COMMDIS416 1st Edition Lecture 5 Outline of Last Lecture I. Evidence-Based Practice II. What is Evidence-Based Practice?III. Key Steps in the EBP Process IV. Levels of Evidence a. Example b. Example V. Non-Evidence Based Treatments VI. Scientific Fraud VII. Systematic Reviews and Practice Guidelines VIII. Barriers to Evidence-Based Practice IX. Systematic Reviews a. Evaluating the Quality of a Systematic Review X. Practice Guidelines XI. ASHA’s N-CEPXII. Improving Quality of Services a. Learning Questions Outline of Current Lecture I. Telepractice These notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.a. Telecommunication Technology and Therapy II. Quality of Services III. Service Delivery Modela. Why Telepractice?IV. Applications in Speech-Language Pathology a. Applications in Audiology V. Telepractice Examples VI. Telepractice Settings VII. Client/Clinician SatisfactionVIII. Performance and Outcome Measurement IX. Telepractice Equipment a. Telepractice Technology b. Connectivity X. Telepractice Platforms XI. Facilitators in Telepractice XII. Privacy and Security XIII. Patient/Client Considerations a. Clinician Considerations XIV. Roles and Responsibilities XV. Lee Silverman Voice Treatment (LSVT) XVI. Telepractice-Regulatory and Legal Issues XVII. Evaluating EmployersXVIII. Legal Issues Summarized XIX. Telepractice Challenges XX. Training the SLP/Audiologist for Telepractice XXI. Barriers Current LectureI. Telepractice Terminology:- Telepractice - Telemedicine - Telehealth - Tele-speech-language pathology - Teleaudiology - TeleSpeech Therapy - TeleSLP- Speech TeleTherapya. Telecommunications Technology and Therapy - What is Telepractice?o Telepractice is the application of telecommunications technology at a distance bylinking clinician to client, or clinician to clinician for assessment, intervention, and/or consultation Synchronous (real-time): patient interactive [most common] Asynchronous: store-and-forward [record themselves and send you file for later review) o Telepractice (new and controversial), is an appropriate model of service delivery for the profession of speech-language pathology and audiology…”The quality of the services delivered via telepractice must be consistent with the quality of services delivered face-to-face.”II. Quality of Services - Adherence to ethnical and legal guidelines (mandated by ASHA Code of Ethics) - Evidence-based practice (techniques and principles for intervention or assessment plan) - Quality control (is the treatment affective?, would face-to-face be better for them?)III. Service Delivery Model- TELEPRACTICE IN SPEECH-LANGUAGE PATHOLOGY IS NOT A TECHNIQUE-IT IS A SERVICE DELIVERY MODEL- Primary use of telepractice has been to allow services to traditionally-underserved populations o Individuals with physical disabilities or mobility limitations o Individuals with in geographically-distant locations o Specialty consultation a. Why Telepractice? -Accesso Provide primary healthcare that would not be available otherwise o Eliminate expensive travelo Reduce need to move patient IV. Applications in Speech-Language Pathology - Articulation disorders (Crutchley, Dudley, & Campbell, 2010) - Autism (Parmanto, Pulantara, Schutte, Saptono, & McCue, 2013) - Dysarthria (Hill et al., 2006) - Fluency disorders (Carey, O'Brian, Onslow, Packman, & Menzies, 2012) - Language and cognitive disorders (Waite, Theodoros, Russell, & Cahill, 2010) - Dysphagia (Malandraki, McCullough, He, McWeeny, & Perlman, 2011) - Voice disorders (Halpern et al., 2012, Towey, 2012)a. Applications in Audiology - Aural rehabilitation (Polovoy, 2009; Yates & Campbell, 2005) - Cochlear implant fitting (Wasowski et al., 2012) - Hearing aid fitting (Campos & Ferrari, 2012) - Infant and pediatric hearing screenings (Lancaster et al., 2008) - Pure tone audiometry (Krumm, Ribera, & Klich, 2007) - Speech-in-noise testing (Ribera, 2005) V. Telepractice Examples - BabyTalk: provides teletherapy for children with hearing loss form birth to 3 years of ageo Very poor sound qualityo Hard to see articulators moving - TinyEye: schools that don’t have SLP onsite o Via webcams/onlineVI. Telepractice Settings- University - Healthcare o Hospitalo Skilled nursing facilities o Outpatient o Home health - *Schools (most common) - Private practice VII. Client/Clinician Satisfaction?- The effectiveness of telepractice as a service delivery model in the schools is well documented (Grogan-Johnson et. al., 2011; Grogan-Johnson, Alvares, Rowan, & Creaghead, 2010; Lewis et al., 2008). - In addition, parents, clients, and clinicians report satisfaction with telepractice as a modeof service delivery (Crutchley & Campbell, 2010; Scheideman-Miller et al., 2002; McCullough, 2001). VIII. Performance and Outcome Measurement - Quantitative Data: o Clinical evidence o Assessment and monitoring o Performance measurement - Qualitative Data: o User impressions of effectiveness o User satisfactiono Quality service surveys IX. Telepractice Equipment- Desktop or Laptop computer - Webcam (can be separate or built-in)- Headset with Mic - Printer/scanner - Direct line to internet (no wi-fi)- Teleconferencing platform- Email a. Telepractice Technology- Videoconferencing Equipment (hardware, software, and peripheral devices)- Camera capabilities (e.g., pan-tilt-zoom [PTZ] and resolution), display monitor capabilities (e.g., size, resolution, and dual display), microphone and speaker quality;- Peripheral devices, such as recording devices- Additional modes of real-time interaction through applications such as screen sharing, whiteboards, online presentations b. Connectivity - Network connection speed impacts overall quality of video and audio clarity. - Available bandwidth may be reduced by the number of users on the network- e.g. during peak usage times in schools. - Lower bandwidth may result in delays, loss of data, interfere with quality of signals for clinical decision making or normal turn taking in conversational discourse. - Secure transmission during telepractice may be obtained through the use of encryption, unique passwords, secure connection via virtual private network (VPN), and hardware/software firewalls. X. Telepractice Platforms - SKYPE- Infinite Conferencing- AdobeConnect-