UTS Speech Pathology Telepractice Clinic Presented at SPA 2022
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Speech Pathology Australia National Conference 2022
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UTS Speech Pathology Telepractice Clinic Presented at SPA 2022
- 1. Speech Pathology Reaching Out at UTS (SPROUTS) Providing telepractice and telesupervision to benefit rural and remote clients Courtney Reddacliff, Dr Lucy Bryant, and Professor Bronwyn Hemsley The University of Technology Sydney Paper presented at Speech Pathology Australia National Conference, Melbourne 2022 @CourtneyRedSLP @LucyEBryant @BronwynHemsley Contact: Lucy.Bryant@uts.edu.au (Clinic Manager)
- 2. Acknowledgement of Country The Girra Maa wattle seed artwork signifies our unity and diversity. Produced by Wiradjuri artist Nathan Peckham.
- 3. Background to SPROUTS • Student-led clinic, for Master of Speech Pathology students at UTS • Established in August 2019 as a telepractice clinic (to rural areas) • Expanded from Jan 2020 to include in person on- site services at UTS • Expanded tele-supervision (COVID-19) • Responsive to COVID-19 impact on placements • Primary aim was education @CourtneyRedSP @LucyEBryant @BronwynHemsley @GoSHspeech #SPROUTSClinic #SpaConf
- 4. The SPROUTS Vision Statement Engage our students to collaborate with partners, professions, and communities locally and nationally Empower the profession of speech pathology and our students to embrace technological advancements that reflect the future of the profession Deliver unique and high-quality clinical education to students that will establish their capabilities as forward- thinking and collaborative professionals. @CourtneyRedSP @LucyEBryant @BronwynHemsley @GoSHspeech #SPROUTSClinic #SpaConf
- 5. • Referrals for children: - Rural Schools - Local Health Services - Sydney Families • Referrals for Adults: - Local Health Services - Hospitals and Rehab - Word of Mouth - Community Associations SPROUTS Telepractice Services in 2022 UTS @CourtneyRedSP @LucyEBryant @BronwynHemsley @GoSHspeech #SPROUTSClinic #SpaConf
- 6. Establishing SPROUTS services in Schools • Co-design of the clinic with NSW Department of Education • SPROUTS Manager contacts schools each Term to identify referral needs • Appointments available 1-2 days a week • Services only offered to children who cannot access locally due to: • Wait list • Socio-economic factors • Access/location @CourtneyRedSP @LucyEBryant @BronwynHemsley @GoSHspeech #SPROUTSClinic #SpaConf
- 7. Establishing SPROUTS services in Schools • Parent gives consent forms • Parent provides case history information • Contact with parents where possible or through the school system • Many homes lack internet access sufficient for telepractice so services are during School Terms @CourtneyRedSP @LucyEBryant @BronwynHemsley @GoSHspeech #SPROUTSClinic #SpaConf Photo credit: M. Bryant (Lucy’s Mum)
- 8. How does SPROUTS telepractice work? • Student-led assessment and intervention • Services are supervised by a clinical educator (CPSP) • Clients of school age attend online sessions at school with an SLSO • Using the platform Coviu® @CourtneyRedSP @LucyEBryant @BronwynHemsley @GoSHspeech #SPROUTSClinic #SpaConf
- 9. @CourtneyRedSP @LucyEBryant @BronwynHemsley @GoSHspeech #SPROUTSClinic #SpaConf Telepractice Resources – An Example
- 10. Models of SPROUTS Telesupervision: A @CourtneyRedSP @LucyEBryant @BronwynHemsley @GoSHspeech #SPROUTSClinic #SpaConf Client at school/home Telepractice Client at school/home requires: - Internet - Computer with camera and mic - A quiet and private space to work - A support person to assist SPROUTS Model A: CE & Student on Campus, Client at school/home
- 11. SPROUTS Model B: Everyone at home. Tele-super-practice! Client at school/home Telepractice Clinical Educator at home Telesupervision Student at home Telesupervision Clinic Manager ALL require: - Internet - Computer with camera and mic - A quiet and private space to work Models of SPROUTS Telesupervision: B
- 12. SPROUTS Services delivered • Over 100 placements (for UTS students) • Over 50 clients and many more staff/parents • Four Schools in NSW • ~700 occasions of service over a 2.5 years • Student gains in clinical competency and proficiency @CourtneyRedSP @LucyEBryant @BronwynHemsley @GoSHspeech #SPROUTSClinic #SpaConf
- 13. SPROUTS Services delivered • Client improvements in speech, language, literacy, academics, confidence • Screening services helped schools to access local services • Supported local families to access NDIS funding for local services • Increased student knowledge and understanding of rural work • Increased capacity in school staff to support children with speech, language, learning needs @CourtneyRedSP @LucyEBryant @BronwynHemsley @GoSHspeech #SPROUTSClinic #SpaConf Photo credit: W. Bryant (Lucy’s Dad)
