Speak Out June 2020

clients over the past couple of months due to an increase in difficulty contacting some clients, increase in cancellations and rescheduling due to illness and other family circumstances. Given we are a government service, we have been able to be flexible with following up these clients. “I think we have also been lucky in that we have been able to follow the lead of many of the other states and certainly our changes have been less significant in comparison. For the most part we will return to pre-COVID ways of working. I expect we will continue to use telepractice as an alternative when the need arises. We have had many positive experiences via telehealth as a team and have received positive feedback from clients, and will likely continue to be a part of our service.” "Telehealth was also the push we needed to get all of our systems integrated online." “My business partner, Jess, and I were due to open a brand new practice, Protea Therapy, at the end of March. Our target population was children aged 0-18 but with a special interest in speech sound disorders, feeding and medically complex children (the focus of my PhD), and children with cleft lip and/or palate (the focus of Jess’ PhD). We already had a few referrals, and were looking forward to starting to see clients in our lovely room in a GP clinic in Carlton North. "Luckily, we both also have other strings to our bows—Jess as a lecturer and postdoctoral researcher, and me as a writer/editor and postdoctoral researcher." Moving her practice to telehealth provided professional and personal challenges for Katherine Sanchez. Her learning curve into telehealth was steep, but says it was the push they needed to get all of the business systems integrated online. “Telehealth was an innovation for us, although I know many speech pathologists have been effectively practising this way for years. I’ve also shifted more intensively towards parent coaching, which I’ve really been enjoying. “Getting the right hardware was key! A second monitor, a good webcam, and a headset have all helped me to deliver services smoothly. I also got my license to deliver Hanen: It Takes Two to Talk via telepractice, and I have been using these resources individually with families. “In terms of my own learning, I was involved in writing about telehealth resources, so I had an opportunity to familiarise myself with the literature and see what resources other writers found too. I also loved SPA’s webisodes on telehealth and joined a lot of telepractice Facebook groups for ideas. Katherine Sanchez Private Practice and Postdoctoral researcher, Melbourne

“Telehealth was also the push we needed to get all of our systems integrated online. Our patient forms are now online, we take online payments, and we’ve got our telehealth platform talking to our practice management software. I haven’t used any paper yet! It’s been a learning curve, but it’s great to have a new way of working that makes our services more accessible for some families." Kristin Bayley Clinical Director, To the Moon and Back, Sydney For Kristin the key to making a smooth transition was to start preparations early. The practice with four speech pathologists in Sydney works primarily with children and some adults diagnosed with ASD and related disabilities. As the gravity of the situation became more obvious to Kristin and the team they realised they needed a plan. “I felt that the better prepared our staff and families were, the smoother and the more successful the transition would be. We also needed a clear plan for how and when we would make the decision to shut down. We developed a three phase plan- and we will return to a similar three-phase plan when we start to think about making a slow, measured move back to ‘normal’. “Once we decided that we would go to 100% telehealth, we conducted a number of risk assessments of clients to access this telehealth model. We were very fortunate that all of our families had a device they could access a telehealth and had adequate internet access. Some families were concerned about privacy and so we had to do a lot of research into the ins and outs of safety and security on telehealth, and of course turn around consents very quickly! “All of this occurred before we could even consider how the clients would benefit from telehealth. We needed to identify those clients that likely wouldn’t benefit from 1:1 client/therapist sessions. For these clients, we offered a parent coaching model. Other clients moved seamlessly into 1:1 telehealth. Because we were likely in this for the “long-run” we felt it would be worthwhile to ‘teach’ telehealth skills just like we’d teach any other type of skill and developed a checklist of telehealth skills that could be used quickly to assess what skills were needed and whether it would be possible to teach these skills. “We were aware that some families would be dubious of the benefits of telehealth and wanted to allow them to try before they committed. We offered a set up session at no charge which allowed us to talk them through the process and for us to see how their child would go with accessing telehealth. “Honestly, I was worried this would be the end of my business. Given the complexity of some of our clients, I was not sure telehealth would be feasible. But that worry only lasted for a brief time. I have an amazing team and I could quickly see how they would rise to the challenge, think creatively to make telehealth work for our clients. We had a 90% retention rate of clients over the COVID period. “My worries then turned to our staff. We work very much as a team at TMB. Many of our clients see more than one team member – e.g. one for speech and another for behaviour. We have many opportunities for team collaboration and peer supervision. I was conscious that part of our culture was the incidental chats, quick clinical debriefs that occurred in the staff room between sessions. We needed to find a way to replace these chats with an online format. I knew long email chains just wouldn’t do. “After reaching out to the Speech Pathology Private Practice Facebook Group – I got some really great ideas. We all joined Microsoft Teams as a group sharing space. This has been

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June 2020 www.speechpathologyaustralia.org.au

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