trappa.is

Trappa: a case study of successful delivery of speech therapy to Icelandic children- Comparison analysis of online speech therapy in

Iceland Tinna Sigurðardóttir,Speech pathologist

tinna@trappa.is

INTRODUCUTION

Reykjavík school of musicBA Icelandic 2010MS Speech Pathology 2012Kópavogsbær municipality 2012-2013Reykjavík municipality 2013-2015Founder of Trappa Founder of Kara Connect

FTÍBABBL OG SPJALL

TRAPPA

Founded in 2014

Since 2016 sessions have increased by 70%

Client number has increased by 76%

Staff increased by 66%

BECOMING..

EXPERIMENT IN VESTURBYGGÐ 2014 - 2015

4 children

Weekly sessions

Parent and teacher counselling

Services before Trappa - 3 - 4 times per year

Good results and satisfaction with parents and teachers

NEED FOR SERVICESNumber of individuals given ICD-10 codes F80-F80.9 by the arrival of health care center 2004-2015. Referrals 0 - 5 yrs: 47. Total number of children 0 - 5 yrs = 4724. Percentage being referred: 1%. 2014

BOYS

GIRLS

NEED FOR SERVICESNumber of individuals given ICD-10 codes F80-F80.9 by the arrival of health care center 2004-2015. https://www.icd10data.com/ICD10CM/Codes/F01-F99/F80-F89/F80-STATE NUMBERS - NOT MUNICIPALITIES

TOTAL NUMBER OF REFERRALS: 7996 - 1% of children 0-16 are being referred!

Note - a child can be counted more than once each year

BOYS

GIRLS

https://www.icd10data.com/ICD10CM/Codes/F01-F99/F80-F89/F80-

NEED FOR SERVICESAmount of individuals given ICD-10 codes F80-F80.9 by the arrival of health care center 2004-2015. Reykjavík area. Referrals: 1,04%.

PROBLEM OF SCHOOLS

• Access to specialists difficult and irregular

• Knowledge and visits of specialists not used for the direct training of a child

• School inclusion demands many different types of professionals and special ed teachers

• Speech therapy is limited

PROBLEM OF CLINICS

• Parents striving to attend clinics during working hours

• Assessment is better paid than therapy sessions. Up to 3 years waiting list!

• Different payers for services makes access inefficient and complicated

• Independent professionals strive for business operations

• Considerable amount of cancellations and holidays

PROBLEM OF AUTHORITIES

● System administration is unclear - cost is escalating but spent on what?

● Increasing demand of results but no one to provide therapy

● Unclear what important skills SLP’s can turn over to students and teachers

CONSEQUENCES

● Not in the spirit of early intervention

● Problem persists, caseload gets heavier

● Increasing costs of special eds

● Lack of professional consultation and coaching to staff and relatives

MORE STRESSFUL CLASSROOM

LESS ACADEMIC ACHIEVEMENT

COMPARISON REPORT:What’s different between online and “nonline” - in person - therapy?

● Data from Icelandic State

Health Insurance

● Data from Trappa

● Data from Kara Connect

CLIENT DISTRIBUTION

SESSION LENGHT

SERVICE SURVEY 2019 - SCHOOL PROFESSIONALS N=28*

● 79% learn methods they continue to use with the student

● 78% have used resources they heard about at the SLP’s

● 97% claim it to be either good or very good to communicate

with specialist through computer

● 100% would like to continue using these services

“Joining sessions like I have been doing is one of the best courses I

have taken.” 2019 - kindergarten teacher

“The communication has been nice and clear. Just like being in the

same room.”

SERVICE SURVEY 2019 - SCHOOL PROFESSIONALS N=28*

● 25% claim children had never met an SLP before Trappa came

along

● 25% claim children met an SLP around 1x per year before

starting using services from Trappa

● 66% would like to add sessions or services

“Parents gain effortless access. They are more happy. That’s

important.” 2019 - kindergarten teacher

SERVICE SURVEY 2019 - SCHOOL PROFESSIONALS N=28*

Teacher name biggest benefits being:

● Service within local community

● Regular services not previously available

● Regular access to professional “Speech pathologists are always ready to assist with resources and resolutions. Always possible to contact them if anything occurs and I always get replies. Speech pathologists care about the children and their future.” Teacher, 2019

Easy Secure video platform- Screen sharing and chat- Easy and secure online booking- Statistics and integrations- GDPR compliant- Customized client consent

Pending - Pilot survey Based on the Telehealth Usability Questionnaireto be presented at NAC 2019 -TURKU

Simple web-based software

Recent appliances

Internet access

HUE camera

Google drive

AWW whiteboard

Airserver

IpadVarious apps

How have we changed the way we work?