- 15. The Student Experience • Often their first experience of rural practice and culture • Many are unfamiliar with the rural and remote context – city born and raised • Experience with elements of diversity in culture • Understanding dialectal differences in slang and common vocabulary Farm life – the experiences, the vocabulary, hunting, fishing Towns vs. cities – public transport, opal cards, shopping centres, escalators • Opportunity to work with Aboriginal children and families @CourtneyRedSP @LucyEBryant @BronwynHemsley @GoSHspeech #SPROUTSClinic #SpaConf
- 16. Speech Pathology Students’ Views… “I really enjoyed the telepractice experience. I would definitely do it in my future practice. It was really helpful having the SLSO there to help with behaviour management”. (2019) “I have heard great things about SPROUTS and I'm looking forward to my experience”. (2022) “It has been a very rewarding experience to be able to provide services to those located rurally via tele practice”. (2020) “The experience [was] rewarding and motivating as even though I am still practicing, they appreciated the service”. (2020) @CourtneyRedSP @LucyEBryant @BronwynHemsley @GoSHspeech #SPROUTSClinic #SpaConf
- 17. Parents’ and Teachers’ Views… “I am hoping sessions will be able to continue next year. We greatly appreciate the additional resource." (Rural School Coordinator, 2021) "You have no idea how much you and your amazing students have helped." (Parent, 2021) "The kids were very happy to have their first appointment and thought it was rather special that the speech therapist was in Sydney!" (Parent, 2020) @CourtneyRedSP @LucyEBryant @BronwynHemsley @GoSHspeech #SPROUTSClinic #SpaConf "We’ve had such a wonderful experience with SPROUTS. All of the students that have helped us have been excellent and we are just really grateful to have been able to access this resource. I’d also like to commend all the students on their patience. It was greatly appreciated." (Parent, 2022)
- 18. Clinical Educator Views … "It has been so rewarding to work with families who were at a loss in terms of accessing speech pathology services until they heard about SPROUTS." (CE, 2022) “I’m grateful to have this opportunity to support the future of speech pathology, in student education, and in using technology to reach rural families.” (CE, 2022) "I love watching our students go from being terrified of a telepractice placement initially, to reaching a point where they use the telepractice tools independently and create fantastic resources for therapy! They build so much confidence and gain such valuable skills!" (CE, 2022) @CourtneyRedSP @LucyEBryant @BronwynHemsley @GoSHspeech #SPROUTSClinic #SpaConf “It’s so rewarding to see just how much everyone takes from the experience. The students are gaining important skills, and the children are making such clear gains in speech and language because they now have access to services.” (CE, 2022)
- 19. Future Directions for SPROUTS • Continuing our rural services with telepractice • Teaching other practices about telepractice • Linking more rural children with local speech pathology services and NDIS funds • Evaluating through co-designed research • Growing rural placements for UTS @CourtneyRedSP @LucyEBryant @BronwynHemsley @GoSHspeech #SPROUTSClinic #SpaConf
- 20. Questions & Comments @CourtneyRedSP @LucyEBryant @BronwynHemsley @GoSHspeech #SPROUTSClinic #SpaConf Photo by Hadija Saidi on Unsplash
- 21. Ask us About our Services and Supports Courtney Reddacliff: courtney.reddacliff@uts.edu.au @CourtneyRedSP Dr Lucy Bryant: lucy.bryant@uts.edu.au @LucyEBryant Professor Bronwyn Hemsley: Bronwyn.hemsley@uts.edu.au @BronwynHemsley @CourtneyRedSP @LucyEBryant @BronwynHemsley @GoSHspeech #SPROUTSClinic #SpaConf Photo from uts.edu.au
Editor's Notes
- Lucy Good morning, all. My name is Lucy, and I am the clinic manager at the UTS SPROUTS Speech Pathology Clinic. Today I am presenting with my colleague, Courtney, a clinical educator in the SPROUTS clinic. We’ve prepared this presentation in conjunction with Professor Bronwyn Hemsley (in the audience today). Bronwyn is our clinic director. AS Courtney (session chair) noted in her introduction, today we are presenting on our experiences providing telepractice services, and using telesupervision, to support clients in rural and remote Australia.
