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COVID-19 and telehealth

The unprecedented circumstances surrounding the outbreak of COVID-19 have led many speech and language therapists (SLTs) to undertake consultation, assessment and intervention remotely via telehealth. In some cases this is an extension of existing practice, in others completely novel.

The RCSLT has therefore updated our guidance.

Introduction 

On 11 March 2020, Secretary of State for Health and Social Care Matt Hancock informed the House of Commons that in response to the COVID-19 outbreak:

“We have moved to a principle of “digital first” in primary care and with out-patients: unless there are clinical or practical reasons, all consultations should be done by telemedicine”.  (Great Britain, House of Commons 2020) 

This will be particularly relevant when social contact in the healthcare context is minimised to prevent infection. Whilst there are positive benefits to the use of telehealth even when such restrictions are not in place, it is essential that the following are taken into consideration to reduce the risks of health inequalities:

  1. Access to digital technology, including data usage (digital poverty)
  2. Difficulties accessing digital technology as a result of communication needs
  3. If there are literacy or language barriers.

The RCSLT is also working with other key stakeholders to identify how some of these challenges can be overcome. This includes for example, supporting work undertaken by others e.g. the Stroke Association in the promotion of ‘Getting Online for People with Aphasia’

This new digital guide has been designed following a UK-wide consultation of stroke survivors’ with aphasia. It contains helpful information and step-by-step guidance on how to get online and search the internet. 

The guide uses aphasia-friendly text supported by pictures and keywords. It can be used with a text reader and covers the use of many devices; computer, laptop, tablet and smartphone, and the guide will:

  • Equip stroke survivors’ who have aphasia with the skills they need to get online and use tools, such as Skype, WhatsApp, Facebook and Zoom, so they can keep in touch with family and friends
  • Enable stroke survivors to connect with the stroke survivor community

Please note:

  • our guidance will continue to be updated with information as it becomes available.
  • for further consistency throughout this guidance we will also use the phrase 'service users and others' to indicate 'service users and their families and carers'
  • the resources throughout this guidance are provided for informational purposes only. No endorsement is expressed or implied, and while we make every effort to ensure our pages are up to date and relevant, we cannot take responsibility for pages maintained by external providers.

Defining terminology 

Telehealth is defined as the “delivery of health care services, where patients and providers are separated by distance... (it) can contribute to achieving universal health coverage by improving access for patients to quality, cost-effective, health services wherever they may be” (World Health Organization, 2016).

We are aware that the use of remote healthcare services is also referred to as telepractice, telemedicine and teletherapy, among others. However, for consistency, throughout this guidance, the RCSLT will refer to the use of remote services as ‘telehealth’. 

Related guidance areas:

The scope of this guidance

This guidance is aimed at all SLTs, regardless of setting or client group or their previous experience of using telehealth, and is intended to: 

  • provide practical guidance and examples of best practice for delivering speech and language therapy remotely; and
  • enable individuals/organisations to understand telehealth options, help justify their decision making and support the implementation at your local level. 

This guidance does not:

  • identify / address every individual risk that may be associated with using telehealth in your speech and language therapy practice; 
  • provide recommendations about specific data management processes, platforms and tools; or
  • replace local and national guidance. 

Please contact us if you have any suggestions or feedback on these pages.  

Last updated: 02 July 2020

Key considerations

Appropriateness for using telehealth 

In this section, we highlight some key aspects to consider when introducing telehealth in your service. 

If you or your service decide to provide a remote healthcare service, appropriateness for using telehealth should be determined on a case-by–case basis, with selections firmly based on the following:

  • Clinical judgement
  • The service user’s informed choice
  • Professional standards of care
  • Telehealth being appropriate for your service user 
  • Access to technology by the service user and/or family

When deciding whether telehealth is appropriate to use, clinical decisions should be made while considering the service user's cognitive, physical or perceptual impairments. We also suggest considering what family, carer or teaching support that the service user has available to them to support their access to the technology, for example where there are literacy or language barriers.

In the event that telehealth is not suitable we suggest discussing the alternative options available (in your organisation and/or setting), including face-to-face (in-person) therapy with your service users, families and or carers. 

If considering whether face-to-face is the most appropriate option, we recommend that you refer to the RCSLT guidance on reducing the transmission of COVID-19 and use of personal protective equipment. This guidance also includes a risk assessment framework and decision making flowchart.

Digital inclusion

Over recent years the role of digital has increased substantially within our society:  

"Since 2005 the number of people using the internet worldwide has quadrupled to four billion and two thirds of the world’s population now own a mobile device ... However, 3.6 billion people still have no access to the internet, and as information, communication and service access increasingly becomes “digital by default,” those citizens who are the least connected risk becoming digitally marginalised" (Hernandez and Roberts, 2018).

"In 2018 there were still 5.3 million adults in the UK, or 10.0% of the adult UK population who are non-internet users" (Office for National Statistics, April, 2020).


Some sections of the population are more at risk of digital exclusion than others, these include people:

  • in specific age groups (such as older people) 
  • with disabilities 
  • in lower income groups or without a job 
  • living in rural areas
  • in social housing or homeless people
  • whose first language is not English (NHS Digital, 2020)

There is a clear and strong relationship between groups that are digitally excluded and those at greater risk of poor health. People from excluded groups or living in deprived areas often lack the skills, ability and means to get online.  

It is therefore important to consider access to technology when considering use of telehealth with your service users. NHS England (also see further reading for UK wide information on digital inclusion) have provided some suggestions for how organizations can support digitally excluded patients by:

  • training their staff to be digital health champions who can support patients with using digital tools
  • connecting with local community organizations providing access and digital skills support, for example, libraries, Online Centres
  • working with and enabling local charities who already engage with deprived communities, for example, homeless charities, social housing groups, charities supporting older people etc.
  • Socially prescribing digital interventions and establishing digital health hubs in the community where people can go to get help and support to use digital health tools

For further reading on digital inclusion: 

Benefits of telehealth

During the COVID-19 pandemic, using telehealth can help avoid unnecessary in-person contact, while the broader benefits of using telehealth are:

  • improving accessibility to services, particularly for individuals affected by limited mobility or access to transport;
  • assisting in caseload prioritisation, allowing for intensive treatment regimes, reduced length of stay in hospital, longer term rehabilitation management; and
  • offering a cost effective use of healthcare funds.

In addition, helping people who are digitally excluded to access and use digital health services and tools can: 

  • improve their health literacy & help people to better manage their health and care
  • offer people a better choice and convenience of service that suits their day to day lives
  • improve our relationships and how we communicate with patients
  • reduce the cost and burden on frontline services (NHS England, 2020)

In an evaluation of the NHS Widening Digital Participation Programme, of those who received support:

  • 59% of people were better able to access and use online health information
  • 65% felt more informed about their health
  • 51% have used the internet to explore ways to improve mental health and wellbeing (e.g. strategies for managing stress).
  • 21% made fewer GP appointments as a result of accessing online information e.g. NHS.UK

Overall, digital inclusion interventions showed a return on investment of £6.40 for every £1 spent (NHS Digital, 2020).

 
In addition, in order to monitor the impact and effectiveness of delivering services via telehealth, SLTs are encouraged to collect outcomes data. The RCSLT has developed the RCSLT Online Outcome Tool to support the collection and reporting of outcomes.
 
