This document summarizes a presentation on developing a telepractice business model during the COVID-19 pandemic. It discusses legal, ethical and financial considerations including: obtaining proper insurance and tax advice; maintaining client privacy and cybersecurity; clearly communicating policies on fees, cancellations and recordings; distinguishing personal and professional device use; and creating best, moderate, and worst case financial scenarios accounting for fixed and variable costs. The presentation advises speech pathologists transitioning services online to carefully prepare for each telepractice session and maintain a professional environment.

1. UTS CRICOS 00099F
UTS COVID-19 Response
Design for responsible tele-
practice at home: legal,
ethical, and business factors
Dr Caroline Bowen AM, Honorary Adjunct Fellow: Academic, UTS.
Dr Geoff Holland, Lecturer, Faculty of Law UTS.
Prof Prabhu Sivabalan, Associate Dean, External Engagement
Prof Bronwyn Hemsley, Head of Speech Pathology UTS,
Director of the UTS Speech Pathology Clinic
Graduate School of Health
The University of Technology Sydney
@BronwynHemsley Bronwyn.Hemsley@uts.edu.au

2. UTS CRICOS 00099F
Acknowledgements
These slides were developed by and in consultation with Dr Geoff
Holland, Prof Prabhu Sivabalan, Dr Caroline Bowen AM and Prof
Bronwyn Hemsley in April 2020
The presentation is offered free of charge at a 1 hour webinar provided
for any health professional anywhere
The information is based on Australian practices, but some of the
material and principles underlying the legal and ethical considerations
are common across jurisdictions and may be useful, but should not be
taken as advice
Business owners should consult with their financial advisors, tax
accountants, and legal representatives for detailed advice on setting up
their practice as required
Please acknowledge authors and UTS appropriately if using or adapting
these slides to support others in transitioning to telepractice business
models, for no charge to delegates

3. Background: The COVID-19 Imperative
• UTS 2027 Strategic Plan that includes reaching out to community and industry partners
• In September 2019, UTS Master of Speech Pathology launched a telepractice clinic for
clinical education (i.e., a student led telepractice clinic, called SPROUTS ‘Speech
Pathology Reaching Out at UTS’)
• With 6 months of experience by the time COVID-19 hit, and having educated more than
half of our 1st year students through the SPROUTS clinic, we sought to share information
freely across disciplines in Australia and overseas in a Webinar format
• Our fortnightly webinars will gradually increase confidence and competence in
telepractice, including that used for student supervision across Australia
• There is an urgent need for student clinical placements throughout 2020 owing to
COVID-19 impacts (reducing availability of in-person placements). These need to be high
quality placements, featuring best practices in telepractice implementation.

4. UTS CRICOS 00099F
Developing your new
telepractice clinic:
Implications for policy
and practice
Dr Caroline Bowen AM

5. REFLECTIONS on the client group
PEOPLE WITH A DISABILITY With the “digital divide”, people with disability cannot necessarily just
“go online”. Often, they don’t have adequate internet or equipment access.
PARENTS AS PARTNERS Parent-education and joint-goal setting may be easier and more effective
(and “checkable”) via telepractice.
ENGAGEMENT Even if they already know you from in-person contexts, pre-schoolers and younger
students may be shy at first. Older students and adults may experience performance anxiety. Take
enough time to engage them.
OLDER CHILDREN, YOUTH and ADULTS May be more comfortable with the technology than you.
You can learn from them.

