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Speech therapy by telehealth: research-based guidelines for clients and their families

27 September 2016 By David Kinnane Leave a Comment

As we’ve noted elsewhere, travelling even short distances to the clinic can be hard for some families. Speech pathology by telehealth is convenient and the evidence-base supporting its use is growing, especially in areas of practice like stuttering (e.g. Bridgman, 2014).

But telehealth has its disadvantages, too. Compared to face-to-face therapy:

families are more likely to cancel appointments at short notice;
you don’t have as much control over preparations, resources or whether the parent and client are prepared for your call;
parents and clients are more likely to get up and leave the room during therapy; and
siblings are more likely to wander in and interrupt (e.g. Bridgman et al., 2015).

Our Telehealth Guidelines are designed to help you explain to clients what you need from them to deliver effective speech therapy via telehealth to their child.

Click here for our Guidelines for Speech Therapy by Telehealth.

Related products:

Lidcombe Program Stuttering Activities: Volume 2 (10 low-prep printable activities for face-to-face and Skype therapy) (from our Teachers Pay Teachers store)

Principal source: Bridgman, K., Block, S., & O’Brian, S. (2015). Webcam delivery of the Lidcombe Program: Insights from a clinical trial. Journal of Clinical Practice in Speech-Language Pathology, 17(3), 125-129.

The tech-savvy speech pathologist: 5 technology-based ethics challenges and how to tackle them

8 August 2016 By David Kinnane Leave a Comment

When people tell me about the so-called “evils” of new technologies, I tell them about one of my first jobs as a lawyer for a big law firm.

I was working on a big international transaction led by one of Australia’s leading lawyers. Sounds glamorous? My job: to come in on Saturday morning and sit by the banks of fax machines (there were about 30 of them) and wait for an important fax from the client. While I waited, I affixed bar code stickers to documents. Then I photocopied each document and put the copies into blue lever arch folders. I then numbered the folders and dictated a note about what I’d done onto a tape recorder to be transcribed by a secretary. After 12 hours of barcoding, the fax arrived. I snatched it, still warm, and called the senior associate. I then read it out – twice – and went home.*

These days, of course, no one sits by fax machines waiting for documents. We check our emails instead. (Sometimes, several times a minute.)

It’s trite to say that technology has changed the way many professionals do their work. New technologies can make our jobs easier. But they trigger a bunch of ethical challenges, too.

Lawyers, such as Tahlia Gordon, have been talking about these issues in the legal sector for a while. Many are just as relevant to speech pathologists.

Here are 5 technology-related ethical issues we all need to think about:

1. Mobile device and “wearable” data breaches

Issue: Most speech pathologists use mobile phones, iPads and other mobile devices for work. I’ve spotted a few trend-setting speech pathologists wearing Apple Watches and other “wearables”. Client confidential information stored on devices like these can leak or be misused. Devices can be lost or stolen. They can also be hacked, e.g. when using unsecured wireless networks in cafes. Often, the information stored on our devices is unencrypted.

Mitigators: Your Code of Conduct should cover technology use, prohibit work via unsecured networks, require password protection, and encryption of sensitive confidential information. Client consents should be requested and obtained before sending reports and other data to them over unencrypted networks.

2. Social media misuses and abuses

Issue: Lots of speech pathologists use Facebook, LinkedIn, Twitter, YouTube, and other social media platforms, especially in private practice. Ethical risks include accidentally disclosing confidential information, breaches of our advertising rules (see Speech Pathology Australia’s Policies & Procedures Manual, Section 3.03), saying something defamatory in the heat of the moment (e.g. when responding to a “troll”, negative online review or challenging comment, inadvertently forming a speech-pathologist-client relationship (e.g. by giving advice over social media), and being hacked.

Mitigators: Have a robust Social Media Policy and enforce it. On social media platforms like Facebook, adopt House Rules about the types of behaviour that are not tolerated when interacting with your page.

3. Plagiarised and ghost-written online content

Issue: Content-rich blogs can attract clients and establish credibility and authority. However, it takes time to establish and maintain a decent blog, and many speech pathologists simply don’t have the time to do it. Sometimes, it can be tempting to use someone else’s work, presenting it as your own without attribution. This is plagiarism and is unethical. Another option is to outsource your blog to a junior staff member or freelancer or “ghost-writer”. If mishandled, these ghost blogs can damage your reputation: a blog that purports to be written by you but is in fact written by someone else may be deceptive. It can also undermine the trust that a good blog establishes with readers. Ghost-written blogs may also be factually incorrect – especially if written by a freelance writer with a limited knowledge of speech pathology. As the blog owner, you have an ethical responsibility to ensure that the information included in your blog is accurate and not misleading.

