Telehealth best practices by Sophie Williams

Some of you will have been offering telehealth services for as long as you’ve been practising, others may have been thrown into telehealth by the Pandemic and some of you might just be coming to telehealth. Whatever the case we can all agree that telehealth is here to stay and provides Speech Professionals and our service users alike, greater flexibility and access to services.

So what is the best set-up for telehealth?

Equipment

One of the beautiful things about telehealth is that you can grab your laptop/ tablet and remote work from anywhere (within reason and internet connection). Some appointments such as meetings or talking therapies require no visual support, other times a session is focussed around a  visual activity. Having two screens allows you to have your activity on one screen whilst on the other maintaining a clear view of the service user throughout the appointment. A clear view is key to making those all important observations of non verbal behaviours such as grimaces, tension or distraction. Noala understands this which is why in Noala you can view your client, your session plan, your activity and your notes all on one screen. You may still choose to use a second screen if your plan includes linking to an external online game of course but when it doesn’t, go ahead and close some of  those open tabs. Phew!

Guide and coach your service user to adjust their camera so that you have a good view of their head and shoulders. If working with a carer or communication partner, consider ahead of the appointment whether you want to have them in the frame also.

A headset is recommended especially if you’re taking the call from an environment where others are present. Wearing a headset ensures service user confidentiality as it prevents others on site, even if in another room, from over hearing the conversation. Even if you have the luxury of working completely solo a headset can still help in many ways. The headphone component can reduce echo; help you hear the service user more clearly; reduce time delays; tune out distractions and give the appearance of privacy which will reassure your service user. The microphone makes your voice clearer against background noise and reduces feedback that occurs from using a computer mic. If you’re carrying out a speech sound assessment consider asking the service user also to use an external microphone as a study into telehealth for SLT (Jessiman, 2003) found fricatives, affricates and /s/ blends particularly difficult to accurately transcribe when the service user used only room microphones.

Technology

For some of your service users live captions will aid their comprehension, but consider first for an assessment whether captions will change the skill you are assessing. Live captions are in the pipeline for Noala!

Now, not all of your service users are going to be tech savvy and the RCSLT recommends making a clinical judgement about the suitability of telehealth for each individual service user. That doesn’t mean however that just because someone doesn’t have the newest iPhone spec that they can’t benefit from telehealth. They could just need a little extra support in getting to grips with the technology. How about scheduling a 15 minute on-boarding or ‘troubleshoot’ appointment ahead of the real thing? This allows:

• The service user to the experience of joining the meeting
• Time to discuss any adjustments needed to their seating, camera or microphone
• You to test out the internet connection and talk through any of the service users’ concerns.

Have your phone ready to call the service user if you need to talk them through joining (or switching on their mic-we’ve all been there). On-boarding information can also be sent to service users when they sign on with you or book in for a remote appointment. Make sure information is easy to read and supported by pictures. The RCSLT have some useful templates available on their website.

Internet & Security

Don’t you feel that how well your day goes depends somewhat on your internet connection?! Glitches to your call are more often than not caused by issues with bandwidth. Bandwidth is how fast your internet speed is, it’s measured as up (upload) and down (download) speed; you can check your internet speeds easily with an Internet Speeds Test. Speeds are measured in Mbps (megabits per second) which is larger than kbps (kilobits per second). The recommended minimum bandwidth for telehealth depends on the videoconferencing platform you are using. Noala recommends 200kbps up and down speed. This is a real important one because the experience of technical difficulties strongly determines how service users and therapists rate the overall experience of telehealth (Sutherland et al, 2021).

Screen sharing and screen control can enhance the intractability of your session; you can reduce risks when screen sharing by hiding other applications on your desktop and making sure notifications are turned off.

Of course most importantly you need a platform which is secure in accordance with GDPR best practice if you’re working from the UK and the European Union or HIPAA compliant if you’re working from the US. You’re in safe hands with Noala.

Workspace

Now sitting at a desk all day, interacting with a computer may not seem like a dangerous occupation (it’s not a kin to taming tigers) yet it does come with its occupational risks to health such as musculoskeletal injury, headaches and eye strain. The Health and Safety Executive (HSE), Britain’s national workplace health and safety regulator provides an online home-working risk assessment tool which you can use to design you workstation with you in mind. So if you’re sitting at your desk for longer than 2 hours leave your dining chair at the table and consider investing in an ergonomic desk chair. Think of an ergonomic chair as ‘having your back,’ it provides you with back support whilst aligning your shoulders, spines and hips and it’s adjustable so that you can sit comfortably at your desk. There are other things to consider for a complete ergonomic desk space such as foot support and keeping your monitors at eye level. You can achieve this with an adjustable monitor or a stand for your laptop although with this option you will also want to invest in a wireless keyboard and mouse. Being more comfortable makes you more productive!

Research has shown that the human brain can only focus (really) on one complex task at a time (see Burgess, 2000). I know SLTs are particularly good at multi-tasking but we’ve all turned the music down when we need to park our car. This is why reducing visual clutter is important for your service users to give their all to your therapy so consider what is behind you in your video. The RCSLT recommends we try to keep backgrounds plain and simple. If this is difficult for you Noala offers the option to change your background and there are some fun things you can do with a green screen, search on YouTube for plenty ‘How To’ videos. The same goes for your clothing, try to keep your shirts plain and simple (you can go as jazzy as you like on the bottom-half no one can see!) This brings us to lighting – make sure the room is bright but that you are not sat in front of a light source.

The only thing left to recommend is giving your workspace a little ‘je ne sais quoi’ so you feel calm and focussed. Maybe you could frame your degree and professional registrations - hang your achievements in pride of place! Maybe have your textbooks organised on a shelf and decorate your space with plants and art - whatever makes you happy. Check out MimiPrints on Etsy for some beautiful Speech Therapy art!

References

Burgess, P. (2000) Strategy application disorder: the role of the frontal lobes in human multitasking. Psychological Research. 62 (279-288).

Crockett, J.L., Becraft, J.L., Phillips, S.T. et al. Rapid Conversion from Clinic to Telehealth Behavioral Services During the COVID-19 Pandemic. Behav Analysis Practice 13, 725–735 (2020).

Jessiman, S. M. (2003). Speech and languages services using telehealth technology in remote and underserviced areas. Journal of Speech-Language Pathology & Audiology, 27(1), 45-51.

Pronk NP, Katz AS, Lowry M, Payfer JR. Reducing occupational sitting time and improving worker health: the Take-a-Stand Project, 2011. Prev Chronic Dis. 2012;9:E154. doi: 10.5888/pcd9.110323. PMID: 23057991; PMCID: PMC3477898.

Sutherland et al (2021) Barriers and facilitators: clinician’s opinions and experiences of telehealth before and after their use of a telehealth platform for child language assessment.

Wales, D., Skinner, L., & Hayman, M. (2017). The Efficacy of Telehealth-Delivered Speech and Language Intervention for Primary School-Age Children: A Systematic Review. International journal of telerehabilitation, 9(1), 55–70.

Badat, R., Books, K., Davies, R., Gower, C., Rabbie, S. & Radford, R. (2020). Telehealth Guidance. Royal College of Speech and Language Therapy.

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