A Comprehensive Look At The Effectiveness Of Telepractice Delivery

Telepractice, the remote provision of services through video conferencing technology, is well-recognized as an appropriate and effective option for delivering special education services in school settings.

Research Backed Findings

This method is recognized by many professional organizations, including the American Speech-Language-Hearing Association (ASHA), National Association of School Psychologists (NASP), and American Occupational Therapist Association (AOTA). Furthermore, telepractice increases access to speech-language therapy, school psychology, occupational therapy, and special education services.

This information is based on literature reviews of reputable sources, systematic reviews, published research studies, and relevant journals and references are cited in the references section below. Learn more about the demonstrated effectiveness of delivering these special services via telepractice, specifically analyzing the five Key Topics and Considerations below, all backed by research findings.

Key Topics and Considerations

Assessments and Interventions

ASHA, AOTA, and NASP have developed comprehensive guidance documents tailored to practitioners within their respective professions. These resources advocate a cohesive set of guidelines on the provision of teleservices, emphasizing the importance of service providers and telepractitioners selecting and employing validated assessment tools and methods.

At VocoVision, we have developed our proprietary Toolkit in collaboration with our clinical experts, and any third-party resources integrated into our Toolkit undergo rigorous vetting by our in-house team. Furthermore, we ensure the tests on the Toolkit are those that are commonly used in schools and districts and are best suited for their student population. Notably, these tools are modified and approved by the test publishers for remote administration and are further substantiated through independent research.

Technical considerations provided by test publishers related to conducting assessments via telepractice can be found in the Technology Platforms and Equipment section of this resource.

Speech-Language Pathology

ASHA supports telepractice as an appropriate model for audiologists and speech-language pathologists (SLPs), stating that it may even serve as the primary mode of service delivery, and recognizes that ensuring the equivalency of telepractice assessments is vital for upholding service quality and adhering to ethical and professional standards ("Telepractice," ASHA, n.d.) ("Code of Ethics," ASHA, 2023).

When providing remote assessments and interventions for children with various speech-language disorders, findings demonstrate:

  • There are no significant differences between standard scores and behavioral ratings for both face-to-face and telehealth assessments, indicating that telehealth delivery was feasible and showed high reliability, with a substantial agreement between assessment scores obtained via telehealth and face-to-face (Alfano, A. R., Concepcion, I., et al., 2022).
  • There are no significant differences in language and social communication outcomes between telehealth and face-to-face interventions (de Nocker, Y. L., & Toolan, C. K., 2023).
  • Speech-language assessment can be conducted successfully in a virtual environment for preschool children with hearing loss (Werfel, K. L., et al., 2021).
  • The psychometric properties of the Test of Narrative Language–Second Edition (TNL-2; Gillam & Pearson, 2017) from online administration showed no significant difference from in-person testing, indicating its validity and reliability for assessing narrative language proficiency in school-age children at risk for language and learning difficulties (Magimairaj et al., 2022).
  • There were no significant differences between speech sound intervention delivered by telepractice and side-by-side service delivery models, including standardized assessment and listener judgments of word productions (Grogan-Johnson, S., Schmidt, A. M. et al., 2013).
  • Services delivered through telehealth were equivalent to services delivered face-to-face and exhibited greater effectiveness than comparison groups that did not undergo telehealth. Additionally, the findings propose a range of advantages associated with using telehealth for individuals with autism spectrum disorder (ASD), their families, and educators (Sutherland et al., 2018).
  • In a study comparing traditional and telepractice service delivery for children receiving speech sound production therapy utilizing ASHA's National Outcomes Measurement System (NOMS) Functional Communication Measure (FCM) as a standardized metric, no significant differences in median change scores were found between the two groups, indicating comparable treatment outcomes. The findings support the efficacy of telepractice in treating speech sound disorders in school-age children alongside traditional methods (Coufal K. et al., 2018).
  • The utilization of live-stream, video telepractice demonstrates promise as an effective service-delivery approach for stuttering treatment (McGill et al, 2019).