In response to COVID-19, the RCSLT has also been working with SLT members to develop additional online resources, including an app for collecting data for patients with confirmed or suspected COVID-19.

 

While we have outlined the benefits of using telehealth, we also appreciate that there are risks associated and these can vary across clinical settings. Therefore, we encourage you to visit the RCSLT’s Clinical Topics A-Z (containing specific information for the different clinical areas), our managing risk section and both the assessment and resources sections in this guidance, for further information. 

 

Responsibilities

Visit Professional Autonomy and Accountability for guidance to support you in adhering to the standards of the regulator, the Health Care Professions Council (HCPC). 

Key sections of the standards include:

  • Promote and safeguard the interests of service users and carers
  • Communicate appropriately and effectively
  • Delegate appropriately
  • Respect confidentiality   
  • Manage risk

The standards also highlight the importance for all SLTs to:

  • Understand the legislation
  • Act as resource investigators
  • Build supportive infrastructure
  • Work in partnership

Insurance

One of the benefits of being an RCSLT member is that your annual membership includes professional indemnity/medical malpractice cover as part of the insurance provision under the RCSLT’s group policies.

Below is an extract from the RCSLT insurance policy: 

“The RCSLT insurance cover is designed to protect all members whilst working with the standards set by the HCPC, within the scope of Speech and Language Therapist and within their own scope of practice. 

This cover will also cover members who are, as part of their daily work, working in what could be seen as an extended role i.e. working in a way which may be outside of the current remit of an SLT but that has an emerging evidence base etc. as long as this falls within what could conceivably be something which an SLT is best placed to do, the member is appropriately trained and has ongoing supervision/support to do this (falls within their own scope of practice).”

If you have any concerns about whether your proposed work is covered by the RCSLT insurance policy then please contact the RCSLT’s Insurance Broker, Premierline Insurance Broker. Contact details can be found here

If you have additional insurance we suggest that you inform your insurance company you are implementing a telehealth service, while also requesting written confirmation that telehealth services are being covered by your insurance provider, particularly if you work in dysphagia.

Equipment and technical support

In preparation for introducing telehealth, you may need to do the following:

  • Ensure that you have the equipment required to deliver speech and language therapy digitally. Video-conferencing solutions will require a computer with a broadband internet connection, webcam and microphone.  
  • Develop new skills and undertake training to use new technology.
  • Identify sources of technical support, both during the set-up phase and for ongoing troubleshooting.

More information is available in the 'selecting a platform' section. 

To share learning in this area, please contact the RCSLT to find out how. Independent practitioners can also seek support and advice via the Association of Speech and Language Therapists in Independent Practice (ASLTIP) forum.

Other considerations

Before starting to use telehealth, it will be necessary to communicate this to all key stakeholders, including service users and others, and the funders of your service.

Depending on where your service is typically delivered and how it is funded, you may need to provide additional documentation such as a risk assessments and data protection impact assessments. In some circumstances, contracts and/or terms and conditions may need to be amended to stipulate you are providing services via telehealth. 

This documentation may need to be in place and authorised before you contact service users and others about the use of telehealth to deliver therapy. 

For more templates and more information, please see the resources and information governance sections. 

Telehealth provides an alternative method of delivering a high quality, valuable service. Nevertheless, SLTs in independent practice may decide to review their fees. If so, it is suggested that you consider factors like your costs, overheads and the increased planning time that telehealth may require. 

You need to communicate any changes in your fees clearly to your service users before commencing therapy via telehealth.

Consent to use telehealth

In deciding that telehealth may be suitable to use with a service user, it is important that you gain informed consent from them before commencing telehealth sessions, as you would for in-person therapy. Please see the RCSLT guidance on consent.

In addition to this guidance, we suggest that you consult any local and national guidelines related to consent for telehealth that are relevant and applicable to your service. 

For example, according to guidance issued by NHSX during the COVID-19 pandemic, the consent of the service user is implied by them accepting the invite and entering the consultation. 

As part of the process of obtaining consent, we suggest that you inform service users of: 

  • their rights and responsibilities when receiving assessment, intervention or training using telehealth (including their right to refuse this mode of delivery)
  • the principles of telehealth and the evidence to support its effectiveness to support their decision making
  • the key aspects to be aware of related to security, and;
  • the alternative service provision options, should the service user decline, or is unable to access, therapy sessions via telehealth.

On gaining consent, ensure you have documented this in your clinical notes. Informed consent to telehealth can be given in verbal or written (e.g. via email) form. 

You can find some example forms in the consent section in our resources

We also encourage you to consider the following:

Information governance and telehealth

This section provides guidance for SLTs around information management and data protection when implementing telehealth.

More detailed information can be found in the RCSLT information governance guidance.

This section details best practice to enable individuals/organisations to understand options and justify their decision making. It is not intended to replace or override local context, service, organisational or government guidance. Instead, the focus is on practical, profession-relevant strategies to translate existing guidelines into clinical practice.

Key policies and authorities on information management

This section highlights some key policies and national authorities providing guidance on information management, which is relevant when using telehealth. It is not designed to explore this in detail.

More information about the national guidance and legislation relevant to information governance is available here

Please note: This guidance will continue to be updated to include guidance and UK-wide national policies.

Information Commissioner’s Office (ICO)

The ICO is the UK’s independent authority set up to uphold information rights in the public interest, promoting openness by public bodies and data privacy for individuals.

National Cyber Security Centre (NCSC) 

The NCSC is the UK's independent authority on cyber security.

Assessing and managing risk

Throughout their practice, including when using telehealth, SLTs are responsible for complying with the data protection law. As part of the accountability principle, individuals are required to take responsibility for processing personal data, and this includes assessing and managing risk.

This resource follows the key principles of the GDPR Data Protection Impact Assessment (DPIA) process. This process is designed to support the systematic analysis, identification and minimisation of data protection risks related to a project or plan involving telehealth.

The ICO has created templates to support with undertaking a DPIA:

The data protection officer within your organisation can assist with assessing and managing risk. Depending on the size and type of your employing organisation, you may also have a dedicated department to support with completing and signing off DPIAs (e.g. an IT or information governance department in the NHS).

When completing a DPIA for using a specific platform to deliver speech and language therapy services remotely, you will need to have a detailed knowledge of:

  • the client group;
  • the requirements of the telehealth activities; and
  • the capability of the chosen platform.

The resources section contains some examples of DPIAs for specific platforms, developed in response to the COVID-19 pandemic. 

Please note: these are examples that have been shared for illustration purposes only. No endorsement is expressed or implied. 

Maintaining security during telehealth sessions

A DPIA supports individuals to undertake an assessment of the risks and identify measures to reduce risk before starting to use a specific platform or new piece of technology.

However, assessing and managing risk will be a continual process when delivering speech and language therapy via telehealth.

Here are some practical considerations, designed to support SLTs with maintaining security during telehealth sessions.

Selecting a platform

Conferencing is possible from a desktop computer, laptop, or smartphone rather than requiring a dedicated, specially equipped room. 

There may be platforms approved by your employer. Follow local guidance for approved platforms or discuss this with your health informatics/IT department.

Below you will find some examples of desktop videoconferencing software used for telehealth by SLTs and other services. These tables compare:

  • basic specifications; and
  • basic functionality

Please note: The RCSLT cannot recommend specific platforms, apps or resources and this table offers a comparison of some available platforms.

