Therapy services for children and youth living in rural areas of high-income countries: a scoping review

Figures & data

Table 1. Electronic database search terms.

Term	Variations
Children	Disabled child(ren); neurodevelopmental disorder(s); handicap(ped); disability(ies); disabled child; handicapped child; disabled youth; disabled young adult
Rehabilitation	Rehabilitation; activities of daily living; correction of hearing impairment; early ambulation; exercise therapy; neurological rehabilitation; occupational therapy; speech language pathology; speech therapy; recreation therapy; audiology; rehabilitation of speech and language disorders; rehabilitation; vocational; telerehabilitation; physical therapists; audiologists; occupational therapists; physical therapists; physical therapy modalities; physical therapist assistants; speech language pathologists; physical therapy specialty; audiologists, recreational therapists.
Multidisciplinary Care Team	Interdisciplinary; interprofessional; transdisciplinary; inter disciplinary; inter professional; multidisciplinary; intra professional; intra disciplinary; intraprofessional; intradisciplinary; trans disciplinary; multidisciplinary.
Rural	Rural health;, rural health services; rural population; hospitals, rural; rural, medically underserved area; health services accessibility; remote, telemedicine; telerehabilitation; health disparity; health equity.

Figure 1. PRISMA diagram.

A flow chart is presented, presenting the PRISMA diagram. Five thousand nine hundred and ninety-seven studies are identified through the initial database search. One thousand three hundred and sixty two duplicates are removed. Four thousand six hundred and thirty five articles are screened at the title and abstract phase. Four thousand two hundred and twelve are excluded as they were found to be irrelevant. Four hundred and twenty three are screened at the full text stage. Three articles are found through a hand search. A final total of thirty-seven studies are included in the scoping review.

Table 2. Studies about services provided in-person.

