By: Genevieve Richardson, MS, CCC-SLP, and Erica Ortiz, MCD, CCC-SLP, Telepractice Committee Co-Chairs, and Alyssa Gilman, MS, CCC-SLP; Remyanne Hilchey, SLPD, CCC-SLP; and Kendall Kordes, MS, CCC-SLP

Teletherapy still gets side-eyed by some—parents, educators, even seasoned clinicians. There's a lingering belief that it just can't match the effectiveness of in-person therapy. But when you peel back the skepticism and look at the strategies, creativity, and connection involved, a different story emerges. Telepractice isn’t just working; it’s thriving.

This round table conversation from the Texas Speech-Language-Hearing Association (TSHA) Telepractice Committee pulled back the curtain to share what’s really happening behind the screen. Here are the key takeaways:

1. Engagement Isn’t About Sitting Still

One therapist shared a common concern from caregivers: “My child won’t sit still. How will they focus online?” The response? That’s okay. We don’t expect them to.

Instead, therapists are leaning into:

• Movement-friendly sessions (wiggles are welcome!)
   
• Home-based “show and tell” to spark excitement
   
• Parallel play (e.g., building Mr. Potato Head together on-screen)
   
• Digital favorites like Boom Cards and Pink Cat Games
   
• Incorporating kids’ own interests—Minecraft, Paw Patrol, and more
   

One mom even said after the first session, “I didn’t think he’d last five minutes—he stayed for 30 and didn’t want to leave!” That first session often flips the script on doubt.

2. Changing Minds in the School System

In many districts, teletherapy still feels like a backup plan, but data—and experience—say otherwise. One school-based clinician shared that her district is now collecting data on outcomes and finding teletherapy just as effective as in-person.

Why it works in schools:

• Flexibility to include teachers and paraprofessionals
   
• More frequent communication partner training
   
• Fewer scheduling disruptions
   
• Increased access to services in rural or underserved areas
   

It is not a lesser service but simply a different delivery model. And, in some cases, it is more impactful.

3. AAC Success—Even Virtually

One clinician described a “Talk Like a Pirate Day”-themed session in which students communicated via their augmentative and alternative communication (AAC) devices. In those moments, AAC came alive. Students used their devices while teachers and the therapist modeled vocabulary together in real time.

What made AAC work:

• Core vocabulary modeled onscreen and with devices
   
• Boom Cards and digital sticker books for interaction
   
• Real-time tech support from paraprofessionals or parents
   
• One student even said, “I have something to say. I’m ready for speech,” and then later selected “Goodbye” when he was done.
   

With multiple communication partners modeling language, students thrived.

4. Caregiver Coaching That Happens Naturally

In a home-based session with a new AAC user, one therapist walked the mother of the client through each modeling strategy. Within weeks, the parent was seamlessly using core words during play. She wasn’t just observing; she was becoming the co-therapist.

Coaching strategies that stuck:

• Using real-time play to model strategies
   
• Asking reflective questions (“Do you feel comfortable jumping in here?”)
   
• Focusing on one skill per session, like wait time or parallel talk
   
• Building confidence by celebrating small wins
   

And the bonus? Caregivers walk away truly understanding what the goals are and how to support them.

5. Access: No Longer Limited by Zip Code

Telepractice bridges gaps in care that once seemed impossible to close.

Especially helpful for:

• Rural families with no local providers
   
• Clients with mobility or transportation challenges
   
• Families juggling school, work, and other therapy services
   

One therapist shared how she began seeing a kindergartner in a rural area where speech services were waitlisted for months. Within weeks, progress had already started, and the caregiver felt empowered.

6. Adults Are Embracing It Too

It’s not just for kids. Adults, including stroke survivors and professionals with communication goals, are finding new freedom in virtual sessions.

What’s working for adult clients:

• Using Zoom’s whiteboard for goal-setting, memory recall, or writing practice
   
• Screen-sharing real-world tasks (menus, car auctions, or emails)
   
• Practicing tech literacy, including text-to-speech, FaceTime, and iPad apps
   
• Sessions at work or home, like one executive who logs in from his office at 5 p.m.
   

Another adult client practiced dictating texts with his therapist until he could message his daughter independently. This exemplifies the practical, functional benefits of telepractice.

7. Mindset Is the Hardest Hurdle

The technology? It's manageable. The strategies? Still grounded in evidence-based practice. The biggest challenge? Helping others believe teletherapy is just as effective.

How to support the mindset shift:

• Share real-life success stories
   
• Back it up with growing research on outcomes
   
• Reframe “screen time” as meaningful interaction
   
• Highlight caregiver and communication partner involvement
   

Telepractice isn’t second-best; it’s an opportunity to deliver high-quality, personalized care in a way that traditional models can’t always match.

8. Virtual Therapy Builds Real-World Skills

Two areas are making a difference beyond the session:

1. Digital Homework and Reinforcement
 Therapists are sharing whiteboard screenshots, annotated videos, and interactive links via secure drives. One therapist sends session notes embedded on a YouTube video the client requested.

2. Virtual Communities
 Clients learn how to use Zoom and then join national groups, like aphasia support networks or virtual conversation circles. These connections reduce isolation and give clients a reason to keep using their skills.

9. Let’s Keep This Conversation Going

The COVID-19 pandemic may have brought telepractice into the spotlight, but it continues to evolve with creativity, technology, and connection.

Key benefits to highlight:

• Flexible scheduling and real-time feedback
   
• Built-in caregiver involvement
   
• Research-backed outcomes
   
• Expanded access across populations
   

And, most importantly, it meets people where they are.

What Do You Need Next?

This is just the beginning. If you’re a Texas Speech-Language-Hearing Association (TSHA) member, we’d love to hear from you:

• What barriers are you facing?
   
• What support or resources would help you feel more confident?
   
• What stories or tools would help shift the mindset in your workplace?
   

Please complete our survey to let us know how we can support you! You can find the survey online at  https://forms.gle/tbVRkA6M8S7w8bBF9 or from the QR code to the right.

We welcome your insights and collaboration as we shape the future of telepractice.