However, please also note that this: 

  • is a list of commonly used platforms to illustrate the differences; and 
  • is not exhaustive and other platforms are available. 

 

Telehealth comparision 

 

Telehealth platform comparision 

 

Other software considerations

When deciding which software or platform to use we also suggest you consider the following factors.  

Privacy settings 

  • Ensure that you understand all of the security features of your chosen platform prior to your first telehealth session.
  • Check the level of encryption. Ensure that the site name begins with ‘https://’ and has a padlock symbol next to the URL in the browser bar. There are a variety of online website encryption checkers to check that any platforms and website resources you share are secure. 
  • More information about a company’s privacy settings and use of data can be found through Polisis
  • UK Safer Internet Centre provides information on some commonly used platforms when considering video conferencing options for use with children and young people.

System Requirements

Different functionalities (e.g. screen sharing, giving remote control, increased people on the call, etc.) require different systems and bandwidth. 

See here for an example of bandwidth requirements and here for broadband testing.

 

Recording

Should you wish to record a telehealth session, we encourage you to do the following: 
  • Gain consent as per current guidelines
  • Check the privacy settings of the platform 
  • Refer to local information governance policies 
  • Ensure that the recording is saved to a secure local drive (e.g. a drive on your PC/MAC rather than ‘cloud storage’) and uploaded to the service user’s record
  • Consider ways to record securely and where it will be stored. Follow usual data storage procedures to save to computer: 
    • Screen recording software - e.g. bandicam, screencast-o-matic
    • MS Windows - windows/Alt/R
    • Mac - shift/command/5 (see infographic table)

The illustration below explores other considerations when preparing to record a therapy session.

Recording a session

Please see our resources section for:

  • Case studies illustrating how services have implemented various platforms (available in the 'implementation of telehealth' section of this guidance).  
  • User guides and information sheets about different platforms (available under ‘selecting a platform’, in the resources section).

Carrying out a telehealth session

Before implementing telehealth we suggest that you consider whether it is appropriate and how you will support your service users and others to access the delivery of therapy.

For those for whom it may not be appropriate, SLTs can still offer a supportive service indirectly, through those who remain physically close to the person (others). For example, with coaching, training, advice and support. 

While many SLTs are learning how to work remotely for the first time, so too are some service users and others. 

While deciding if the implementation of telehealth is appropriate, we encourage you to contact the service user or family to enquire what they have access to within their home environment; e.g. a printer, good internet access, headphones, an electronic device with a camera (PC, laptop, tablet, mobile).

This information could be obtained via the telephone, email or even by post. 

Please see 'carrying out a telehealth session' in the resources section for some useful documents that you could send to your service users and/or their families/carers.

It is important to remember that your clinical decision making is no different to in-person sessions; however, additional considerations are required. For more information regarding best practice see here

See below for a step-by-step guide to ensure a supportive approach when starting telehealth with your service users and their families.

1. Gaining consent

More information can be found in the consent section of this guidance.

2. Getting set up

Once consent is obtained, SLTs can support the service user in setting up the agreed platform. We suggest providing them with handouts, which could contain information on the platform and helpful tips for setting up the ideal environment for the session. 

User guides and information sheets are available under 'carrying out a telehealth session' in the resources section.  

3. Before your first telehealth session

Before your first therapy session, SLTs could consider a session with the service user and others to practice using the platform, and to discuss: 

  • jointly agreed expectations of therapy including support from families/carers, and reducing background distractions;  
  • any current concerns;
  • appropriate and meaningful targets relevant to the current (remote) situation; and
  • resources available at home for therapy and/or assessment (e.g. toys for children, thickener and/or prepared foods for dysphagia reviews/assessments).

See the section on assessment for more information.

It may be that previous targets need to be adapted or changed based on the current needs of the service user. 

We suggest SLTs are mindful of the service user's wellbeing and their expectations of what you can provide and what they can carry out. Service users may have external factors that could impact your therapy.

We encourage you to support individuals and others to feel empowered in order to guide the therapy programmes and plans that you are delivering; including the setting of realistic and meaningful targets (see section on ‘empowering families’).

Tip: Ensure you have the service user's telephone number if technology fails and you need to guide them through setting up the platform or troubleshooting.

4. Carrying out therapy

Once the therapy session is underway you can support your service user and others by doing the following:

  • Being open and transparent 
  • Clarifying the expectations and aims of the session, as you would in any therapy session
  • Allowing time for discussion and questions, at the beginning and/or end of the session (e.g. concerns, behaviours, difficulties they may be facing at home, updates since the last session)
  • Checking that they can hear you well and can see the same thing as you (if you are sharing resources via screen share) 
  • Agreeing a time and date for the next session
  • Being explicit and not assuming that the service user and others can interpret what you are saying or doing (telehealth may limit the amount of non-verbal communication we typically use in-person)
  • Modelling, observing and providing feedback to families/carers for any therapy activities you are recommending they carry out at home 
  • Offering weekly check-ins if sessions are irregular or consultative
  • Providing printed or digital visual supports to use before, during or after the session, such as: 

5. After the session

Following the telehealth session we suggest completing your clinical notes, and sending any resources to the service user and/or others with details of the next appointment (with the video link). 
 
As with in-person sessions, remember to raise any safeguarding concerns with the appropriate safeguarding lead/organisation.
 
We recommend you request feedback on the therapy to help you refine future sessions. Online questionnaires are useful for collating feedback and this feedback could ultimately help the growing evidence base for telehealth. 

 

Please also see the resources section for more information.

Empowering service users and others 

Promoting and protecting the interests of service users is a requirement of all HCPC registrants

To help you do this when carrying out therapy remotely, we encourage you to: 

  • Discuss current goals 
    Considering many adults are currently home working, discuss what goals would best benefit them. If their goals and priorities may change, discuss this in the first session and review these goals regularly. Their priorities and goals may fluctuate and change dependent on their current concerns and availability. 
  • Ask for feedback 
    Following the session we suggest asking service users and others to complete a brief questionnaire on the session. This can give them an opportunity to voice their ideas and provide you with constructive feedback on your sessions.

Questions could include: 

  • What did you like/not like about the session? 
  • How useful was the session?
  • How well did your SLT listen to your needs?
  • How well did your SLT explain the activities and their connection to the service users goals?
  • What could be improved? 
  • Would you like another session? (And if not, ask for reasons)
  • How easy did you find the technology for your session? 

See 'empowering service users' in the resources section for an example feedback form.

Give time to service users and others 
This will enable them to discuss their concerns and wellbeing. It is crucial in this current situation that we are also supporting and promoting wellbeing.

Ask families and/or carers to be involved in the session 
They can get involved by participating or being coached through delivering the activities. They will then be able to replicate similar activities at home with confidence. We suggest coaching families through reflection and feedback once they have carried out the activities to increase effectiveness and understanding of the activity.

Reassure families and/or carers 
We suggest that you reassure them throughout therapy sessions that you do not expect them to become experts. Empower them by focusing on areas in which they feel confident and comfortable, while asking them what they feel is achievable.  

Provide specific adaptations to therapy activities 
They could therefore continue to step activities ‘up and down’ throughout the week before your next session. It can be useful to talk about the goals and types of cues they can use to help. If possible, offer availability for service users and others to contact you via email or telephone if they require any further support before your next session.

