Tele-Ethics in Communication Disorders: Asking the Right Questions, Finding the Right Answers

Purpose: A hypothetical case is used to illustrate legal and ethical issues involving the decision to replace the traditional in-person service delivery model with telepractice in schools beyond the context of the initial COVID-19 health emergency. In this clinical focus article, the reader follows Maria, the lead speech-language pathologist (SLP) in the district, as she determines the feasibility of continuing telepractice in her district now that students and clinicians are returning to schools. First, she considers the support needed to implement this service delivery model within the school setting given the anticipated changes to the rules and regulations governing lawful and ethical provision of telepractice after the health emergency ends. Next, she decides if telepractice is warranted in the district by considering the rationales behind the requests. Faced with balancing school, student, and clinician needs, Maria uses an ethical decision-making model to determine if requests for telepractice, tied to health safety concerns and potentially influenced by implicit bias, reflect legal, ethical, and/or moral issues driven by fear or unconscious discriminatory motives. Conclusions: The health emergency gave SLPs working in schools the unique opportunity to experience the benefits and utility of telepractice. Following the return to schools, continuation of telepractice services will require support and training of SLPs. Many factors must be considered including equivalency of services, technology, and protection of privacy as they relate to the changes to the laws and regulations governing telepractice after the health emergency allowances end. Of primary importance is the selection of telepractice to address student needs, not to avoid specific schools because of their characteristics or location. An ethical decision-making model can be used as a framework to guide service delivery model decisions that balance the needs of the student, the clinician, and the district.

Case Study Analysis of an Adaptive Academic School Service Delivery Model With Multiple Disabilities/Handicapped Students

This chapter focuses on multiple disability (MD) or multiple handicapped (MH) students. Being considered equal to their grade- and age-level peers is essential for MD/MH students. Thus, in this chapter, use of the adaptive academic service delivery model with MD/MH students is examined through a case study within a junior and high school setting. This chapter includes a discussion about the causes and characteristics, the educational placement and instructional strategies, and the eligibility criteria for students with multiple disabilities or multiple handicaps. The chapter concludes with a discussion about future trends for MD/MH students and service providers.

The PrEP Up Pharmacies Study: Protocol for integrating and disseminating pre-exposure prophylaxis (PrEP) screening and dispensing in community pharmacies for Black men who have sex with men in Atlanta, Georgia (Preprint)

BACKGROUND Black men who have sex with men (BMSM) suffer from alarmingly high rates of HIV in the United States. Pre-exposure prophylaxis (PrEP) can reduce risk of HIV infection by 99% among MSM, yet profound racial disparities in the uptake of PrEP persist. Low PrEP uptake in BMSM is driven by poor access to PrEP including inconvenient locations of PrEP-prescribing physicians and distrust of physicians and stigma, which limit communication about PrEP and its side effects. Previous work indicates that offering HIV prevention services in pharmacies located in high poverty, racial minority neighborhoods is feasible and can reduce stigma because pharmacies offer a host of less stigmatized health services (e.g. vaccinations). We present a protocol for a pharmacy PrEP model that seeks to address challenges and barriers to pharmacy-based PrEP specifically for BMSM. OBJECTIVE To develop a sustainable pharmacy PrEP delivery model that can be implemented to increase PrEP access in high poverty, racial minority neighborhoods for BMSM. METHODS This study design is a pilot intervention to test a pharmacy PrEP delivery model among pharmacy staff and BMSM. We will examine the PrEP delivery model’s feasibility, acceptability and safety, and gather early evidence of its impact and cost with respect to PrEP uptake. A mixed methods approach will be performed including three study phases: 1) a completed formative phase with qualitative interviews from key stakeholders; 2) a completed transitional pilot phase to assess customer eligibility and willingness to receive PrEP in pharmacies during COVID-19; and 3) a planned pilot intervention phase which will test the delivery model in two Atlanta pharmacies in high poverty, racial minority neighborhoods. RESULTS Data from the formative phase showed strong support of pharmacy-based PrEP delivery among BMSM, pharmacists and pharmacy staff. Important factors were identified to facilitate implementation of PrEP screening and dissemination in pharmacies. During the transitional pilot phase, we identified 81 individuals who would have been eligible for the pilot phase. CONCLUSIONS Pharmacies have proven to be a feasible source for offering PrEP for White MSM, but have failed to reach the most at-risk, vulnerable population – BMSM. Increasing PrEP access and uptake will reduce HIV incidence and racial inequities in HIV. Translational studies are required to build further evidence and scale pharmacy-based PrEP services specifically for populations that are disconnected from HIV prevention resources.

