Telehealth placements

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The scope of this guidance

This guidance is intended for all SLTs and aims to provide information on telehealth placements, and complements the RCSLT practice-based learning guidance 2021.

It provides information on:

  • The context of delivering telehealth placements
  • Roles and responsibilities during telehealth placements
  • Information governance and digital inclusion
  • Telehealth placement resources
  • Evidence-based practice

This is general guidance and as such does not cover every instance and eventuality. Please discuss any specific questions with the relevant HEI.

Defining terminology

Practice placement

The period(s) of study undertaken by learners as a formal element of their speech and language therapy pre-registration training based within a working environment (including HEI-based clinics, as well as those outside the academic institution) (RCSLT, 2018).

During practice placements, students are assessed against learning outcomes set by the HEI for the placement. To pass the placement they must reach the competency level required for their level of learning, in line with the HCPC Standards of Proficiency (HCPC, 2014).

“Placements are essential to develop the skills and proficiencies necessary to be registered as an allied health professional with the HCPC.” (HEE, July 2020).

Practice educator

A practice educator is a HCPC registered SLT who supports learners in the workplace to develop their Standards of Proficiency (HCPC, 2014).

The practice educator holds responsibility for signing off the student’s competency and assessment criteria, based upon the standards produced by the education provider and relevant professional body; although it is recognised that local models of delivery and assessment will apply (RCSLT, 2018).

Telehealth

The RCSLT uses the WHO definition of telehealth: the “delivery of health care services, where patients and providers are separated by distance… (it) can contribute to achieving universal health coverage by improving access for patients to quality, cost-effective, health services wherever they may be” (World Health Organization, 2016).

The RCSLT has developed practical telehealth guidance.

Telehealth placements

Telehealth placements refer to student practice-based learning activity being carried out remotely. Telehealth is the context of the delivery of the practice placement, based on the mode of service delivery within the placement setting. The practice educator/student can be working remotely from a clinical site, university location, or from home.

Practice-based learning activities

All practice-based learning activities are intended to develop clinical and professional skills, and the application of theory to practice.

Practice-based learning activities provide students with the opportunity to develop all the Standards of Proficiency (HCPC, 2014).

Direct client-centred care

Direct client-centred care refers to all practice-based learning that directly involves working with service users, carers, and members of the multi disciplinary team (MDT).

Direct client-centred care provides students with the opportunity to develop Standards of Proficiency 8 and 9 which relate to communication and interpersonal skills (HCPC, 2014).

Further information on practice-based learning activities and direct client-centred care can be found in the RCSLT practice-based learning guidance 2021.

Context

During COVID-19, the provision of in-person speech and language therapy was restricted, in line with government public health guidance. Many services adapted to deliver remote intervention via telehealth.

There was already an existing evidence base for the effectiveness of telehealth in all areas of speech and language therapy. Access a table of evidence here.

Telehealth is suited to working with interpreters. Professional interpreters must be employed and included in planning and debriefing.

For more information please see: Working with interpreters via video-conferencing software to deliver telehealth (Bilingualism London CEN).

Delivering telehealth placements

Student practice placements can be offered via telehealth. Students can participate remotely in practice-based learning activities and direct client-centred care to meet their practice placement sessions and develop their Standards of Proficiency (HCPC, 2014).

Practice-based learning activities include:

  • Simulated learning environments
  • Case studies with/without video
  • Role play
  • Involving expert service users and carers (SUC)
  • Project work
  • Attending CPD activities

Direct client-centred work might include:

  • One-to-one assessment and therapy sessions with a service user
  • One-to-one work with a carer
  • Training sessions (e.g. parent training and coaching)
  • Work with the MDT (e.g. meetings, case conferences, ward rounds)
  • Groups (e.g social skills groups, communication café style sessions)

For further details on practice-based learning activities and direct client centred work, see our practice-based learning guidance.

