When Judah Sossin, 5, goes to speech therapy, he walks to the family computer outfitted with a $25 camera. His mom accesses an email with a log-in password, clicks on it, and his therapist appears on the top right of the screen.
“The first time, I watched,” recalled Samantha Sossin of Hollywood. But now Judah will tell her, “OK, Mom. Goodbye.”
Sossin said she knew Judah had some articulation issues with his L’s, R’s and W’s, and they had a consultation two or three months ago with Avivit Ben-Aharon, founder and clinical director of the first telespeech clinic in South Florida. Sossin asked if they could wait until summer to start, and she got some “exercises we could try at home.”
“But once we started speech therapy [this summer], pretty much right away I’ve seen improvement. And it’s totally convenient. I have three kids — he’s my middle child — and unlike other doctor appointments, it’s right here in my house,” Sossin said.
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“When it’s time to go on the computer for speech — I don’t call it therapy, I call it speech — he is excited. He wants to do it because he knows he’s good at it,” Sossin said. “It’s been wonderful and my son enjoys it and he’s making progress. It’s win, win, win.”
Mercy Mijares of Miami Lakes is also pleased with the progress her son, Alejandro, is making via telespeech therapy.
“My son speaks very well and has a very good vocabulary,” Mijares said, but he needed help “working on intonation, staying on subject, expressing himself — that type of speech therapy. His teacher recommended Avivit’s program.”
Ben-Aharon met with Mijares, and then did a two-hour observation of Alejandro in class and at lunch before beginning telespeech with him six months ago.
“What I find is he’s completely engaged with her for the full 30 minutes,” Mijares said of Alejandro, 11, who has auditory processing deficits, learning disabilities and ADHD.
“One of the biggest challenges is his attention span. In a therapy session, inevitably there’s a noise outside” and he’s distracted, Mijares said. “It kind of isolates him just to be with her and because he loves computers, like all children do, then he’s interacting with a computer and with a person and it really works out very, very well.”
Telespeech, also called telepractice, began in the 1970s via television due to the “shortages of speech pathologists in certain rural areas,” said Wendy Nottoli, president and director of Kendall Speech and Language Center. It involves a certified speech and language pathologist from a remote site providing one-on-one speech therapy to a client via a secure Internet site.
Michele Boisvert, whose company provides on-site and telespeech services to autistic students in Massachusetts, said that in 2008, when she founded NetSLP.com, “it was very new.” Telepractice grew primarily “due to the access of high-speed internet,” she said.
As of June 20, Florida has approved Medicaid reimbursement for telepractice for the special needs students who qualify. The practitioners must be certified in Florida.
Yet Janet Brown, director of healthcare services in speech-language pathology at the American Speech-Language-Hearing Association, said, “Telepractice is still somewhat new and unfamiliar to insurers.”
Because of the reimbursement issue, schools are “where most of telepractice is happening,” Brown said, noting that “50 percent of our speech-language pathologists [who belong to ASHA] work in schools.
Ben-Aharon, founder and clinical director of Gr8 Speech Inc. in Hollywood, said she works “with schools with very small caseloads, addressing needs in areas that are hard to staff.” Her teletherapists also work with private clients in Florida and in the other 26 states in which they are licensed. “The youngest is about 4 1/2, and our oldest client is 85 years old,” Ben-Aharon said.
Advocates of telespeech say it is just as effective as traditional therapies, but there are no large-scale, randomized studies proving this. ASHA, at the request of a rural school district that wanted Oklahoma to allow Medicaid reimbursement for speech telepractice, sponsored a study of 578 children given telespeech therapy in Oklahoma. The students’ progress compared favorably to national norms, according to the study published in “Perspectives of the ASHA Special Interest Groups.”
Kent State University in Ohio sponsored a study of 14 children with speech-sound disorders randomly given side-by-side or telepractice therapy during a five-week summer session. The study found no significant differences in their progress.
“For the majority of things speech-language pathologists do, it’s a natural connection,” Brown said of telepractice. For a teenager working on language skills, Brown said working interactively on a computer is “much more acceptable to a kid who might feel self-conscious about seeing a speech therapist.”
But some speech therapists question how effective telespeech is, and whether it works in more complex social transactions, such as students with expressive language issues or lacking conversational skills.
“There’s a huge difference between face-to-face as opposed to doing [speech therapy] online,” said Nottoli of Kendall Speech and Language. “We’ll have to leave it up to the practitioners to be honest and true,” she said, adding, “My concern is, ‘Is this just a scheme to get coverage?’ ”
Boisvert, the Massachusetts therapist who provides students on the autism spectrum with both on-site and telespeech services, said, “The important thing is having somebody there on site who can then reinforce the strategies. In my case, it’s typically their one-to-one aide or a classroom aide or paraprofessional.’’
And Nottoli questions how well telespeech would work “for the more involved social thinking kind of challenges.’’
For children on the autism spectrum, she noted, “I have to teach the kids how to play. Play intervention requires two people interacting. I get vibes from kids that make me go in a different direction [during a session] and I don’t think I could get that” from a computer screen.
Nonetheless, advocates say issues can be resolved with parents working with the telespeech therapist.
“Parents need to be reassured and have their questions answered,” said Brown. Parents should be able to ask if they can decline telepractice if it’s not working for their child, Brown said.
“Let’s say the child . . . had behavior issues and wasn’t responsive to telepractice or the child did need a lot of hands-on manipulation of the mouth or lips or tongue in order to work on articulation,” Brown elaborated.
Much depends on the child. As Mijares said of Alejandro’s sessions with Ben-Aharon, “He really, really enjoys talking to her. The 30 minutes . . . fly by for him.”
Gr8 Speech, Avivit Ben-Aharon, clinical director: 954-247- 8757 or www.gr8speech.com