Provide therapy activities and ideas 
Service users and others can carry these out during their everyday activities. Although, be aware of overloading them with activity requests that may not be achievable. If you are providing resources, consider the best format for this (i.e. digital, printed). 

During gaps in therapy, SLTs can work with the service users and others to carry out adapted therapy activities/programmes so their progress towards their target continues.

Please see an illustration to summarise the information above.

Please see the resources section for more information.

Remote assessments

In this section you will find information on:

  • Administering assessments via telehealth 
  • Administering formal assessments via telehealth
  • Licensing, copyright and intellectual property
  • Considerations when assessing particular client groups:
    • Speech assessment considerations
    • Dysphagia assessments 

Administering assessments via telehealth

Like many clinical services, speech and language therapy is traditionally based on in-person verbal interaction between the individual and the clinician. 

This section of the telehealth guidance outlines some key considerations when delivering speech and language therapy assessments remotely.

Assessment methods have historically relied on tasks and interpersonal processes that require in-person interaction, such as the manipulation of physical materials, standardised interactions between the therapist and service user, and clinical observation of the person in a physical environment (Wright et al 2020).

When delivering assessments remotely the options may include:

  • pausing aspects of assessment services;
  • using informal assessment;
  • using digital versions of the assessment;
  • scanning assessments;
  • careful manipulation and handling of physical assessments; and
  • using a visualiser.
Best practice is to try and ensure your assessments, when carried out through telehealth platforms, align with the following standards:

 

There is an emerging evidence base around the administration of speech and language therapy assessments via telehealth, which indicates that telehealth assessment works and is acceptable (Edwards et al 2012; Waite et al 2010, 2006). 

Please also see 'evidence base' in the for more information.  

However, before administering an assessment remotely, it is necessary to decide whether a telehealth assessment is suitable for the individual that you are working with (Tucker 2012). 

There are a number of key considerations to be aware of before undertaking an assessment remotely. Prior to administering the assessment remotely, we suggest that you also consider the following:

  • Prepare carefully for the assessment as you would usually do, including: 
    • undertaking a risk assessment 
    • gathering information about the service user, including any information that will influence the suitability of the assessment process (e.g. any linguistic, cultural or communication barriers)
    • ensuring that you have all of the materials available
  • Practice using the assessment via telehealth (for example, with a colleague) 
  • Keep the administration of the assessment as similar as possible to how it would be administered when carrying it out in-person. 
After administering the assessment remotely, we then suggest that you consider the following:

 

  • Clearly document that the assessment was completed remotely in the health and care record and in any reports, including the duration it took to complete the assessment.
  • Overtly discuss and address the validity of the data gathered, using professional judgement to determine whether it was a true representation of the service user or whether further information gathering is required.  

The illustration below summarises some of these key considerations.

 

Telehealth


Administering formal assessments via Telehealth 

If your approach to assessing an individual involves the use of a formal assessment, there are some additional considerations when delivering this remotely.

 

Normative scores

There are normative score data considerations when moving from an in-person to telehealth administration. A normative score is only useful when:

  • You can administer the assessment in a standardised fashion
  • The service user is cooperative and responds to the assessment 
  • The assessment environment supports an optimum performance from the service user

As with all assessments, the SLT will need to use professional judgement to determine whether it is appropriate to use norms when administering a formal assessment remotely.

The following differences can have a detrimental impact on the validity of the assessment norms: 

  • A weak connection results in not being able to see or hear the service user clearly
  • The service user is distracted and/or not in optimum conditions
  • The SLT has had to deviate from the standardised procedure
  • The service user has to respond differently from the standardised response requirement

Conclusions or decisions based on data that are skewed are likely to no longer represent an individual’s abilities or functioning. We suggest that these factors are considered when deciding whether to: 

  • proceed with modified assessment procedures in the specific situation; 
  • use alternative measures that are available to use in a remote format; or 
  • wait until in-person services are again feasible.

Licensing, copyright and intellectual property

With published formal assessments there may be licensing, copyright and intellectual property considerations which restrict the way in which an assessment can be used. This is relevant to consider when planning to administer an assessment via telehealth. 

This illustration below summarises some of the key issues to be aware of.


Telehealth Licensing

Considerations about licensing, copyright and intellectual property also apply to the use of questionnaires and rating scales,including outcome measures and feedback forms. SLTs are advised to check whether there are restrictions on sharing these forms electronically (e.g. creating an online form, or sending via email or SMS). 

In response to an increased demand for clinicians to deliver services remotely, some publishers have modified their policies on how published tools can be used. These include the following:

  • Digitising assessments 
  • Emailing a link to the assessment interface to the respondent
  • Presenting stimuli over their remote platforms
  • Permission to allow you to be creative with their materials
  • Using document scanner equipment
  • Continuing as normal
Please note: The RCSLT cannot recommend specific assessment products or publishers. Any resources related to specific products in this guidance are provided for informational purposes only. No endorsement is expressed or implied. 
 
We suggest that SLTs check on publishers’ websites for more information about specific assessments.

 

Considerations when assessing particular client groups

This section sets out some key considerations for specific client groups. Though please note, it is not exhaustive and members are also encouraged to review the following RCSLT guidance: 

  • Clinical Topics A-Z 
    Contains specific information about assessment for the different clinical areas found within speech and language therapy
  • Managing risk
    Provides some useful information that could be relevant to undertaking telehealth assessments

Speech assessment considerations

When completing speech assessments we suggest that SLTs:

  • can see the service user’s mouth clearly — if the service user is wearing a headset, make sure that the microphone is not obstructing the view of their articulators;
  • check that the audio is clear with no background noise;
  • ensure adequate lighting conditions to view the user’s face while avoiding strong sources of light from behind the user;
  • assess the quality of images and audio, as this can impact the confidence of your assessment results (if recording the session please also ensure that you have consent for this). 

Dysphagia assessments 

Dysphagia assessments for adults and paediatric service users have been documented via telehealth in many clinical areas (Ward et al 2012; Malandraki & Kantarcigil 2017; Burns et al 2019) including:

  • Paediatrics (Luke & Ruchlin 2015, Raatz et al 2019)
  • Stroke (Morrel et al 2017)
  • Parkinson’s Disease (Theodoros et al 2019)
  • Head and Neck Cancer (Ward et al 2007)
  • Nursing Home residents (Bidmead et al 2015) 

Useful information on paediatric and adult dysphagia assessments via telehealth can also be found under 'remote assessments' in the resources section

Speech Pathology Australia also provides a lot of information relevant to this area. 

Remote dysphagia assessments require a risk assessment to be done, and such risks include:

  • loss of video connection during assessment meaning that the therapist cannot see the assessment;
  • instructions not followed/heard by assistant;
  • change in patient status;
  • aspiration/respiratory changes;
  • choking; and
  • need for emergency procedures for the above risks.

We also suggest that you clearly outline emergency procedures. Below are some considerations for developing these: 

  • Who is responsible in an emergency?
  • Are all the relevant parties involved, informed and do they understand their role?
  • What process(es) should be followed should an issue arise (e.g. choking, altered health state of service user)?
A useful table of emergency management and troubleshooting can be found here.

You may also need to consider:

  • Procedures for access to thickener for assessment (e.g. sending out sachets or thickener tubs before the assessment with instructions for family members or a video consultation to take an assistant/family member through the instructions).
  • Providing training and supporting resources to staff/carers and families. This will help them with understanding the assessment process and their role in supporting, enhancing diagnostic accuracy and reducing risks for the service user. 

