Updated 4 April 2020
Download a print-friendly copy of the guidelines here.
Telepractice in speech and language therapy is the remote provision of speech and language therapy services using technology. These may include the delivery of assessment, intervention, and/or consultation services to clients, carers, clinicians, or others.
There are currently no national allied health-specific guidelines for telepractice in Singapore. SALTS has put together this resource page for Singapore speech and language therapists looking to engage in telepractice.
Standard of Care
As with standard care, speech therapists using telepractice are bound by professional practice expectations outlined in the Allied Health Professions Council (AHPC) Code of Professional Conduct, and other national and institution guidelines.
Speech therapists engaging in telepractice should possess the necessary knowledge and skills to provide the level of clinical service required, as they would in standard care.
With reference to the Ministry of Health’s Telemedicine Guidelines (2015), Speech therapists and organisations providing telepractice services should take steps to manage risks and ensure that you have a documented risk management plan in place.
The American Speech-Hearing Association’s (ASHA) telepractice portal suggests to manage security risks by obtaining informed consent from clients. This process should be documented, and documentation may include:
- Description of services and equipment to be delivered
- How telepractice may differ from in-person services
- Client’s right to revert to traditional face-to-face care
(in view of the current COVID-19 situation, this may mean deferment of consultation)
- Assessment modifications
- Potential confidentiality issues
- Types of equipment used
- Identity of every person present
- Client’s and clinician’s location
- Billing and costs
The Telebehavioural Health Institute lists some other considerations in risk management.
Before initiating telepractice, speech therapists must obtain informed consent for therapy services, with compliance to Section 3 of the AHPC Code of Professional Conduct and the Personal Data Protection Act. Some considerations during informed consent taking as outlined in the AHPC Code of Professional Conduct is as below:
- You must ensure that your client understands their need for therapy, the treatment or services to be provided, the risks involved and expected outcomes from the treatment provided prior to proceeding, except in an emergency situation.
- If your client is unable to give consent, informed consent should be obtained from authorised caregivers.
- You must respect the decision of your client or caregivers (where applicable).
- You must respect your client’s wish for a second opinion, and/or decision to consult with other health professionals.
This process should be documented, and documentation may include the items listed above. Speech Pathology Australia (SPA) has published a sample Telepractice Informed Consent template. While this was developed for the Australian speech therapy community and should not be directly applied to your service, it can be a good reference for developing a consent form suited to your service.
With reference to the Ministry of Health’s Telemedicine Guidelines (2015), speech therapists are obliged to ensure that client information and records are protected by having a confidentiality policy in place. You must comply with the applicable existing legislation and regulations and take reasonable steps to ensure no unauthorised access, use or accidental disclosure of patient information. These include the PDPA and the AHPC Code of Professional Conduct.
The Personal Data Protection Council (PDPC) provides comprehensive information and support to help organisations and individuals align to PDPA requirements. One good resource is their PDPA Starter Kit.
It is important for speech therapists to maintain comprehensive clinical records and document all professional encounters that take place through telepractice. This includes where the intervention was delivered, the technology used and the details of the care encounter.
With reference to the Ministry of Health’s Telemedicine Guidelines (2015), speech therapists and organisations should have policies and procedures to document, record, store, and retrieve client records that respect client confidentiality. When possible, telepractice security policy and procedures should be integrated with those for electronic health records.
As therapy services are based on the needs of the individual client, telepractice may not be suitable for all clients. Appropriateness of service delivery through telepractice must be decided on a case-by-case basis.
Some key considerations on client selection for telepractice include:
- Physical and sensory ability to access telecommunication technology
- Cognition, behaviour, and motivation
- Communication characteristics of client
- Availability of technology and appropriate equipment
The suitability of telepractice for different client populations should be considered. Published evidence should be consulted as available. Here are some avenues where you can find information:
- ASHA Telepractice Evidence Map
- Weidner & Lowman, (2020). Telepractice for Adult Speech-Language Pathology Services: A Systematic Review.
- The International Journal of Telerehabilitation (open access)
With reference to the Ministry of Health’s Telemedicine Guidelines (2015), speech therapists should ensure the technology and equipment used are secure (i.e. provide end-to-end security design, authentication enabled, keeps an audit trail of conversations for record keeping) and considered acceptable for safe delivery of services, amidst other factors.
The Royal College of Speech and Language Therapists (RCSLT) gives some examples of telepractice platforms for speech and language therapy. Here are some other telepractice platforms you can consider:
The Straits Times offered some helpful tips to improve security on the Zoom platform, and SPA provides a comprehensive documents on the Technology Privacy and Security for Telepractice FAQ.
In the event that telepractice has to be discontinued or is no longer appropriate for your client, you should take reasonable measures to ensure the client will be referred to another appropriate service in a timely manner.
SALTS maintains a directory of subsidised paediatric services (SALTS members can access a more detailed directory here upon login). Please note that the operations of some of these services may also be affected by the current COVID-19 situation.
- Ministry of Health Telemedicine Guidelines
- Allied Health Professions Council Code of Professional Conduct
- Personal Data Protection Act
The SALTS committee is grateful for the help of the speech therapists from AWWA’s Community Integration Service (Ms Joan Chia and Ms Xie Xingrui) in developing our guidelines!
We recognise that this is a time where all speech therapists in Singapore will need support. Join us on our Telepractice Resources Telegram group. This is an open group for all practicing speech therapists in Singapore, and not limited to SALTS members. In this group, we hope that speech therapists can share resources in your move to telepractice, so we can all learn together.
Our international colleagues have been very generous in sharing some resources. We are grateful to:
- Dr Clare Burns and her team at the University of Queensland for sharing access to the Queensland Health eLearning: Conducting Clinical Swallowing Examinations via Telepractice
- Ms Mélanie Gréaux at the University of Cambridge for supporting our evidence-based practice in telepractice: Telehealth EBP