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Dr. Alice Eriks-Brophy from the Faculty of Medicine at the University of Toronto spent this past week in Sioux Lookout learning about Keewaytinook Okimakanak's K-Net Services and meeting with potential partners in a research initiative she is leading. The project involves examining the use of video conferencing as a means for delivering speech and language assessments with First Nation schools.

Join at http://meeting.knet.ca / Research / Speech-language Pathology

Remote Delivery of Speech-Language Pathology Assessments for Aboriginal Children in Northern Ontario using Videoconferencing

This project will examine the feasibility of conducting speech and language assessments of Aboriginal children referred for possible communication disorders living in remote areas using videoconferencing technology.  The project will validate a protocol to examine the potential of obtaining an unbiased assessment of speech and language using videoconferencing and will examine the role of technology in enhancing the effectiveness of community-based speech and language intervention.  The project is funded by the Ontario Ministry of Children and Youth Services and has received substantial technical, equipment and resource support from K-Net.  The project represents a collaboration among professionals, local community personnel, researchers and telehealth and Internet connectivity providers in the Sioux Lookout Region of northern Ontario and other southern regions of the province.  The project will also include a capacity building component whereby the participating Aboriginal community members will receive training in the nature and assessment of communication disorders in children and the appropriate procedures to be used in the assessment of children using videoconferencing.  It is hoped that this project can lead to the implementation of innovative telerehabilitation-based speech-language pathology services in Aboriginal communities.

Speech-language pathology (SLP) services are limited by a system-wide shortage of trained professionals, while the demand for such services is high.  Individuals residing in remote or isolated northern communities, including Aboriginal communities in particular, may experience serious obstacles in obtaining access to appropriate assessment and intervention services.  Speech and language skills are crucial components for academic, vocational and social skills. Deficits in speech and language propagate through a child’s life with increasingly negative consequences for learning, employment, social and personality adaptation. Early identification and intervention services for children with identified speech and language difficulties has been shown to result in long-term improvement in communication development and educational achievement for these children.  Any means of reducing wait times for assessment and service provision had great potential benefits for these children and their families.  These benefits should be extended to all children residing in Ontario, including those living in northern Aboriginal communities where access to service if often delayed or even non-existent. 

The application of technology to the assessment of children in remote, isolated, and/or Aboriginal communities has great potential in removing barriers to appropriate services for these children.  Ontario has developed a strong telehealth network that has been used extensively in providing medical assessment and treatment to individuals living in remote areas. Providing pediatric rehabilitation services to children and youth in First Nations and Aboriginal communities is very different from providing these services in other rural communities and requires careful research and training of all involved.  Videoconferencing has not commonly been used in Canada for performing assessments of children referred for potential speech and language difficulties, and for Aboriginal children in particular.

The incidence of children and youth with speech and language difficulties in Aboriginal communities is reportedly very high, while the waiting list for initial assessment and treatment is lengthy and may exceed 12 months in areas where SLP services are not available. In Northern Ontario, SLP services have become more difficult to obtain recently since Federal funding for transportation for SLP services was discontinued.  In addition, the recruitment of medical and rehabilitation professionals for isolated First Nations is an ongoing challenge.  The need for alternative delivery of SLP services has therefore become more urgent than ever.

The College of Audiologists and Speech-Language Pathologists of Ontario (CASLPO) has developed a position statement on the use of telepractice approaches in providing services to clients with speech, language, or hearing difficulties.  The use of teleconferencing meets the College’s requirement for face-to-face assessments through interactive, real-time visual and auditory access to the individual being served.  Nevertheless, the potential for such technology to introduce bias in the assessment process, particularly when the child being assessed and the professional doing the assessment represent different cultural backgrounds, is high.  Sources of bias in the SLP assessment process may stem from the referral source, the examiner, the procedures and materials used in the assessment, and the interpretation of performance, all of which have a potentially significant impact on placement decisions and the perceived need for services.  To date, no standard test protocol to assess Aboriginal children referred for potential speech and language difficulties has been developed, nor has the capability of teleconferencing to provide an unbiased, valid assessment of Aboriginal children presenting with a variety of communication and behavioural characteristics been sufficiently explored.

In this project, the feasibility of conducting remote speech and language assessments of children of various ages and from various Aboriginal communities through statistically evaluating the results of face-to-face versus remote assessment results.  Speech and language assessments will be carried out through videoconferencing technology with children who have been referred for assessment due to concerns regarding their speech and language development.  The children will be located in communities served by the KO Telehealth North Network.  The researcher will be present at the near site to interact with the child, and will assist in the administration and scoring of the assessment.  The remote site SLP will be located in various southern locations where compatible videoconferencing technology is available.  This SLP will direct and administer the assessment in real time as it progresses using videoconferencing and will record and score the responses of the child.  The results of the assessment from both sites will be compared and the degree of correspondence between the obtained scores will be evaluated.  The project will include measures of client satisfaction obtained from parents and teachers of the children who participate in the assessment and intervention phase of the study. Unbiased assessments would strive for inter-rater agreement levels of 95% or higher across all sections of the assessment with the exception of articulation measures, where 85% agreement will be acceptable. Data from the pilot project will be used to further develop a proposal aimed at the development of a major implementation study of SLP services in First Nation Community schools.