Our priority is the safety and well-being of NZSTA members, their families, our students, our volunteers, and the communities we work in. We know that the pandemic will have impacts on all of us and we want to be a source of support, information, and encouragement during this time.
We will be updating this page frequently.
Last updated 30 March 2020
This is changing daily. If in doubt, play it safe!
The vast majority of us should not be doing any face-to-face clinical work at this time. We should follow the public advice around hand washing, maintaining a distance of 2 metres, and sanitising all surfaces that have been in recent contact with others.
For those of us in hospital settings, our advice is to avoid any face to face interaction without first consulting with your team regarding protocols, personal protection equipment, etc. Follow the advice of your DHB for that day. Do not rely on advice from the day before as things are changing quickly. If you are not getting daily advice, please contact our admin team who will forward your concerns on to our Professional Standards portfolio.
Official NZ government update regarding PPE as of 29 Mar 2020:
Official NZ government update regarding PPE as of 28 Mar 2020:
Please let us know if anyone is asking you to work with less that the recommended level of personal protection equipment.
Government information and support
Registration for pandemic response workforce
The Ministry of Health is urging professionals, including speech-language therapists who have a current APC (annual practicing certificate) to register their interest in helping withe the pandemic response. Clinicians will be matched with employment that fits their skill set. There are opportunities for both client facing and non-contact services.
You can register here
Accident Compensation Corporation – ACC
ACC is regularly updating their telehealth page. Their update on 23 March suggested that expanded use of telehealth is approved. Talk to your case manager and them directly.
For financial support, refer to Work and income
Telepractice will be a key part of our kete as we enter level 4 of the alert system.
Telepractice refers to the provision of therapy, consultation or assessment live using videoconferencing tools. This includes calling a family member or parent to provide advice, providing coaching via video link, and both individual and group sessions.
Advice for those who are new to telepractice
Telepractice is based on the evidence-based, face-to-face work we typically do. It should feel very similar to the work we already are familiar with.
It is a different service delivery method, but it is not a completely different approach to therapy and intervention.
- Telepractice may not be appropriate for all families. Some families will have other priorities at this time. Some will not have the technology or the headspace to learn new technologies. Some families may not feel comfortable having people ‘virtually in’ their home.
- Think of your personal therapy style and approach. If you don’t typically play board games during therapy, you probably don’t need to learn to do this remotely at this time. If you don’t normally use picture stimuli, learning to do this remotely might not be necessary.
- If homework is part of the evidence base for the therapy approach you are using, find creative ways to continue to offer this remotely as well.
- Be kind to yourself – take this in steps – you don’t have to learn everything overnight!
Here are some guidelines and evidence to assist with your professional development in this area of practice:
- 2018 Allied health best practice guidelines which were developed with input from the NZSTA
- ASHA’s evidence map on telepractice
- 2020 The Informed SLP’s review of the evidence base for telepractice
- Ministry of Health’s telehealth advice group page which includes links to the NZ Telehealth resources
- RCSLT’s advice on various aspects of Telehealth include an app guide
- Systematic review of telepractice in ASHA perspectives published Feb 2020 (free to non-ASHA members during the COVID epidemic
- Systematic review of telepractice from 2015
Telepractice tools and considerations
It is important that appropriate consideration is given to the selection of tools we use for telepractice. A variety of software applications exist that allow people to communicate over video, not all of these are well suited for clinical purposes.
This is an area of practice that requires planning and careful thought, but in many situations, it can be an effective method of service delivery, but not one that can be simply attempted last minute. You can try one and then change to something at a later time.
We do not endorse any specific video meeting applications and urge you to do your own research. Examples includes Zoom (HIPPA compliant version), GoToMeeting, Doxy.me, TheraNest, VSee, WebEx, Simple Practice, Thera V, TheraPlatform, BlinkSession and many others.
A wide range of tools can be used including computers with webcams (built in or external), tablets including iPads, and smartphones. Each have their pros and cons.
- It is strongly recommended that the information transmitted between clients and clinicians is encrypted so that 3rd parties can not access the information when it is in transit over the internet.
- HIPAA does not apply in New Zealand, however, these strict USA guidelines for protecting health information is an indication that the service meets certain criteria. Some services refer to a BAA (Business Association Agreement) to refer to their privacy standards.
- Some video conferencing services have a multi-tier pricing scheme, some without this level of protection and often a more expensive level that does.
- Consider privacy expectations within your client’s home and your home office – presence of other family members, expectations around recording the session (or not), and even the presence of virtual assistants (e.g., Alexa, Siri, etc) that could be transmitting information remotely.
- It is important to consider adequate audio conditions for both you and the client.
- You may consider the use of a headset with a microphone, however, some computers have high-quality microphones and speakers built into them.
- It is essential that both clients and clinicians have sufficient bandwidth to provide a smooth experience.
Group versus individual sessions:
- Both are possible via telehealth, however additional checks need to be done before starting a group session. All clients need to agree regarding their privacy expectations, particularly regarding who else is or isn’t present in the background if/when recording is allowed.
Once you have worked through the above considerations, you can develop an informed consent process that is appropriate for your clients. For some, the client may need to experience a practice conversation with the technology to fully understand the experience. As always, be mindful to apply communication access principles with your consent processes.
Shared therapy materials:
- Screen sharing on both tablets and computers can be used so that both clients and the clinician can have a shared experience.
- A variety of tools can increase the interactive nature of your therapy. We are not endorsing any specific tools, but realise that having examples can help clinicians start to find the appropriate tools for them:
- Familiar techniques like using visual schedules and having sensory breaks are just as important in telepractice as in face-to-face sessions
- You can also hold up portable whiteboards, maps, story books, soft toys, etc.
Do not underestimate the power of you – you are the most important part of therapy. Your knowledge, your tone of voice, your gestures, your facial expressions, your confidence, and your empathy. Everything that makes you a great therapist in face-to-face settings is what will serve you well in telepractice.
And keep up all your standard practices such as a monitoring progress and client engagement, so you can evaluate over time if the therapy is working for your client and adjust as needed.
Other resources (will expand with time)
La Trobe has a collection of resources for telerehab for aphasia
American Speech-Language-Hearing Association (ASHA) has granted 90-day public access to a few of its Perspectives on Telepractice articles
- Alvares, R. “Working With Facilitators to Provide School-Based Speech and Language Intervention via Telepractice”
- Ben-Aharon, A. “A Practical Guide to Establishing an Online Speech Therapy Private Practice”
- Cohn, E. and Cason, J. “Ethical Considerations for Client-Centered Telepractice”
- Pullins, V. and Grogan-Johnson, S. “A Clinical Decision Making Example: Implementing Intensive Speech Sound Intervention for School-Age Students Through Telepractice”
- Tindall, L. “Client Safety and Telepractice in a Clinic or Home Setting”
- Weidner, K. and Lowman, J. “Telepractice for Adult Speech-Language Pathology Services: A Systematic Review”
- Aphasia friendly information about COVID-19 (visuals, posters, etc.) from Aphasia Access