Occupational Therapy

AOTA recognizes the significance of telehealth as an integral component of school-based occupational therapy, enabling practitioners to adeptly address the digital gap and ensure access to services (The American Journal of Occupational Therapy, 2018 ; Occupational Therapy Code of Ethics, AOTA, 2020.).

When providing remote assessments for children and youth with developmental disabilities, including motor function, behavior, and language, findings demonstrate:

  • Telerehabilitation was found to be either more effective or as effective as face-to-face care (Tatiana Ogourtsova et al., 2023).
  • Equivalency across methods of service delivery without clinically meaningful differences in scores among referred pediatric patients (Hamner et al., 2021).
  • High satisfaction rates and improvements in handwriting performance for school-based children using telerehabilitation technologies (Criss, M. J., 2013).

School Psychology

NASP recognizes and supports the numerous benefits of telehealth and telepsychology services, including expanding access to remote or underserved populations (e.g., counseling, consultation, assessment), decreasing travel times, scheduling flexibility, and heightened professional efficiency, and efficacy (“Professional Code of Ethics,” NASP, 2020) (NASP, 2021).

The use of administration of behavioral rating scales has long been done remotely to have a more flexible approach to collecting data from individuals and families. This and the increased use of telehealth and telepsychology services has led to the increased development of remote assessments, which are expected to continue to grow in number (Mulligan et al., 2023).

Subsequent research demonstrates that these assessments have shown equivalency to, or demonstrated parity with, the in-person psychoeducational and diagnostic assessments:

  • In an equivalency study involving the WJ (Woodcock-Johnson) IV cognitive and achievement batteries, the results suggested that teleassessment, when executed with careful consideration and intentional planning, demonstrated equivalency to conventional, in-person assessment. (Wright, 2018).
  • Similarly, a study conducted by the psychological assessment publisher PAR (Psychological Assessment Resources) explored the equivalency of the RIAS-2 (Reynolds Intellectual Assessment Scales™) cognitive battery. The outcomes showcased parity with the conventional practice of conducting psychoeducational assessments in person (Wright, 2018).
  • In a cross-sectional study that looked at whether cognitive (Wechsler Intelligence Scale for Children-Fifth Edition) and academic (Kaufman Test of Educational Achievement-Third Edition) subtests were equally valid when given via teleassessment or in-person to clinically referred youth, the results showed that both methods were equally valid. There were no important score differences in referred pediatric patients (Hamner T. et al., 2021).
  • In a recent study utilizing the Kaufman Brief Intelligence Test–2nd Edition Revised (KBIT-2 Revised; Kaufman and Kaufman 2022), an assessment often used to estimate cognitive abilities, results revealed no differences between the remote and in-person administration of the assessment (Mulligan et al., 2023).
  • During the creation of the KBIT-2 Revised, three studies were conducted to establish the test norms when administered remotely and in person (Mulligan et al., 2023):
    • Study 1: 34 demographically matched pairs of children aged 4-5 were randomly assigned to either in-person or remote administration of the KBIT-2 Revised.
    • Study 2: A sample of 262 children aged 6-16 who were administered the KBIT-2 in 2020 were compared to a sample of 108 children who were administered the KBIT-2 Revised in 2017.
    • Study 3: A sample of 108 examinees aged 6-89 who were administered the KBIT-2 Revised in 2022 were compared to a sample of 34 demographically matched pairs of examinees who were administered the KBIT-2 Revised in 2022.

The results showed that there were no significant differences between the two groups within each study in terms of their KBIT-2 Revised scores. Notably, this is the inaugural tool to establish standards gathered through remote assessments, with a strong and sizable group of participants. This sets a positive direction for the advancement of remote assessment methods.

Telepractioner & Teleprofessional Standards

Ensuring that practitioners are adequately prepared and competent in conducting remote assessments is paramount to the implementation and outcomes of teleservices. Acknowledging ASHA, AOTA, and NASP’s guidelines regarding the provision of teleservices, to ensure service quality and uphold professionalism and competency, telepractitioners and teleprofessionals should:

  • Remain aware of licensure/certification requirements and ensure appropriate licensure/certification in the state where they are practicing as well as where the student resides.
  • Adhere to all professional ethics, standards, policies, and positions.
  • Obtain professional development to ensure their own competency in the delivery of teleservices.