- Lucy Our conference is being held on the lands of the Wurundjeri people and we wish to acknowledge them as Traditional Owners. We would also like to acknowledge the Gadigal People of the Eora Nation upon whose ancestral lands our UTS campus now stands. We would like to pay respect to the Elders past, present and emerging, acknowledging them as the traditional custodians of knowledge for this land. We would like to extend that respect to any Aboriginal people joining us today. We would also like to thank and acknowledge our project partners the NSW Department of Education, our School sites in Rural and Remote NSW, and our school clients and their teachers and parents.
- LB SPROUTS is an acronym for "Speech Pathology Reaching out at UTS" SPROUTS is a student-led service, with all services delivered by our Masters of Speech Pathology students across their novice, intermediate and entry-level placements. We established the clinic in August 2019 at UTS. Drawing from our own experinces growing up in rural and regional NSW, and discussion with colleagues and partners in the NSW Department of Education, we saw a need that we could fill with a telepractice service. We established the clinic in 2019 with students on campus, delivering telehealth services to children, and then expanded in 2020 to offer in-person services and to offer services to adults, as well as children. When COVID-19 restrictions hit in March 202, the on-campus clinic closed but SPROUTS continued to provide telepractice services. We had already been running a telepractice clinic for 6 months, so we were able to quickly transform and expand our telepractice service to include Sydney clients across the lifespan. We were also able to implement telesupervision with clinical educators, students and clients all in their own homes, online. We were also able to use our experience to deliver four workshops in April and May 2020 where we taught 650 other allied health professionals about transitioning quickly to a fully online service.
- Lucy SPROUTS aims to provide access to services for people with any communication or swallowing need who may be unable to access other speech pathology services. This is achieved by utilising the technology and resources available at the University. We achieve these aims by utilizing the technology and resources available at UTS Our vision was borne out of the strategic directions and values of UTS: Engage our students to collaborate with partners, professions, and communities locally and nationally Empower the profession of speech pathology and our students to embrace technological advancements that reflect the future of the profession Deliver unique and high-quality clinical education to students that will establish their capabilities as forward-thinking and collaborative professionals.
- Lucy While we are focusing on rural sites in our presentation today, through SPROUTS our services reach more people than just rural and remote school students. We provide services to children and adults for free on a ‘word of mouth’ referral system. That allows us to maintain a manageable caseload without waiting lists beyond the current ‘Term’ or ‘Wave’ of placements. We have “put the word out” ourselves to some extent, through our partners in the NSW Department of Educations, with some local health service, and through community organizations and associations. As this map shows, most of our clients are based in NSW, but are spread trough the 4 eastern states of Australia. From Sydney, we reach 1200km to the north, 1400km to the south, and over 450 west into rural NSW.
