Intervention Service Delivery

of a postgraduate degree after being ‘away’ from studies for a while. Meeting other students and being able to share their concerns, hopes and aspirations helps to allay fears and confirms that they are not alone in their situation. Under normal circumstances, much of the course is conducted online, but four week-long, on-site visits to the University throughout the programme (with lectures, discussion groups, workshops and, of course, tea breaks) have always played a significant role in establishing and maintaining a sense of community.

With COVID-19, all face-to-face methods were suspended. As programme co-ordinator, Dr Tonsing had to find a way to help students gain and maintain a sense of community in a completely online environment. In previous years, the department’s seminar room had been the place where students would meet during most of the contact week, having their tea breaks, sharing lunch, working on their studies or chatting. Dr Tonsing therefore decided to replace this room with a virtual one—the Blackboard course room. She wanted students to come to think of their virtual course room as a social space, not just an academic one. She started the virtual contact week by facilitating social interaction among students, encouraging them to share their personal journeys through the lockdown. Students were asked to share their videos and invite the class into their study space, an exercise that helped all of them visualise each other’s individual circumstances and appreciate how innovative students had to be at times to make sure they had good reception and no disturbances, with some sitting outdoors or in their cars.

Time was also scheduled in the course room for synchronous verbal discussions, student presentations and practical workshops. Breakaway sessions were created during which students paired up to engage in an activity. As if walking around in the classroom from pair to pair, the lecturer entered these breakaway rooms to see how students were progressing. A colleague with a severe disability who uses AAC gave a guest presentation online using her AAC device, and students were able to engage with her live. Since this colleague uses spelling to compose her messages, the chat tool came in very handy. Everyone shared tea breaks in the virtual room too, engaging in small talk and chat.

A very successful strategy for second-year master’s students was a series of scheduled virtual writing meetings, patterned after the Shut Up & Write method invented by Rennie Saunders.11 Three to four hours every day of the contact week were dedicated to this activity. Students all entered the virtual course room, and one student was assigned as timekeeper. Students spent 50 minutes working on parts of their dissertation, took a ten-minute break during which they could engage in social chat with the other students, followed by another 50-minute writing session. Many students commented on the usefulness of the strategy to progress in their writing and felt more connected and more accountable in the process.

Although students still commented that they missed the ‘real’ tea breaks, they were generally positively surprised about what was possible online, especially when synchronous engagement via audio and video was included. Dr Tonsing reports that she personally realised again how important it is to recognise people as integrated, whole beings and to connect with them in ways that communicate ‘I see you’— even if this has to happen during a virtual tea break.

Dr Maria du Toit

Dr Renata Eccles

Dr Renata Eccles and Dr Maria du Toit of the Department of Speech-Language Pathology and Audiology were familiar with remote service provision before the start of the lockdown. Globally, tele-practice has become a successful platform to offer healthcare, including speechlanguage therapy services.12 Tele-intervention specifically refers to treating communication- and swallowing-related conditions via a tele-practice approach.13,14 Speech-language

11 Shut Up & Write is owned and operated by Writing Partners, a 501(c)(3) non-profit organisation. https://shutupwrite.com. 12 Krikheli, L, Carey, LB, McDonald, CE, & Malik, N. 2017. Telehealth use in speech-language pathology: An exploratory scoping review (prepared for Cabrini Health, Victoria). Melbourne: La Trobe University, participatory Field Placement Report, pp 1–52. http://hdl.handle.net/1959.9/563260 13 American Speech-Language-Hearing Association. 2020. COVID-19: Tracking of state laws and regulations for telepractice and licensure policy. https://www.asha.org/ uploadedFiles/State-Telepractice-Policy-COVID-Tracking.pd 14 Cason, J, Behl, D, & Ringwalt, S. 2012. Overview of states’ use of telehealth for the delivery of early intervention (IDEA part C) services. International Journal of

Telerehabilitation, 4(2): 39–46. https://doi.org/10.5195/IJT.2012.6105.

therapists (SLTs) are obligated by their professional code of conduct to provide remote services that are equivalent to the quality of services provided face-to-face.15,16 According to the scope of practice, SLTs are expected to use tele-practice to provide services when direct therapy is not accessible. In South Africa, guidelines were issued early in 2020 by the HPCSA and the South African Speech-Language and Hearing Association (SASLHA) on delivering services under a state of disaster such as the COVID-19 pandemic,17 but guidelines specific to tele-practice are still limited.

