JCPSLP vol 14 no 3 2012

Sightspeed Business did not provide the capacity to record and play back video instantaneously. To counteract this problem, families attended a local studio for individual sessions (see videoconferencing using ISDN). Parent feedback from the questionnaire was again positive. All families reported how much they had enjoyed connecting with other families with one participant in rural Victoria commenting “it’s great to know there is someone else out there!”. In using web-based conferencing, more technology problems were encountered than in method 1. Some predictable difficulties occurred since transmission relied on the quality and speed of the families’ individual internet connections. The biggest challenge, however, was preventing significant amounts of audio feedback and echo. A number of solutions were trialled and use of an FM transmitter with a Direct Audio Input (DAI) connected to the clinician’s laptop allowed for clearer transmission of the audio signal. Although this solution was found to improve audio quality greatly, feedback reoccurred occasionally. Two presenters were then used: one to present and one to manage and troubleshoot the technology. This is in contrast to other methods, where one presenter was able The telepractice service delivery model was altered in two ways in the third method as a result of parent feedback. First, a residential component was added, to further facilitate social support opportunities. Second, the group sessions delivered remotely used in-home videoconferencing technology. Three families were accommodated at the RIDBC campus in Sydney and attended the first three group sessions and an individual session while on site. All the participants had dedicated in-home videoconference equipment supplied on loan by RIDBC Teleschool. This equipment utilised the cellular network for transmission of the signal. The remaining group sessions used a multipoint connection that was created by using RIDBC Teleschool’s videoconference camera with specialist software installed. This camera and software has the capacity to link sites using ISDN and/or cellular connections. PowerPoint slides and videos were shared with families as per method 1, and participants could now see all participants and slides simultaneously. Individual sessions were recorded using computer software. The footage was reviewed during the session using the document camera that transmitted directly from the computer. Using dedicated videoconferencing equipment ensured a high-quality picture and audio for all group and individual sessions which was confirmed by all participants on the questionnaire. Parents again highlighted how positive it had been to meet and connect with other families in a similar situation. They also reported that the residential component had provided opportunities for them to socialise with the other parents. Parents said they felt more confident and open in sharing during later group sessions. Delivering the It Takes Two to Talk program by telepractice Apart from mastering the technology required for successful telepractice, it was also important to ensure that the content of the course was maintained, while altering the presentation to suit the service delivery mode. The It Takes to manage both the material and technology. 3. Combining videoconferencing with on-site sessions

Two to Talk program outlines six minimum requirements for an adapted program (summarised in Box 1). All requirements for the program were maintained in each method described and essentially telepractice changed only the relative location of the presenter and participants. Box 1. Minimum requirements when adapting It Takes Two to Talk: the Hanen Parent Program 1. Ensure a recent assessment of each child is available. 2. Conduct and record a pre-program consultation. 3. Develop individual goals for the children collaboratively with parents. 4. Provide a minimum of 4 group sessions and a minimum of 10 group hours. 5. Use full teaching cycles as per the program. 6. Conduct one or more individual sessions involving coaching and feedback. Source: Conklin et al., 2007, p. 562. Additional planning was required to deliver some of the practical elements of the program, including facilitating group discussions and modifying group activities. For example the “icebreaker” task is usually done in groups of four. However, telepractice does not allow for participants to hold separate discussions using the same multipoint connection. In each of the methods, all participants were involved in the activity together (Conklin et al., 2007, p. 113). Some adaptation in the role play activities was also required. For example, in method 1 presenters modelled role-play activities, as only one site could be seen at a time. In method 3 it was possible to have participants from different locations work together on the role play activities. In the “Birthday Game” (Conklin et al., 2007, p. 119) participants are asked to form a line in the order of their birthdays without talking. When conducting this activity by telepractice, participants were still able to determine their birth order without speaking. However, instead of forming a line, they wrote a number on a piece of paper, and displayed it to the group to indicate their place in the “line”. This worked successfully in all three telepractice methods described. Discussion in pairs was possible. In method 1 two pairs were formed by members of the same family at the same location. The remaining 2 participants (in separate locations) used the videoconference equipment for their discussion. All other participants muted their microphone so their discussion did not interrupt the videoconference pair. They also turned the speaker volume down, so they weren’t hearing the discussion of the videoconferencing pair. At other times discussions were conducted as a whole group. Other practical considerations include advanced planning, for example, booking rooms for the telepractice sessions, and sending out resources and handouts required for each session well in advance. Reviewing the program for each week ahead of time and making modifications to activities was also very important. Often a backup plan was required to enable the session to continue despite technology problems, for instance, having videos available in multiple formats in case of technology problems. Another consideration is the number of participants. The group numbers were smaller than typical for the It Takes Two To Talk program. While this was mainly due to the family availability and suitability for each course, the smaller

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JCPSLP Volume 14, Number 3 2012

Journal of Clinical Practice in Speech-Language Pathology