- Lucy We co-designed the SPROUTS clinic in 2019, in partnership with the NSW Department of Education, to provide a service that was student-led. The Department of education put us in contact with specific schools, and we were able to meet and discuss with school leaders to determine their needs so we could further the co-design process. Each term, in my role as the clinic manager, I reach out to the schools to determine their referral needs. I discuss with them what we are able to offer, based on our capacity. They often have meetings with staff to identify and prioritise the children they view as needing services, and those that will benefit most. They refer children for speech, language, literacy, multimodal communication, and fluency assessment and intervention. And this semester, we received our first paediatric voice referral. There are some referral requirements that we do put in place. Key is that we only offer services to children who cannot access speech pathology in their local community. We work with our colleagues in rural and remote Australia, and we never offer a service where it is already being provided. For a lot of the children that we see, their lack of access to local services stems from one of 3 factors: They might be on a waitlist for a local community health service, but that is long. In some cases, these children are older and they are triaged as a low priority for the limited community health services available. If these children do ever make it to the top of their local waitlist, we happily handover to the local service and our students prepare and provide that handover. Many children do not have access to services due to socio-economic factors. For them, access to speech pathology through their school is the only way for them to receive a service Finally, geographical isolation limits access for a lot of children. For some of the children we see, the closest speech pathologist to their home, public or private, is over 100Km away.
- When a school refers a child to SPROUTS, we require that they first have the permission of the parent. The parent’s details are given on the referral form, so we can get in touch with them. We always attempt to call the parent before we book the first appointment. That call gives us a chance to talk to the parent, answer their questions, find out their concerns, and reassure them about the service we provide. If we do manage to contact the family directly, we let them know that we will be sending some forms home from school, so they know what to expect. Sometime, we just are not able to contact the family directly. In these cases, we rely on our partners within the schools. They contact the family and send home the case history and consent forms. When they get these back, they scan them and send them on to us. Due to their remote location, many of these parents do not have a reliable internet connection at home. Some don’t get mobile service. The school really does provide a key communication pathway in these cases. We see the children while they are at school, with the support of school staff. I am going to hand over to Courtney now to
- CR Thanks Lucy. As mentioned I am one of the clinical educators at the SPROUTS clinic and have been fortunate enough to provide supervision to over 40 of our SPROUTS students so far. As Lucy also noted, we provide services to our rural and remote clients via telepractice. Given the circumstances over the past few years I'm quite confident that many of us have become quite familiar with telepractice, so I won't go into too much detail about how it works, but rather provide a brief overview of our specific set up in the SPROUTS clinic. We tend to use Coviu as our telepractice platform, with Zoom available as a back up if we have any technical issues. To start the telepractice sessions the Clinical Educator and Student log in to Coviu and set up by uploading any resources they will need. The client then logs in from school or home with support of a teacher, student learning support officer or parent. The resources are displayed on screen and we typically start with a visual schedule to show our clients and the support person what they can expect from the session. The speech pathology students help the clients to use the Interactive tools which are a feature of Coivu including the pencil and sticker functions throughout the session. The clients tend to find these very engaging, and this helps to foster participation throughout the session. However if they do become distracted by these at any point Coviu has a great feature that allows you to lock and unlock the tools during the session – which can be very helpful if your client begins to cover the screen in stickers.
- CR Here's one example of a resource used in a telepractice session. This was developed for a client working on production of multisyllabic words. An on screen dice roller is displayed and the student speech pathologist and client take turns rolling dice and saying one of the corresponding words. They earn stickers for their correct productions and compete to earn the most stickers.
- CR As well as offering our services via telepractice, we are also set up to provide our students with telesupervision, which as Lucy mentioned, proved to be extremely helpful during the peaks in the pandemic where we not able to attend campus. We have a few models of telesupervision depending on the location of the students and clinical educators. In this model you can see the Clinic Manager, Clinical Educator, and Student at UTS are all on campus. The client is at school or home for their online session. The CE and student work from different rooms within the clinic, with the CE supervising by logging into the Coviu session.
- In this model you can see the Clinic Manager can be on campus, the Clinical Educator and Student and client can all be at home. We also run this model with the students on campus and the clinical educator online at home, so we have a lot of variations in our model to be flexible to locations. This has been very beneficial in maintaining continuity of services and student placements during the Covid-19 pandemic and recent flooding events.
