JCPSLP Vol 16 no 3 2014_FINAL_WEB

telehealth would require a partnership between all SLPs. Most participants believed that telehealth was limited to specialised research and university settings. Several questioned the relevance of the current evidence given that highly controlled research conditions do not reflect their clinical settings. The majority of participants thought telehealth intervention would be more time consuming than the equivalent intervention delivered FTF due to the required preparation and technical problem-solving. Participants also reported that a fear of technology posed a significant barrier. People are a bit reluctant to take things on, you know … “I don’t know how to make this work” so it’s kind of a technological fear. (Rhonda) A number of participants questioned the appropriateness of telehealth for clients from culturally and linguistically diverse backgrounds and those with complex communication needs. In addition, most participants said that they would not assess dysphagic clients via telehealth due to safety concerns. The participants largely reported that clients have little or no access to the required technology and limited capacity and willingness to accept telehealth. Most also reported that clients prefer FTF services. Conversely, two remote SLPs felt their clients would welcome telehealth because of improved access and reduced travel time. Several participants were unwavering in believing that their service must be delivered FTF to be effective. They were concerned that telehealth could negatively affect rapport building and client relationships. Additionally, they feared missing crucial incidental information only available when in the same room as the client. Paediatric SLPs thought therapeutic processes such as modelling, behaviour management and managing sensory needs could be difficult via telehealth. They were also concerned that parents would not be engaged as they would need to manage the session and their child independently without a SLP in the room. Conversely, one paediatric clinician thought telehealth could provide a useful insight into a child’s home environment and an opportunity for better treatment generalisation. Overall the majority of paediatric SLPs felt strongly that the relationship-based approach frequently used with parents would not be compatible with telehealth. The five SLPs who intended to use telehealth in the future recognised the need to allow sufficient time to develop and trial methods and resources. In addition, one SLP emphasised the need to gain their client’s perspective before commencing. Participants broadly believed that telehealth should not replace FTF delivery but many recognised that telehealth could be an appropriate adjunct delivery option. Theme 4: Organisational and policy barriers Limited or no access to telehealth technology in the workplace is a significant barrier, particularly within the government sector. Three participants indicated that they had no access to necessary equipment while 13 indicated that although the equipment was available, medical and mental health staff had priority access. Conversely, SLPs in the private sector did not report access to equipment as being a significant barrier. Eight participants identified that using Skype to deliver services was problematic, primarily because it was against organisational policy (in a range of settings). This policy was reported to be in place because of concerns about reliability, security and confidentiality. The

participants indicated that these barriers could be overcome with the provision of appropriate equipment and ongoing ICT support. I know we have them [video-teleconferencing facilities] here, I wouldn’t know where they are though and I wouldn’t know whether we could use them. (Trudy) Three participants highlighted environmental workplace barriers, such as a lack of confidentiality in open-plan offices and shared work stations. Allocation of telehealth- specific therapy rooms was identified as a facilitator to overcome this. Participants from the private sector felt that SPA must lobby Medicare and private health insurers to promote the need to fund SLP services via telehealth. There was also confusion about whether new initiatives such as the National Disability Insurance Scheme would fund telehealth services. Participants also indicated that workplace policy documents to support the implementation of telehealth are needed. Discussion This study was designed to explore the existing barriers and potential facilitators to telehealth use identified by SLPs not using this service delivery method. Coding of data generated the following themes: information, training, clinician attitudes and perceptions, and organisational and policy barriers. Given the paucity of research investigating this population, it is important to compare and contrast these findings with what is known about SLPs who use telehealth. Identification of common barriers and facilitators may lead to an important increase in the uptake of telehealth. Many participants recognised the broad appeal of telehealth including five participants who indicated a desire to utilise it in the future. Two significant factors differentiate telehealth users (Hill & Miller, 2012) from non-users: attitudes and perceptions, and organisational and policy barriers. The participants in this study hold some perceptions that contradict recent research including that clients have limited capacity for telehealth (Dunkley et al., 2010; Sharma, Ward, Burns, Theodoros & Russell, 2013) and that telehealth is limited to research settings and rural and remote areas (Mashima & Doarn, 2008). Clearly there is a need for further dissemination and promotion of evidence that has highlighted the use of telehealth across diverse settings and locations (i.e., Mashima & Doarn, 2008; Reynolds et al., 2009). Access to appropriate technology is problematic. Organisational policy preventing the use of Skype appears common despite its recent use in SLP literature (e.g. Boisvert, Hall, Andrianopolous & Chaclas 2012; Erickson, 2012). However, the DoHA Telehealth Technical Standards Position Paper (2012) supports such policy by highlighting that “consumer-centric” options like Skype have lower security and poorer quality compared to business grade options (e.g. Polycom, Redback). Despite the accessibility of the telephone, its potential use to deliver clinical services is not being realised, even with supporting evidence (e.g., Carey, O’Brian, Onslow, Block, Jones, & Packman, 2010) and reduced confidentiality concerns. Overall, the SLPs without access to appropriate technology viewed telehealth more negatively which highlights the importance of funding appropriate infrastructure and recognising potential use of existing resources. As in previous studies (Hill & Miller, 2012; Mashima & Doarn, 2008), the need for cost-benefit analyses was emphasised in this research. Many participants were not convinced that telehealth would improve cost

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JCPSLP Volume 16, Number 3 2014

Journal of Clinical Practice in Speech-Language Pathology