By Kristin Chmela, M.A., CCC-SLP
For those working with individuals who stutter, telepractice services are becoming more popular as a way to help clients with limited or no access to speech therapy or with needs that require more specialized assistance.
While adhering to ethics and restrictions (see ASHA, 2010), we provide telepractice using various delivery models, including face to face intervention, co-treatment and/or consultation services, practice and/or maintenance programs, parent and teacher education, as well as clinical training and ongoing support.
In addition, we use telepractice globally to help students and clinicians develop and/or improve clinical skills. While unpublished, our preliminary outcomes suggest telepractice is a viable method for delivering these aforementioned services. Education regarding issues pertaining to telepractice services is crucial, and three factors related to stuttering and telepractice are highlighted below.
Thus far, our experience indicates that telepractice has not interfered with our ability to create positive, genuine relationships with our clients, related others, and professionals. Modeling easy, relaxed speech, pausing frequently, and listening attentively are important.
We also implement creative ways of providing feedback and connecting with clients, such as sending words of encouragement by mail and, if possible, having occasional person to person visits. Don't be surprised, however, if the child you are working with via telepractice won't speak to you when you meet in person for the first time!
Getting help via telepractice is not for every client, nor is it for every clinician. Treatment must reflect all communication needs and must suit the individual client.
As co-treatment with a 7 year old and her school speech-language pathologist unfolded, various methods of communication prior to and after therapy sessions aided the collaborative process. Parents and teachers were involved during various sessions, and additional speech and language goals were implemented by the school therapist at other times during the week.
Often technical issues interfered with clarity of productions of both fluency shaping and stuttering modification procedures, which felt frustrating at times. Clinicians embarking on this adventure need knowledge in the area of stuttering, experience in treatment, and lots of patience.
While making understanding clients' experiences in initial interviews and during treatment a top priority, we acknowledge "missing" certain things because we are not 'there.' For example, we won't notice how the twelve year old purposefully dropped his paper on the floor when his teacher called on him to read aloud, or the way a young child transitioned to and from therapy. We aren't able to reach out by moving physically closer to the woman who tearfully recalls memories of childhood bullying, nor stand behind the teenager to show him we 'have his back' as he bravely orders his own hot chocolate at the local diner for the first time.
Some positive evidence exists for stuttering and teletherapy (see reference below), but more research is needed, as well as guidance and training for specialists in stuttering seeking to utilize teletherapy. Every client teaches us something more about being a successful clinician, and with that in mind, we are carefully and exuberantly modifying, developing, implementing, and utilizing telepractice services, one client at a time.
Editor's Note: To reach Kristin Chmela at the Chmela Fluency Group, call (847) 383-5589 or e-mail firstname.lastname@example.org.
The American Speech-Language-Hearing Association (2010). Professional Issues in Telepractice for Speech-Language Pathologists [Professional Issues Statement]. Available from www.asha.org/policy.