Information regarding COVID-19

We are closely monitoring the evolving COVID-19 situation through official channels including Unite Against COVID-19, the Ministry of Health and the World Health Organization.

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 20 May 2020

 

Level 2 guidance for SLTs

Our collective success in the fight against COVID-19 has allowed us as a nation to transition to alert level 2 on 14 May 2020.

It also means that more decision making will be handed back to us as individuals and local teams. Our clinical training, problem-solving skills, and communication skills will set us up well for this next stage in our collective response against COVID-19. We all have been asked to work safely, but the details of what that means will at times need to be decided at the local level. That said, we are here to support and will be providing guidance throughout.

Advice for health based SLTs

We released our updated guidelines for speech-language therapists working in the health settings on 12 May 2020.

20 May 2020 update: Following on from recent decisions of our colleagues in otolaryngology and NZOHNS, starting today we are now advising members that non-essential endoscopy can now be re-established for ‘low-risk COVID-19 patients. Please continue to follow the NZSTA Level 2 Guidance for Health SLTs for infection control and PPE based on i) your patient’s COVID-19 status, ii) your own hospital alert level, iii) the current government alert level and iv) the procedure being used.

Advice for SLTs working in the community

We released our updated guidelines for speech-language therapists working in the community on 14 May 2020.

Both sets of guidelines are likely to have information relevant to all SLTs and will be updated as needed.

 

Level 3 guidance for SLTs

Our work lives at alert level 3 will be very similiar to alert level 4.

Speech-language therapists will continue to primarily work remotely through telepractice. Contactless delivery of communication equipment, once properly sanitised, is also allowed.

Advice for hospital based SLTs

For some SLTs working in DHBs, who primarily work with an acute caseload, level 3 means continuing to triage patients through telephone calls to the wards, establishing COVID-19 status in all patients before visits and using distancing wherever possible. Many standard assessment procedures are still to be avoided or are limited in use.

We have two documents to support SLTs working in DHBs:

  • NZSTA guide for clinical swallowing evaluation without CRT and FEES: click here
  • NZSTA COVID-19 guide for level 3 for DHB SLTs : click here

The guidelines were developed in consultation with the NZSTA and the SLT Health Leaders Group and released to all members 1 May 2020.   This guidance is specific to the tasks conducted by speech-language therapists (SLTs) and should always be followed alongside Government and DHB level policies and recommendations.

Our NZSTA COVID-19 for level 3 guidelines specify what is high and low risk and is essential for anyone whose work includes AGPs:

  • High risk AGPs– FEES, Cough reflex testing (CRT), Laryngectomy and Tracheostomy
  • Lower risk AGPs- Bedside clinical swallowing evaluations, mouth cares, EMST and VFSS

If in doubt, contact your senior management team and local infection control officer for clarification and support.

Advice for community based SLTs

In-person appointments in the community are only allowed if they meet the current Ministry of Health criteria for urgent care and then only after completing a risk assessment and when appropriate measures are in place to protect public health including infection control procedures, appropriate use of PPE, and accurate documentation to support contact tracing.

Specifically, the Ministry of Health’s current definition of urgent care for community allied health professionals:

  • a condition which threatens life or limb OR
  • a treatment that is required to maintain the basic necessities of life OR
  • a treatment that cannot be delayed or carried out remotely without risking significant harm or permanent/significant disability AND
  • the treatment cannot be delivered by a service which is currently operating or by a health professionals who are already in contact with the patient

Infection control for all COVID-19 levels

It is our professional duty to stay up-to-date and prioritise the health and safety of our communities and clients.

Universal requirements

We all need to follow the public health advice around hand washing, maintaining a social distance of 2 metres, and sanitising all surfaces that have been in recent contact with others.

It is currently best practice to maintain a log of everyone you encounter both your personal and professional lives. We can assist contact tracing efforts by having a well-maintained log of every close contact including names, dates, times, locations, names, and ideally an email or phone number.

NZSTA PPE information specific for SLT

Here is a link to the NZSTA Infection Control Standards for usual practice (outside of a pandemic) and these may be useful for you in your discussions.

The level of PPE recommended for SLTs depends on

a) the activity you are performing and

b) the infection status of your client / patient. Below is a table of typical PPE for SLT interventions. Please use this guide in your discussions with your infection control team and medical colleagues if you are conducting face-to-face consults. See the NZSTA COVID-19 guide to Level 3 for DHB SLTs for further guidance.

