Telepractice (Teletherapy) Basics for Speech and Language Pathologists

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What is telepractice (teletherapy)?

Telepractice is the newest addition to the field of speech and language pathology and it has gained popularity over the past three years. It is an exciting and innovating service delivery as it helps to reach individuals in remote or rural areas where speech therapy is sometimes not an option.

Telepractice was approved by the American Speech-Language-Hearing Association (ASHA) as an appropriate method of service delivery in 2005. ASHA's position is that “telepractice is an appropriate model of service delivery for the professions of speech-language pathology [and audiology]. Telepractice may be used to overcome barriers of access to services caused by distance, unavailability of specialists and, or subspecialists, and impaired mobility” (ASHA, Speech-Language Pathologists Providing Clinical Services via Telepractice: Position Statement [Position Statement], 2005).

ASHA has also added telepractice to its directory of special interest groups (SG-18) (2011)

ASHA defines telepractice as the application of telecommunications technology to delivery of professional services at a distance by linking clinician to client, or clinician to clinician, for assessment, intervention, and/or consultation.” Telepractice typically occurs in real time and ‘face to face’ with a clinician via online videoconferencing.

Who provides telepractice or online speech therapy services?

Speech and language pathologists:

·       To provide speech and language services to rural schools,

·       To provide voice, aphasia or cognitive therapy to satellite clinics from hospitals or private practices or to individuals in underserved or remote areas,

·       To provide speech, language or cognitive services to remote home health agencies, and

·       To consult and train individuals or families, for instance, communication coaching, augmentative and alternative communication (AAC), early childhood parent training, etc.


·       To provide hearing screening,

·       To provide infant hearing screening, and

·       To provide hearing aid training, etc.

Basic Equipment for Conducting Telepractice or Online Speech Therapy


·       Computer

·       Web camera with 15 FPS (frames per second) capture rate (built in or separate)

·       Headset with attached microphone (analog or USB)

·       High-speed internet connection (150 kbps minimum)

Video Conferencing Software for Telepractice or Online Speech Therapy

In addition to the above basic equipment, teletherapists must choose a video conferencing tool. Some teletherapists use Skype or other video conferencing software used by the general public to provide online speech therapy (telepractice). However, practitioners must be aware that Skype and other free video conferencing software do not comply with HIPPA and their use puts your clients at risk for privacy and confidentiality breaches.

Many video conferencing software solutions, for example, Skype, provide basic video and audio functionality, chat and screen sharing, but the teletherapist and the client are not able to manipulate the exchanged materials simultaneously. This may create certain limitations for therapy.

Speech and language pathologists might consider the TheraPlatform video conferencing platform, which was developed by a speech and language pathologist with therapists in mind. The TheraPlatform platform is HIPPA compliant and therapists using TheraPlatform are provided with a written business associate agreement (BAA). TheraPlatform is the only telepractice video conferencing platform on the market that has built-in apps ready to be used for online speech therapy on both web and mobile devices. All apps included in TheraPlatform are fully interactive on both the client and therapist sides and they track data. In addition to the apps included with TheraPlatform, teletherapists can use and share their own materials, such as flashcards, worksheets and Powerpoint presentations.


Some clients may present with physical or cognitive challenges that prevent them from benefiting from telepractice (online speech therapy). Being able to sustain attention for reasonable time, follow simple commands and manipulate a computer mouse are some of the basic physical and cognitive requirements of participating in teletherapy. Teletherapists should develop their own protocols to determine candidacy for telepractice.

Environment of Telepractice Session

In order to provide high-quality telepractice (online speech therapy), the therapist should consider the environment, the location, of both the client and the clinician. Light, distractions, noise level, comfort and safety should be evaluated and modified as needed prior to beginning a session.

Use of Facilitators

Younger children working from home may need the supervision of their parents, especially in the beginning of the program. The parent may need to teach the child the basic computer skills needed for speech telepractice and help the child get ready for his or her sessions. Children who receive speech telepractice services from their school will need supervision as well. Facilitators may include a teacher’s aide or other type of support personnel on the site.

The aide may:

·       Escort children to and from therapy sessions,

·       Set up equipment for sessions,

·       Troubleshoot as needed,

·       Control child’s behavior as needed, and

·       Communicate with on-staff teachers and staff about scheduling and changes.

Additional Documentation

ASHA advises that teletherapists should provide their clients with an informed consent form prior to conducting speech therapy online. Clients should also be informed regarding

·       Differences between telepractice and traditional therapy,

·       Potential confidentiality issues, and

·       Descriptions of the equipment involved.


Currently, speech and language pathologists providing telepractice or online speech therapy must be licensed in the state of their client’s residency.

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