Purpose: The aim of this study is to examine e-helpers’ experiences and perspectives regarding the teletherapy service delivery model. In the context of teletherapy, an e-helper is a parent, caregiver, or other adult who provides on-site support to the client during remote speech and language therapy sessions by assisting with technical setup, managing materials, and facilitating the implementation of the therapist’s instructions. This study aims to explore how e-helpers understand and perform their roles within the teletherapy process and how they evaluate this service model overall.
Method: Eleven e-helpers who regularly attended teletherapy sessions were included in the study. Semi-structured interviews were conducted with the e-helpers, and the data were analyzed using content analysis.
Results: Five themes were identified as a result of the analysis: (1) the pre-teletherapy decision-making process, (2) advantages and disadvantages of teletherapy, (3) intentions to continue, (4) views on communication with the therapist, and (5) suggestions for increasing the preferability of teletherapy. Most e-helpers stated that teletherapy provided convenience in terms of accessibility and time management; however, they indicated that the presence of an e-helper is critical for younger age groups or clients experiencing technological limitations.
Conclusion: Active participation by e-helpers in the teletherapy process is a significant factor in enhancing the service's effectiveness. The findings indicate a need for structured training programs to enable e-helpers to support teletherapy more efficiently. The study provides supporting evidence that teletherapy can be adopted as a more widespread service delivery model in the future.
teletherapy, e-helper, speech and language therapy, service delivery model, qualitative research
Abendroth, K. J., Oxley, J. D., & Hays, K. M. (2022). Book sharing with AAC over telepractice: A tutorial. Communication Disorders Quarterly, 43(4), 272–276. https://doi.org/10.1177/15257401211024539
Aggarwal, K., Patel, R., & Ravi, R. (2021). Uptake of telepractice among speech-language therapists following COVID-19 pandemic in India. Speech, Language and Hearing, 24(4), 228-234. https://doi.org/10.1080/2050571X.2020.1812034
Akamoglu, Y., Meadan, H., Pearson, J. N., & Cummings, K. (2018). Getting connected: Speech and language pathologists’ perceptions of building rapport via telepractice. Journal of Developmental and Physical Disabilities, 30(4), 569-585. https://doi.org/10.1007/s10882-018-9603-3
Akram, S., Mumtaz, N., Shahid, N., & Saqulain, G. (2021). Satisfaction and competence with telepractice services in Pakistan amid COVID-19 pandemic: The speech-language pathologists’ perspective. Iranian Rehabilitation Journal, 19(3), 251-260. https://doi.org/10.32598/irj.19.3.1335.3
Al Awaji, N. N., Almudaiheem, A. A., & Mortada, E. M. (2021). Assessment of caregivers’ perspectives regarding speech-language services in Saudi Arabia during COVID-19. PLoS One, 16(6), e0253441. https://doi.org/10.1371/journal.pone.0253441
Alvares, R. (2013). Working with facilitators to provide school-based speech and language intervention via telepractice. Perspectives on Telepractice, 3(2), 44-48. https://doi.org/10.1044/teles3.2.44
Alyahya R. S. W. (2025). The satisfaction of clients and caregivers with telehealth speech-language pathology services. Digital health, 11, 20552076241313163. https://doi.org/10.1177/20552076241313163
American Speech-Language-Hearing Association. (2021, Haziran). Telepractice ASHA. Available from https://www.asha.org/practice-portal/professional-issues/telepractice/
American Speech-Language-Hearing Association. (2020). ASHA COVID-19 survey results—May 2020. Available from. https://www.asha.org/siteassets/uploadedfiles/covid-19-tracker-survey-may-2020.pdf
Anderson, K., Balandin, S., Stancliffe, R. J., & Layfield, C. (2014). Parents' perspectives on tele-AAC support for families with a new speech generating device: Results from an Australian pilot study. Division 18 Newsletter, 4(2), 52-60. https://doi.org/10.1044/teles4.2.52
