Telehealth Tips for Speech-Language Pathologists
By Elisabeth Cade, MA, MHA, CCC‑SLP, CDP
Speech-Language Pathologist, Connecticut
Telehealth can be a great option for speech-language pathologists in our ever-changing healthcare environment. Many of us were unceremoniously introduced to telehealth in the wake of COVID-19; once Medicare approved it and we figured it out, we were able to continue to serve the needs of our patients during the forced isolation of the pandemic shutdown. Almost overnight, we learned of various platforms that we could use for telehealth. We worked to maintain our ability to develop and sustain rapport while adapting our face-to-face techniques in this new frontier.
In the current post-pandemic world, telehealth remains relevant as we continue to strive for increased efficiency of service provision, especially as reimbursements decline. For those of us providing services in patients’ homes, SLPs often need to “cover more ground” geographically than our PT/OT colleagues, making telehealth a particularly valuable tool to us. Clinicians who are new to telehealth may have questions or reservations, to which I say, “Why reinvent the wheel?”. Here are some tips based on my own experience over the last few years.
Do Your Homework
- Verify that your patient’s insurance covers telehealth, and if so, confirm the inclusion of all the billing codes that you expect to use.
- Determine whether your patient has access to technology, either independently or with assistance. They will need a laptop or desktop computer or a tablet-type device and a robust internet connection. The use of a smartphone would technically be feasible, but the small screen poses a significant barrier to success.
- Identify whether your patient is clinically appropriate for telehealth. Cognitively, your patient and/or their caregiver will need to be able to attend and benefit from verbal/visual feedback and education. I find telehealth to be very conducive to having the active participation of my patients’ spouses/family members/caregivers, facilitating both education and carry-over for their HEPs.
- Is your patient medically stable? The presence of tracheostomy and/or non-oral feeding might be a red flag that this patient would be better served by in-person therapy.
Consider Your Options
Telehealth allows us to provide necessary services for patients within our state(s) of licensure who might not otherwise have access. If geography is not a barrier, telehealth does not have to be an all-or-nothing proposition. Using a hybrid approach, you may be able to see your patient for the initial evaluation in person and then move to telehealth. You could provide primarily telehealth visits with intermittent in-person visits as needed, or you could do half and half. Telehealth also provides an excellent way to “rescue” a session that might otherwise have been canceled because of inclement weather or family illness. It could even provide an avenue for us to cover some of our colleagues’ sessions when they need time off, whether planned or unplanned. Knowing this, it might be wise to explore your telehealth options for each patient upon initial evaluation, even if just to keep it “in your back pocket” as a potential tool. While some patients will not be a good fit for telehealth, those who may be “on the fence” can likely be encouraged with a “Let’s give it a try and see how it works” attitude, especially if in-person treatment is not otherwise available to them. I have been pleasantly surprised to experience increased participation of family/caregivers during treatment sessions using telehealth, resulting in an improvement in their ability to assist with exercises and carryover strategies for functional situations.
Know Your Technology and Tools
A robust, secure telehealth platform (here at FOX we like Microsoft Teams) will integrate patient invitations with email and online calendars. Explore features such as a whiteboard (so your patient can see what you write or draw), screen share, and backgrounds. Using screen share, I can provide written stimuli created in advance or in real-time using Word, Google Docs, or Notepad.
Plan for the most efficient use of your materials. Handouts or worksheets can be emailed before or following your session. Hard copies (like MIT stimulus cards) can be shown on camera, while digital materials can be shared via screen share. I keep digital materials accessible in a secure cloud location with frequently used HEPs in a folder on my computer desktop. I’ve found it helpful to have a notepad and marker handy for use in clarifying my message with aphasic patients so that I can quickly jot down a few words for display.
We all know that point of service (POS) documentation improves not only our efficiency but also the quality of our documentation. Explore ahead of time so that you will know how to click into your documentation in a different tab or by using a split screen to get POS documentation during your session. I like to talk through my documentation with my patients so that they know what I’m working on, which also helps me to stay patient-centered in my care plan.
Communicate with your patient/support person ahead of time so that they know what to expect. They should know how to access the telehealth platform and be prepared with a quiet, well-lit environment, having the patient well-positioned in front of their device to be able to see and be seen. If your patient requires assistance with the process, their support person must plan to be available for the session.
Prepare for your session by having your cell phone handy. You may need to call your patient to help them to troubleshoot in case of connectivity issues. Have your session materials planned and at hand. I prefer to use a headset or earbuds, but this is not a necessity if you are in a private space. Position yourself in a quiet, well-lit area with little distraction behind you. I always like a glass of water or a cup of tea as well!
What About Swallowing?
Swallow evaluations and treatment can be done via telehealth with adequate support for your patient, dependent on the nature and severity of the dysphagia. Having a support person to get foods/liquids ahead of time is recommended. Swallow exercises and education about food consistencies and strategies can absolutely be taught and practiced via telehealth, with written materials provided via screen share and email.
Like COVID-19, telehealth is here to stay, and SLPs are particularly well-positioned to embrace it. While it may at first feel awkward, spending a little extra time on the front end to ensure that the session will be billable, your patient knows what to expect and has support available if needed, and your materials are ready will set you up for success. Embracing telehealth can help us to achieve our goals along with those of our patients. Once you understand how to adapt your clinical skills to the virtual format, you should find that in addition to maximizing patient outcomes, it improves your own efficiency while allowing increased flexibility in scheduling.