➔ Economically viable

➔ 50/50 RVK/rural Iceland

➔ Different payers -one click

➔ Shorter sessions (25%)

➔ 100% want to continue

➔ Transfer of knowledge

➔ Less cancellation (7,4%)

Trappa: pilot

Overview

➔ Less paperwork -systems connecting

➔ GDPR compliant

➔ We start immediately

➔ Less cancellation

➔ Less commuting -more sessions

➔ Specialist available as needed - not temporarily

➔ Everyone wants to continue using it

➔ Economically viable

➔ 50/50 RVK/rural Iceland

➔ Different payers -one click

➔ Shorter sessions (25%)

➔ 100% want to continue

➔ Transfer of knowledge

➔ Less cancellation (7,4%)

Trappa: pilot

Overview

➔ Less paperwork -systems connecting

➔ GDPR compliant

➔ We start immediately

➔ Less cancellation

➔ Less commuting -more sessions

➔ Specialist available as needed - not temporarily

➔ Everyone wants to continue using it

trappa.is

Everyone should have equal access to specialist, regardless of where

they live.

trappa.is

CONCLUSION

➔ Less paperwork - systems connecting

➔ GDPR compliant

➔ We start immediately

➔ Less cancellation

➔ Less commuting - more sessions

➔ Specialist available as needed -not temporarily

➔ Everyone wants to continue using it

➔ Economically viable

➔ 50/50 RVK/rural Iceland

➔ Different payers - one click

➔ Shorter sessions (25%)

➔ 100% want to continue

➔ Transfer of knowledge

➔ Less cancellation

TRAPPA SURVEY 2019 - PARENTS N = 19 - responce rate 50%

● 63% have learned methods to help their child language

development during sessions

● 53% have used resources they heard about during sessions

● Less time commuting

● Regular access to professional

● Regular services not previously available

CLIENTS

2019

● Reykjavík● Árborg● Vestur Hún● Austur Hún● Dalabyggð● Vesturbyggð● Fjarðabyggð● Stykkishólmur● Snæfellsbær● Súðavík● Tálknafjörður

● 20+ skólar og leikskólar

Trappa sinnir þó ekki einungis fjarþjónustu en um 10% skjólstæðinga eru staðþjónustuþegar. Auk þess sinnir Trappa ráðgjöf og ýmsum verkefnum í skólum og leikskólum.

TRAVEL EXPENSES

● Calculations based on services paid by state

● Does not include assessment costs or travel costs when service is paid by municipality.

● Economically viable for state and parents

STUDIES SHOW..

Delivery of intensive voice therapy for vocal fold nodules via telepractice: A pilot feasibility and efficacy study. Journal of voice, 29(6), 696-706.doi:

Expanding use of telepractice in speech-language pathology and audiology. The volta review, 112(3), 227-242.

Telepractice services at sound beginnings at Utah state University. The volta review, 112(3), 365-372.

A Pilot Exploration of Speech Sound Disorder Intervention Delivered by Telehealth to School–Age Children

Improving the access of young urban children to speech, language and hearing screening via telehealth. Journal of telemedicine and telecare, 17(5), 240-244.

Telepractice in Speech-Language Therapy: The Use of Online Technologies for Parent Training and Coaching.

Working alliance in online therapy as compared to face-to-face therapy: Preliminary results. Cyberpsychology & behavior, 5(2), 95-105

“As good as in person or better”

http://dx.doi.org/10.1016/j.jvoice.2014.12.003http://search.proquest.com/docview/1266509704?pq-origsite=gscholarhttps://www.researchgate.net/publication/269418636_Internet-based_intervention_training_for_parents_of_young_children_with_disabilities_a_promising_service-delivery_modelhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296798/https://www.researchgate.net/publication/310814149_Telepractice_in_Speech-Language_Therapy_The_Use_of_Online_Technologies_for_Parent_Training_and_Coaching

COMPLICATED SYSTEMS

LANGUAGE EVALUATIONRESULTS 80<

Therapy payed by stateLong waiting listsNeeds referral from doctor

LANGUAGE EVALUATIONRESULTS >80

Therapy payed by municipality but procedure is unclear