Placement capacity

There are national concerns regarding practice placement capacity for the period of 2020-21 and SLTs are encouraged to consider telehealth placements where students cannot attend in person.

They can be provided by a practice educator who is working in person with clients, whereby the student joins remotely, or when both the educator and student are both working remotely.

Telehealth placements may provide the opportunity to expand practice placement capacity, as it may be possible to:

  • Offer higher student ratios
  • Use on/off screen observation
  • Work from another location
  • Not be restricted by room size

All SLTs are requested to offer multiple students-to-educator ratio placements, where possible.

Roles and responsibilities

For placement roles and responsibilities please also refer to:

Further information on placement roles and responsibilities can be found in the roles and responsibilities section of the practice-based learning guidance.

In this section you will find additional considerations related to the telehealth context.

Student role

Preparation
Students should prepare for telehealth placements in the same way as an in-person placement. Additionally, students should contact their practice educator in advance of the first day to ask for information regarding the online platform details, which they should test before starting placement.

Students should also refer to the RCSLT telehealth guidance.

Reasonable adjustments 
Students should disclose any reasonable adjustments required, where possible, before starting placement. If difficulties arise relating to the telehealth context, they should be raised in a timely way, openly and honestly. The HEI, placement provider and student should jointly identify the adjustments required and work collaboratively to enable their implementation.

Presentation 
Students are expected to dress professionally with student identification visible.

Video calls should be conducted with a background that is clear from distractions, with no personal or sensitive information on display. Wall art or décor should not be offensive or overly distracting and there should be adequate lighting.

Where this is not possible from a home location, the student should communicate with the service provider and HEI to arrange working from a clinic base or university location.

Client confidentiality  
Telehealth calls should be carried out in a quiet, private space that is free from distractions including other people and pets. Use headphones wherever possible to ensure calls are not overheard and only the student can hear the service user speaking.

Student confidentiality  
Personal information should not be disclosed to a service user. If a personal phone is needed to ring a service user, ensure call blocking is enabled. Students should only use an email linked to the placement setting (e.g. nhs.net) or their university email address.

We also suggest that students agree on a preferred method of communication with their practice educator and share a phone number in case of online access difficulties.

Observation sessions 
If students are observing telehealth sessions, make sure to agree the etiquette before the call. This would usually involve introductions at the start of the call and then muting the student’s microphone and possibly video as well.

Practice educator role

Positive commitment to the placement  
Telehealth will be a new way of working for many SLTs and students, and it is important to create a positive learning environment via telehealth, being open, approachable and a positive role model for the student. Students can be an asset to telehealth work and service provision.

Induction sessions
An induction should be carried out, referring to information and documents which are relevant to the telehealth placement, such as housekeeping rules, exchanging contact details, appropriate boundaries, local information governance policy, access to electronic records, and health and safety.

Managing expectations 
It is important to be honest about what may or may not be possible on the telehealth placement. The student should also be informed about the level of expectation in terms of modes of communication; e.g. phone/email/online platforms, planning and organisation, deadlines for sending work for feedback.

Supportive supervision 
Supervision may need to be arranged as an online conversation before/after sessions with service users, and may also include written communication via email. When working online, it may be more difficult to gauge how well a student is coping, so the practice educator may need to address this directly as part of clinical supervision.

Supervising more than one student 
Telehealth can lend itself to an increased student-to-educator ratio. A clear supervision model should be followed for multiple students. All students should receive some individual supervision and feedback, alongside peer/paired/group supervision.

Reasonable adjustments 
The Equality Act (2010) advises that HEIs and practice education settings are legally obliged to make appropriate reasonable adjustments for students with identified physical, learning and mental health concerns.

As telehealth placements are a new way of working for some people, difficulties may come to light during a placement; these should be raised openly and honestly. Collaboration between student, practice educator and HEI should ensure effective support is put in place.

