked to idicate their level of traiig regardig telepractice prior to implemetig the service delivery model. Results as reported idicated that the majority of the SLPs (86.7%) did receive some type of traiig i telepractice before iitiatig service. The fial questio asked of this group of SLPs experieced i telepractice was what type of additioal traiig they felt they eeded, if ay. Results, as they were with resposes for areas ot suitable for telepractice, were mixed. Resposes o prior traiig received ad additioal traiig desired are listed i Table 1. Iteratioal Joural of Telerehabilitatio Vol. 4, No. 2 Fall 2012 ( /ijt ) 63

4 Table 1 Prior Traiig Received ad Additioal Traiig Desired Prior traiig Additioal traiig desired O the job (5) Jourals (3) Demostratio (1) Noe (1) Noe (4) Specific techology, procedures, ad studet selectio criteria (3) Specific techology ad specific materials (1) Studet selectio criteria (1) Note. The correspodig umbers represet the umber of SLP participats (=7) who selected the optio; multiple optios were selected by the same participats. Attitudes toward Telepr actice The ext sectio of the survey ivestigated all 170 SLP participats attitudes toward telepractice usig a 5-poit Likert scale with gradiets from Strogly Agree through Strogly Disagree. Data from these questios revealed that statemets to which the majority of the SLPs agreed were i the eed for procedures ad guidelies, cofidetiality, iformed coset, ethical cosideratios, techology procedures, ad studet selectio criteria. Coversely, the greatest disagreemets occurred with statemets relatig to telepractice assessmet, establishmet of rapport via telepractice, ad effectiveess of telepractice as compared with iperso speech-laguage therapy. Essetially, the SLPs reported eutral attitudes toward a iterest i providig telepractice i schools ad i other settigs. Data for these items are show i Table Iteratioal Joural of Telerehabilitatio Vol. 4, No. 2 Fall 2012 ( /ijt )

5 Statemet M SD Strogly agree % Agree % Neutral % Disagree % Strogly disagree % Table 2 Data for Statemets Targetig SLPs Attitudes toward Telepractice 15. Specialized traiig will be eeded by the SLP to deliver telepractice services Assessmets ca be completed as accurately via speech-laguage telepractice as compared to i-perso assessmets A differet set of materials will eed to be acquired to deliver speech-laguage telepractice services Rapport betwee SLP ad SCHOOL PERSONNEL ca be established durig speech-laguage telepractice as strogly as durig i-perso speech-laguage therapy 19. Rapport betwee SLP ad STUDENT ca be established durig speech-laguage telepractice as strogly as durig i-perso speech-laguage therapy It is importat to meet the studets iperso at some poit durig the speechlaguage telepractice program Speech-laguage telepractice services ca be as effective, i terms of studet progress toward goals, as i-perso therapy A set of approved ethical guidelies should be determied before the implemetatio of ay speech-laguage telepractice program i the schools. 24. Studet ad SLP cofidetiality guidelies, icludig archival procedures, should be icluded i school speechlaguage telepractice program guidelies Iformed coset procedures for all participats should be icluded i school speech-laguage telepractice programs Licesure laws should allow for reciprocity betwee states for school speechlaguage telepractice purposes Miimum techology stadards should be icluded i school speech-laguage telepractice program guidelies Procedures to follow i the presece of techology failures should be icluded i school speech-laguage telepractice programs. 29. Studet selectio criteria should be icluded i school speech-laguage telepractice program guidelies. 30. I would be iterested i providig speechlaguage pathology services via telepractice i SCHOOL settigs. 