Mitigators: Always attribute sources. Use appropriate website disclaimers. Have a clear editorial policy about your content. Review blog content critically before posting to ensure it is technically correct and not misleading.

4. Cloud-based software

Issue: Services like Dropbox, Evernote, and Google Docs are cost effective tools to create, edit, share and access documents from multiple devices. But using these services can be an legal and ethical minefield when it comes to questions like “Who owns the data?”, “Where is the data stored?”, “Is the data confidential, encrypted and/or otherwise protected?”, “Who can access the information?”, “What happens if the service provider goes bust?” and “Does the service comply with applicable privacy and health record laws?”. Regulators like the Office of the Australian Information Commissioner have published lists of questions to ask cloud-based service providers about privacy. But, in practice, it’s very difficult to get straight answers to these questions from service providers, and impossible to negotiate changes to the service terms of big generic service providers like Dropbox.

Mitigators: Have a well-drafted Privacy Policy and follow it. Don’t store confidential client data in the cloud. If you do, investigate “medical quality” cloud storage systems that warrant that they are compliant with privacy and health record laws, rather than generic cloud-based storage services like Dropbox.

5. Giving free advice online

Issue: These days, any member of the public with an Internet connection is a potential client. The line between general informational advice and speech pathology advice can be hard to draw, particularly if you respond to specific comments and questions made by users in response to content on your site.

Mitigators: Use appropriate disclaimers. Do not offer recommendations tailored to the unique facts of a person’s circumstances online. Instead, invite the person to contact you personally to discuss their circumstances and to explore whether you are in a position to help them prior to deciding whether to establish a speech pathologist-client relationship.

Bottom line

Almost all speech pathologists use technology to deliver speech pathology services to clients. Most of us – me included – probably don’t give much conscious thought to some of the ethical issues that arise from new technologies. We should. It’s tempting to wait for professional bodies and ethics experts to figure out rules to manage some of these issues. But we should use our professional judgment to decide how to use technology ethically in our everyday practice, remembering that our professional ethics are based on values, not rules.

Principal source: Gordon, Tahlia. (2015). 7 ethics nightmares you didn’t know you had. Law Society of NSW Journal Issue 13 (July), 34-37.

* Actually, being a Saturday night in the 1990s, I probably went to the pub.

Speech pathologists: how to talk about what you do for a living without being “salesy”

27 July 2016 By David Kinnane Leave a Comment

“I need a blood test”*

Lots of people have never met a speech pathologist. Some have a rough idea of what we do, often along the lines of: “Oh, you work with kids with speech impediments, right?”

Others have absolutely no idea. And fair enough. There are loads of professions I know little or nothing about.

One of our key professional duties is to advocate for people with communication and swallowing needs. But it’s hard to advocate for some groups of clients if the public don’t know what we do or why we’re qualified to speak on issues as varied as adolescent literacy, Parkinson’s Disease, dementia care, youth justice, stroke rehabilitation, accent modification and professional communication.

Our peak bodies – like SPA and ASHA – do their best to spread the word through terrific projects like Speech Pathology Week, the 900 swallows initiative or the SPA Book of the Year Awards. But every speech pathologist has a role to play in educating the public about what we do: one of the main reasons I post so often to my clinic website.

Despite our collective efforts, I’d hazard a guess that few members of the general public understand our full scope of practice, or the many different ways we help people in different places. Shockingly, I didn’t know the full scope our practice until the second semester of my degree!

Getting the word out, ethically

One of the main themes that crops up whenever I speak to groups of speech pathologists or speech pathology students about private practice is a deep sense of ambivalence about self-promotion. And for good reason. We work with people with health needs who are vulnerable to misleading and deceptive advertising. It’s one of the main reasons the profession in Australia has such a robust Code of Ethics – Advertising policy.

But I think we can do more to explain what we do to others without trying to “sell” ourselves. And it’s a fairly simple idea, borrowed from Michael Port’s research on networking and marketing strategies for professionals:

How to explain what do you do for a living in 5 steps

The next time someone asks you what you do – at a barbeque, a kid’s birthday, a networking event, cousin’s wedding, etc. – don’t say “speech pathologist” and leave it at that. Instead, use Port’s simple 5-part formula, which I have adapted for speech pathologists as follows:

Summarise your key client groups: Who do you help most often: Infants? Toddlers? Preschoolers? School-age children? Teenagers? Young offenders? Young and middle aged adults? Older folk?
Identify two or three of the most critical problems that your clients face: In what areas of practice do you help clients? Language? Literacy? Speech? Voice? Fluency/stuttering? Feeding? Swallowing? Life-long disability/Multi-modal/AAC? Accents/intelligibility?
List some of the main ways you help people: One-to-one or group therapy? Telehealth? Parent training? Client coaching? Advocacy/education/lobbying?
Explain the number one result you want your clients to achieve.
Talk about the deeper benefits your client’s experience.

