Speech and language screening for children with medical complexity: A comparison of telepractice and in-person methods

Abstract

Effective communication is vital for healthy development and successful educational and vocational outcomes. For children with medical complexity (CMC), the interaction between medical complexity and a speech and language impairment may put them at particular risk for adverse effects. It is important that these children are promptly assessed and diagnosed so that intervention can be started early. Medical complexity is rare in childhood, thus CMC usually access speech pathology services through tertiary facilities where staff have specialist experience and resources, and work as part of a coordinated tertiary team. Unfortunately these facilities are typically located in metropolitan centres, which may compromise service accessibility for CMC living in rural and remote locations.A potential solution to improve service accessibility is remote speech and language screening using telepractice. Telepractice screening allows the speech-language pathologist (SLP) to distinguish those children who need further assessment at the tertiary hospital from those with normal speech and language. This model is increasingly used for the delivery of tertiary medical services, however, there is little research to support the use of telepractice for paediatric speech and language screening, and very few studies have included CMC. Thus, the overall purpose of this research project was to investigate the role of telepractice for remote speech and language screening of CMC. To achieve this aim, two studies were carried out.The first study was an international survey of tertiary SLPs that aimed to describe access difficulties experienced by CMC, and to investigate the rate of telepractice adoption among SLPs who work with CMC. The survey was administered in 2011 (n = 46) and repeated in 2015 (n = 47). This survey identified widespread access difficulties experienced by CMC, highlighting a need for alternative service delivery models such as telepractice. Telepractice adoption among tertiary SLPs more than doubled between 2011 and 2015 (p < 0.05), and in 2015 the rates of telepractice adoption were higher (40%) than previously reported for the general speech pathology profession. Tertiary SLPs were willing to use telepractice with their CMC patients, and considered a wide range of patient groups and service types to be appropriate for telepractice delivery. However, some SLPs were reluctant to use telepractice for direct services such as screening, and a number of barriers to telepractice adoption were identified, including inability poor audio and image quality, lack of experience with telepractice, concerns about behaviour management and use of hands-on techniques, and concerns about the caregiver's inability to assist during telepractice sessions.ii The second study was an exploratory method comparison study that aimed to investigate the feasibility, validity, and acceptability of speech and language screening via telepractice for CMC.This study compared in-person speech and language screening with two telepractice screening ...