6. GENERAL PREPARATION & PLANNING
1. PREPARE Familiarise yourself with Government and professional association resources that are
pertinent to telepractice in all settings.
2. PLAN Make a plan for developing your own SKILLS and KNOWLEDGE around telepractice as a
component of Professional Development / Self Regulation activities. Document all of your training
(e.g., in your ‘log’ of training) along with any related readings, and mastery of new technology. Helpful
resources include:
Speech Pathology Australia (SPA) SITE “Learning to use Telepractice”.
FACEBOOK “SPA Private Practice Member Community”
THE THREE RIVERS UDRH Excellent self-paced course from CSU. Takes ≈ 4—6 hours.
https://www.openlearning.com/csu/courses/three-rivers-udrh-telehealth/HomePage/
ASHA https://www.asha.org/About/Telepractice-Resources-During-COVID-19/
EVIDENCE BASE
https://www.asha.org/EvidenceMapLanding.aspx?id=8589944872

7. GENERAL PREPARATION & PLANNING
3. INSURANCES
Ensure you have Professional Indemnity and Public Liability cover
Remember, you have a Duty of Care to yourself and others
Have your annual premiums changed in response to COVID-19?
4. TAXATION
Discuss changes in arrangements (due to Telepractice) with your tax advisor
Consider calling the ATO or the appropriate agency in your country
Measure your work-space e.g., how much of your home do you heat/cool relative to your
practice?
5. ADVERTISING
Observe your professional association’s advertising guidelines
Deter clients from writing flowery testimonials (e.g., in Facebook)
6. BROWSER SECURITY / MAINTAIN GOOD “WEB HYGIENE”
Guard against malware, fraud, cybercrime and phishing (calls, texts and emails)
Consider carefully all aspects of documentation, privacy and confidentiality relative to your
browser settings and your telepractice platform’s security
7. PRESERVE CONFIDENTIALITY and PRIVACY according to the “usual” rules

8. REFLECTIONS on THE IMPORTANCE OF
1. ROUTINE TIME-KEEPING AROUND TELEPRACTICE; TIME SPENT
with the client e.g., building rapport, assessment, intervention …
with the parent or helper e.g., joint goal setting, explaining tasks …
2. HAVING A CLEAR POLICY ON UNSCHEDULED NON-ATTENDANCE
“NO SHOWS”
LATE STARTS
CANCELLATIONS
3. CONSIDERING THE ETHICS OF CHARGING FOR SERVICES YOU HAVE NOT DELIVERED
Are the rules different in telepractice?
4. A PRIVACY STATEMENT and Clinic Manual THAT INCLUDE TELEPRACTICE

9. PREPARE AND PLAN for a TELEPRACTICE SESSION
FOR A CLIENT OR GROUP
1. ADEQUATELY INFORM THE CLIENT AND/OR HELPER Consider making a permission form
(e.g., parent consent form), clearly outlining roles and responsibilities and specifying what is
expected of the “helper”
2. Verify that the helper will be physically present to support the client
3. Verify the client’s contact details: phone, email, address for invoices
4. Verify that your client and you have appropriate equipment and web access
5. FAMILIARISE YOURSELF WITH THE TELEPRACTICE PLATFORM
Practice sharing the tools and therapy materials ahead of time
6. Have THIS client’s materials within reach, in the necessary order
7. Plan BREAKS between clients (case notes, log COVID-19 issues, stretch, 250 steps!)

10. WORKING WITH FAMILIES & “HELPERS”
1. Exercising judgement, exchange cell phone numbers (to call or text) and email addresses before
starting.
2. Also before starting, discuss their expectations, intervention aims/goals, and any concerns.
Gather feedback and outcomes after a session, or after a series, as indicated.
3. Ask the parent/helper to sign onto the platform 5 minutes before each session to troubleshoot
technical difficulties.
4. Remind them to prepare client for the session, e.g., toilet needs.
5. Explain their role in the session, e.g., observe unless asked to speak.

11. WORKING WITH FAMILIES & “HELPERS”
6. Explain to them how and when you would like to address THEIR questions, e.g., at the time, after
the session, with or without the client present …
7. Based on the client’s needs, explain your behavioural expectations for the client, and the parent’s
or helper’s role in this.
8. Discuss, fees, charges (and contracts if applicable) up-front.
9. Suggest they consult their private health insurer | DVA https://www.dva.gov.au/ | Medicare office
with regard to rebates.
10. Help them, if necessary, with browser security settings, especially regarding “tracking”.