The resources under 'remote assessments' in the resources section will provide some further information about telehealth assessments for dysphagia.

 

Evidence-based practice

The following resources provide a summary of evidence and research relating to telehealth: 

Finding evidence 

Access research articles through our RCSLT Journals Collection, and more resources to support using evidence-based practice in our Research Centre.

Articles

This section contains a list of relevant articles about telehealth. Please note that this list is not exhaustive. Please contact us with any suggestions.

Bernie, E. (2019). Critical Review: What is the efficacy of a telepractice service delivery model when compared to traditional on-site therapy for school-aged children receiving speech sound intervention (SSI)? (Masters Dissertation, University of Western Ontario, Ontario, Canada). Available at https://www.uwo.ca/fhs/lwm/teaching/EBP/2018_19/Bernie.pdf <Accessed 14 May 2020>

Bidmead, E., Reid, T., Marshall, A., & Southern, V. (2015). "Teleswallowing": A case study of remote swallowing assessment. Clinical Governance, 20 (3), 155-168. 10.1108/CGIJ-06-2015-0020.
 
Burns, C. L., Ward, E. C., Gray, A., Baker, L., Cowie, B., Winter, N. & Turvey, J. (2019). Implementation of speech pathology telepractice services for clinical swallowing assessment: An evaluation of service outcomes, costs and consumer satisfaction. Journal of Telemedicine and Telecare, 25 (9), 545–551. 10.1177/1357633X19873248.

Elkbuli, A., Ehrlich, H., & McKenney, M. (2020). The effective use of telemedicine to save lives and maintain structure in a healthcare system: Current response to COVID-19. American Journal of Emergency Medicine. 10.1016/j.ajem.2020.04.003.
 
Greenhalgh, T. & IRIHS research group (2020). Video consultations: information for GPs.
Available at https://design-science.org.uk/wp-content/uploads/2020/05/NHS_VC_Info-for-GPs.pdf <Accessed 14 May 2020> 

Greenhalgh, T., Wherton, J., Shaw, S. & Morrison, C. (2020). Video consultations for COVID19 – An opportunity in a crisis? BM, 368. 10.1136/bmj.m998.
 
Greenhalgh, T., Wherton, J., Shaw, S. & Morrison, C. (2020). Video consultations for covid-19. BMJ, 368, 998. 
 
Grogan-Johnson, S., Alvares, R., Rowan, L., & Creaghead, N. (2010). A pilot study comparing the effectiveness of speech language therapy provided by telemedicine with conventional on-site therapy. Journal of Telemedicine and Telecare, 16 (3), 134-139.

Hernandez, K. and Roberts, T. (2018). Leaving No One Behind in a Digital World. K4D Emerging Issues Report. Brighton, UK: Institute of Development Studies.

Hill, A. & Theodoros, D. (2002). Research into telehealth applications in speech-language pathology. Journal of Telemedicine and Telecare, 8 (4), 187-196.
 
Howell, S., Triptoli, E. &  Pring,T. (2009).Delivering the Lee Silverman Voice Treatment (LSVT) by web camera: a feasibility study. International Journal of Language Communication Disorders, 44 (3), 287-299.
 
Leite, H., Hodgkinson, I. R. &Gruber, T. (2020). "New development: ‘Healing at a distance’—telemedicine and COVID-19." Public Money & Management. 10.1080/09540962.2020.1748855

Marshall, J., Booth, T., Devane, N., Galliers, J., Greenwood, H., Hilari, K., et al. (2016) Evaluating the Benefits of Aphasia Intervention Delivered in Virtual Reality: Results of a Quasi-Randomised Study. PLoS ONE 11(8): e0160381. https://doi.org/10.1371/journal.pone.0160381 <Accessed 15 May 2020>.

Mathers, A. (2016) The Buckinghamshire remote therapy project, RCSLT Bulletin, March, 18-19.

Matthews, R. (2014). The ‘acceptability’ of Skype mediated Speech and Language Therapy provision to school aged language impaired children (Doctoral Thesis, UCL, London, UK). Available at https://discovery.ucl.ac.uk/id/eprint/1435404/ <Accessed 14 May 2020>.

Mold, F., Hendy, J., Lai, Y. L. &  de Lusignan, S. (2019). Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review. JMIR Medical Informatics, 7 (4), e13042.

Molini-Avejonas, D.R., Rondon-Melo, S., de La Higuera Amato, C.A., Samelli, A.G., 2015. A systematic review of the use of telehealth in speech, language and hearing sciences. Journal of Telemedicine and Telecare, 21(7), 367-376.
 
Morrell, K., Hyers, M., Stuchiner, T., Lucas, L., Schwartz, K., Mako, J., Spinelli, K. J. & Yanase, L. (2017). Telehealth Stroke Dysphagia Evaluation Is Safe and Effective. Cerebrovascular Diseases, 44 (3-4), 225-231. 10.1159/000478107.

 

NHS Digital, https://digital.nhs.uk/about-nhs-digital/our-work/digital-inclusion/what-digital-inclusion-is (accessed, June 2020)

NHS England, https://www.england.nhs.uk/ltphimenu/digital-inclusion/digital-inclusion-in-health-and-care/ (accessed, June 2020)

Office for National Statistics, (2020)

Ohannessian, R., Duong, T. A., & Odone, A. (2020). Global Telemedicine Implementation and Integration Within Health Systems to Fight the COVID-19 Pandemic: A Call to Action. JMIR Public Health and Surveillance, 6 (2), e18810.
 
Palsbo, S. (2007). Equivalence of functional communication assessment in speech pathology using videoconferencing. Journal of Telemedicine and Telecare, 13 (1), 40-43.
Raatz, M. K., Ward, E. C., & Marshall, J. (2019). Telepractice for the Delivery of Pediatric Feeding Services: A Survey of Practice Investigating Clinician Perceptions and Current Service Models in Australia. Dysphagia, 35, 378–388. 10.1007/s00455-019-10042-9.

Reese, R. M., Jamison, R., Wendland, M., Fleming, K., Braun, M. J., Schuttler, J. O., & Turek, J. (2013). Evaluating interactive videoconferencing for assessing symptoms of autism. Telemedicine and e-Health, 19 (9), 671–677. 10.1089/tmj.2012.0312.

Robbins, T., Hudson, S., Ray, P., Sankar, S., Patel, K., Randeva, H., & Arvanitis, T. N. (2020). COVID-19: A new digital dawn? Digital Health. 10.1177/2055207620920083.

Shankar, M., Fischer, M., Brown-Johnson, C. G., Safaeinili, N., Haverfield, M. C., Shaw, J. G.,  Verghese, A. & Zulman, D. M. (2020). Humanism in telemedicine: Connecting through virtual visits during the COVID-19 pandemic. Annals of Family Medicine. Preprint. Available at https://deepblue.lib.umich.edu/handle/2027.42/154738 <Accessed May 2020>. 

Shaw, S., Seuren, L., Greenhalgh, T., Cameron, D., A’Court,  C., Vijayaraghavan, S., Morris, J., Bhattacharya, S. & Wherton, J. (2020). Interaction in Video Consultations: a linguistic ethnographic study of video-mediated consultations between patients and clinicians in Diabetes, Cancer, and Heart Failure services. Journal of Medical Internet Research, 22 (5), e18378.