Ashburner, J., Vickerstaff, S., Beetge, J., & Copley, J. (2016). Remote versus face-to-face delivery of early intervention programs for children with autism spectrum disorders: Perceptions of rural families and service providers. Research in Autism Spectrum Disorders, 23, 1-14. https://doi.org/10.1016/j.rasd.2015.11.011
Campbell, D. R., & Goldstein, H. (2021). Genesis of a new generation of telepractitioners: The COVID-19 pandemic and pediatric speech-language pathology services. American Journal of Speech-Language Pathology, 30(5), 2143-2154. https://doi.org/10.1044/2021_AJSLP-21-00013
Cangi, M. E., & Toğram, B. (2020). Stuttering therapy through telepractice in Turkey: A mixed method study. Journal of fluency disorders, 66, 105793. https://doi.org/10.1016/j.jfludis.2020.105793
Cheung, W. C., Aleman-Tovar, J., Johnston, A. N., Little, L. M., & Burke, M. M. (2023). A qualitative study exploring parental perceptions of telehealth in early intervention. Journal of Developmental and Physical Disabilities, 35(3), 353-373. https://doi.org/10.1007/s10882-022-09853-w
Chua, C. H., Seow, F. C., Tang, F. M., & Lim, L. M. (2022). Factors affecting telepractice use in COVID-19. Proceedings of Singapore Healthcare, 31. https://doi.org/10.1177/20101058221074120
Cotelli, M., Manenti, R., Brambilla, M., Gobbi, E., Ferrari, C., Binetti, G., & Cappa, S. F. (2019). Cognitive telerehabilitation in mild cognitive impairment, Alzheimer’s disease and frontotemporal dementia: a systematic review. Journal of telemedicine and telecare, 25(2), 67-79. https://doi.org/10.1177/1357633X17740390
Crutchley, S., Campbell, M., & Christiana, D. (2012). Implementing a school-based telepractice program. Perspectives on Telepractice, 2(1), 31–41.https://doi.org/10.1044/tele2.1.31
DiFabio, D., Moodie, S., O'Hagan, R., Pardal, S., & Glista, D. (2023). Barriers and facilitators to paediatric caregivers' participation in virtual speech, language, and hearing services: A scoping review. Digital health, 9, 20552076231216684. https://doi.org/10.1177/20552076231216684
Douglass, H., Lowman, J. J., & Angadi, V. (2021). Defining roles and responsibilities for school-based tele-facilitators: Intraclass correlation coefficient (ICC) ratings of proposed competencies. International Journal of Telerehabilitation, 13(1), e6351. https://doi.org/10.5195/ijt.2021.6351
Fairweather, G. C., Lincoln, M. A., & Ramsden, R. (2017). Speech-language pathology telehealth in rural and remote schools: the experience of school executive and therapy assistants. Rural and Remote Health, 17(3), 1-13. https://doi.org/10.22605/RRH4225
Farmani, E., Fekar Gharamaleki, F., & Nazari, M. A. (2024). Challenges and opportunities of tele-speech therapy: Before and during the COVID-19 pandemic. Journal of public health research, 13(1), 22799036231222115. https://doi.org/10.1177/22799036231222115
Finak, P., Hastings-Truelove, A., Fecica, A., & Batorowicz, B. (2023). Therapy services for children and youth living in rural areas of high-income countries: a scoping review. Disability and Rehabilitation, 45(11), 1893-1915. https://doi.org/10.1080/09638288.2022.2074552
Fitton, L., Bustamante, K. N., & Wood, C. (2017). The social validity of telepractice among Spanish-speaking caregivers of English learners: An examination of moderators. International Journal of Telerehabilitation, 9(2), 13–24. https://doi.org/10.5195/ijt.2017.6227
Fong, R., Tsai, C. F., & Yiu, O. Y. (2021). The implementation of telepractice in speech language pathology in Hong Kong during the COVID-19 pandemic. Telemedicine and e-Health, 27(1), 30-38. https://doi.org/10.1089/tmj.2020.0223
Freckmann, A., Hines, M., & Lincoln, M. (2017). Clinicians’ perspectives of therapeutic alliance in face-to-face and telepractice speech–language pathology sessions. International Journal of Speech-Language Pathology, 19(3), 287-296. https://doi.org/10.1080/17549507.2017.1292547
Fromm, C., & McKenna, M. (2025). Learning from caregivers: Insights into pediatric speech and language services delivered via telepractice during COVID-19. Journal of Communication Disorders, 106577. https://doi.org/10.1016/j.jcomdis.2025.106577