12. MAINTAIN A PROFESSIONAL “LOOK”
1. Create a professional environment in your workspace.
2. Dress professionally (in your typical work attire)
3. Select a quiet space (a room with a door is best), with suitable lighting and a background that
won’t distract
4. Virtual backgrounds are a matter of taste and can be irritating and visually distracting (abstract,
interrupting)
5. A little bit of “you” in the background (e.g., your bookcase) can improve authenticity, but avoid
anything personal or private
ADVISE CLIENTS/FAMILIES/HELPERS
TO GUARD THEIR PRIVACY

13. It’s probably
best NOT to
have the local
birdlife
squawking and
chewing in the
background!
ON
REFLECTION

14. TECHNOLOGY TIPS and TECHNIQUES
Before a session, check camera and video monitor placement via the platform e.g., COVIU, Skype,
FaceTime, VSee, Zoom.
Use the PASSWORD feature in Zoom, but NOT WAITING ROOM.
Before a session, check mic and sound via the platform.
Perform a tech “trial run” with parents before beginning services.
Prepare to troubleshoot audio and visual issues with the platform. Have a contingency plan ready
before providing services.
For the most stable, reliable connection, connect your computer to your modem via Ethernet. Have
clients do the same.
If using Wi-Fi, sit close to your modem, and ask household members to avoid using the Wi-Fi while
you provide telepractice services, and not to enter the room, or be on view to (or be able to view) the
client.

15. REFLECTIONS
SOCIAL MEDIA PLATFORMS
Inadequate security means that social media channels platforms (e.g., Facebook messenger video
chat) are not appropriate for telepractice for health purposes (BUT, SOME PROFESSIONALS USE
THEM, INADVISEDLY).
GUIDING PRINCIPLE
Use the best means of communication possible. Where there is a breach, it is important that if audited
you are able to say that you used the highest security software available, meeting your country’s
standards for transmitting health information.
“FOREIGN” COUNTRIES
Be aware of international standards if you are sourcing or providing services and information from/to
overseas, e.g., RCSLT in the UK and ASHA in the US allow testimonials while SPA in Australia does
not.

16. UTS CRICOS 00099F
MORE ON LEGAL ISSUES
Dr Geoff Holland

17. More on responsibilities
• Scope of practice – seeing new client groups (e.g., adults when main area of expertise is
children)
• Obtaining mentoring/supervision and working to level of knowledge and experience
• Be open about the risks and benefits of telepractice
• Unknown factors in the circumstance of a new model of service delivery being
implemented rapidly
• Principle of ‘do no harm’ applies
• Over-selling the telepractice model as being ‘better’ or ‘equivalent’ – primarily we know it
is not ‘worse’ ie outcomes are not inferior.

18. Team meetings and consultations with others
Consider privacy and recordings of case history, data collection during sessions.
What happens to the recordings, who has access to them?
How are team meetings managed?
How will you consult with class teachers?

19. Device security: Responsible practitioner
New threats come through daily, ramped up because of COVID-19
Health information is the highest prize, particularly of children’s health data (since they have longer
lives, usefulness)
Watch for any attempts to Trojan horse
Ensure staff are aware not to open or distribute emails even if they appear to be from trusted source
names, interrogate the actual email address it is arriving from (could mimic names of colleagues etc)
Check/test Firewalls will enable the telepractice software, and consider how this will work

20. Confidentiality and Privacy
Give your clients the same advice, the extent to which they can follow it might vary
Clients should be informed of any risks and safety considerations as well
Remember! Use the best available communication technology - using software that meets your
country’s standards for privacy in relation to health information

21. Distinguish ‘personal’ and ‘professional’ use of
devices at home
Need to clearly distinguish between personal and professional use
Use different browsers for each of these purposes and consider the security of the browser
Staff and clients should check the security settings of their own individual browsers
Clients might need guidance on their security settings of the browser in relation to ‘tracking’ of data

22. Clients being properly informed
Clients should be sufficiently aware of what steps are being taken to protect their privacy
Clients should be given the opportunity to be informed and agree to the procedures/steps/taken to
reduce the risk of a breach
Clients should be aware of what standards are in place and are being met in relation to privacy

