For the past four years, I’ve provided telepractice service in the school setting. That means, I use videochat to work with clients who need speech therapy services. I currently work part time in a school contract, where I provide both telepractice and in person service. I spend most days videochatting from home. But I do visit the school for assessments and some meetings. At contracts where I’ve worked, I typically have a SLP-Assistant or SLP-Aide (titles vary by state). That means, I have access to a real live person onsite who can assist.
Telepractice in the Schools
Since I began telepractice, I’m often asked questions about how it works. Many speech-language pathologists (SLPs) are curious about this as a profession. I’ve compiled some of my most commonly asked questions here. Keep in mind, there are many companies out there that do telepractice only. I can’t speak to those, as I haven’t had a contract like that. I spend about 75% of my work time in telepractice and 25% of my time traveling to my telepractice site (a rural school). Therefore, I can comment about what it’s like to work in the hybrid service delivery model.
But first, I need to be completely honest. I am not unbiased. Since I began working in this setting, my work-life balance has drastically improved. I am confident that I do better work now, because I have the space and time to do it well. My work is focused. My days are more tied to home and family life, which I enjoy. Overall, telepractice was a great move for my career. That said, it isn’t for everyone. If you are curious about telepractice, read on for some great questions and honest answers of what it is like to work in this setting.
1. What are some challenges that are specific to the telepractice setting?
Some rural schools do not have access to a good internet connection. This is something that SLPs need to be willing to work with. Video may cut out or be jumpy in this case. Luckily for me, this is usually not the case. The districts I’ve worked with have had decent internet connections for the most part.
In my own experience, I’ve struggled occasionally with clients who don’t respond much to videochat. In those cases, I have some tricks that I’ve learned over the past four years for gaining engagement. That could be another blog post in and of itself. For young, wiggly clients, I make use of parents or paraprofessionals onsite. It also helps to switch up activities to maintain engagement. It’s a learning process, and I’m still working on getting better in this area.
2. Are there any specific clientele for whom telepractice is not a good fit? Are you able to work with a variety of people with varying diagnoses?
There are definitely challenges with all settings. This is an excellent question because it’s true – it’s not the best setting for every single client. I say that with a caveat.
First of all, I love providing telepractice. I love connecting with children who can’t come to speech because of distance or health issues. I also serve families with very busy schedules who don’t want to drive to another appointment. When approached by a new client, I do consider if telepractice really is the best fit.
You should have a system in place to determine if telepractice is a good fit for your client or student. Here are some examples of questions you may want to ask yourself:
- Does the student have the motor control needed to access and interact with the videochat program? Can the client hear you?
- Behaviorally, is the student able to attend to and interact with you? If not, is there an adult with them that can help? Is that enough?
- Can they benefit from your direct instruction? Are there cognitive concerns about the child’s ability to interact with videochat and benefit from the instruction?
- Do they need direct instruction? Is there a combination of consultation or other services that would better serve that child?
You may have even more questions than these, this is just a starting point. As the clinician, do your best to think through who could be seen via telepractice and how it would benefit your learners.
3. How flexible is the telepractice setting? Can you do telepractice while living/traveling abroad?
In order to do telepractice, you need high speed internet, a webcam, and a headset for high quality audio. I have done telepractice while traveling (within the United States) with my laptop. This requires looking ahead at the internet connection available to ensure I’ll have what I need. Streaming video takes a lot of bandwidth, so don’t assume you can work from anywhere with a wifi connection.
There would be some potential tricky aspects of living abroad and doing telepractice. It can be done, but you’d need to consider a few things first. Most importantly, do you have access to a good internet connection? Secondly, if you are somewhere with a different time zone, what would that look like for your own schedule? Is that something you are willing to do?
I do know of someone who worked from Mexico while house sitting for a friend. She had a great experience doing telepractice that way. I don’t know anyone who has done telepractice while extensively living abroad.
4. What do you like the most about telepractice? How does it compare to other work settings, such as schools or private practice?
This is a great question. This one could also be an entire blog post in and of itself. So that I don’t go on and on here (and I could), I’m going to answer a different question. I’ll talk about what I like more about telepractice than other settings, as well as some of the downsides.
Let’s start with what I like. I like helping children who might not receive services at all if it wasn’t for telepractice. That part is very rewarding. I like that I spend more time focused on therapy. This means less time spent on office politics or dealing with behavior situations. In the school setting, I was often interrupted from the work I needed to do for behavior emergencies. This didn’t allow me the time and concentration needed to do my work well. Also, I like the flexibility and how comfortable it is to be able to work from home and not commute. This has allowed me to enjoy more of my home life.
Some downsides are that it can be isolating, and you can feel like an outsider. This may be the case if you are contracting for a school. Also, sometimes you don’t get the hours you’d like to work. You may feel underemployed (because there aren’t more hours available to work). I did have one season where I really needed to work more hours, but they weren’t available. That was stressful. Thankfully, it was only a few months in the big picture of four years.
5. What does the market for telepractice look like currently? Is there a demand for SLP’s in the telepractice setting?
I’m honestly not sure on this one. I work for an organization that a friend worked for (and spoke highly of). So, I didn’t really have to enter the job market here – I just called a phone number my friend gave me, met the Chief Operations Officer, and then signed a contract. For other SLPs I know, I would say it wasn’t difficult for them to get hired in telepractice. However, they may not be working as many hours as they’d like. I do know other SLPs who would like more hours, but their contract companies don’t have any available. In other words, most people are employed, but some SLPs feel underemployed in this setting.
Telepractice: Challenges and Rewards
Telepractice has been a great experience that has given me more personal freedom. I am humbled to be the SLP for those who wouldn’t otherwise have one. However, this setting doesn’t come without unique challenges. If you want to know more about telepractice, or have anything to add, please find me on Instagram.