Speech therapy: overcoming service delivery challenges in rural settings
Residents of rural and remote Australia often experience disadvantages and inequalities when it comes to healthcare access and delivery. There are only about 10 speech pathologists practising in remote and very remote regions of Australia per 100,000 inhabitants, while in major cities there are 26 per 100,000 inhabitants.
Traditionally, access to speech and language sessions for children has been restricted to in-person visits. As a result, access to speech therapy for children living in rural and regional areas has been extremely limited and non-existent in many remote areas.
However, the introduction of telehealth has played a critical role in increasing accessibility to health care, as speech pathologists across Australia have the resources to reach more children in remote areas. Telehealth is rapidly becoming an essential part of speech pathologists’ core business model, with research demonstrating that telehealth-delivered assessments achieve comparable results to in-person consultations.
Here, we delve into the role telehealth can play in overcoming the challenges of delivering speech therapy services for children in regional and rural Australia.
The access challenge
Children living in regional and remote Australia often experience disadvantaged health and developmental outcomes compared to their peers residing in urban areas. Research indicates that 27% of children in regional and remote areas are likely to be developmentally vulnerable compared to 21% in towns and cities.
Not only are children in remote communities more likely to experience socioeconomic conditions that impact health and development, but they are also more likely to experience a lack of timely access to appropriate services, including health care.
Limited availability and longer travel distances can significantly affect the quality of care because healthcare practitioners have a reduced opportunity to get to know the patient and visits are likely to be less frequent. Another consequence of limited healthcare availability is longer wait times, meaning there is often a delay to patients receiving the help required. A two-month wait time for an initial assessment is typical and often the beginning of many years of struggle to get adequate support.
We know that early childhood is a period of considerable developmental plasticity which influences long-term growth. Children with developmental challenges are often excluded from their community and a disproportionate number of young offenders have language impairments. Access to timely and quality healthcare services becomes critical to prevent and address patient concerns from the onset.
Despite the high number of vulnerable children living in regional and remote communities, access to specialist care services, like speech pathology, is limited. Data suggests that less than a quarter of all employed speech pathologists in Australia work within regional and remote regions. This indicates a significant imbalance between the services available in rural regions compared to urban areas which needs to be addressed.
The assessment challenge
Like other health domains, speech therapy requires a diagnosis of the speech impediment before being able to offer the appropriate therapy. Speech pathologists use standardised assessments as diagnostic tests to determine what speech or language impairment a child has. All of these tests have been developed to be delivered in-person.
Harnessing technology creates new opportunities for speech pathology services. For example, Coviu has been working for many years with test provider Pearson Clinical to bring their standardised assessments into a telehealth consultation. Digital versions of these tests have been taken through clinical validation in collaboration with researchers from Australian universities.
This came in handy during the pandemic as many speech pathologists were inhibited from assessing children in person. It allowed them to continue diagnosing children and preparing them for telepractice, that is speech therapy delivered via telehealth. This will now also be useful to address the challenges of rural Australians to gain access to speech and language assessments and therapy.
Role of telehealth
Telehealth provides an alternative to many in-person consultations and is an important tool for ensuring accessible health care. Phone and video telehealth are the common modalities; however, there can be limitations to phone consultations, such as not being able to physically see a patient’s facial expression or body movements.
Advantages to video telehealth include enhanced diagnostic accuracy and rapport building, more accurate decision-making, improved visual cues, better communication and reduced medication errors. Other benefits for practitioners and patients alike include convenience, accessibility, time-saving, infection control and increased appointment flexibility.
In the context of remote and regional health care, telehealth has been used successfully by a range of practitioners working with children, including speech pathologists. With the use of telehealth, patients are no longer limited to geographical services. By leveraging telehealth, speech pathologists with regional or remote patients do not have to travel as often as they did, giving them scope to see more clients, both new and existing, and deliver more accessible speech pathology services.
Where possible and practicable, speech pathologists can use Coviu and the CELF-5 A&NZ screening tests to complete assessments for patients in remote locations. This screening test provides an accessible method to complete a comprehensive battery of tests to provide a streamlined and flexible approach to language assessment. Not only suitable for use in remote locations, but speech pathologists can also leverage technology in face-to-face sessions if other testing kits are unavailable.
Telehealth can play a significant role in reducing the healthcare barriers for rural and remote patients. With digitisation, these patients can access healthcare services more easily through telehealth, helping to boost outcomes in these regions. A leading benefit of this delivery model is the newfound flexibility patients and speech pathologists alike receive with a reduced need for travel, while helping to increase access to timely care.
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