KITKeeping in Touch: Speech and Language via Skype

Helen Poole Sheena Round Reader in Applied Health Psychology Consultant SLT/Network Manager

Outline

• Background to KIT Project

• Evaluation

• Implications

• Recommendations

Evaluation: what’s already known?

• ‘Remote’ delivery of health care increasing

• Clinical use of Skype reviewed (Armfield et al 2013)

• In Speech and Language Therapy (SLT)

– Videoconferencing review (Theodolos & Hill 2002)

– Range of disorders, e.g. stuttering, dysphagia,

Parkinson’s disease

– Variety of purposes, including: screening,

assessment, and review. Limited for therapy

– Predominantly adult populations and case series

Evaluation: Rationale & Aims

• Data on use in UK NHS context sparse

Aims

• To evaluate use of Skype to deliver SLT to children within an NHS context

• To determine acceptability and engagement

• To evaluate any resource implications

Evaluation: Methods

• Prospective study using mixed methods

• Purposive sample

– 7 Speech and Language Therapists (SLTs)

– 9 Clients: Children aged between 3 ½ years and 14 years

and their parents/carers

• SLTs and clients provided with Tablets to Skype

• Variety of session types

• SLTs and clients completed

– On device questionnaire (N=49 sessions)

– Interviews at end of study period (N=11)

Evaluation: Findings

Online questionnaire SLT Client

Easy to connect 84% 93%

No difficulty with visual display

80% 93%

No difficulty with sound

80% 93%

Successful interaction 87% 93%

Sessions and Resources• Duration (N=49) between

15 & 45 minutes, Mean=27.8 (SD9.9)

• Mileage saving per session, mean=8.2 (SD10.1), range 0-50 miles

• Travel time savings per session M= 26.6 (SD13.2), range 15-60 minutes

Table: Percentage agreement with statements

Projected Savings

Travel ~ £87, 000

DNAs ~ £27.000

+

+

Experience

-

Convenience and

Satisfaction

Acceptability

Evaluation: Clients views“I think the technology

of it is brilliant. It’s such an advancement. To be able to

just use a screen and a call…I mean it’s really

come along...”

She showed us initially. But after that you didn’t really need any help setting it up. Did you? You knew what you were

doing

I think short sharp bursts…are better.And she enjoyed it. And she could stay focussed. Because it was only about

twenty minutes

Like ‘C’ says, it…is just easier ‘cos she doesn’t have to miss any of her lunch hour. Or she doesn’t have to miss an art

lesson…

…it is very much like, having her [child]sit on the rug. And doing everything…As you’re having a therapy session

in your living room.

I’d say it was all good. I wouldn’t say there was

any negatives to it...

When you’re on the Skype you sort of have everything ready. You’re a little bit more organised I

think

In their own words

video

Evaluation summary

Findings

• Positive response to use of Skype

• Connectivity, need for planning

• Increased engagement

• Resource efficient

Limitations

• Sample, potential bias

Quality Service

Provided

Low Risk

Equality of Access

Cost Savings

From Time & Travel

Skype is Free

Increased Productivity RIF study

provides an evidence

base

Patient Centred

Links with remote mobile

working

NHS protocol for Skype

Provider Benefits

Challenges

• Confidentiality of data

– Agreement to implementation for clients

– Risk assessment in NHS

– Different way of working for SLTs

• New processes needed for loan tablets

• Activity data changes

• Estate considerations

Future

• Trust Support

– Trust wide survey based on results of evaluation (staff and service users)

• Implementation across SLT

– All therapists a possibility

• Apps

– Procurement process, development

Sheena Round, Helen Poole, Ricky Wallace, Paul Fergus, Carolyn Lees, Ursula McCormick, Catharine Barley, Pam Monti, Louise Simcock, Claire Bimson, Lois Hatfield, Catherine Webb, Claire Hanlon, Chelsea Dobbins, Chris Wright, Caroline RandAcknowledgements: The participants, LJMU, Liverpool Community Health Trust, NHS NW Innovations Fund

The KIT team

ReferencesArmfield, N.R., et al. (2012) Clinical use of Skype: a review of the evidence base. Journal of Telemedicine and Telecare, 18(3): 125-7.

Beijer, L., et al. (2010). Evaluating the feasibility and the potential efficacy of e-learning-based speech therapy (EST) as a web application for speech training in dysarthric patients with Parkinson's disease: a case study. Telemedicine Journal and e-health, 16(6): 732-738.

Carey, B., et al. (2010). Randomized controlled non-inferiority trial of a telehealth treatment for chronic stuttering: the Camperdown Program. International Journal of Language & Communication Disorders/ Royal College of Speech & Language Therapists, 45(1): 108-120.

Grogan-Johnson, S., et al. (2010). A pilot study comparing the effectiveness of speech language therapy provided by telemedicine with conventional on-site therapy. Journal of Telemedicine and Telecare, 16(3): 134-139.

Hill, A. and D. Theodoros (2002). Research into telehealth applications in speech-language pathology. Journal of Telemedicine and Telecare, 8(4): 187-196.

Hill, A., et al. (2009) Using telerehabilitation to assess apraxia speech in adults. International Journal of LanguageCommunication Disorders, 44(5): 731-47.

Mashima, P., et al. (1999). Telehealth applications in speech-language pathology. Journal of Healthcare Information Management, 13(4): 71-78.

Sharma, S., et al. (2012). Assessing dysphagia via telerehabilitation: Patient perceptions and satisfaction. International Journal of Speech-language Pathology, 15(2):176-83

Sicotte, C., et al. (2003). Feasibility and outcome evaluation of a telemedicine application in speech-language pathology. Journal of Telemedicine and Telecare, 9(5): 253-258.

Styles, V. (2008). Service users' acceptability of videoconferencing as a form of service delivery. Journal of Telemedicine and Telecare 14(8): 415-420.

Theodoros, D. (2012). A new era in speech-language pathology practice: innovation and diversification. International journal of speech-language pathology 14(3): 189-199.

Van den Berg, N., et al. (2012) Telemedicine and telecare for older patients: a systematic review, Maturitas, 73(2): 94-114

(Williams, P. (2012). Speech and language therapists say ‘yes’ to bridging barriers with technology. Telerehabilitation, accessed 12/12/12 http://www.ithealthboard.health.nz/sites/all/files/Telerehabilitation%20Flyer%20v2.pdf