31. I would be iterested i providig speechlaguage pathology services via telepractice i OTHER settigs besides schools Questio 21 requested SLPs to provide their beliefs regardig whe i-perso meetigs should occur, with choices provided as: assessmet, mothly, midschool year, dismissal, or do ot eed to meet. A field for other suggestios was also provided. Resposes were compared betwee those SLPs with prior telepractice experiece (=14) ad those without experiece (=156). These results idicate that assessmet is preferred by more tha half of the respodets to be coducted osite. More tha a quarter of the SLPs feel that there should be a osite visit mothly. While 14% of SLPs with telepractice experiece believed that o meetig is ecessary, oly 6% of SLPs without telepractice experiece thought similarly, a differece of greater tha half. Commets that did ot fit the categories or combiatio of categories, i order of decreasig frequecy, icluded: depeds o cliet (4 resposes), as ofte as possible (3), weekly or biweekly (3), do ot believe i telepractice (3), ad prior to assessmet (1). Additioal aalysis of results to Statemet 30 regardig level of iterest i providig telepractice i school settigs was coducted to compare resposes of those SLPs experieced versus ot experieced i telepractice. The graph i the followig figure reveals this compariso of iterest. Iteratioal Joural of Telerehabilitatio Vol. 4, No. 2 Fall 2012 ( /ijt ) 65

6 Figure 1. Compariso of Iterest i Telepractice i School Settigs. Respose Groups Reasos to Use/Not Use Telepr actice The fial four items of the survey were ope-eded to elicit idividual commets that might allow for additioal expressio of attitudes ad beliefs about telepractice. For Questios 32 ad 33 all 170 of the SLPs were ivited to provide reasos for ad agaist the use of telepractice i school settigs. The commets were reviewed, sorted, ad couted by the frequecy of terms i aswers. The most frequet resposes by the SLPs cited studet reasos for both categories. There were o reasos to use telepractice for 15 SLPs, while oly two SLPs idicated there were o reasos ot to use it. There were more reasos ot to use tha to use telepractice. These resposes are show i Table 4. Cliicia Experiece Resposes by SLPs with greater tha 25 years experiece i the field of speech-laguage pathology were compared to those SLPs with less tha five years experiece for Statemets 30 ad 31. Table 3 displays those results. Additioally, SLPs experieced i telepractice delivery respoded to these same iterest statemets with averages of 2.79 ad 2.71, respectively, which may idicate a iterest i telepractice approximately equal to those SLPs with 1-5 years experiece i the field. Cautio must be exercised i viewig these results due to the small sample sizes. Table 3 Averages for Attitudial Statemets 30 & 31 Iterest i providig Telepractice SLPs 25+ years ( = 74) SLPs with 1-5 years ( = 17 ) I school settigs I other settigs Note. Scale of 1 Strogly agree to 5 Strogly disagree. 66 Iteratioal Joural of Telerehabilitatio Vol. 4, No. 2 Fall 2012 ( /ijt )

7 Table 4 Reasos to Use ad Not to Use Telepractice i School Reasos to use telepractice Reasos ot to use telepractice Studet Beefit 54 Rural or other locatio 54 Cost of travel/time 33 Ease SLP Shortage 30 Collaboratio 19 No reaso to use it 15 Beefits for SLPs 3 Beefits for Families 1 Studet Type/Age 54 Impersoal 53 Lack of Physical Cotact 24 Effectiveess 23 Techology stadards or failures 18 Lack of collaboratio 15 Cost 15 Ethical cocers 11 Lack of support 8 Lack of stadardized assessmets 4 Lack of traiig of SLPs 3 Family requests or lack of ability to hadle telepractice 2 SLPs offered isightful commets for these questios. Uder reasos to use speech-laguage telepractice services i schools, oe SLP wrote, I feel that SLP telepractice should ONLY be used i cases where NO i-perso SLP services are possible. Aother SLP revealed that she felt it could be a useful tool i light of recet floodig ad toradoes i the south ad west i this coutry. School services could perhaps be resumed more quickly through the use of cetral locatios where telepractice coectios could be arraged. Oe SLP idicated