Please note the PPE level numbers do not correspond to the COVID-19 Alert level numbers, please see the NZSTA guidelines which outlines which level is needed for each of the colour coded hospital alert levels (green, yellow, red, etc.)

Please let us know if anyone is asking you to work with less than the recommended level of personal protection equipment.

 

Official information for health and disability workers from outside of NZSTA

Specific Ministry of Health information:

 

World Health Organisation Information on:

Transmission of COVID-19 2 April 2020: click here

5 key moments when proper hand washing is required: click here

 

Supporting Communication Rights

It is important that all New Zealanders can effectively communicate during this pandemic. We have a key role to play in promoting communication rights.

Information for people with disabilities and their whānau can be found on their dedicated page  and in Easy Read formats

In hospital settings, patient-provider communication is essential so that everyone can describe symptoms, rate pain, request (or refuse) assistance, and maintain social connection (even if remotely). Using white boards and visual supports can help reduce the impact of masks on face-to-face communication.

In the community, we can support communication access by

  • increasing access to low tech, high tech, and visual supports
  • using telepractice to coach on the use of aided and unaided forms of communication
  • ensuring that video content has subtitles
  • ensuring that images on social media have alt text

Resources for hospital settings

Patient Provider Communication
Collection of bedside resources in English, Arabic, French, German, Hebrew, Italian, Mandarin, Portuguese, and Spanish. They are looking for additional translations.

This site includes directions and case examples and includes this collection of free resources and training materials.

Other resources
Practical AAC have curated a set of resources to talk about COVID

Amy Reinstein’s page of free AAC printable resources

TalkLink is also gathering resources to help support communication and understanding during this time

 

Telepractice resources

Telepractice will be a key part of our kete.

Telepractice refers to the provision of therapy, consultation or assessment remotely via video conferencing or the telephone.  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, in-person work we typically do.
It is a different service delivery method, but not a completely different approach to therapy and intervention.

Remember:

  • 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!

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.

Software:

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.

There is also software that allows an iPad, for example running therapy apps or AAC apps, to be screen mirrored to your computer. This allows you to share your screen within many video conferencing applications.

Hardware:

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.

Privacy:

  • It is strongly recommended that the information transmitted between clients and clinicians is encrypted so that 3rd parties cannot 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
  • You are encouraged to close your email and other applications containing confidential information to avoid inadvertently sharing this information during a session

Privacy concerns:

The Privacy Commissioner has the following general information about privacy and health care provision and some information specific to whether it is appropriate to share someone’s COVID status here.

Audio:

  • 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.

Internet Speed:

  • 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 is not present in the background if/when recording is allowed
  • Similarly, having a plan regarding if/when microphones will be muted in groups sessions is recommended
  • Be mindful of the auditory processing challenges and the effect of lag between when one person speaks and the other hears your words

Informed consent:

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. Again, be mindful to close applications such as email that have confidential information exposed.
  • 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:
    • Interactive PDF annotation software (e.g., Foxit Reader, Adobe Acrobat Reader, etc), interactive PowerPoint Games, interactive Google Docs, and others
    • Online games, virtual manipulatives, and digital materials (ABCYA.com, toytheater.com, Teachers Pay Teachers, Boom Cards, Simplify, etc.)
  • 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.

Additional Resources to assist with your professional development

Publications:

 

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.

Maintaining good mental health

Here is some information from the Allied Health Aotearoa New Zealand:

Mental Health Foundation Toolkit Poster:
https://www.mentalhealth.org.nz/assets/5-ways-toolkit/Five-Ways-to-Wellbeing-at-Worknew.pdf

Resource page for frontline workers:
https://www.mentalhealth.org.nz/get-help/covid-19/

Health Central tips:
https://healthcentral.nz/taking-care-of-your-mental-health-while-self-isolating/

New Zealand Psychological Society:
list of resources (this includes information on working from home, workplace issues and more)

Resource for discussion COVID with children:
https://www.savethechildren.org.nz/issues-and-concerns/covid-19

Here is an asynchronous learning module on keeping well when working from home:
https://likeminded.co.nz/wr/story.html

 

For financial support and wage subsidy please refer to Work and Income:

individuals

businesses, including self-employed clinicians