Telepractice Models for Improving Access for All DHH Children

The issue

Children who are deaf or hard-of-hearing (DHH), and their families, require ongoing, specialized support. For many families, access to services is limited. First, only a small number of children are born with significant hearing loss. This means necessary services are not available in every child’s local community. Second, there is a shortage of qualified teachers of the deaf (ToDs), and their training is often focused on a particular communication mode or age group. Third, DHH children have diverse needs based on age, communication mode, hearing technologies, and cause of deafness. Meeting the individual needs of each DHH child is a complex task and, often, there is simply a mismatch between the ToD’s unique skills and the specific needs of the DHH child. These issues are magnified for families whose ability to attend sessions is restricted by family responsibilities, work commitments, limited transportation options, or geographical location.

Telepractice (also known as “telehealth” or “telemedicine”) provides a possible solution for overcoming all of these challenges by connecting families with qualified ToDs when and where services are needed.

What we know

Telepractice means using technology to connect people in two different locations for the purpose of accessing services. Telepractice requires high-speed internet connections, a camera, a microphone, and a computer, tablet device, or dedicated videoconferencing equipment. Telepractice can include professional consultations, team meetings, and/or direct instruction to individuals or groups. Currently, interactive audio and video connections (similar to Skype or Facetime) are used to connect DHH children and their families with ToDs and speech-language pathologists (SLPs) in real-time. Telepractice can take place at home, in school, or at any location that is convenient for the family. The potential uses of telepractice are continually expanding and evolving as internet speeds increase and new technologies emerge.

Telepractice is not only about the technology. Telepractice is a novel approach to supporting DHH children. It requires new skills and a different way of thinking. Telepractice promotes equal participation by parents and professionals and enables the family-centered principles of ‘in-person’ sessions to be applied more consistently. Parents become active participants in their child’s learning, keen observers of their child’s development and detailed reporters of their child’s progress. Professionals learn how to create interactive sessions, teach through a visual medium and use coaching strategies to transfer knowledge to people at a distance. The shift from in-person to telepractice requires an attitude of persistence, creativity, and flexibility, and most participants will need additional support to fully develop the relevant skills.

What we don’t know

Studies show that parents and professionals are willing to participate in telepractice, but evidence is still emerging about the effectiveness of these services. A few pilot studies have compared telepractice services to in-person services but the sample sizes were small, the patterns of service delivery varied, and participants’ familiarity with telepractice was limited. These studies reported that telepractice is a promising method of ensuring equal access to services, but further studies are required.

Despite preliminary research results, many professionals and parents continue to prefer in-person sessions. The basis for these preferences is currently unknown but may stem from concerns about the technology, anxiety about learning new skills, or a lack of understanding about the benefits of telepractice.

Some professional organizations, such as the American Speech-Language-Hearing Association (ASHA), outline skills required to deliver effective telepractice services. However, no certification or accreditation is required to become qualified as a telepractitioner. Currently, families cannot verify the proficiency of those offering telepractice or the quality of services they are providing.


Telepractice is still transitioning from the healthcare sector to the education field. As a result, current licensing and reimbursement practices may not adequately cover telepractice services. Decision-makers at the state and federal level should consider the potential benefits of telepractice and amend current regulations to support delivery of services in this manner.

ToDs and SLPs need to expand their skills beyond the use of technology to include innovative telepractice methods and techniques. Specific telepractice training programs would assist in establishing a minimum level of proficiency. Agreed industry standards would ensure that professionals deliver consistent telepractice services. Parents, professionals and other stakeholders need to re-examine the current perception that telepractice is inferior to in-person sessions. In order to establish telepractice as a viable alternative to in-person sessions, professionals (and parents) need to shift from a mindset of ‘second-best’ to one of ‘equivalent.’

With the support of parents, professionals and other stakeholders, telepractice has the potential to ensure equal access to high-quality services for all DHH children.

Posted on Oct. 10, 2017 by
Melissa McCarthy
Renwick Centre
Royal Institute for Deaf and Blind Children
Melissa.McCarthy {at}


Further reading