that telepractice could be used to supervise/ guide speech-laguage assistats. A huma coectio was the focus for several SLPs as reasos ot to use telepractice. Examples icluded: We sped our etire time tryig to teach childre to commuicate effectively perso-to-perso. Telepractice has o place i this paradigm; We are losig the positive beefits of huma iteractio face to face huma cotact; The art of commuicatio ca ever be replaced with techology. Fially, the survey probed for additioal commets regardig speech-laguage telepractice as a service delivery model i school settigs ad i other settigs. Out of the 56 commets that were provided regardig telepractice i school settigs, 18 idividuals felt that it was iappropriate while 11 thought it was a good idea with aother eight focusig o telepractice as a good tool for workig with studets. Eleve SLPs felt that guidelies ad support were eeded to implemet telepractice, but eight SLPs idicated that they did ot feel they had eough kowledge about it to commet. Discussig the use of telepractice i other settigs, 33 commets were geerated with eight SLPs statig affirmatio of use ad seve agaist it. Te SLPs thought telepractice could be a good applicatio for therapy with the adult populatio, but four revealed that more support would be eeded for a viable telepractice program. I the other settigs, oe SLP remarked that she would like to see telepractice beig utilized i hospital ad ursig home settigs to esure all patiets have access to etire SLP scope of practice services. Aother quote of a affirmative ature was I thik this is a positive step i the right directio give all the advacemets i techology, while aother SLP coutered, I am opposed to the idea aywhere. We re already becomig a world relyig too much o commuicatio without persoal cotact, thus creatig a geeratio with limited speakig experiece. These resposes were foud to be similar to those geerated for reasos to ad ot to use telepractice, ad will be further elaborated i the discussio sectio. Overall, there were more egative remarks (29) tha positive oes (19) for use of telepractice i schools, ad more positive (19) tha egative (11) commets for telepractice use i other settigs. Iteratioal Joural of Telerehabilitatio Vol. 4, No. 2 Fall 2012 ( /ijt ) 67

8 Compariso to the Asha (2002) Study Comparisos of the results of the curret survey, ad selected portios of the ASHA 2002 telepractice survey revealed few similarities. Cautio must be exercised i comparig these two studies due to differig populatios ad geographical locatios, size of samples, ad questios posed. Use of Telepr actice The survey results reported upo i the curret survey could be iterpreted to coclude that the major barriers to telepractice utilizatio are the eed for procedures ad guidelies, cocers for lack of cofidetiality ad other ethical cosideratios, ad studet selectio criteria. However, factors beyod the scope of decisio makig for the practicig SLP must be cosidered. Decisios regardig telepractice made at the admiistrative level, icludig budget allocatio for equipmet ad persoel, have sigificat impact o barriers ad icidece of telepractice. I compariso, ASHA s 2002 survey reported that 11% of 1667 SLP ad audiologist respodets had used telepractice. ASHA s researchers cocluded that barriers to telepractice utilizatio for its members icluded lack of kowledge, cocers regardig applicability to certai groups of patiets, cost, ad lack of professioal stadards. Disorder Type Respodets of both surveys served idividuals with motor speech disorders icludig articulatio/ phoological impairmets. Not surprisigly, the schoolbased SLPs served more cliets with laguage disorders (71%) tha the SLPs ad audiologists i the ASHA 2002 survey (42%). It could be iferred from these results that the telepractice programs i both studies mirrored traditioal therapy that would have bee provided by these two groups of practitioers i terms of types of commuicatio disorders ad cliets served. Tr aiig Twety-oe percet