Galvin, E., Gavin, B., Kilbride, K., Desselle, S., McNicholas, F., Cullinan, S., & Hayden, J. (2024). The use of telehealth in attention-deficit/hyperactivity disorder: a survey of parents and caregivers. European Child & Adolescent Psychiatry, 33(12), 4247-4257. https://doi.org/10.1007/s00787-024-02466-y
Grillo, E. U. (2019). Building a successful voice telepractice program. Perspectives of the ASHA special interest groups, 4(1), 100-110. https://doi.org/10.1044/2018_PERS-SIG3-2018-0014
Grogan-Johnson, S. (2014). Teletherapy: Serving school-age children. In K. Todd Houston (Ed.), Telepractice in speech-language pathology (pp. 117–125). Plural Publishing, Inc. ISBN13: 978-1-59756-479-3
Guglani, I., Sanskriti, S., Joshi, S. H., & Anjankar, A. (2023). Speech-language therapy through telepractice during COVID-19 and its way forward: A scoping review. Cureus, 15(9). https://doi.org/10.7759/cureus.44808
Gürsoy, M. D., Tığrak, T. K., & Köse, A. (2022). Telepractice with preschool children: Speech-Language pathologists' perspectives in Turkey. International Journal of Telerehabilitation, 14(2), e6465. https://doi.org/10.5195/ijt.2022.6465
Hall-Mills, S., Johnson, L., Gross, M., Latham, D., & Everhart, N. (2022). Providing telepractice in schools during a pandemic: The experiences and perspectives of speech-language pathologists. Language, Speech, and Hearing Services in Schools, 53(2), 290-306. https://doi.org/10.1044/2021_LSHSS-21-00023
Hill, A., & Theodoros, D. (2002). Research into telehealth applications in speech-language pathology. Journal of Telemedicine and Telecare, 8(4), 187-196.https://doi.org/10.1258/135763302320272158
Howells, S., Cardell, E. A., Waite, M. C., Bialocerkowski, A., & Tuttle, N. (2019). A simulation-based learning experience in augmentative and alternative communication using telepractice: speech pathology students’ confidence and perceptions. Advances in Simulation, 4(Suppl 1), 23. https://doi.org/10.1186/s41077-019-0113-x
Kairy, D., Lehoux, P., Vincent, C., & Visintin, M. (2009). A systematic review of clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation. Disability and rehabilitation, 31(6), 427-447. https://doi.org/10.1080/09638280802062553
Kelchner, L. N., Fredeking II, J. C., & Zacharias, S. C. (2021, January). Using telepractice to deliver pediatric voice care in a changing world: breaking down challenges and learning from successes. In Seminars in Speech and Language, 42(1), 54-063. Thieme Medical Publishers, Inc. https://doi.org/10.1055/s-0040-1722320
Kobak, K. A., Stone, W. L., Wallace, E., Warren, Z., Swanson, A., & Robson, K. (2011). A web-based tutorial for parents of young children with autism: results from a pilot study. Telemedicine and e-Health, 17(10), 804-808. https://doi.org/10.1089/tmj.2011.0060
Kollia, B., & Tsiamtsiouris, J. (2021). Influence of the COVID-19 pandemic on telepractice in speech-language pathology. Journal of Prevention & Intervention in the Community, 49(2), 152-162. https://doi.org/10.1080/10852352.2021.1908210
Kraljević, J. K., Matić, A., & Dokoza, K. P. (2020). Telepractice as a reaction to the COVID-19 crisis: Insights from Croatian SLP settings. International Journal of Telerehabilitation, 12(2), 93-104. https://doi.org/10.5195/ijt.2020.6325
Kwok, E. Y. L., Chiu, J., Rosenbaum, P., & Cunningham, B. J. (2022a). The process of telepractice implementation during the COVID-19 pandemic: a narrative inquiry of preschool speech-language pathologists and assistants from one center in Canada. BMC Health Services Research, 22(1), 1-9. DOI: 10.1186/s12913-021-07454-5
Kwok, E. Y. L., Pozniak, K., Cunningham, B. J., & Rosenbaum, P. (2022b). Factors influencing the success of telepractice during the COVID‐19 pandemic and preferences for post‐pandemic services: An interview study with clinicians and parents. International Journal of Language & Communication Disorders, 57(6), 1354-1367. https://doi.org/10.1111/1460-6984.12760
Lam, J. H. Y., Lee, S. M. K., & Tong, X. (2021). Parents’ and students’ perceptions of telepractice services for speech-language therapy during the COVID-19 pandemic: Survey study. JMIR pediatrics and parenting, 4(1), e25675. https://doi.org/10.2196/25675
Lincoln Yvonna, S., & Guba Egon, G. (1985). Naturalistic inquiry. Beverly Hills: Sage Publications.
