In this period of confinement, with schools at a standstill and consultations in doctors' surgeries suspended, the question of speech and language therapy has arisen for many patients. What continuity should be offered, knowing that some of the knowledge acquired may be lost if therapies are suspended?
W
e asked Christelle Maillart, professor in Speech and Language Therapy, who was impatiently awaiting the position of the INAMI (the Belgian National Institute for Health and Disability Insurance) regarding “telepractice”. According to her, the adaptation and questioning of practitioners in this period of crisis could be an opportunity to explore new modalities of remote consultations, which, to date, have rarely been used.
Since the beginning of the confinement, the situation of speech and language therapists in Belgium has been unclear. But the INAMI has just taken a stand. What is your reaction?
On Friday 3rd April, Maggie De Block took exceptional measures to ensure continuity of care in a number of medical disciplines - including speech and language therapy - via “telepractice”, i.e. remote therapeutic monitoring using digital tools. The INAMI therefore now provides reimbursements even for sessions taking other forms than face-to-face consultations.
Telepractice, or consultation by computer? What do we know about the effectiveness of such methods?
Countries such as Canada and Australia, where the immense distances hinder the possibility of seeing each other easily, have been practising speech and language therapy in teleconsultation for several years. As such, we already benefit from their experience and from studies showing the effectiveness of these modalities. It is clear that the modalities are of little importance (face-to-face or telepractice), as any method is more effective than no treatment at all. Moreover, from the beginning of the containment measures, France and Luxembourg have been very dynamic on these issues. The key point is that the patient must remain "actively engaged" during the remote session. More and more tools allow this - quality videoconferencing, remote keyboard control, videos, animations, etc. It also appears that many children master these techniques very quickly and show pride, adaptation and autonomy when using these tools.
Who are the patients in speech and language therapy?
Speech and language therapy covers many areas: communication and language disorders (sometimes due to handicaps) for which follow-up can begin as early as the first year of life, learning disorders affecting primary and secondary school children, disorders related to deafness or voice problems, disorders caused by health incidents (such as strokes in adults). Patients in speech and language therapy are not a homogenous group; the treatments and responses to them are varied, including with a view to the potential development of telepractice.
What is happening at the CPLU (Uliège’s Psychology and Speech Therapy Clinic - Clinique psychologique et logopédique)?
This ministerial decision has been received rather positively and enthusiastically, even though it has also generated some anxiety, of course. We are thinking, working on these telepractice interventions, and learning a lot from our colleagues abroad. With regards to the patients, these services are certainly in demand. Some speech therapists had already started to provide remote monitoring on a voluntary basis. All in all, the feedback is very motivating.
Your particularity, at ULiège, is to train speech and language therapists in parallel with your clinical and research activities. What about your students’ internships?
This is another issue of this confinement: on-site placements are suspended, which is quite unfortunate for students in Speech and Language Therapy who have legal obligations of internship hours to validate their diploma. Work is being done to "reopen the internships" via telepractice - which also implies training the internship leaders at the same time – training the trainers! Tele-consultation also opens up a great opportunity to "see" more of our students in the field.
Do you think that Belgian speech and language therapists will now start using remote monitoring?
Will all speech and language therapists be able to do this? No, probably not. It will depend on the type of patient. For some of them, it won't work. We're in a crisis situation, and so unprepared, whereas telepractice requires specific preparation. Furthermore, in the current confinement, many professionals are faced with the difficulty of teleworking with their children at home.
What about after the lockdown?
What happens in the medium and long term because of this period of crisis will be interesting to observe. We are already seeing that we have been forced to reinvent ourselves in our practices. We are confronted with a very fine challenge. This remote practice framework is defined as temporary, but we hope that it can last, and provide a solid structure for initiatives taken so far. Very effective hybrid formulas could be developed.
Christelle Maillart is a full professor in the Faculty of Psychology, Logopaedics and Educational Sciences. She chairs the Speech and Language Therapy Department and heads the Enfances Research Unit, whose objective is to look at the child and their development, environment and surroundings.
