westchester medical center's teletherapy program for cochlear implanted children


The Cochlear Implant Center  Telepractice Proposal for Westchester Cochlear Implant Program.  Katrina R. Stidham MD, Director of the Center and Chief of Neurology

For children receiving cochlear implants, speech therapy is essential for their success in developing speech and language skills.  It has been well documented that children who do not receive appropriate speech therapy after implantation do not develop the same language skills in their lifetime as those who receive consistent services early on.  Unfortunately, for many children, speech therapy services are not always easily accessible.  Speech pathologists in the community are often scarce and frequently do not have experience in working with children with cochlear implants.  Many children live far away from the implant center and have difficulty with transportation to the center to receive services.  Even for children who can get here, a long drive to the center often results in a fatigued child who is less able to benefit from the therapy session.

In recent years teletherapy has been utilized for children with cochlear implants to allow them to receive speech therapy services at.  Private speech pathologists and some implant programs in different regions of the country have implemented teletherapy programs to provide children with speech therapy services with excellent results.  The American Speech and Hearing Association (ASHA) supports this service delivery model.  ASHA states that this form of speech therapy when implemented correctly provides equal outcomes to face-to face interventions.

Unfortunately, in New York teletherapy is often not a covered benefit for many private payor insurances and is never a feasibly covered benefit for Medicaid patients with Medicaid reimbursement being <$10/session.  The majority of patients who would benefit most from teletherapy do not have access to this service due to the financial barrier. These are the same children who often live far away from the center and have difficulty getting to the center for face-to face therapy services.

The Westchester Cochlear Implant Program would like to offer teletherapy services to this underserved pediatric cochlear implant population utilizing the generous donation from Jeunesse and future donations from Partners in Hearing Inc., and additional donors.  The following outline details the proposed program for teletherapy sessions.

1. Teletherapy speech therapy sessions will be offered to children who have undergone a cochlear implant and need speech therapy services that cannot be met in their community or school, and for whom transport to the cochlear implant center is difficult.

2. Teletherapy sessions of 45 minutes will be scheduled once weekly. Scheduling can be more flexible for the patient because travel is not involved. Teletherapy can be provided alone or in conjunction with a weekly office visit.

3. Parents will receive an emailed lesson plan 5-7 days before each session to allow them to prepare appropriate household materials to use during the session. This helps parents to understand session goals and will assist in carryover because they will be using familiar items from their home.  Lesson plans will be available in both English and Spanish.

4. On each session’s day, parents will receive an email with a link to the secure video conference platform VidYO currently utilized by other Teletherapy programs at WMC. The family needs to have a computer or tablet with a webcam, microphone and internet access.  Due to the small picture size, access from a Smartphone is not recommended for therapy. 

5. During each session the parent, therapist and child will work together.  The parent will be coached to use strategies to achieve listening, language and speech goals.  Household items can include, toys, games, and everyday items.  These will help the parents learn to incorporate language into their daily routine. Additionally, there are many apps and online tools, which can be shared on the screen, using Zoom

6. After the session, the family has access to a recording of the session in order to review strategies as needed.  This recording will also assist in tracking the child’s progress. 

7. Clients can email the speech pathologist at any time with questions.  

8. All patients will sign a Teletherapy Consent form and a Photo Video Release .

9. Ipads can be loaned to patients with access to Verizon wireless internet.  These patients must sign a Technology Loan Agreement Form. 

10. The Speech Pathologist can provide therapy from the Center or off-site location with hard wired internet access to provide the best video connection to the patient.