Mansour, N. (2024). Students’ and facilitators’ experiences with synchronous and asynchronous online dialogic discussions and e-facilitation in understanding the Nature of Science. Education and Information Technologies, 29, 15965–15997. https://doi.org/10.1007/s10639-024-12473-w
Musaji, I., Roth, B., Coufal, K., Parham, D. F., & Self, T. L. (2021). Comparing in-person and telepractice service delivery for spoken language production and comprehension using the National Outcomes Measurement System. International Journal of Telerehabilitation, 13(1), e6373. https://doi.org/10.5195/ijt.2021.6373
Myers, B., Hary, E., Ellerston, J., & Barkmeier-Kraemer, J. M. (2022). Telepractice considerations for evaluation and treatment of voice disorders: tailoring to specific populations. American Journal of Speech-Language Pathology, 31(2), 678-688. https://doi.org/10.1044/2021_AJSLP-21-00206
Overby, M. S. (2018). Stakeholders’ qualitative perspectives of effective telepractice pedagogy in speech–language pathology. International Journal of Language & Communication Disorders, 53(1), 101-112. https://doi.org/10.1111/1460-6984.12329
Rao, P. K., & Yashaswini, R. (2018). Telepractice in speech-language pathology and audiology: Prospects and challenges. Journal of Indian Speech Language & Hearing Association, 32(2), 67-72. https://doi.org/10.4103/jisha.jisha_39_17
Retamal-Walter, F., Waite, M., & Scarinci, N. (2023). Exploring engagement in telepractice early intervention for young children with developmental disability and their families: a qualitative systematic review. Disability and Rehabilitation: Assistive Technology, 18(8), 1508-1521. https://doi.org/10.1080/17483107.2022.2048098
Richmond, T., Peterson, C., Cason, J., Billings, M., Terrell, E. A., Lee, A. C. W., ... & Brennan, D. (2017). American Telemedicine Association’s principles for delivering telerehabilitation services. International Journal of Telerehabilitation, 9(2), 63-68. https://doi.org/10.5195/ijt.2017.6232
Shahouzaie, N., & Gholamiyan Arefi, M. (2024). Telehealth in speech and language therapy during the COVID-19 pandemic: a systematic review. Disability and Rehabilitation: Assistive Technology, 19(3), 761-768. https://doi.org/10.1080/17483107.2022.2122605
Simpson, J. (2013). Challenges and trends driving telerehabilitation. In: Kumar, S., Cohn, E. (eds) Telerehabilitation. Health Informatics. Springer, London. https://doi.org/10.1007/978-1-4471-4198-3_2
Sippl, T., & Ciccia, A. H. (2014). Reaching the neediest preschoolers: Not surprisingly, providing telepractice services to preschoolers can be tough. How do you captivate a child who can’t sit still? Here’s what one SLP learned is crucial to effective web-based early intervention. The ASHA Leader, 19(2), 42-48. https://doi.org/10.1044/leader.FTR1.19022014.42
Snodgrass, M. R., Chung, M. Y., Biller, M. F., Appel, K. E., Meadan, H., & Halle, J. W. (2017). Telepractice in speech–language therapy: The use of online technologies for parent training and coaching. Communication Disorders Quarterly, 38(4), 242-254. https://doi.org/10.1177/1525740116680424
Swales, M., Theodoros, D., Hill, A. J., & Russell, T. (2020). Speech-language pathologists’ perceptions of the use of telepractice in the delivery of services to people with Parkinson’s disease: A national pilot survey. International journal of speech-language pathology, 22(4), 387-398. https://doi.org/10.1080/17549507.2019.1650110
