Telepractice Readiness Form
Tracy Sippl, M.S., CCC-SLP - Telepractice Consultant
Evaluation Date
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Month
-
Day
Year
Date
Evaluator Name
First Name
Last Name
Evaluator Title
School District Name
How many Speech/Language Pathologists (or SLPs) does your district employ?
Preparedness Ratings
Rate each item to determine your school district's readiness for the delivery of telepractice services!
Does each Speech/Language Pathologist (SLP) have the necessary equipment to provide HIPAA-compliant telepractice services?
Unsure/No
Yes
Laptop is less than 3 years old
Laptop has a 15" or larger screen
Laptop has at least a 2.4 GHz processor
Laptop with at least 8GB of RAM
Laptop is able to connect via Ethernet cable
An external webcam with built-in microphone
External speaker(s)
A bi-aural, stereo headset with USB connector
Laptop is NOT a Chromebook
Comments about equipment available
Has each SLP received training to... (e.g., follow the American Speech-Language-Hearing Association's "Code of Ethics")?
Unsure/No
Yes
...schedule telepractice sessions within the platform?
...implement the platform's tools?
...locate materials for telepractice?
...share a variety of materials from within the platform?
...troubleshoot technology during telepractice?
...understand the impact of Tele-Ethics: office space, and appearance of self/office?
...maintain HIPAA-Compliance and Confidentiality?
Comments about training of each SLP
Training of Tele-Facilitators - Is each SLP able to explain...
Unsure/No
Yes
...maintenance of confidentiality and the steps involved?
...telepractice space requirements?
...how to sign into the platform?
...platform and technology troubleshooting techniques?
...client's behavioral expectations and behavior modification techniques?
Comments about Tele-Facilitator training
Training and Use of Digital Assessments - Is each SLP able to...
Unsure/No
Yes
... locate digital assessments?
... use each digital assessment?
... share the digital assessment items via the platform?
... explain the use of digital assessments in the evaluation report?
... explain to the Tele-Facilitator about appropriately assisting the client during use of digital assessments?
Comments about using digital assessments for evaluations
Does the district have the following resources available for each site?
Unsure/No
Yes
A technology checklist?
A template for "Informed Consent" paperwork?
A "telepractice evaluation report" template available?
A telepractice mentor available for each SLP?
Does the district plan to conduct IEP Team meetings virtually?
Comments about district resources
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