of the telepractice users i the ASHA 2002 survey had received previous educatio or traiig, with the majority (47%) learig o the job. I compariso, 86% of the telepractice users from the 2011 survey had received prior traiig; most received o the job traiig. The SLPs i the curret study did ot feel that they eeded specialized traiig o telepractice techology but rather that specific guidelies ad procedures should be established by the speechlaguage pathology professio. It could be speculated that improvemets i the techology itself has caused this shift over the past 9 years from a focus o the techology to oe that is studet-cetered ad procedure-cetered. Iterest i Service Provisio I the ASHA 2002 survey, 43% expressed a iterest i usig telepractice i the future. I the subsequet ASHA (2011) survey oly 32% of the SLP participats expressed iterest i providig telepractice services. Whe comparig these studies with previous research, it appears that the SLPs cotiue to reflect ad questio how best to serve their studets regardless of service delivery model. Possible Treds Iterest A possible tred was oted regardig iterest i providig future telepractice services betwee those SLPs who had experiece i telepractice versus those who had ot. Not surprisigly, those SLPs who had experiece i telepractice were more iclied to express iterest i this type of service. The graph i Figure 2 reveals this compariso. It may be surmised that awareess, actual exposure, ad cofidece led to a willigess to participate i future telepractice situatios. Discussios ad etworkig amog these two groups of SLPs may help to dispel apprehesio toward this emergig form of service delivery ad icrease acceptace ad trust (Buck, 2008; Dukley, Pattie, Wilso, & McAllister, 2010; Whitte & Love, 2005). Cliicia Age Aother tred was a stroger iterest i providig telepractice by youger SLPs, (i.e., those with less experiece i the field of speech-laguage pathology). These resposes may reveal that more experieced SLPs are less iterested i pursuig this ew form of service delivery tha those ewer to the field of speech-laguage pathology. If so, exposure ad istructio to telepractice services at the graduate level may help speed SLPs acceptace, cofidece, ad utilizatio of this emergig form of service delivery. Aother coclusio, however, could be that youger SLPs are simply more familiar with techology, ad as such, would make better cadidates for tryig ad usig telepractice services tha vetera SLPs. Iterpretatio of the results across the spectrum of all experiece levels appears to idicate that the majority 68 Iteratioal Joural of Telerehabilitatio Vol. 4, No. 2 Fall 2012 ( /ijt )

9 of SLPs i this ortheaster state are udecided or ot highly iterested i pursuig the use of telepractice. Perceived Beefits The SLPs listed advatages for studets (e.g., improved access; specialists with expertise to match speech disorder eeds; appropriate frequecy of services due to improved access, etc.) as their top reaso for use of telepractice. Cocer about meetig the eeds of studets was listed as the most sigificat barrier. Perceived Cotr aidicatios More reasos ot to use telepractice (=12) were geerated tha reasos to use telepractice (=7) i school settigs. Approximately 25% of the 170 respodet SLPs oted that they were usure or udecided about telepractice, with the rest of the group slightly less iterested (44%) tha i favor (31%) of the use of telepractice i school settigs. The impersoal ature of telepractice icludig the lack of huma touch appears to be a barrier to acceptace of a telepractice service delivery model by the typical SLP who may build relatioships with educators through commo activities withi the school buildig. There appears to be professioal skepticism about usig telepractice to admiister assessmets via telepractice. From these results, it appears that there is ucertaity about the outcomes associated with the use of telepractice, especially for particular studets who may have more complex therapeutic