CONTENTS This is a threaded discussion page for the International Stuttering Awareness Day Online Conference paper, Low-Cost Video-Conferencing for the Provision of Remote Stuttering Intervention: Myth or Reality? by Richard McGuire (Iowa). Welcome From: Rick McGuire Date: 10/10/98 Time: 1:55:13 PM Remote Name: 134.29.30.79 Comments I welcome everyone to this conference and look forward to your comments and questions. Re: Welcome From: richard mcguire Date: 1/9/99 Time: 6:52:26 AM Remote Name: 195.92.194.82 Comments amazingly, we share the same name, and i have a slight speech impediment, amazing really, andyway, laters..... rickymac Great potential and potential problems to be solved From: Judy Kuster Date: 10/10/98 Time: 1:55:55 PM Remote Name: 134.29.30.79 Comments I am personally fascinated by your exploration of DVC in service delivery and also believe it will develop into a model in the not-too-distant future. I appreciate your candor in describing some of the current problems and like you, believe with advances in the technology and just as important, advances in the public's use of that technology, many of the problems will be solved. I'm wondering if you have considered some of the barriers that may currently be in place that are not related directly to the technology? Do you think there will be a need for a person in Iowa who is contacted by a person in California for therapy to be licensed to practice in both states, for example? Also, I suspect you have the answer to this one because you are already providing supplemental therapy over the net, but how is the privacy of the client protected when therapy is being done over a network? Is there a password that limits access so that just anybody is not able to tune in either accidentally or intentionally? Re: Great potential and potential problems to be solved From: Rick McGuire Date: 10/10/98 Time: 1:56:29 PM Remote Name: 134.29.30.79 Comments Judy, Thanks for the questions. I havn't place much thought into the issue of providing services "across state lines." I would question the ethical considerations of a professional in California providing service to a client in Iowa. My interpretation of ASHA's Code of Ethics is that you can not rely exclusively on distance or remote treatment in service delivery. I believe you need to have face-to-face therapy interactions which can be supplimented via technology. I also wonder about therapists who live near a state border who is involved in home health service provision. I have a colleague in this situation in Souix Falls, SD who, I believe, provides service in Northwest Iowa. I am unsure what licenses she holds but she does cross state lines. Insights anyone? As for the privacy issue, we use point-to-point connections in our DVC which eliminates accidential connections and interference. I realize that someone administering the network could "evesdrop" but don't believe that this is a major invasion of privacy. I look at it in a manner similar to telephone privacy. There are some DVC software that doen't not provide point-to-point connections where this may be a big problem. DVC From: Trisha and Charlet Date: 10/10/98 Time: 1:57:00 PM Remote Name: 134.29.30.79 Comments Your paper regarding the use of technology for delivering therapy to clients is timely !! As we read your paper, some questions came to mind that we pose for consideration. 1. What measures will be necessary to ensure client confidentiality on the Internet? 2. How might equipment and training be provided to clients who cannot afford the necessary equipment or Internet access? 3. You state that "remote intervention may best be used in providing theraputic interaction with adults who stutter." In your opinion, will remote intervention be as effective for children and adolescents who stutter? Trisha Olson and Charlet Sperbeck Graduate Students, Communication Disorders Mankato State University Re: DVC From: Rick McGuire Date: 10/12/98 Time: 4:14:07 PM Remote Name: 134.161.228.83 Comments 1. What measures will be necessary to ensure client confidentiality on the Internet? The type of connection made for DVC is a "point-to-point" connection and is similar to a telephone connection. When I initiate a conference, I "dial-up" the specific Internet address of the client. We connect to each other and have no interference with others on the network. The only individuals who can evesdrop on this session would be network administrators who I believe are too busy or disinterested in "spying" on a therapy session. I don't see a problem with confidentiality. 2. How might equipment and training be provided to clients who cannot afford the necessary equipment or Internet access? This is an issue with the second element, Internet access, being the most problematic. As far as hardware goes, we have provided loans to clients for the duration of the intervention. Since the network connections to date have been relatively slow (modem speeds of 28.8 Kbps) the actual computer doesn't need to be the latest and fastest models. I am aware of of a few sources to get corporate hand-me-down computers for organizationa and individuals with specific needs. As for the Internet connections, this is only as good as the telephone access or with increasing frequency, cable network (more and more cable television providers are including cable modems as a means of internet access). In some cases clients may not have phone or cable service. In the cases where they do have the service, there may not be the funds to cover the $20 to $50 per month internet service charge. In this case, a granting source may be a solution. Although, paying a client's internet service payment may be less expensive than sending a therapist out to a remote location for direct service provision. 3. You state that "remote intervention may best be used in providing theraputic interaction with adults who stutter." In your opinion, will remote intervention be as effective for children and adolescents who stutter? The comment about DVC working best with adults relates to (1) their ability to understand, problem-solve, and interact with the technology involved independently, and (2) relates to a more mature level of committment and involvement in therapy. I believe DVC could be effective with children but may require a "aid" on their end (e.g, parent). I believe that therapy with children may be focused to a greater extent on primary characteristic of stuttering and subtle speech characteristics may not be real evident in this technologic approach. remote service delivery From: LH Date: 10/10/98 Time: 9:06:27 PM Remote Name: 155.247.229.163 Comments As a resident of a very remote part of the world, I am extremely interested in the potential of DVC to provide services to people places that are inaccessible, either physically or financially. Leaving the American context for a moment, what do you think about training paraprofessionals and people in related but different professions such as visiting nurses and special education teachers to provide some of the therapy under the remote supervision of a speech pathologist? Certainly