Hospice delivery models and survival differences in the terminally ill: a large cohort study

ObjectiveA common difficulty at the end of life (EOL) is to determine an appropriate service model, such as hospice share care (HSC), hospice inpatient care (HIC) and hospice home care (HHC). This study aimed to recommend the appropriate hospice delivery model based on the physical, psychosocial and spiritual needs of patients referred for hospice care.MethodsThis cohort study included patients who received only one kind of hospice delivery model between 2006 and 2020. Data were analysed with descriptive statistics, Fisher’s exact test, non-parametric analysis of variance, Kaplan-Meier curves and Cox proportional hazards model that determined the patients’ clinical characteristics for a hospice delivery model and overall survival.ResultsA total of 8874 hospice patients were recruited, of which 7076 (79.7%) were HSC patients, 918 (10.4%) were HIC patients and 880 (9.9%) were HHC patients. There were significant differences in the physical symptoms and demographic, psychosocial and spiritual factors among the three groups (p<0.001). The patients who received the HHC were less to have dyspnoea (18.5%) and dysphagia (28.7%). The HIC patients showed higher severity of symptoms and experienced greater psychosocial distress (73.2%). The HSC is appropriate for noncancer patients . Patients with cancer were associated with less dyspnoea (32.4%) and dysphagia (46.5%). Patients with lung cancer who received the HHC had better survival than those who received other types of hospice care (HR=0.75, 95% CI: 0.66 to 0.86, p<0.001).ConclusionsThis study provides guidance regarding the appropriate hospice service model, based on individualised palliative needs, targeting improvement in EOL care.

The Speech-Language Pathologist Evaluating Appropriateness of Learning Apps as a Service Delivery Model for Children With Hearing Loss

Purpose: This study aimed to gain insight from speech-language pathologists (SLPs) regarding appealing features of speech and language applications to use as a service delivery model in schools for children who have a hearing loss. Method: A 1-hr focus group was conducted with three SLPs to identify appealing design features of speech and language apps, their benefits, and potential concerns. Participants were provided two speech and language applications to navigate through and review. Participants responded to Likert scale surveys and verbally provided benefits and drawbacks of the features as part of the structured discussion. Results: SLPs identified a range of appealing features for speech and language apps to utilize as a service delivery model for children with hearing loss. They preferred interfaces that allowed the opportunity for SLP and student collaboration rather than student isolation. Conclusions: SLPs have valuable input in regard to future speech and language app design informed by their experiences with children with hearing loss. SLPs are key stakeholders in the design process and should be included in future design and research endeavors.

Acceptability of HIV testing for adolescents and young adults by delivery model: a systematic review

HIV infections are prevalent among adolescents and young adults, of whom 44% remain unaware of their diagnosis. HIV screening presents numerous challenges including stigma, fear, and concerns about confidentiality, which may influence young people’s acceptance of HIV screening and linkage to care differently from individuals in other age groups. It is imperative to understand which care delivery models are most effective in facilitating these services for youth. This systematic review analyzes the rates of HIV test acceptance and linkage to care by care delivery model for adolescents and young adults. Studies were classified into emergency department (ED), primary care/inpatient setting, community-based program, or sexually transmitted infection clinic models of care. From 6395 studies initially identified, 59 met criteria for inclusion in the final analyses. Rate of test acceptance and linkage to care were stratified by model of care delivery, gender, race, age ranges (13–17, 18–24 years) as well as site (North America vs rest of the world). A significant difference in acceptance of HIV testing was found between care models, with high rates of test acceptance in the ED setting in North America and primary care/hospital setting in the rest of the world. Similarly, linkage to care differed by model of care, with EDs having high rates of linkages to HIV care in North America. Future studies are needed to test mechanisms for optimizing outcomes for each care delivery model in addressing the unique challenges faced by adolescents and young adults.

The Evolution of Telehealth From Pre-COVID-19 Pandemic Through A Hybrid Virtual Care Delivery Model: A Pediatric Hospital’s Journey

The COVID-19 pandemic transformed care delivery and influenced telehealth adoption by rehabilitation professionals and their patients. The purpose of this paper is to describe a pediatric health system’s telehealth services pre-pandemic and how those services were scaled during the pandemic. A secondary aim is to provide a roadmap for the operational delivery of telehealth and rehabilitation services, including transition to a hybrid care delivery model. Findings suggested that telehealth can be rapidly scaled to address patient healthcare needs for an early intervention population during a pandemic. Telehealth use during the pandemic helped ensure continuity of care and likely reduced the risk of exposure to patients and staff to the virus. Benefits included enhanced access to care, and savings in time and money for families. Interestingly, as the pandemic declined, the use of telehealth services declined due to patient preference, with many families opting to request a return to in-person care.