At VocoVision, we require practitioners and professionals to have two years of in-school experience to be considered for remote positions and ensure they are licensed in both the states where they live and where services are provided. Once expertise and experience have been verified, telepractitioners have access to a library of resources on best practices for the delivery of virtual services and receive ongoing clinical and technical support.

Parent & School Involvement

The involvement of parents and caregivers is crucial for supporting student progress, engagement, and outcomes in a virtual environment. The available research and studies demonstrate:

  • There are no significant differences in parental satisfaction between face-to-face and telehealth interventions for children on the autism spectrum (de Nocker et al, 2023).
  • Telehealth services received satisfaction ratings that were either more favorable or on par with those of in-person visits in a study assessing satisfaction among caregivers and pediatric patients either prior to or during the COVID-19 pandemic (Kodjebacheva, G., Culinski, T. et al, 2023).
  • Parents reported high levels of satisfaction and reliability in a study examining telehealth for occupation-based coaching intervention designed to improve family occupational participation, adaptability, and cohesion for families of children with special healthcare needs (Sarah L. Smith, Elizabeth Humphreys et al., 2022).
  • Parents and guardians indicated overall satisfaction with pediatric speech-language pathology telepractice services (Passalacqua & Perlmutter, 2022).

Technology Platform & Equipment

Acknowledging ASHA, AOTA, and NASP’s guidance documents regarding the provision of teleservices, service providers and telepractitioners should have access to and expertise with high-quality, appropriate technology. At a minimum, web-based synchronous telepractice services require a reliable and secure internet connection, a computer, and a webcam for both the student and the telepractitioner. The performance of technology and equipment significantly contributes to student success. In a study we conducted, it was revealed that 77% of virtual special education teachers emphasized the indispensability of technology for student success (VocoVision, n.d.).

It’s important that practitioners prepare for assessments done remotely in the same way that they would for an in-person assessment. Part of that includes reading the guidance from the test publishers located on the test publisher website where you can find specific considerations for conducting assessments via telepractice.

In accordance with the recommendations from these test publishers, VocoVision prioritizes optimal connectivity by conducting thorough assessments of internet speeds, computer capabilities, and the technical expertise of our telepractitoners. Additionally, we ensure the security of internet networks and provide continuous technical support to both schools and telepractitioners.

Privacy & Protection

Ensuring the protection of confidential information is crucial during the delivery of teleservices, achieved through compliance with relevant privacy regulations and the implementation of secure communication and data storage protocols. In line with ASHA, AOTA, and NASP's guidance documents regarding the provision of teleservices, it is imperative for service providers and telepractitioners to uphold high degrees of privacy, confidentiality, informed consent, and security.

At VocoVision, we provide an array of comprehensive resources to our telepractitioners and teleprofessionals and ensure that the VocoVision video conferencing software is fully compliant with the standards set by HIPAA, FERPA, and HITECH regulations.

References

Expand References

American Speech-Language-Hearing Association. (2023). Code of ethics [Ethics]. Available from www.asha.org/policy/.

American Speech-Language-Hearing Association (n.d.). Telepractice. (Practice Portal). www.asha.org/Practice-Portal/Professional-Issues/Telepractice/.

American Occupational Therapy Association. (1993). Core values and attitudes of occupational therapy practice. American Journal of Occupational Therapy, 47, 1085–1086. https://doi.org/10.5014/ajot.47.12.1085.

Alfano A.R., Concepcion I, Espinosa A, Menendez F. Pediatric language assessments via telehealth: A systematic review. Journal of Telemedicine and Telecare. 2022;0(0). doi:10.1177/1357633X221124998.

American Speech-Language-Hearing Association. (n.d.). Telepractice Advocacy in States. American Speech-Language-Hearing Association. www.asha.org/advocacy/telepractice/.

American Occupational Therapy Association (2020). Evaluation Considerations for Delivering Virtual School-based OT Services via Telehealth. Retrieved July 11, 2023  from https://www.aota.org/-/media/Corporate/Files/Practice/virtual-services/Evaluation-Considerations-Delivering-Virtual-School-Based-Telehealth.pdf.