Practice coordinator role

  • Work with HEIs to ensure timely practice placement offers, including telehealth placements.
  • Work with HEI colleagues to look at ways that telehealth placements can be successfully developed in their service.
  • Develop innovative placements which will aim to expand telehealth placement opportunities. For example, increasing student-to-educator ratio, running groups with multiple students involved, groups of students doing case studies or workshops, MDT placements.
  • Develop an action plan for the academic year 2020-21, which includes telehealth.

Service manager role

  • Take responsibility to facilitate all eligible staff offering student placements, including via telehealth.
  • Where appropriate, and in collaboration with the HEI, work with relevant departments, such as IT, to ensure equipment is available and there is access to the necessary online systems and platforms.

HEI role

  • Consider which students are best suited to a telehealth placement. For example anybody at high-risk of COVID-19 (BAME students, students who are immunosuppressed, or those who are shielding, etc).
  • Provide students with placement guidance before starting practice placement, and with specific telehealth information, where needed.
  • Where appropriate, and in collaboration with placement providers, work with relevant departments, such as IT, to ensure equipment is available and there is access to the necessary online systems and platforms.
  • Facilitate students working from the university for telehealth placements, if the student cannot work from the placement site or from home.
  • Work with placement providers to facilitate and develop innovative placements, including telehealth.
  • Work with HEI disability services, students and practice educators to manage reasonable adjustments to support engagement with telehealth placements.
  • Provide educator training, including information on delivering telehealth placements.

Information governance

Students and practice educators are required to conduct themselves according to HCPC guidelines and the wider RCSLT information governance guidance.

It remains standard that HEIs are responsible for ensuring students have completed the appropriate mandatory training before attending placement. Placement providers are responsible for the induction of students to the local policies and procedures. Specific consideration of local implementation in the telehealth context will be required, including safeguarding and information governance.

Requirements for consent to treatment from a student and associated information governance do not change in relation to the telehealth service delivery method. However, there are specific adaptations for the telehealth context which are outlined in the RCSLT telehealth guidance.

Where students are providing telehealth services using their personal devices and/or from their home, the placement provider should ensure professional and local governance is applied.

Implementation of a Data Protection Impact Assessment (DPIA) may be useful. Best practice guidance by the National Cyber Security Centre (NCSC) can be accessed here.

Some telehealth platforms and/or infrastructures do not support more than two callers per meeting. In this scenario, recording student-led sessions may be beneficial to the supervision process. This will require the client to specifically consent to the session being recorded, and a form may be helpful to evidence this.

Placement providers will need to prepare for this in advance of the placement starting, in liaison with their local data protection officer and, where relevant, practice education team.

Digital inclusion

Students should be provided with the appropriate resources to engage in the learning opportunities of the practice placement. The responsibility of sourcing and providing the physical resources and environment needs to be agreed locally, between the placement provider, HEI and student.

Some sections of the student population are more at risk of difficulties with digital inclusion, these include students:

  • with disabilities;
  • living with limited internet speed/access;
  • living in shared housing with limited privacy; and
  • with limited access to the hardware required.

A student should not be allocated to a telehealth  placement unless it can be effectively facilitated. This should be determined between the HEI and placement provider during the allocation process.

More information on digital inclusion, appropriateness and the key considerations for using telehealth can be found in the RCSLT telehealth guidance.

Telehealth placement resources

The resources in this section and throughout this guidance are provided for informational purposes only. No endorsement is expressed or implied, and while we make every effort to ensure our pages are up to date and relevant, we cannot take responsibility for pages maintained by external providers.

