How to Know What Works

Evidence for Teletherapy and Beyond

Meredith Harold, PhD, CCC-SLP

www.meredithharold.com

www.theinformedslp.com

Introduction & Disclosures

Financial Disclosures

• Salary from and owner of The Informed SLP

• Adjunct faculty at the University of Kansas

Non-Financial Disclosures

• President-Elect of Kansas Speech–Language–Hearing

Association

• Board member of ASHA CRISP Committee

• More at www.meredithharold.com

What’s the evidence for telepractice?

Is there research to suggest it works?

Broad take-homes

• Quantity: There’s just not a lot of telehealth research in our field

• Pace: Telehealth (technology and practice) has moved faster than either policy or science for it

• Populations: Research available is with likely-to-be-compliant populations

• Parents (parent coaching)

• Older children (> 5)

• Adults (over half of studies; Molini-Avejonas et al., 2015)

• Some areas have more evidence. e.g. telehealth can be as effective as in-person services for:

• TBI

• Autism– but mostly older children in mainstreamed classrooms

• Hearing loss

• Dementia

• Fluency disorders

• Speech sound disorders [treatment]

• Less evidence for:

• Dysphagia

• Pediatric speech–language assessment

• Language disorders in school-age children

Broad take-homes

from ASHA’s Evidence Maps

• PROS: When looking across studies…

• improved access to care

• fewer missed appointments

• cost-effectiveness

• and patient satisfaction

… are primary benefits (Covert et al., 2019; Molini-Avejonas et al., 2015; Sutherland et al., 2018)

• CONS: Very little research on telehealth best-practices; no great answer to the question of, “What’s the right way to do telehealth?”

Broad take-homes

Teletherapy success dependent on things like clinicians’:

• Nonverbal communication skills

• Knowledge of EBP

• Comfort and problem-solving skill with technology

• Ability to calm own, and clients’, fears of telepractice

Hines et al. (2015)

Overby & Baft-Neff (2017)

Broad take-homes

Early intervention research

• More treatment research than assessment:• But clinicians who do telehealth assessment report feeling

very confident about it (Blaiser, 2016)

• All* treatment research is on parent coaching. Everything from:• 10 minutes per week w/ SLP (Peter et al., 2019)

• … to pre-recorded modules that parents watch on their own time (Douglas et al., 2018)

• … to weekly coaching sessions, with a variety of kids, e.g. parents of kids with autism (Meadan et al., 2017)

Early intervention research

• Results comparable to good parent coaching:

• e.g. improved initiations and responses between parent and child (Baharav & Reiser, 2010)

• also Blaiser et al. (2013) & Behl et al. (2012)

• With some things even better than face-to face:

• e.g. parent practice with feedback (Inbar–Furst et al., 2019)

• “.. a by-product of this increasingly accessible service delivery platform may be that parents receive the type of therapy that has been found to support successful outcomes for children.”

Why aren’t more states doing it?

• A survey of coordinators across 26 states indicated that they’re most concerned about:

• security

• privacy

• quality of services

.... in the use of telehealth for IDEA Part-C services

(Cason et al., 2012)

SLPs are the ones equipped to make decisions about what

can be adequately provided via telehealth and what can’t; and increased trust in SLPs’

clinical decision making

and less fear of the unknown will allow us to make good, responsive decisions for clients.

Preschool & school-age research

• More research on older children• Difficult to find papers on ages 3–4; 5+ easier; 8+ even

easier.

• Assessment research. Taylor et al. 2014 found:

• Strongest evidence: screenings• Some evidence: speech, and language assessments

• Some newer assessment research too; e.g. CELF-4 can be reliably administered via telepractice (Sutherland et al., 2018)

• Difficulty with assessment comes mostly from things that are just plain harder to hear via digital audio, including:• judgement of individual speech sounds

• detection of pluralization

• discriminating between similar sounding words

Preschool & school-age research

• More treatment research than assessment

• telehealth equivalent to face-to-face treatment,

• communication outcomes similar,

• and better than no-treatment conditions

(Coufal et al., 2018; Grogan-Johnson et al., 2013; Sutherland et al., 2018; Wales et al., 2017)

Adults research

Caughlin et al., 2019:• efficacy and cost of telerehabilitation same as face-to-face

• patients satisfied with telehealth

• clinicians prefer face-to-face, but will use telerehabilitation when face-to-face not feasible

Weidner & Lowman, 2020 (systematic review):• “Overall, results… support the use of telepractice as an

appropriate service delivery model in speech–language pathology for adults. Strong research designs, including experimental control, across multiple well-described settings are still needed to definitively determine effectiveness of telepractice services.”

Is there….. any more in the literature?

Telepractice How-To and Tips

Lean on clinical experts

Best Practices for Assessment and Treatment

(within telepractice; regardless of service delivery model)

Lean on the research

Autism

Speech

Sound

Disorders

Fluency Language Pragmatics Feeding

And

everything

else we

work with!

Is there….. any more in the literature?Expert Opinion, Tutorials, and Perspective Pieces

Is there….. any more in the literature?Expert Opinion, Tutorials, and Perspective Pieces

Is there….. any more in the literature?Expert Opinion, Tutorials, and Perspective Pieces

Is there….. any more in the literature?Expert Opinion, Tutorials, and Perspective Pieces

Is there….. any more in the literature?Expert Opinion, Tutorials, and Perspective Pieces

How do I know what’s evidence-based?For other topics?

In a way that’s efficient?

EBP

It’s what worksWhat we’re supposed to be doing (Code of Ethics)And what our clients need from us…

SLPs: what this feels like

Research Clinical Practice

Leadership Businesses

“Just read the

research!”

“No worries;

we got you!”

cost

time

clinical utility

format

culture

“You don’t need

the research.”

“There is a well-established disconnect between EBP and the

realities of clinical services provision…” (Douglas, 2016)

Our field is starting to correct for this,

with solutions that didn’t exist just a handful of years ago.

but also…

Current solutions for SLPs

Research Clinical Practice

Leadership Businesses

Evidence

Evidence-based

Not evidence-based

Journ

al arti

cles

Filtere

d and analyzed

articles &

reviews Pseudoscience

Courses (including ASHA CEUs)

Products, Tools, Handouts

Websites, Blogs

… that range from highly evidence-based

To somewhat evidence-based

To not evidence-based (and even entirely

misaligned with what the data shows works)

Filtered and analyzed articles & reviews

Research Clinical Practice

“the blue section”

Speech

BITE

ASHA’s

Evid

ence M

aps

The In

form

ed SLP

• Free

• Treatment research

• Quality appraisal

• Free

• Assessment & treatment

research: systematic

reviews & guidelines

• Quality appraisal

• Brief take-homes

• Members-Only

• Assessment & treatment research

• Editorial review/descriptions

• Web, print, and audio formats

Journ

al arti

cles

ASHA’s Evidence M

aps,

The Info

rmed SLP &

SpeechBITE

Pseudoscience

Courses, Products, Tools, Handouts, Websites, Blogs

Highly

evidence-

based

Not EBP

Finding more journal articles

• PubMed

• (ERIC)

• (Google Scholar)

“the purple section”

Obtaining free copies of journal articles

• UnPaywall

• Google search of title

• Email the author

Meredith Harold, PhD, CCC-SLP

www.meredithharold.com

meredithharold@gmail.com

Thank you all for learning with me!

See accompanying document for references.