Sylvan, L., Goldstein, E., & Crandall, M. (2020). Capturing a moment in time: A survey of school-based speech-language pathologists' experiences in the immediate aftermath of the COVID-19 public health emergency. Perspectives of the ASHA Special Interest Groups, 5(6), 1735-1749. https://doi.org/10.1044/2020_PERSP-20-001
Tambyraja, S. R., Farquharson, K., & Coleman, J. (2021). Speech-language teletherapy services for school-aged children in the United States during the COVID-19 pandemic. Journal of Education for Students Placed at Risk (JESPAR), 26(2), 91-111. https://doi.org/10.1080/10824669.2021.1906249
Taylor, O. D., Armfield, N. R., Dodrill, P., & Smith, A. C. (2014). A review of the efficacy and effectiveness of using telehealth for paediatric speech and language assessment. Journal of Telemedicine and Telecare, 20(7), 405-412. https://doi.org/10.1177/1357633x14552388
Tomaiuoli, D., Del Gado, F., Marchetti, S., Scordino, L., & Vedovelli, D. (2021). Telepractice in school-age children who stutter: a controlled before and after study to evaluate the efficacy of MIDA-SP. International Journal of Telerehabilitation, 13(1), e6380. https://doi.org/10.5195/ijt.2021.6380
Topbaş, S., Birol, N. Y., Berber, H., Polat, B., Kırımtay, B., & Yılmaz, A. (2020). COVID-19 pandemisi sürecinde dil ve konuşma terapisi yönetimi:“Şimdi ne yapmalıyız?”. Dil Konuşma ve Yutma Araştırmaları Dergisi, 3(1), 1-30.
Tucker, J. K. (2012). Perspectives of speech-language pathologists on the use of telepractice in schools: The qualitative view. International Journal of Telerehabilitation, 4(2), 47-60. https://doi.org/10.5195/ijt.2012.6102
Türkan, A. F., & Koçak, A. N. (2021). Dil ve konuşma terapisi alanında tele terapi hizmeti alan bireylerin memnuniyetlerinin incelenmesi. Dil Konuşma ve Yutma Araştırmaları Dergisi, 4(2), 192-219.
Van Eerdenbrugh, S., Schraeyen, K., Leysen, H., Mostaert, C., D'haenens, W., & Vandenborre, D. (2022). Delivery of speech-language therapy and audiology services across the world at the start of the COVID-19 pandemic: A survey. Perspectives of the ASHA Special Interest Groups, 7(2), 635-646. https://doi.org/10.1044/2021_PERSP-21-00134
Waibel, K. H., Garner, S. J., Bojicic, I., & Smith, R. (2017). Outcomes of a military regional multispecialty synchronous telehealth platform and the importance of the dedicated patient presenter. U.S. Army Medical Department Journal, 2–17, 1–8.
Ward, E. C., & Burns, C. L. (2014). Dysphagia management via telerehabilitation: A review of the current evidence. Journal of Gastroenterology and Hepatology Research, 3(5), 1088-1094. https://doi.org/10.6051/j.issn.2224-3992.2014.03.408-17
Weidner, K., & Lowman, J. (2020). Telepractice for adult speech-language pathology services: a systematic review. Perspectives of the ASHA Special Interest Groups, 5(1), 326-338. https://doi.org/10.1044/2019_PERSP-19-00146
Yang, H. W., Burke, M., Isaacs, S., Rios, K., Schraml-Block, K., Aleman-Tovar, J., ... & Swartz, R. (2021). Family perspectives toward using telehealth in early intervention. Journal of Developmental and Physical Disabilities, 33(2), 197-216. https://doi.org/10.1007/s10882-020-09744-y
Yoo, J., Yoon, M. S., Lee, C. K., Hong, G. H., & Choi, S. J. (2021). An exploratory survey of priorities in establishing telepractice system for SLPs and caregivers in Korea. Communication Disorders Quarterly, 42(4), 230-237. https://doi.org/10.1177/1525740120916414