eeds. The SLPs also questioed the ability to establish rapport whe services were provided at a distace via telepractice. Cotiued research ito huma dyamics, studet cadidacy, ad professio-specific guidelies should assist i providig the clarity that these SLPs appear to require before demostratig readiess ad willigess to accept the use of telepractice i speech-laguage pathology. CONCLUSIONS Limitatios to the curret research iclude a small sample size ad represetatio from oly oe state. Review of the overarchig results of the quatitative survey i this study of 170 SLPs idicated reticet or outright resistace toward practicig speech-laguage pathology through telepractice. This group of respodets offered essetially eutral or egative attitudes about the telepractice eviromet, the possibility of establishig rapport with cliets, ad the likelihood of effective outcomes. The curret usage level of telepractice by 1.8% of the respodig SLPs demostrates that few SLPs who respoded to the survey have provided or have cotiued to provide telepractice services. Factors that could be cotributig to this small utilizatio of telepractice iclude: age of respodet SLPs, lack of iterest i explorig techological optios, the curret budgetary costraits for fudig techology i schools, ad admiistrator iterest ad attitudes toward telepractice (a area for future research). I the preset study, oly the less experieced SLPs, who are presumably youger tha the more experieced SLPs who have bee practicig loger, ad those SLPs who have telepractice experiece idicated willigess to use telepractice. Perhaps these results reveal that youger SLPs, more accustomed to usig techology, are ready to egage i telepractice. Further comparative studies o this topic may shed light o the cotiuig tred of limited acceptace ad use of telepractice i speech-laguage pathology. Sice several of the SLPs i this portio of the study idicated that they o loger provided cliical services via telepractice, aother valuable lie of iquiry would pertai to the reasos for the lack of cotiuace. Iteratioal Joural of Telerehabilitatio Vol. 4, No. 2 Fall 2012 ( /ijt ) 69

10 Refereces 1. Alverso, D., Holtz, B., D lorio, J., DeVay, M., Simmos, S., & Poropatich, R. K. (2008). Oe size does t fit all: Brigig telehealth services to special populatios. Telemedicie ad e-health, 14, doi: / tmj America Speech-Laguage-Hearig Associatio. (2002). Survey report o telepractice use amog audiologists ad speech-laguage pathologists. Retrieved from 3. America Speech-Laguage-Hearig Associatio. (2005a). Kowledge ad skills eeded by speechlaguage pathologists providig cliical services via telepractice. doi: /policy.KS Retrieved from 4. America Speech-Laguage-Hearig Associatio. (2005b). Speech-laguage pathologists providig cliical services via telepractice: Positio statemet. Retrieved from 5. America Speech-Laguage-Hearig Associatio. (2005c). Speech-laguage pathologists providig cliical services via telepractice: Techical report. doi: / policy.tr Retrieved from org/docs/html/tr html 6. America Speech-Laguage-Hearig Associatio. (2010). Professioal issues i telepractice for speechlaguage pathologists. doi: /policy.pi Retrieved from 7. America Speech-Laguage-Hearig Associatio. (2011) Membership survey: CCC-SLP survey summary report: Number ad type of resposes. Retrieved from Membership-Survey-CCC-SLP-Summary-Report.pdf 8. Beefield, N., & Ruk, J. (2008). A primer o Pesylvaia Cyber Schools. Retrieved from uscharterschools.org/cs/r/lpt/uscs_rs/ Brady, A. (2007). Movig toward the future: Providig speech-laguage pathology services via telehealth. Home Healthcare Nurse, 25, Brow, J. (2009). Telepractice: The ext geeratio. Presetatio at Texas Speech-Laguage-Hearig Associatio (TSHA) Aual Covetio. Retrieved from New%20Folder/Brow,%20Jaet-Telepractice_The%20 Next%20Geeratio.pdf 11. Buck, S. (2009). Nie huma factors cotributig to the user acceptace of telemedicie applicatios: A cogitive-emotioal approach. Joural of Telemedicie ad Telecare, 15, doi: /jtt Bulik, R. J. (2008). Huma factors i primary care telemedicie ecouters. Joural of Telemedicie ad Telecare, 14, doi: /jtt Chumbler, N. R., Kobb, R., Brea, D. M., & Rabiowitz, T. (2008). Recommedatios for research desig of telehealth studies. Telemedicie ad e-health, 14, doi: /tmj Creswell, J. W. (2008). Educatioal research: Plaig, coductig, ad evaluatig quatitative ad qualitative research (3rd ed.). Upper Saddle River, NJ: Pearso Publishig. 