The American Journal of Occupational Therapy, 2018, Vol. 72(Supplement_2), 7212410059p1–7212410059p18. https://doi.org/10.5014/ajot.2018.72S219.

Coufal K, Parham D, Jakubowitz M, Howell C, Reyes J. Comparing Traditional Service Delivery and Telepractice for Speech Sound Production Using a Functional Outcome Measure. Am J Speech Lang Pathol. 2018 Feb 6;27(1):82-90. DOI: 10.1044/2017_AJSLP-16-0070. PMID: 29188278.

Criss, M. J. (2013). School-based Telerehabilitation In Occupational Therapy: Using Telerehabilitation Technologies to Promote Improvements in Student Performance. International Journal of Telerehabilitation, 5(1). https://doi.org/10.5195/ijt.2013.6115.

de Nocker, Y.L., Toolan, C.K. Using Telehealth to Provide Interventions for Children with ASD: a Systematic Review. Rev J Autism Dev Disord 10, 82–112 (2023). https://doi.org/10.1007/s40489-021-00278-3.

Donald M. Hilty, Daphne C. Ferrer, Michelle Burke Parish, Barb Johnston, Edward J. Callahan, and Peter M. Yellowlees. The Effectiveness of Telemental Health: A 2013 Review. Telemedicine and e-Health. Jun 2013.444-454. http://doi.org/10.1089/tmj.2013.0075.

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), 210–220. https://doi.org/10.1177/1525740113484965.

Hamner, T., Salorio, C., Kalb, L., & Jacobson, L. (2021). Equivalency of in-person versus remote assessment: WISC-V and KTEA-3 performance in clinically referred children and adolescents. Journal of the International Neuropsychological Society, 1-10. doi:10.1017/S1355617721001053.

Hass, M. R., & Leung, B. P. (2020). When you can’t R.I.O.T., R.I.O.: Tele-assessment for school psychologists. Contemporary School Psychology. https://doi.org/10.1007/s40688-020-00326-5.

Kaufman, Alan S., and Nadeen L. Kaufman. 2022. Kaufman Brief Intelligence Test, 2nd ed. Revised. Bloomington: NCS Pearson.

Kodjebacheva, G., Culinski, T., Kawser, B., & Coffer, K. (2023). Satisfaction With Telehealth Services Compared with Nontelehealth Services Among Pediatric Patients and Their Caregivers: Systematic Review of the Literature. JMIR Pediatrics and Parenting, 6, e41554. https://pediatrics.jmir.org/2023/1/e41554. DOI: 10.2196/41554.

McGill, M., Noureal, N., & Siegel, J. (2019). Telepractice treatment of stuttering: A systematic review. Telemedicine and e-Health, 25(5), 359–368. https://pubmed.ncbi.nlm.nih.gov/30063187/.

Magimairaj, B.M., Capin, P., Gillam, S.L., Vaughn, S., Roberts, G., Fall, A.M., and Gillam, R.B. (2022). Online administration of the Test of Narrative Language Second Edition: Psychometrics and consideration for remote assessments. Language, Speech, and Hearing Services in Schools, 53(2), 404-416. https://doi.org/10.1044/2021_LSHSS-21-00129.

Mulligan, Christy A., and Justin L. Ayoub. 2023. Remote Assessment: Origins, Benefits, and Concerns. Journal of Intelligence 11: 114. https://doi.org/10.3390/ jintelligence11060114.

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National Association of School Psychologists. (2021). School Psychologists Should Embrace Telecounseling as an Option in the Post-COVID-19 World. A Closer Look: NASP’s School Psychology Newsletter. Retrieved from https://www.nasponline.org/professional-development/a-closer-look/school-psychologists-should-embrace-telecounseling-as-an-option-in-the-post-covid-19-world.

Passalacqua, N. G., & Perlmutter, A. (2022). Parent Satisfaction with Pediatric Speech-Language Pathology Telepractice Services During the COVID-19 Pandemic: An Early Look. ASHAWire, 7:6, 2110-2121. Doi: https://doi.org/10.1044/2022_PERSP-21-00286.

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