RCSLT resources

Other resources

Telehealth placements – examples of innovative practice

  • Birmingham City University (BCU) – The information, qualitative data and feedback included in this presentation outlines the process of transition to virtual placements.
  • Leeds Beckett University (LBU) has developed a range of telehealth placement opportunities. Students have engaged with clients online, in both one to one and groups contexts. They have also worked on a number of online projects, from developing resources for clients, to creating videos for services. Feedback from students, clients, and practice educators has been positive. LBU is continuing to develop telehealth placement opportunities to find ways that students can develop their clinical skills, as well as being an asset to speech and language therapy services.
  • Meriah Hobbs‘ presentation outlines how she organised and delivered a virtual placement for four international students at Queen Margaret University in Edinburgh. Meriah explains how she set up, managed and delivered the placement to ensure the experience was a positive one for everyone involved. Meriah delivered this presentation as part of the NHS Education for Scotland (NES) AHP webinar series. Further information can be found in the resources section of this guidance.
  • Sarah Ghazzawi, a senior SLT in Stroke and Neurology at Doncaster and Bassetlaw Hospitals, shares her experiences of using telehealth to enable student placements during the first COVID-19 lockdown. She sets out the steps that were taken to adapt the placements and the challenges and opportunities that the experience offered those involved.
  • Sheffield University (SU) benefited from the support of external practice educators who adapted placements to support students to continue their clinical education. However, innovation in providing additional learning opportunities to enable students to progress has still been required. Throughout spring and summer 2020, the university was able to move to remote delivery of established in-house clinics via telehealth. This continues in the new academic year.
    The presentation provides a snapshot of four of these clinics, including feedback from service users, carers and students. The article outlines the key learning points from moving to this method of placement delivery.

  • University of East Anglia (UEA) – While clinical placements are still the optimum learning environment for a wide range of professional skills, the full lockdown in March 2020 cancelled them all. UEA developed an online simulated placement to enable students to still gain a range of professional skills, including that of the newly emerging telehealth delivery method. Although students were initially sceptical of the value of this, the placement became a hugely valuable development tool and springboard into clinical placement next year. The article demonstrates the success of the project.

Other examples of innovative practice can be found in the practice-based learning resources section.

A list of simulation resources can also be found in the practice-based learning section.

If you have any telehealth resources or examples of best practice, please email them to info@rcslt.org to be added to this guidance.

Evidence-based practice

  • Brennan, D., Tindall, L., Theodoros, D., Brown, J., Campbell, M., Christiana, D., Smith, D., Cason, J., & Lee, A. (2010). A blueprint for telerehabilitation guidelines. International journal of telerehabilitation, 2(2), 31–34. 
  • Carline, C.H., Milam, J.C. (2012) Promising practices in e-supervision: Exploring graduate speech language pathology interns perceptions. International journal of telerehab. 5(2) 21-31
  • Grogan-Johnson, S., Alvares, R., Rowan, L. and Creaghead, N. (2010) A pilot study comparing the effectiveness of speech & language therapy provided by telemedicine with conventional on-site therapy. Journal of telemedicine and telecare. Vol16 (3) 134-139
  • Howells, S., Cardell, E., Waite, M.C., Bialocerkowski, A. & Tuttle, N. (2019) A simulation based learning experience in augmentative and alternative communication using telepractice: speech pathology students’ confidence and perceptions. Advances in Simulation. 4(suppl 1):23
  • Cassel, S.G. and Hadley, A.J., (2016) A pedagogical note: Use of telepractice to link student clinicians to diverse populations. International journal of telerehabilitation. Spring; 8(1) 41-48
  • Overby, M.S. (2018) Stakeholders’ qualitative perspectives of effective telepractice pedagogy in speech-language pathology. International journal of language & communication disorders. Vol 53(1) 101-112
  • RCSLT (2020) Telehealth guidance: evidence-based practice. Available at: /members/delivering-quality-services/telehealth/telehealth-guidance#section-9
  • The Speech Pathology Association of Australia Ltd (2014) Telepractice in Speech Pathology Position Statement 
  • Theodorus, D. (2008) Telerehab for service delivery in speech language pathology. Journal of telemedicine and telecare. 14(5) 221-224
  • Theodorus, D. (2012) A new era in speech language pathology practice: Innovation and diversification. International Journal of speech language pathology. 14(3) 189-199

References

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