15. Creswell, J. W., & Plao-Clark, V. L. (2011). Desigig ad coductig mixed methods research. Thousad Oaks, CA: Sage Publicatios, Ic. 16. Dukley, C., Pattie, L., Wilso, L., & McAllister, L. (2010). A compariso of rural speech-laguage pathologists ad residets access to ad attitudes towards the use of techology for speech-laguage pathology service delivery. Iteratioal Joural of Speech-Laguage Pathology, 12, doi: / Fik, A. (2003). The survey kit (2d ed.).thousad Oaks, CA: Sage Publicatios. 18. Hill, A. J., Theodoros, D. G., Russell, T. F., Cahill, L. M., Ward, E. C., & Clark, K. M. (2006). A Iteretbased telerehabilitatio system for the assessmet of motor speech disorders: A pilot study. America Joural of Speech-Laguage Pathology, 15, doi: / (2006/006) 19. Hill, A., & Theodoros, D. (2002). Research ito telehealth applicatios i speech-laguage pathology. Joural of Telemedicie ad Telecare, 8, Retrieved from pdfviewer/pdfviewer?vid=4&hid=6&sid=ae1dc4fc-7f74-422b-b0a5-1b ec7%40sessiomgr Hou, B., & Trottier, K. (2006, November 13). Meetig the challege of rural service delivery. The ASHA Leader Olie. Retrieved from telepractice/telepracticerefereces.htm 21. Jueger, J. M. (2009a, July). Telepractice i speech/ laguage: How to get there from here. Sessio preseted at the America Speech-Laguage-Hearig Associatio (ASHA) Schools Coferece, Kasas City, MS. 22. Jueger, J. M. (2009b, September 22). Telepractice i the schools. The ASHA Leader, 14(12), Kelso, G. L., Fiechtl, B. J., Olse, S. T., & Rule, S. (2009). The feasibility of virtual home visits to provide early itervetio. Ifats & Youg Childre, 22, Mashima, P. A., & Doar, C. R., (2008). Overview of telehealth activities i speech-laguage pathology. Telemedicie ad e-health, 14, doi: / tmj Melie, T. (2006). Research i commuicatio sciece ad disorders. Upper Saddle River, NJ: Pearso Educatio, Ic. 26. Müller, E. (2009). Servig studets with disabilities i state-level virtual K-12 public school programs. Retrieved from Project Forum Natioal Associatio of State Directors of Special Educatio (NASDSE) website: igstudetswithdisabilitiesistate-levelvirtualk- 12PublicSchoolPrograms.pdf 27. Natioal Ceter for Educatio Statistics. (2008). Number of full-time ad part-time public school staff, by type of staff ad state: Retrieved from ed.gov/surveys/sass/tables/sass0708_ _s1s_05. asp 28. Polovoy, C. (2008, July 15). Telepractice i schools helps address persoel shortages. The ASHA Leader, 13(9), Iteratioal Joural of Telerehabilitatio Vol. 4, No. 2 Fall 2012 ( /ijt )

11 29. Theodoros, D. G., (2008). Telerehabilitatio for service delivery i speech-laguage pathology. Joural of Telemedicie ad Telecare, 14, doi: / jtt Torres, J. (2004). Utilizatio ad reimbursemet of telepractice amog speech-laguage pathologists i upstate New York hospitals. Retrieved from ProQuest Dissertatios ad Theses database. (UMI No ) 31. Whitte, P., & Love, B. (2005). Patiet ad provider satisfactio with the use of telemedicie: Overview ad ratioale for cautious ethusiasm. Joural of Postgraduate Medicie, 51, Whitte, P., & Holtz, B. (2008a). A series of papers for those yearig to propel telehealth to ew heights. Telemedicie ad e-health, 14, doi: / tmj Whitte, P., & Holtz, B. (2008b). Provider utilizatio of telemedicie: The elephat i the room. Telemedicie ad e-health, 14, doi: /tmj Iteratioal Joural of Telerehabilitatio Vol. 4, No. 2 Fall 2012 ( /ijt ) 71

12 72 Iteratioal Joural of Telerehabilitatio Vol. 4, No. 2 Fall 2012 ( /ijt )

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