Written by Vina Cristobal
May 29, 2020 — While healthcare is evolving to meet the patient demand during the COVID-19 pandemic, the University of Hawaiʻi Speech and Hearing Clinic (UHSHC) – a University Health Partners (UHP) clinical training site – swiftly added telepractice to their services.
The clinic had already been preparing for these services since its temporary closure in March, following Governor David Ige’s stay-at-home order. To properly ensure the best care for its patients, the UHSHC staff members took action to acquire national training from the American Speech-Language-Hearing Association (ASHA), where they developed technological skills and evidence-based practice for service delivery using telepractice.Starting on May 4, 2020, the Center for Medicare & Medicaid Services (CMS) authorized UHSHC to receive reimbursement for telepractice services.
“We began implementing new virtual service-delivery models and extended our tradition of care by providing interim services via videoconference with our patients and families,” said Dr. Susie Peterson, Speech-Language Pathologist at UHSHC. “Because, like many UHP clinics, we provide both clinical service to patient and training for students. Telepractice allows our students to connect with our patients with faculty supervision and leadership.”
Dr. Peterson, along with fellow faculty clinicians Dr. James Hall, Dr. Pauline Mashima and Dr. Samantha Robler had previous experience with the technology, so they were able to provide guidance about telepractice to their colleagues.
“We hold ourselves to the standard of providing services via telepractice that are ‘equivalent to the quality of services provided in person (ASHA, 2016)’,” said Dr. Kristine Noel, Speech-Language Pathologist at UHSHC. “We are learning and applying new practices to identify patients for whom telepractice is appropriate; to use appropriate technology models to deliver services; to select interventions appropriate for the technology and patient; and to maintain therapeutic relationships with patients via a videoconference platform.”
The UHSHC received assistance and guidance from Dr. Lee Buenconsejo-Lum, (JABSOM Associate Dean of Academic Affairs. and Interim Associate Dean for Clinical Affairs, Dr. Patricia Blanchette, who is also UHP’s Chief Medical Officer.
“We are fortunate to have faculty with some expertise and interest in starting telepractice,” Dr. Buenconsejo-Lum said. “This provides not only a critical learning opportunity for our CSD students and care opportunity for patients, but has also allowed increased awareness of the many applications of telepractice of speech-language pathology. Telemedicine is here to stay. Delivering care where patients live, work and go to school will become the new normal.”
Dr. Blanchette has been particularly interested in continuing the students’ training and best preparing students for extending their experience and preparation for telepractice. She perceived telepractice as a continuing service of the clinic and the curriculum.
“We will graduate students who are well prepared for using telepractice to extend their care into areas not possible in the past, including to patients who are at a considerable distance or who are confined by virtue of having an infectious illness,” she said.
As part of their curriculum, students have the opportunity to meet with patients under faculty supervision. However, the switch to telepractice was a new facet in their training. Faculty professors noticed an enthusiastic sense of energy, purpose and perspective in their students.
Telepractice provides patients a new “setting” to learn, practice, and generalize skills and strategies. It also supports patients who especially enjoy working with student clinicians.
“One of our patients especially looks forward to meeting and working with new student clinicians as we rotate them through their clinical assignments and enjoys connection with them via videoconferencing,” said Dr. Noel.
Patients and their loved ones are developing a new level of relationship with the clinicians as well. The sessions through telepractice have allowed clinicians to “enter” into the lives of their patients, creating a space for authentic connection to happen. Parents, spouses, guardians and siblings are able to witness their loved ones receive audiology and speech-language services, and actively participate in the sessions.
“They’re trusting and relying on us to continue [providing] quality care,” said Dr. James Hall, an audiologist at UHSHC and Director of the online Speech Pathology and Audiology (SPAPP) undergraduate program at UH Manoa.
Faculty and student clinicians also utilize sessions to educate family members of patients. Based on the patient’s progress and needs, the clinicians offer families resources and education in developing the skills they can use at home to improve and support the patients’ care.
Jonathan L., whose child is a patient at the UHSHC, says that the distance learning has been beneficial.
“I would say that this is better than private therapy, from my daughter’s experience,” Jonathan said. “We just feel that by having her [being treated through telepractice], she is seeing the newest techniques that the student clinicians are learning. The clinicians use specific strategies for each person. Parents can see what is happening in the session, which does not happen in a private practice setting. You have many minds working with the patient and brainstorming ways to help her.”
In addition, Jonathan believes that it is beneficial for student clinicians to receive hands-on training by engaging with patients, and work together with families on new ways to treat his daughter. The clinic has also been flexible with patients’ schedules and keeps them updated on appointments through phone reminders.
For more information, please contact the University of Hawaiʻi Speech and Hearing Clinic at (808) 692-1580.