there would have to be direct contact some times between slp and client, but it seems to me that a lot of the work could easily be done by onsite service providers or parents who have received some training. It would certainly be a way to provide consistent and long-term treatment for people who might otherwise get to see a slp maybe three or four times a year at best. Lou H Re: remote service delivery From: Rick McGuire Date: 10/12/98 Time: 4:18:51 PM Remote Name: 134.161.228.83 Comments Lou, I believe that TRAINED para-professionals under supervision are an asset to therapeutic intervention. With the push to reduce health care costs in the US, along with the lack of trained professionals in some regions of our country as well as in other areas of the globe, I believe there is a need for speech aids. The issue is related to the training of these para-professionals and the supervision that they receive. I believe that DVC could be considerably more effective if you had a trained aid on sight with the client and the clinician could work with the aid and the client remotely. This would be an ideal solution. Stuttering Children Treatment From: Ira Zimmerman Date: 10/11/98 Time: 5:00:21 PM Remote Name: 209.156.101.12 Comments In the U.S. there is a problem in public schools getting stuttering children proper treatment for their stuttering. Tragically, this delayed treatment could lead to a life long problem with stuttering. How do you think video technology can be used to treat kids who stutter? Wouldn't it be nice if each state had at least one fluency specialist who reviews that state's treatment of all stuttering children using the latest video technology? What do you think? Re: Stuttering Children Treatment From: Rick McGuire Date: 10/12/98 Time: 4:27:18 PM Remote Name: 134.161.228.83 Comments I believe that certain aspects of stuttering therapy may be adequately provided via DVC. My concerns relate to the lack of clarity (resolution) in the DVC signal that may mask some of the speech characteristics of the child who stutters. However, your suggestion of a "state expert" may benefit from DVC. This expert could conference with a less experienced clinician to guide her/him in the provision of fluency therapy. The use of DVC may make this type of service delivery possible when now it would require extensive travel. There are many possible applications of DVC for direct interection between clinicians as well as between PWS. When you have an isolated PWS, DVC may provide a "remote" support group via connections with other individuals who stutter. Re: Stuttering Children Treatment From: LH Date: 10/12/98 Time: 5:51:24 PM Remote Name: 155.247.228.165 Comments What you describe in your answer to Ira is pretty much what I was wondering about as a way to provide therapy for people in remote areas. A question, though: what kind of training should an onsite assistant service delivery person receive to work via DVC with a remote SLP in bringing assistance to the isolated or remote client? Lou H. Re: Stuttering Children Treatment From: RIck McGuire Date: 10/14/98 Time: 5:10:57 PM Remote Name: 134.161.228.83 Comments Assuming that they aid is already trained to provide therapy activities under the direction of a clinician, the individual would need minimal training related to technology. The individual would need reasonable computer skills including simple problemsolving of basic computer problems as well as some specific training related to the DVC application employed in the provision of remote service. The students and parents I involved in the projects done under my supervision were trained in one afternoon on the DVC technology and applications. I will admit that all had computer skills coming into the projects. Service options for the future From: Laurie in Minnesota Date: 10/17/98 Time: 10:56:06 AM Remote Name: 209.18.159.238 Comments I read your article with great interest. My rural location makes it difficult for clients to access services. I will be looking forward to more information on this topic in the future. Re: Service options for the future From: Rick McGuire Date: 10/19/98 Time: 9:34:45 AM Remote Name: 134.161.228.83 Comments One problem with the use of DVC for those who are in truely remote areas is that there may be a lack of adequate internet service in some of these areas. I have found in parts of rural Iowa, the quality of the telephone lines are such that effective DVC is difficult. As I said in my paper, this technology will continue to improve so keep looking for new imformation and applications. "Therap" from the Greek "to guide" From: Chuck Goldman Date: 10/18/98 Time: 9:45:51 AM Remote Name: 152.163.206.194 Comments Call me plain old-fashioned but I don't see it in most cases. It's hard enough establishing a clinical relationship face-to-face but subtleties may be everything in clinical communication. How can a therapist "guide" his client if the path is so remote. Video-conferencing in terms of education, and information sharing may eventually reign supreme. Re: "Therap" from the Greek "to guide" From: Rick McGuire Date: 10/19/98 Time: 9:31:18 AM Remote Name: 134.161.228.83 Comments I agree that DVC is not the same as face-to-face interaction. I also agree that much of the subtle aspects of interaction is lost through remote intervention. However, I also recognize that there are situations where persons who stutter would benefit from remote service if face-to-face service is unavailable or for more frequent interactions with the clinician via supplimental DVC (supplimental to the face-to-face sessions). I believe that one may still "guide" using DVC although this may not be as efficient as "guiding" face-to-face. I would like to highlight that I believe it is unethical to use DVC for service provision without some face-to-face therapy. Parent Counselling via VC From: Anthony Wray Date: 10/19/98 Time: 2:34:52 PM Remote Name: 209.167.144.11 Comments Rick: I am relieved to learn of other clincians who are ready to look for new ways to use technology to expand the range of our service delivery. I am currently looking for pilot clients for a Parent Counselling program via internet-based video-conferencing. Any interested families should visit http://www.prevent-stuttering.com/Video-Conf.html for more info. I am currently counselling amother in the Canary Islands (off of Spain) who has no access to services. She video-taped several samples of her son's speech in English and Spanish, transferred it to a North American VHS format, translated and transcribed 35+ pages into text for me. In exchange I am providing her with free parent counselling via video-conferencing. We are still in the early stages of this project, but I will keep my colleagues informed as there are developments. Anthony Wray, M.A. Speech-Language Pathologist http://www.prevent-stuttering.com Re: Parent Counselling via VC From: Rick McGuire Date: 10/22/98 Time: 2:46:13 PM Remote Name: 134.161.228.83 Comments Anthony, I commend you for your efforts. I wish you success in your efforts to use technology as a tool for your clients. Rick