Tele-intervention has been used for over three decades but, owing to advancing technology and a higher demand for SLT services, its implementation has increased in the last ten years.18 Even though tele-intervention has been available for a long time, delivering services via tele-practice was not introduced during undergraduate training. SLTs reported that, upon exiting their study programme, final-year students’ knowledge regarding tele-health was limited.19 Tertiary institutions are among the key constituents that should be involved in telehealth education, training and development.

It was not until the COVID-19 pandemic that tele-intervention became the paramount means of undergraduate training for service delivery. Owing to restrictions resulting from COVID-19, and the suspension of face-to-face academic training, the American SpeechLanguage-Hearing Association (ASHA) released guidelines on the provision of tele-intervention by undergraduate students, and the supervision thereof. Tele-intervention is one of the few opportunities available to SLTs for continued service delivery during pandemics.

The Department of Speech-Language Pathology and Audiology (SLPA) has various clinics offering SLT and audiology services to members of the public. The SLPA programmes are considered professional programmes, as students are required to deliver services to the public as part of their training. As set out by the HPCSA, students need to accumulate a minimum of 400 hands-on clinical hours during the course of their undergraduate studies, in order to be deemed competent SLTs or audiologists.

SLPA lecturers faced the dual ethical responsibilities of providing continuous, high-quality services to vulnerable populations and ensuring students met the necessary requirements to obtain their degrees. Therefore, a framework was developed to deliver early communication intervention (ECI) services at a distance when face-to-face services were not possible.

All students received orientation sessions prior to the commencement of tele-intervention via narrated PowerPoints, video demonstrations and trial tele-sessions. Clients then received tele-intervention information letters that included a technology survey and were required to complete a consent form.

ECI tele-intervention sessions were conducted with caregivers, and the child was not typically involved. Each week students evaluated the functional application to daily life of the concepts covered in the previous session using reflection questions. This provided students with an opportunity to revise the previous strategy if implementation was unsuccessful. Otherwise, a new strategy was introduced and its relevance to the families’ identified goals outlined. Descriptions of the strategy were provided, and the family was able to discuss the information with the students and lecturers. The caregiver also practised the strategy in the session to refine its use and maximise the potential for success. Students, together with the caregiver, then jointly planned how to apply the strategy meaningfully in the family’s specific daily routines. This allowed the students to troubleshoot potential challenges with the family. The lecturer was able to provide guidance throughout the session when required, but formal feedback and marks were received.

In the next step, families were encouraged to send feedback regarding the implementation of the strategy prior to the next session. This was done via formal reports from home, emails, WhatsApp messages or voice notes, shared Google documents or videos of the implementation. In the third step, students used this information to plan accordingly. Finally, the day before the next session, students sent the family a brief outline and possible demonstration of the concepts to be covered. The cycle then started again.

The students and caregivers involved in the intervention were asked to reflect on the tele-framework. Their expectations prior to the intervention and the challenges experienced were similar for both students and caregivers. These included difficulty tracking the child’s progress and managing demanding schedules, and issues with connectivity. Nonetheless, tele-ECI was a positive experience for everyone involved. It encouraged caregivers and students to apply comprehensively a parent-led approach, which is recognised as an evidencebased approach for early language facilitation. All caregivers reported improvement in their children’s communication abilities. Through this framework, the lecturers reached their goal of equipping students with the skills to provide continuous, high-quality ECI services under challenging circumstances.

15 American Speech-Language-Hearing Association. 2016. Scope of practice in speech-language pathology [Scope of Practice]. Available from www.asha.org/policy/. doi:10.1044/ policy.SP2016-00343 16 Health Professions Council of South Africa. 2020. Speech, language and hearing professional board guidance on the application of regulations, rules and guidelines during

COVID-19 pandemic. 17 South African Speech-Language and Hearing Association. 2020. Memorandum: What to do in level 4 under the state of disaster May 2020 (version 2). https://docs. mymembership.co.za/docmanager/editor/34/UserFiles/guideline_document.pdf 18 Hill, AJ, & Miller, LE. 2012. A survey of the clinical use of telehealth in speech-language pathology across Australia. Journal of Clinical Practice in Speech-Language Pathology, 14(3): 110–117. 19 Govender, SM, & Mars, M. 2018. The perspectives of South African academics within the disciplines of health sciences regarding telehealth and its potential inclusion in student training. African Journal of Health Professions Education, 10(1): 38–43. https://doi.org/10.7196/AJHPE.2018.v10i1.957