Styles, V. (2008). Service users' acceptability of videoconferencing as a form of service delivery. Journal of Telemedicine and Telecare, 14, 415-420.
Technology Enabled Care in Scotland (2020). Coronavirus resilience planning: Use of Near Me video consulting in GP practices. Available at https://tec.scot/wp-content/uploads/2020/03/Near-Me-Covid19-Primary-Care-Guidance-v1-pdf-version.pdf <Accessed 14 May 2020>

Theodoros, D., Aldridge, D., Hill, A. J., & Russell, T. (2019). Technology-enabled management of communication and swallowing disorders in Parkinson's disease: a systematic scoping review. International Journal of Language and Communication Disorders, 54 (2), 170-188. 10.1111/1460-6984.12400.

Trethewey, S. P., Beck, K. J., & Symonds, R. F. (2020). Video consultations in UK primary care in response to the COVID-19 pandemic. British Journal of General Practice, 70 (694), 228-229.

Ward, E., Sharma, S., Burns, C., Theodoros, D., & Russell, T. (2012). Validity of Conducting Clinical Dysphagia Assessments for Patients with Normal to Mild Cognitive Impairment via Telerehabilitation. Dysphagia, 27 (4), 460-472. 10.1007/s00455-011-9390-9.
 
Ward, L., White, J., Russell, T., Theodoros, D., Kuhl, M., Nelson, K., & Peters, I. (2007). Assessment of communication and swallowing function post laryngectomy: A telerehabilitation trial. Journal of Telemedicine and Telecare, 13 (3_suppl), 88–91. 10.1258/135763307783247293.

Wherton J, Shaw S, Papoutsi C, et al (2020) Guidance on the introduction and use of video consultations during COVID-19: important lessons from qualitative research, BMJ Leader Published Online First: 18 May 2020. doi: 10.1136/leader-2020-000262.

Woolf, C., Caute, A., Haigh, Z., Galliers, J. R., Wilson, S., Kessie, A., Hirani, S. P., Hegarty, B. & Marshall, J. (2016). A comparison of remote therapy, face to face therapy and an attention control intervention for people with aphasia: A quasi-randomised controlled feasibility study. Clinical Rehabilitation, 30 (4), 359-373. Available at: https://openaccess.city.ac.uk/id/eprint/8288/ <Accessed 15 May 2020> 

Implementation of telehealth

In this section you will find case studies illustrating how speech and language therapy services have adapted the way they deliver their services by using telehealth.

Please note: these are for reference only.

Case studies 

We are aware that there are other examples of good practice across the profession and we would encourage you to share your experiences with us. If you have an example that you would be happy to share in this section, please contact us at info@rcslt.org

 

National guidance and policy  

Here you will find links to relevant UK-wide legislation, policy and frameworks.

Please note: The resources throughout this guidance are provided for informational purposes only. No endorsement is expressed or implied, and while we make every effort to ensure our pages are up to date and relevant, we cannot take responsibility for pages maintained by external providers.

UK-wide

England

Wales

Key bodies to be aware of when planning the implementation of a Telehealth Service in Wales include:

Scotland

Northern Ireland

  • AHP Virtual Consultation Guidance: this guidance was developed by a group of AHPs from across Northern Ireland and collates available resources on virtual consultation including the evidence base, patient selection, the consultation and evaluation.

 

FAQs

Please see below for a selection of FAQs taken from the RCSLT telehealth webinar held on 12 June 2020. 

The free telehealth webinar was chaired by Judith Broll, Director of Professional Development, RCSLT and featured presentations by:

  • Rachel Radford, Clinical Specialist Speech and Language Therapist
  • Rebekah Davies, Digital Health Clinical Practitioner, SLT - Dysphagia/Voice/Head & Neck Cancer
  • Ellie Jones, SLT in Stroke Therapy Team

With support during the Q&A session by:

  • Shermeena Rabbi, Consultant SLT
  • Meera Mehta,  Highly Specialist SLT 

You can download the full telehealth FAQ document by visiting the RCSLT webinar webpage. This document contains many more FAQs around different topic areas relating to telehealth.

If you have a specific question, on a specific topic, to save time we encourage you to search the PDF. If you unsure how to do this, please follow these instructions:

  1. Open the document 
  2. On your keyboard press ‘ctrl + F’ simultaneously
  3. In the box that opens (top right corner) type your 'key term' and press enter. 
  4. It should then highlight all questions containing that keyword.

Please see below for a small selection of those FAQs.

Q: What level of support is being offered to NQPs starting at this time?

A: (Rachel) I’m not aware of anything specific but it would be good to share information as we get new starters into our departments. We are using microsoft teams for clinical supervision video sessions and electronic patient records mean we can screen share and access records to support new therapists. Making sure they are established on the telehealth platform is important.

A: (Meera) I am currently supervising an NQP who works in mainstream and special schools. The supervision has continued on our online platform (Google meets) on a weekly basis. We also have a google chat platform on our system and the NQP and supervisee are able to communicate, where required, during the day (to ask quick questions).

The NQP has been carrying out therapy sessions and phone reviews online since March 2020. We have access to weekly meetings for mainstream therapists and special school therapists where the team discusses speech and language therapy sessions and shares resources.

I have also attended and observed online sessions with my supervisee with consent from parents and provided support where required e.g speech sessions, attention autism sessions and remote PECS sessions. My supervisee has also had the opportunity to observe myself and other experienced therapists on the team to get a better idea on how to run sessions remotely.

The NQP therapist was also allocated time to attend webinars on teletherapy as soon as we knew we were going to run these. There are several American platforms running telehealth webinars on how teletherapy works while Facebook has a lot of telehealth groups which talk about starting teletherapy.

As a team, we have weekly coffee meetings (informal) where we are able to brainstorm and catch up as a team. This is also a platform for therapists to ask questions where stuck.

 

Q: Is there a hub where people are sharing resources re: teletherapy?

A: (Rachel) Yes, the RCSLT Telehealth Professional Network.

The RCSLT has established a new online community platform (or professional network) where members can share information, ideas and mutual support on the topic of telehealth.

The Professional Network is open to all members, providing an opportunity to connect and network across specialisms and geographical boundaries.
To sign up to the online platform, please fill out your details here.

 

Q: I work in a community clinic and specialise in Parkinson’s but do pick up other patients and I have booked a young man with a Cochlear Implant and he wants to improve his speech. I’m aware that video consulting may impact on quality of sound and he sometimes uses a BSL interpreter. I have limited experience with this client group and it would be good to find out how to incorporate BSL interpreter

A: (Rachel) You could invite the interpreter onto the call if they are able to join remotely so that all three of you can be seen. If they can be present with you in the clinic and be seen by the webcam whilst socially distancing, this might work.

We have done this for MDT clinics but others may have had direct experience with BSL interpreters and telehealth, this is also a good resource.  

 

Q: How do we ensure that offering telemedicine (or telehealth) is equitable and that we are able to reach families who do not have access to technology? Ensuring that we are not just targeting the middle class?

A: (RCSLT) We have recently updated our Telehealth guidance to include further information about the key things to consider when deciding whether telehealth is an appropriate option for the individuals that you are working with, including access to technology.

A: (Meera) Firstly, if parents do not have access to technology, the SLT can utilise that time owed to the students/school to create come programmes which the school can print and send to parents. This can have clear instructions of use with resources attached. The key is to keep it short and simple.

