SCIENTIFIC
Speech Language Pathology Perceptions in the Time of COVID-19 : Telehealth and Dysphagia Services in West Virginia
AUTHORS :
Catherine M . Ray , MS , CCC / SLP College of Education and Human Services , West Virginia University
Cassaundra Corbett Miller , EdD , CCC / SLP Center for Excellence in Disabilities , West Virginia University
Lesley Cottrell , PhD Department of Pediatrics West Virginia University
INTRODUCTION
The prevalence of feeding disorders in typically developing children can be as high as 25 % of the population . 1 For children with developmental disabilities , the frequency of feeding challenges is much higher at 85 %. This health disparity is specifically salient for children living in rural settings . 2 While many cases are pediatric in nature , feeding and swallowing difficulties occur across the lifespan , which may require the care of a speech language pathologist ( SLP ). Speech language pathologists identified swallowing challenges in more than 50 % of older individuals diagnosed with intellectual disabilities . 3 Disordered feeding and swallowing , or dysphagia , can result in an inability for individuals to thrive and often limits achievement of developmental milestones . 1 In addition , poor growth , chronic dehydration , social isolation , family stress , and the need for alternative nutrition , such as a gastronomy tube , can be consequences of feeding and swallowing dysfunction . Thus , access to these services is crucial for individuals with disabilities .
Despite the increased need for SLP services in the rural setting , many rural counties are medically underserved . Previous researchers have demonstrated that geographic isolation and lower pay are two common factors contributing to the limited SLP services and access in rural communities . 4-6 When faced with these challenges , many providers ( including SLPs ) carry sig-
ABSTRACT
INTRODUCTION Little is known about the nature and frequency of telehealth services in rural settings , particularly those within West Virginia ( WV ) with historically limited access to speech and language services . The purpose of this work is to define these services in WV and to discuss how the 2019 coronavirus pandemic ( COVID ) precautions affected the need to use telehealth from the speech and language pathologist ( SLP ) perspective .
METHODS An online survey was administered to WV SLPs exploring their feeding and swallowing expertise , service coordination , patient service utilization , and approaches , particularly post- COVID . Our approach yielded responses from 124 SLPs from 37 of the 55 WV counties .
RESULTS The majority of the sample provided a variety
nificant caseloads , serve large regions , and have a breadth of service knowledge they must maintain . For many SLPs , telehealth produces challenges and benefits to their practice in the rural setting .
In 2002 , telehealth first appeared in the academic literature as a feasible treatment modality for dysphagia . 7 Almost 20 years later , Burns and colleaguges 8 further support telehealth as a cost efficient modality with high practitioner and patient satisfaction in the treatment of dysphagia . Telehealth can broaden access for rurally located patients requiring specialized dysphagia intervention . 9 Few SLPs in rural settings are experienced in telehealth despite its existence and evidence supporting telehealth for more than two decades . 9 The emergence of COVID in the spring of 2020 accelerated the use of telehealth to quickly increase access to medical care for rural populations and individuals identified as high risk . 10-11 Millions in the United of services across large regions of WV . SLP experiences were varied . Half of survey respondents cited a shortage of experienced clinicians as a primary reason for feeding and swallowing service denial . The majority of SLPs had incorporated telehealth into their approach since COVID ; however , a subsample reported restrictions in access to technology , policies , and training . Many respondents were not sure of security risks and requested training in security and methods for active participation .
CONCLUSIONS Our findings reveal the need for increased systematic and educational support for SLPs providing feeding services via telehealth . Provider access , training , and use of telehealth approaches are pivotal for reaching people with disabilities and are crucial for removing the isolation for this population .
States successfully utilized remote healthcare for the first time during the pandemic . 11 While the existence of telehealth spans multiple decades , the eminent need for feasible and contactless healthcare expeditiously broadened reimbursement , lessened licensure limitations , and facilitated the introduction of remote medical care into the mainstream healthcare system . The large-scale transition to telehealth during the pandemic made healthcare accessible ; 11-13 however , little is known about the current state of telehealth for pediatric dysphagia with the pandemic-driven service expansion for these services in West Virginia ( WV ).
Prior to the COVID pandemic , a national study reported that more than half of participating SLPs had used telehealth at least once . 14 These findings did not compare provider practices based on rurality and did not specifically look at each state . Thus , WV provider service patterns were not avail-
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