- CR Since August 2019, we have successfully established the program, and provided placements to over 100 UTS Master of Speech Pathology students at the Novice and Intermediate stage of their training. We provide services to four NSW schools, and have provided approximately 700 appointments over the last 2.5 years. The clinic has been extremely beneficial to our speech pathology students, who have gained valuable experience in the provision or services via telepractice and improved competence in working with clients, families and schools in rural and remote areas.
- CR The clinic has also been highly beneficial to our rural and remote clients with parents and teachers reporting noticeable improvements in their speech, language literacy, academic achievements and confidence. Further to this, the provision of online student-led services to rural and remote schools in NSW has increased access to speech pathology services for clients who were otherwise not able to access services. Through our student-led clinic, we have provided screening services which have enabled the schools to then make arrangements with local speech pathologists. We have also provided comprehensive assessments and assessment reports to assist rural and remote families to access NDIS funding , which has then provided the financial means for them to begin session with their local speech pathologist. Along the way, we support our speech pathology students to lead these processes and therefore they gain a valuable understanding of the role they can play as a speech pathologist in supporting rural and remote schools and families.
- Now I will discuss some of the outcomes of the clinic and feedback that we have received .
- CR For many UTS students, the rural telepractice clinic of SPROUTS is their first experience in working with children outside of Sydney, and with rural culture. This has led to some interesting conversations and a few communication breakdowns here and there, which have been a memorable learning for all involved! I vividly remember the look of horror on one of my students faces when their client gave an in depth description of their recent hunting trip, which was a completely foreign concept to the Sydney born and bred student! Similarly, our students have come to realise that a number of the things that they see everyday such as big shopping centres and escalators are not part of daily life for our rural and remote clients. This created an interesting (and unintended) vocabulary building opportunity when 'escalotor' was used as a target word in therapy. Through our provision of services to rural and remote schools we have also worked with a number of Aboriginal children and their families, and our student speech pathologists have demonstrated improved competency in planning and providing culturally safe services via telepractice.
- CR We regularly collect feedback from our speech patholgosy students as part of our ongoing evaluations and improvements to the SPROUTS clinic. Here are some examples of student feedback, we find that often students report that their experiences with the SPROUTS clinic have been highly rewarding and they have enjoyed gaining skills and experience in the delivery of services via telepractice, being well aware that for many clinics this is now a standard service delivery option.
- CR We also seek out feedback from parents and teachers of our rural and remote clients and find that they are often highly appreciative of the service and really enjoy working with the student speech pathologists.
- CR Our clinical educators also really enjoy being a part of the unique service that SPROUTS provides. Speaking from my own personal experience as a clinical educator for SPROUTS, my students and I recently completed the Lidcombe Program with a young child who came to us with a moderate-severe stutter. They had been on the waiting list for community health services but reached out to SPROUTS as they were worried community health might not get them in before the child reached school age. In the end, the day that this little one completed their therapy with us (and was maintaining consistent severity ratings of zero stuttering) was the same day that community health let them know they had a spot available for them. It was so great to know that we'd been able to provide a timely service in an instance where that extra waiting time may have been detrimental to the outcomes for the child. I'll hand back over to Lucy now to discuss the future directions for the SPROUTS clinic.
- Lucy SPROUTS will continue to offer services to children, and to adults, in rural and remote NSW through telepractice. As we learn lessons and build our skills along the way, we will continue to offer support and education to anyone who asks. We want to share what we learn to benefit our profession. We will continue to work with local services in the communities that we reach. We especially want to support children to access those local services, by offering assessment and supporting applications for NDIS funding. As children access funding, they can move to receiving in-person services within their own communities wherever possible. While SPROUTS is all about our clinical services and education, we will be evaluating our service into the future through co-design research. This research will help us to continue developing our clinic to provide the best service possible to our clients, and the best educational experiences for our students. We connect our student to rural NSW through telehealth, but in the future, we well be focusing on growing those experiences of rural practice by establishing partnerships with rural speech pathologists and supporting them to take students on clinical placements. If you are interested in perusing such a partnership, please contact Bronwyn. She’s here and very happy to chat to you.
- Lucy
- Lucy Please contact Bronwyn, Courtney, or myself if you have any questions, or you would like to chat about telehealth or rural placements. You can reach any of us via Twitter or Email.