Secondly, if parents would like support but do not want to/cannot engage in teletherapy, the SLT can take short and simple videos of how to use the resources (which parents can duplicate at home).

And finally, the SLT can offer weekly/fortnightly/monthly phone calls to offer support to those who do not have access to the internet. For children in primary school, there are several items at home which can be used to make sessions fun and engaging which parents would be able to carry out e.g blanks level questions using items in the house, Picture Exchange Communication System (PECS) sessions using motivators + snacks at home, working on receptive language e.g. linguistic concepts (infront, behind, next to, on, under, etc.) using items at home.

The SLT would need to provide clear instructions on how to carry these out but I do feel that it is possible for all service users to gain some type of access to the speech and language therapy service (even if it is not by video).

 

Resources

The resources in this section and throughout this guidance are provided for informational purposes only. No endorsement is expressed or implied, and while we make every effort to ensure our pages are up-todate and relevant, we cannot take responsibility for pages maintained by external providers.

 

General resources 

 

Consent to use telehealth

Information governance and telehealth 

Selecting a platform

How to’s and user guides

Carrying out a telehealth session 

Empowering service users, families and carers

Remote assessments

Evidence-based practice

Implementation of telehealth 

References

Barts Health NHS Trust (2020). Quick guide for patients on video consultations. Available at https://www.bartshealth.nhs.uk/a-quick-guide-to-video-consultations-for-patients <Accessed 15 May 2020>.
 
Bernie, E. (2019). Critical Review: What is the efficacy of a telepractice service delivery model when compared to traditional on-site therapy for school-aged children receiving speech sound intervention (SSI)? (Masters Dissertation, University of Western Ontario, Ontario, Canada). Available at https://www.uwo.ca/fhs/lwm/teaching/EBP/2018_19/Bernie.pdf <Accessed 15 May 2020>

 

Bidmead, E., Reid, T., Marshall, A., & Southern, V. (2015). "Teleswallowing": A case study of remote swallowing assessment. Clinical Governance, 20 (3), 155-168. 10.1108/CGIJ-06-2015-0020.

Burns, C. L., Ward, E. C., Gray, A., Baker, L., Cowie, B., Winter, N. & Turvey, J. (2019). Implementation of speech pathology telepractice services for clinical swallowing assessment: An evaluation of service outcomes, costs and consumer satisfaction. Journal of Telemedicine and Telecare, 25 (9), 545–551. 10.1177/1357633X19873248.

Doughty, K., Monk, A., Bayliss, C., Brown, S., Dewsbury, L., Dunk, B., Gallagher, V., Grafham, K., Jones, M., Lowe, C. and McAlister, L. (2007). Telecare, telehealth and assistive technologies - do we know what we're talking about?. Journal of Enabling Technologies, 1(2), 6-10. Available at: http://telecareaware.com/wp-content/uploads/2008/12/jat1-2debate_article.pdf <Accessed 15 May 2020>

Edwards, M., Stredler-Brown, A., Houston, K.T. (2012). Expanding Use of Telepractice in Speech-Language Pathology and Audiology. Volta Review, 112(3) 227-242.

Elkbuli, A., Ehrlich, H., & McKenney, M. (2020). The effective use of telemedicine to save lives and maintain structure in a healthcare system: Current response to COVID-19. American Journal of Emergency Medicine. 10.1016/j.ajem.2020.04.003.

Great Britain, House of Commons (2020). HC coronavirus debate [Hansard], 11 March 2020, 673, col. 383. [Online]. Available at: https://bit.ly/2yTyHTq  <Accessed 15 May 2020>

Greenhalgh, T. & IRIHS research group (2020). Video consultations: information for GPs. Available at https://design-science.org.uk/wp-content/uploads/2020/05/NHS_VC_Info-for-GPs.pdf <Accessed 15 May 2020>

Greenhalgh, T., Wherton, J., Shaw, S. & Morrison, C. (2020). Video consultations for COVID19 – An opportunity in a crisis? BM, 368. 10.1136/bmj.m998.

Greenhalgh, T., Wherton, J., Shaw, S. & Morrison, C. (2020). Video consultations for covid-19. BMJ, 368, 998. 

Grogan-Johnson, S., Alvares, R., Rowan, L., & Creaghead, N. (2010). A pilot study comparing the effectiveness of speech language therapy provided by telemedicine with conventional on-site therapy. Journal of Telemedicine and Telecare, 16 (3), 134-139.

Hernandez, K. and Roberts, T. (2018). Leaving No One Behind in a Digital World. K4D Emerging Issues Report. Brighton, UK: Institute of Development Studies.

Hill, A. & Theodoros, D. (2002). Research into telehealth applications in speech-language pathology. Journal of Telemedicine and Telecare, 8 (4), 187-196.

Howell, S., Triptoli, E. &  Pring,T. (2009).Delivering the Lee Silverman Voice Treatment (LSVT) by web camera: a feasibility study. International Journal of Language Communication Disorders, 44 (3), 287-299.

Leite, H., Hodgkinson, I. R. &Gruber, T. (2020). "New development: ‘Healing at a distance’—telemedicine and COVID-19." Public Money & Management. 10.1080/09540962.2020.1748855

Luke, T. A., & Ruchlin, R. R. (2015). Telehealth technology and pediatric feeding disorders. in N. R. Silton  (Ed), Recent Advances in Assistive Technologies to Support Children with Developmental Disorders (1st ed.). Hershey, PA: IGI Global.

Malandraki, G. A., & Kantarcigil, C. (2017). Telehealth for Dysphagia Rehabilitation: The Present and the Future. Perspectives of the ASHA Special Interest Groups, 2 (18), 42-48. 10.1044/persp2.SIG18.42.
 
Marshall, J., Booth, T., Devane, N., Galliers, J., Greenwood, H., Hilari, K., et al. (2016) Evaluating the Benefits of Aphasia Intervention Delivered in Virtual Reality: Results of a Quasi-Randomised Study. PLoS ONE 11(8): e0160381. https://doi.org/10.1371/journal.pone.0160381 <Accessed 15 May 2020>.

 

Mathers, A. (2016) The Buckinghamshire remote therapy project, RCSLT Bulletin, March, 18-19.

Matthews, R. (2014). The ‘acceptability’ of Skype mediated Speech and Language Therapy provision to school aged language impaired children (Doctoral Thesis, UCL, London, UK). Available at https://discovery.ucl.ac.uk/id/eprint/1435404/ <Accessed 15 May 2020>.

Mold, F., Hendy, J., Lai, Y. L. &  de Lusignan, S. (2019). Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review. JMIR Medical Informatics, 7 (4), e13042.

 

Molini-Avejonas, D.R., Rondon-Melo, S., de La Higuera Amato, C.A., Samelli, A.G., 2015. A systematic review of the use of telehealth in speech, language and hearing sciences. Journal of Telemedicine and Telecare, 21(7), 367-376.

Morrell, K., Hyers, M., Stuchiner, T., Lucas, L., Schwartz, K., Mako, J., Spinelli, K. J. & Yanase, L. (2017). Telehealth Stroke Dysphagia Evaluation Is Safe and Effective. Cerebrovascular Diseases, 44 (3-4), 225-231. 10.1159/000478107.

