8 Pros and Cons of Telepractice for SLPs

Since the beginning of the Pandemic in 2020, a lot of professions jumped on the Telepractice bandwagon. Thank goodness, it was about time! My hope is that, as we evolve into a new normal, we can keep the positives that came from the Pandemic, like working remotely and telehealth for all professions. There are a lot of pros of telepractice for SLPs.

I have been doing Telepractice since 2011. However, there were a lot of naysayers up until we were forced to do it. To me, Telepractice just makes sense. The main reason being that you can reach more people who would otherwise not have access to services. Since 2011, I have served clients abroad whose parents work for a U.S.-based company and are placed in a country that does not have Speech-Language Pathologists. I have worked with clients in Zambia, Ivory Coast, Panama, Ecuador, Kazakhstan, and beyond.

Surprisingly, it’s easier to see clients abroad than across the U.S. because of licensure barriers (more on this in the Cons section). There are a lot of positives with Telepractice, but like everything, there are also limitations. Below are pros and cons that I have found with Telepractice in Speech-Language Pathology.

Cons

I am starting with the cons first so I can end on a good note with the pros 🙂  Do not let the cons listed below dissuade you from this very important platform for providing services.

1. Internet connectivity– I have had clients around the world who live in a country that has regular rolling power outages (to save energy, different areas will be without power for several hours) or have spotty WIFI.

Even in the U.S., I have lost WIFI due to storms or switching internet providers. If possible, have a personal hot spot or WIFI booster available as a backup. If you are on a video call, sharing screen, using other videos, and have a spouse also working from home, a WIFI booster is helpful 😀

2. Time difference/change– You may have clients in countries that are 12+ hours ahead. Scheduling around their school/work schedule in addition to yours can be tricky. I have gotten up as early as 3:30 am for a client. Of course, that was a one-time thing. You can set your own schedule, but if you aren’t willing to get up early or stay up late, you will miss out on a lot of clients.

Along with that, countries observe daylight savings differently. Some don’t observe it all, but most do, and they change their clocks at different times. I use WorldTimeBuddy.com to figure out what time the session will be in my client’s country starting 4 weeks before and after we change our clocks.

3. An adult needs to be there– So, my pediatric clients can usually troubleshoot better than myself or their caregivers. However, you will need an adult there to make sure they get online at the right time, find the link, and help redirect them if they get easily distracted. I have had clients get up from the computer to show me something, and never return.

If you have a client who stays seated but gets off task and the adult is in another room, one trick I use is to cover up the camera, so they think something is broken and they go get the adult. That’s when I can tell the adult what happened and what I need them to do to help us get back on task.

4. Not suitable for all clients– Telepractice is suitable for a lot of people! More populations than you would think. I have done sessions with a client as young as 18 months old and yes, I worked with him directly. I have also worked with kiddos who ‘have a short attention span’ and have sustained their attention for a full hour. Again, Telepractice works for most populations! When in doubt, just try it.

However, there are some populations that it may not be suitable for. So far, the only kiddos I have been unable to do Telepractice with are the ones that can’t engage in joint attention (like the ones with severe-profound autism or cognitive impairments). If an in-person provider isn’t available, try caregiver coaching.

5. Licensure– You have to be familiar with licensure in the state and country where you are as well as the client. Keep this in mind if you or your client travels for a holiday. Depending on the short-term location, you may not be able to see them.

The U.S.

As I said above, it can be easier to see clients in other countries than in the U.S. That is because each state in the U.S. has different requirements. Most states require that the provider be licensed in the state where they are and where the client is. Some states require that the client be seen in person first or have an in-person assessment. None of this makes sense, don’t get me started on thinking logically!

Internationally

There are some countries that do have Telepractice regulations. If you are working with international clients, you will need to check to see if their home country has regulations on Telepractice. If not, like if a country doesn’t even have our profession, you can provide Telepractice services.

Pros

Despite the cons, I do believe that the pros outweigh them by 1,000%. There is no need to elaborate too much on these benefits 😉

1. More access around the world- Hands down this is the best reason. Providing speech therapy via Telepractice gives clients access who normally wouldn’t have access.

2. No commute- There is no commute for your or your client, except your couch to your office. This saves everyone time, gas, and other resources.

3. Fewer cancellations– There are fewer cancellations because clients don’t have to cancel for minor illnesses or transportation issues.

What ASHA Says:

ASHA has a practice portal devoted to Telepractice. Be sure to check that out for up-to-date information.

The type and quality of in-person and online services should be the same. Meaning, sessions and assessments done online are not less than or worse than those done in person. Additionally, the cost should be the same. If you are a provider and charging less for online sessions, please don’t!

Assessments

Assessments can be given online. Many commonly used measures, such as the CELF-5, have been converted online and can be given both in-person and online. Instructions to modify an assessment online are given. Usually, it is as simple as having the client set up a second camera behind them so you can see where they are pointing. Make sure they mute the second camera’s microphone and speaker!

Licensure

Most states require that the provider be licensed in BOTH the state where they are located AND where the client is located. So, if I am in D.C. and my client is in Maryland, I will need to be licensed in both D.C. and Maryland. Fortunately, ASHA is pushing for an interstate compact and there are 14 states that have already joined!

Licensure requirements do vary state by state. During the Pandemic, many of them loosened restrictions but are rolling those back now. For a State By State guide, view ASHA’s website: https://www.asha.org/advocacy/state/  This should be checked regularly if you are providing services across state lines, as they can change at any time.

Activity Suggestions

Check out my other blogs on Telepractice for ideas for activities, using a green screen, and free websites!

10 Speech and Language Activities To Do In Telepractice That Are Not Online

10 Free Websites for SLP Telepractice

Virtual Backgrounds (Green Screen) In Speech Therapy

What have you learned since providing online sessions to clients? What are some of your favorite resources? Let us know in the comments below.