One of the great things I find when introducing myself this way is the genuine interest many people have in what I do. Rather than just a customary exchange of titles before moving onto the next topic (usually property prices in Sydney), it starts a conversation.

Examples

This is how I apply the formula to explain what I do:

I help children and adults…
who have difficulties with their speech, language, literacy, stuttering, voice, and/or accent…
with evidence-based, tailored therapy in my clinic, via Skype, or through online courses,
to pursue their goals and to make the most of their abilities and potential,
to get the most out of life.

Here’s an example for a paediatric speech pathologist focusing on traditional speech and language services:

I help infants, toddlers, preschoolers and children;
who have difficulties with their speech, language (including social use of language), and/or literacy;
to improve their language, intelligibility and literacy through home, (pre)school and clinic visits, parent training, and home programs;
to communicate with confidence, be understood and to participate more fully at home, in extra-curricula activities and at (pre)school.

Here’s another example for a speech pathologist working in a rehabilitation setting:

I help young adults and adults;
who have had a traumatic brain injury or stroke causing language, speech and/or swallowing difficulties;
with evidence-based treatments and carer training based on principles of motor learning and neuroplasticity in a multidisciplinary rehabilitation setting;
to recover maximum communication skills and to learn compensatory strategies for areas of on-going difficulty;
to regain independence and to go back to work.

Not just for introductions

The great thing about doing this simple exercise is the clarity it brings to what we do. I use my 5-part introduction not only to explain what I do to non-speech pathologists, but as a key part of my “mission statement”, business plan, strategy and even branding for my clinic. Once a year (or so!) I reapply the formula, taking into account new target clients, training and new competencies, and proposed service delivery changes for the coming year.

Bottom line

To advocate for, and to market, speech pathology services, we need professional credibility. For credibility, we need the public and potential clients to recognise our expertise, experience and authority across our scope of practice. Explaining who we help, how we help, and the outcomes we deliver for clients is critical for both public advocacy and private practice success. Port’s 5-part formula is a simple way to articulate what we do for a living to people outside the profession.

Related articles:

29 tips to Turn Pro and improve your private practice – Part 1, Part 2, Part 3.
22 lessons I’ve learned from a private practice pioneer in allied health
5 steps I took to comply with Speech Pathology Australia’s advertising rules

Principal source: Port, M. & Wallace, J. (2013). Book Yourself Solid Illustrated. John Wiley & Sons, New Jersey, USA.

Image: https://tinyurl.com/zweegrq

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* True story. This happened to our operations manager a couple of weeks ago:

Ring ring.

Gentleman: “I want to book in a blood test.”

Banter Speech: “Sorry? I’ve think you’ve got the wrong -”

Gentleman: “Can I come in later today? I need a blood test urgently. My doctor said I needed to go to…”

Banter Speech, finally twigging: “Oh, sorry. We’re not that kind of pathologist! Let me see if I can find a local pathology lab to help you out.”

Speech pathologists: 5 best practice ways to improve your advice to clients

16 July 2016 By David Kinnane Leave a Comment

In one capacity or another, I’ve been a professional advisor for almost 20 years. Although advice-giving is a core part of what speech pathologists do, few of us are trained formally in how to do it well.

Bad professional advice can lead clients to make flawed decisions. It can also strain relationships and tarnish your reputation.

It’s sometimes assumed that advice-giving skills emerge organically, with experience and through a painful process of trial and error. But giving good advice is a skill. And, as with most skills, you can get better at it with the right knowledge, systems and practice.

So where should we look for the right knowledge?

Recently, Harvard Business School Professors David Garvin and Joshua Margolis reviewed the research about advice-giving in business and developed a framework of best practices. Applying their guidelines to speech pathology practice, here are 5 evidence-based ways to improve the quality of your professional advice:

1. Before you start, check you’re the right person for the job

Ask yourself: do you have the time, expertise and experience to help? Are there alternative and/or additional sources of guidance to advise the client comprehensively given his/her needs? Do you have a conflict? Would a second (or third) opinion help the client make a decision?

2. Develop a shared understanding with your client

(a) Set the scene: allow clients enough time to explain their challenges, ensure privacy and choose a place free from distractions like buzzing phones or the next appointment.