NHS Digital, available at: https://digital.nhs.uk/about-nhs-digital/our-work/digital-inclusion/what-digital-inclusion-is accessed, June 2020

NHS England, available at: https://www.england.nhs.uk/ltphimenu/digital-inclusion/digital-inclusion-in-health-and-care/ accessed, June 2020

Office for National Statistics, (April 2020)

Ohannessian, R., Duong, T. A., & Odone, A. (2020). Global Telemedicine Implementation and Integration Within Health Systems to Fight the COVID-19 Pandemic: A Call to Action. JMIR Public Health and Surveillance, 6 (2), e18810.

Palsbo, S. (2007). Equivalence of functional communication assessment in speech pathology using videoconferencing. Journal of Telemedicine and Telecare, 13 (1), 40-43.

Raatz, M. K., Ward, E. C., & Marshall, J. (2019). Telepractice for the Delivery of Pediatric Feeding Services: A Survey of Practice Investigating Clinician Perceptions and Current Service Models in Australia. Dysphagia, 35, 378–388. 10.1007/s00455-019-10042-9.

Raman, N., Nagarajan, R., Venkatesh, L., Saleth Monica, D., Ramkumar, V. & Krumm, M. (2019). School-based language screening among primary school children using telepractice: A feasibility study from India. International Journal of Speech-Language Pathology, 21 (4), 425-434. 10.1080/17549507.2018.1493142.

Reese, R. M., Jamison, R., Wendland, M., Fleming, K., Braun, M. J., Schuttler, J. O., & Turek, J. (2013). Evaluating interactive videoconferencing for assessing symptoms of autism. Telemedicine and e-Health, 19 (9), 671–677. 10.1089/tmj.2012.0312.

Robbins, T., Hudson, S., Ray, P., Sankar, S., Patel, K., Randeva, H., & Arvanitis, T. N. (2020). COVID-19: A new digital dawn? Digital Health. 10.1177/2055207620920083.

Shankar, M., Fischer, M., Brown-Johnson, C. G., Safaeinili, N., Haverfield, M. C., Shaw, J. G.,  Verghese, A. & Zulman, D. M. (2020). Humanism in telemedicine: Connecting through virtual visits during the COVID-19 pandemic. Annals of Family Medicine. Preprint. Available at https://deepblue.lib.umich.edu/handle/2027.42/154738 <Accessed 15 May 2020>. 

Shaw, S., Seuren, L., Greenhalgh, T., Cameron, D., A’Court,  C., Vijayaraghavan, S., Morris, J., Bhattacharya, S. & Wherton, J. (2020). Interaction in Video Consultations: a linguistic ethnographic study of video-mediated consultations between patients and clinicians in Diabetes, Cancer, and Heart Failure services. Journal of Medical Internet Research, 22 (5), e18378.

Styles, V. (2008). Service users' acceptability of videoconferencing as a form of service delivery. Journal of Telemedicine and Telecare, 14, 415-420.
Technology Enabled Care in Scotland (2019). Attend Anywhere Progress Report. Available at https://tec.scot/wp-content/uploads/2019/08/Attend-Anywhere-review-2019-v10.pdf <Accessed 15 May 2020>.
 
Technology Enabled Care in Scotland (2020). Coronavirus resilience planning: Use of Near Me video consulting in GP practices. Available at https://tec.scot/wp-content/uploads/2020/03/Near-Me-Covid19-Primary-Care-Guidance-v1-pdf-version.pdf <Accessed 15 May 2020>

 

Theodoros, D., Aldridge, D., Hill, A. J., & Russell, T. (2019). Technology-enabled management of communication and swallowing disorders in Parkinson's disease: a systematic scoping review. International Journal of Language and Communication Disorders, 54 (2), 170-188. 10.1111/1460-6984.12400.

Trethewey, S. P., Beck, K. J., & Symonds, R. F. (2020). Video consultations in UK primary care in response to the COVID-19 pandemic. British Journal of General Practice, 70 (694), 228-229.

Tucker, J. K. (2012). Perspectives of speech-language pathologists on the use of telepractice in schools: The qualitative view. International journal of Telerehabilitation, 4 (2), 47.

Vinson, M. & Stead, A. (2020). Cognitive Assessment using Face to Face and Videoconferencing Methods. Nursing Older People, 32 (2). 10.7748/nop.2019.e1160.

Waite, M. C., Cahill, L. M., Theodoras, D. G., Busuttin, S., & Russell, T. G. (2006). A pilot study of online assessment of childhood speech disorders. Journal of Telemedicine and Telecare, 12 (3_suppl), 92-94.

 

Waite, M. C., Theodoros, D. G., Russell, T. G., & Cahill, L. M. (2010). Internet-based telehealth assessment of language using the CELF–4. Language, Speech, and Hearing Services in Schools, 41 (4), 445-458.

Ward, E., Sharma, S., Burns, C., Theodoros, D., & Russell, T. (2012). Validity of Conducting Clinical Dysphagia Assessments for Patients with Normal to Mild Cognitive Impairment via Telerehabilitation. Dysphagia, 27 (4), 460-472. 10.1007/s00455-011-9390-9.
 
Ward, L., White, J., Russell, T., Theodoros, D., Kuhl, M., Nelson, K., & Peters, I. (2007). Assessment of communication and swallowing function post laryngectomy: A telerehabilitation trial. Journal of Telemedicine and Telecare, 13 (3_suppl), 88–91. 10.1258/135763307783247293.
 
Woolf, C., Caute, A., Haigh, Z., Galliers, J. R., Wilson, S., Kessie, A., Hirani, S. P., Hegarty, B. & Marshall, J. (2016). A comparison of remote therapy, face to face therapy and an attention control intervention for people with aphasia: A quasi-randomised controlled feasibility study. Clinical Rehabilitation, 30 (4), 359-373. Available at: https://openaccess.city.ac.uk/id/eprint/8288/ <Accessed 15 May 2020> 

 

World Health Organization (2016). Telehealth. Available at: https://www.who.int/gho/goe/telehealth/en/ <Accessed 15 May 2020>

Wright, A. J., Mihura, J.L., Pade, H., McCord, D.M. (2020). Guidance on psychological tele-assessment during the COVID-19 crisis. Available at: https://www.apaservices.org/practice/reimbursement/health-codes/testing/tele-assessment-covid-19 <Accessed: 15 May 2020>

 

Contributors

This guidance has been developed on behalf of the Royal College of Speech and Language Therapists (RCSLT) by:

  • Rafiah Badat
  • Kate Boot
  • Rebekah Davies
  • Charlotte Gower
  • Shermeena Rabbi
  • Rachel Radford
With thanks also to the following people for their valuable feedback in the development of this guidance:

 

Philippa Bartley, Sophie Bell, Jill Borland, Kathy Cann, Claire Clark, Delyth Dando, Heather de la Croix, Helen Fletcher, Abigail Hooper, Maria Hopkins, Yasmin Jacob, Laura Lennox, Deborah Mason, Alys Mathers, Dr Rebecca Matthews, Elizabeth Mcbarnet, Eve Merrigan, Sarah Minshall, Yvonne Mobley, Rebecca Palmer, Natalie Pitman, Judy Prendiville, Kate Price, Andrea Robinson, Dr Abi Roper Jenny Ryder, V Saounatsou, Angela Sloan, Abi Starr, Kitty Stewart, Katie Thompson, Georgina Walker, Niamh Ward and Laura Whittall.