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JCPSLP
Volume 14, Number 3 2012
Journal of Clinical Practice in Speech-Language Pathology
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.
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
to manage both the material and technology.
3. Combining videoconferencing
with on-site sessions
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
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