(b) Listen actively and without prejudice – resist the urge to jump in with your preliminary view.

(d) Agree on the scope of advice sought. Is it:

(i) one-off advice for a single decision (e.g. “Do I have a clinical issue?”, “Should I be treated now, or later?”);

(ii) counselling on how to approach a complex situation (e.g. “How do I prioritise my child’s many communications needs?“);

(iii) coaching to enhance skills (e.g. identity mapping to generate and pursue meaningful, client-centred goals); or

(iv) mentoring to provide guidance to aid long-term success (e.g. acting as a sounding board for an adult who stutters or an accent modification client facing specific challenges at work, e.g. with an important presentation).

Don’t overstep boundaries or give unsolicited advice – especially advice that is outside your scope of practice.

3. Craft alternatives

Make it clear to the client that you are an adviser – not the decision-maker. If possible, help the client generate several, evidence-based, viable choices. Spell out the rationale, principles, assumptions and evidence behind each of the options and your advice. Be prepared to challenge assumptions if the facts or situation changes (or if the client changes his or her mind).

4. Help the client make the decision

Ensure all options are evaluated, including the risks and benefits of no treatment. Communicate clearly and in Plain English. Make sure the client understands your advice. Don’t jump straight to a conclusion, e.g. that a child is a “speech” or “language” kid or assume that your client will choose the treatment you consider to be the most logical or evidence-based. Pause frequently for client/family reactions. Make sure the client knows you are available for further clarification and elaboration if and when needed (i.e. that they don’t need to make a decision on the spot, and can think about other options, risks and benefits and come back with questions or concerns).

5. Help put your client’s decision into action

Reaffirm and support the client in making an informed decision, even if the decision is ultimately not your preferred first choice. Document it. Again, convey your availability for additional guidance and support to help the client to pursue his/her goals, including during treatment.

Bottom line

Speech pathologists advise clients in several ways, from face-to-face and tele-health consultations, assessment reports, management plans, home programs, email and SMS responses to queries, therapy and training activities, outcome measurement, discharge recommendations and referrals to other health professionals. Giving professional advice competently requires us to look at our competence and impartiality, the scope of advice sought and our role in giving it, the technical content of our advice, and the process through which we evaluate different options and give our advice. Skilled advising requires creativity and collaboration with clients. We need to understand clients’ problems fully to generate evidence-based, client-centred solutions over the whole term of the professional relationship. Garvin and Margolis’ framework for advising is a useful tool to do this methodically.

Principal reference: Garvin, D.A., & Margolis, J.D. (2015). The Art of Giving and Receiving Advice, Harvard Business Review, January-February, 61.

Image: https://tinyurl.com/jjd4e2c

Speechies in Business

Speechies in Business is owned and operated by David Kinnane, a Certified Practising Speech Pathologist, lawyer, writer and speaker in private practice in Sydney, Australia. You can read more about David’s professional background, qualifications and experience here.David also co-owns and co-manages Banter Speech & Language, an independent private speech pathology clinic, and Bodkin Wood Legal & Advisory, a law firm specialising in allied health issues.

Performance Appraisals for Speech Pathologists

30 June 2016 By David Kinnane Leave a Comment

With the end of the financial year upon us, many of us are in the process of conducting performance appraisals for our employed speech pathologists. Unfortunately, many of us are hampered by the lack of a speech pathologist-specific template that is adaptable for all levels of experience – from new grads to senior clinicians – and management styles.

By popular demand and on the request of our fellow speechies, we’re created an up-to-date template designed specifically for speech pathologists in private practice who want to appraise their staff collaboratively. Main features of our performance appraisal template:

consistent with the Fair Work Australia requirements;
aligned with our current range, areas and scope of practice as defined in the Competency-Based Occupational Standards for Speech Pathologists in Australia;
employees fill out first, so you can prepare for the appraisal meeting properly;
designed to generate SMART reflections and performance goals for each employee for the next 12 months, including your expected and measurable increases in their core activities (e.g. assessment, reporting and treatment), additional activities (e.g. advocacy, education, clinical research and quality improvement projects), professional development and competency, generally;
fully editable Word document: add whatever you want, subtract what you don’t need!
easily integrated with SPA’s Professional Self-Regulation (PSR) requirements. File with proof of SPA membership and PSR compliance statement.

Click here for our Speech Pathologist Performance Appraisal Agreement template.

Looked around but can’t find what you’re after? Drop us an email requesting a template, policy or procedure, and – as with this one – we’ll hop right onto it!