23. Beware the Screen Share Risks
Be careful to close windows or remove items on the desktop that could accidentally be shared
Remind the client not to have personal items open on their desktop
Particularly relevant if the device is being used by multiple parties in a household
Use password protection on teleconference calls; some sort of two-step authentication (e.g., arranging
meeting, and then emailing the link to the meeting on the day)
Not sharing links to meetings and allowing clients to invite others to the meeting

24. Recordings: Audio, video, photo
Sharing of recordings: Agreements
Concern about being recorded without consent (client/staff)
Clients to agree not to record – except in particular circumstances (agree on what they will be)
Therapists to agree not to record – except in particular circumstances (agree on what they will be)
Things to discuss with your staff and clients
No covert recordings
No overt recordings without full permission first
No social media sharing of recordings/photos by clinicians/clients without full permission
Do not assume that because a photo is taken willingly, it is okay to post it on your social media
channels without permission being obtained

25. Transition from ‘office’ to ‘home office’
Tax deductibility – check on this
Keep a log record of the times that you are working at home
Co-ordinate team meetings, perhaps more frequently
Provide good supervision of staff, mentoring and support needs will increase
Learn how to use the features of the videoconferencing
Consider your financial future projections – scenario building and planning
Obtain financial advice

26. Tips for working at home
The Australian Tax Office will be focusing on home office claims
Records to be kept on amount of time spent on work activities
Log of devices and their use at home, proportion to work/personal usage (e.g., of iPads, laptops,
computers, internet)
Ensure device anti-virus software is up to date
Retrospective view – look back at your pattern of working from home prior to COVID-19.
Floor plan/floor space proportion devoted to home office (measure)
Log any COVID-19 impacts as they occur

27. UTS CRICOS 00099F
More on FINANCES
Prof Prabhu Sivabalan

28. Make Your NEW Financial Scenarios
How will you manage new scenarios
Do not fear the numbers – do some projects and put on a $$ cost
Use a spreadsheet
Construct a regular way to update your financial situation
Teach your staff practical strategies for monitoring costs

29. Elements to watch for when making financial
scenarios
Reflect on BEST, MODERATE and WORST case scenarios
What are they?
A best case is a “realistic” best case – it’s not what it is in your dreams, but what it might be, such
that it pleasantly surprises you.
Ditto for “worst” case (except ‘unpleasantly’)
How do we define the variation?

30. Common pitfalls
Symmetry and scenarios are tempting, but often not logical.
If you have five scenarios, there is no reason for them being symmetrically dispersed.
So, if scenarios are based on percentage change from your previous activity:
20% of previous customers
40% of previous customers
60% of previous customers
80% of previous customers
100% of previous customers
The input might be symmetrical, but the output will not! Why?
We often take an expected scenario, and double/halve to get best or worst.
Or we estimate a best or worst, and the expected is that which is mathematically down the middle,
right between both! That’s mathematically symmetrical, but not reflective of any real world
conceptualisation.

31. Common pitfalls – fixed costs and variable costs
All businesses have fixed costs and variable costs – costs that don’t change with greater or less
activity, and costs that do.
Your labour hour charge (billing rate) has to cover your costs.
In your home office activity, what costs are fixed and what are variable?
Materials (stationery, any other technology you use in your work that is variable)
Other labour
Infrastructure costs (equipment, etc)
Regulation related costs (professional services fees, lodgement fees, membership fees, etc)
The more your fixed costs, the more your scenarios will not be symmetrical when measuring profit –
profit will increase exponentially with activity, as costs don’t go up by much when you do an additional
activity/consultation.

32. Treat your forecasts as a living document
Once you’ve come up with your scenarios, don’t take them as “Gospel”.
If circumstances change, adjust them! If things get worse, then all scenarios move negatively (and
vice versa).
A scenario becomes redundant if it is not relevant… so keep at it!

33. Questions and Comments
Resources
Come back in a fortnight!