Author and year of publication	Country	Setting	Methodology	Population characteristics	Details of service provision	Positive outcomes in rural settings	Challenges in rural settings
1. Mello et al. (2016)	United States	Rural and urban	Quantitative	Caregivers of children with ASD (n = 415; n = 101 from rural areas)	Discipline: SLP, OT, ABA and Behavior Support Services, Parent Related Services Therapy focus: ASD Method: individual Location: private clinics, school-based Duration: varied, unspecified Intensity: varied, unspecified	Rural families Access: most used service was speech language therapy Families rated services as somewhat effective Rural and urban families: Access: identified the most needed service was behaviour support service Rural and nonrural families were similarly satisfied with overall services	Rural families: Access: least likely service to be used was service coordination and self-care Less likely to access parent support groups Longer distances to travel to access the services Lower perceptions of effectiveness of behavioural support Fewer BCBA present, less likely to access recommended services
2. Williams et al. (2014)	Australia	Rural	Quantitative	PTs (n = 2) taking part in a 6 month-long post-graduate paediatric clinical and academic training	Discipline: PT Therapy focus: paediatric physiotherapy services Method: outpatient services, family-centred practice Location: clinics and community services Duration: varied, unspecified Intensity: varied, unspecified	Improved accessibility to paediatric physiotherapy	Shortage of paediatric physiotherapy services due to a lack of post-graduate clinical training opportunities in rural workforce Lack of funding for rural programs
3. Monz et al. (2019)	United States	Rural and urban	Quantitative	Caregivers (n = 5122) of children (13–17 years old) with ASD	Discipline: behavioral, developmental/relationship, SLP, OT, psychological; parent/caregiver training Therapy focus: ASD Method: individual, group, social skills training, academic support, animal-assisted activities and therapies, SCERTS, sensory integration, TEACCH and other or unknown Location: client’s home, private or public school or preschool, private clinic, daycare or before/after school program, camp, other or unknown Duration: varied Intensity: varied, median = 6.0 h/week	Rural vs. urban frequency of treatment Not as pronounced SLP and OT mostly provided at public school, and are not dependent on infrastructure (e.g., specialists’ offices)	Intensity of “any” treatment significantly greater in urban than rural setting Less frequent behavioural therapy and SLP in rural areas Less likely to receive individual sessions than in urban areas
4. Chu et al. (2017)	Taiwan	Rural	Quantitative	Children (n = 71; 35 with ASD, 36 with DD), 24–36-months-old	Discipline: SLP, OT, PT, cognitive education and other Therapy focus: ASD Method: individual Location: center-based (daycare or specialized preschool), regular preschool Duration: 1.5 years Intensity: 0–29.8 h/week (higher end being full preschool hours) varied	Children with ASD and DD improved on all domains of cognitive function	Rural children with ASD and DD had limited services and fewer options in services for autism
5. Dew et al. (2013a)	Australia	Rural	Qualitative	Carers (n = 78) of people with diverse disabilities and adults with a disability (n=10)	Discipline: SLP, OT, PT Therapy focus: person-centred community-based therapy services Method: varied, unspecified Location: client’s home, school, clinic Duration: varied, unspecified Intensity: varied, unspecified	Commitment of private practice therapists who work in rural areas	Common concerns of adults with disability and carers: Travelling long distances to access therapy Long wait times for therapy Limited access to therapy past early childhood (problems of recruiting and retaining sufficient therapists to work in rural areas)
6. Rourke et al. (2016)	Canada	Rural	Quantitative	Children (n = 218; 4–11 years old) from a community with a high rate of middle ear disease and conductive hearing loss	Discipline: AUD Focus: paediatric assessment Method: ShoeBOX Audiometer Location: school Duration: mean duration of test = 332 s Intensity: unspecified	Time efficient Largely language independent	Follow-up difficulties
7. Hussain et al. (2015)	Australia	Rural	Mixed methods	Parents (n = 17) of children (age < 18) with DD	Discipline: SLP, OT, PT, Behavioural, Psych Therapy focus: information needs around health, social services, parental perceptions and experiences of service delivery Method: varied, unspecified Location: varied, unspecified Duration: varied, unspecified Intensity: varied, unspecified	None reported	Lack of timely information about services Inadequacies in interaction with service providers (poor staff attitude, lack of experienced staff and high staff turnover) Access challenges (limited services, long wait times, travel and associated costs, and mismatch between the child’s needs and services offered) Administrative services create barriers due to unnecessary bureaucracy
8. Solovieva et al. (2014)	United States	Rural Urban	Quantitative	Individuals with traumatic brain injury (n = 722; all ages, mean age = 40 years)	Discipline: SLP, OT, acute care, inpatient/outpatient services, rehabilitation services Therapy focus: unknown (TBI) Method: varied Location: in-home, nursing home, varied Duration: varied, unspecified Intensity: varied, unspecified	Rural and urban: More felt satisfied with the rehabilitation services received than dissatisfied	Key barriers to service in rural and urban settings: Lack of knowledge of available services and resources Cost of services Difficulty navigating system Difficulty finding qualified providers knowledgeable of TBI Proximity to services
9. Ziviani et al. (2014)	Australia	Rural Urban	Qualitative	Caregivers (n = 10) of children (age ≤9 years) with physical disabilities (1 rural)	Discipline: SLP, OT, PT, social work, family support workers and other early intervention Therapy focus: paediatric Method: varied Location: in-home, nursing home, varied Duration: varied Intensity: varied	Rural and urban: Most parents were happy with responsiveness to needs of child and family Parents valued equipment services for their child with physical disabilities Most families happy with the parent provider relationship	Rural and urban: 50% dissatisfied with therapy quality (e.g., lack of goal setting, high staff-turnover) Difficulty accessing and funding equipment Poor communication and coordination of services Parents with health problems and single mothers more apprehensive about managing their child’s needs
10. Dew et al. (2013b)	Australia	Rural	Qualitative	Caregivers (n = 10) and 60 service providers (n = 60) of children (0–6 years old) with disabilities. Adults with disabilities aged 21 years+ (n = 10)	Discipline: SLP, OT, PT Early intervention (EI) for children with physical disabilities Therapy focus: paediatric Method: person-centred, individual-funding (IF) Location: varied, unspecified Duration: varied, unspecified Intensity: varied, unspecified	Identified innovative approaches to providing services to people with a disability who had IF (e.g., employing local people trained to work as therapy implementers under the direction of therapists based in larger settings)	Four service barriers: Lack of information and advice Limited local service options and capacity; Higher costs and fewer services Complexity of self-managing funding packages
11. Daal’Alba et al. (2014)	Australia	Rural and urban	Mixed methods	OTs (n = 11) working with children (0–6 years old) with a rare developmental disability	Discipline: Early OT intervention Therapy focus: paediatric Method: family-centred approach Location: home, varied Duration: varied Intensity: varied	Rural and urban: Family-centred practice increased the efficacy of therapy interventions support to families Play therapy is a critical area of intervention	None reported
12. Brown et al. (2012)	Canada	Rural and urban	Quantitative	Parents or legal guardians (n = 101) of children (6–13 years old) with ASD	Discipline: SLP, OT, PT, and others Therapy focus: ASD, paediatric Method: unspecified Location: school settings, private Duration: unspecified Intensity: unspecified	Rural and urban: Almost all children had an educational assistant and a family physician	Rural and urban, most common unmet needs: Social activities for the child Information about services and continuous service provision Rural Long travel distance impeded access to services and informal supports (e.g., support groups)
13. Eglison et al. (2011)	Iceland	Rural and urban	Qualitative	Parents (n = 17; 8 rural, 6 urban) of children (7–13 years old) with physical disabilities	Discipline: OT, SLP Therapy focus: paediatric Method: family-centered approach Location: clinic-based Duration: varied Intensity: varied	None reported	Rural Travel costs associated with accessing therapy Less access to OT and PT Structural manner in which services are provided can impede family-centered approach
14. Wisniewska et al. (2012)	Poland	Rural	Quantitative	7–8-year-olds (n = 50) with muscle imbalance	Discipline: PT Therapy focus: paediatric, muscle imbalance Method: comprehensive Location: military hospital Duration: 3-week program Intensity: varied, unspecified	Rehabilitation program eliminated muscle contractures in children and improved the postures	Difficult living conditions Poor social conditions
15. Zaidman-Zait et al. (2015)	Canada	Rural and urban	Mixed methods	Parents (n = 23) of deaf children (age 3–16 years) with additional disabilities	Discipline: AUD Therapy focus: paediatric Method: cochlear implantation Location: children’s hospital Duration: unspecified Intensity: unspecified	Rural and urban Parents satisfied with implant Improved quality of life for child	Limited availability of specialized services in rural settings
16. Barr et al. (2018)	Australia	Rural	Systematic review of quantitative and qualitative studies	Children (0–16 years of age) with hearing impairments	Discipline: AUD Therapy focus: paediatric, hearing loss services Method: varied Location: varied Duration: varied Intensity: varied	None reported	Reduced quality and frequency of service Extensive travel and associated costs Lack of information Minority groups at greater risk of poor outcomes SES influences access to services
17. White et al. (2016)	Australia	Rural	Mixed methods	14-year-old aboriginal boy with neurological meliodosis	Discipline: PT, OT, SLP Therapy focus: paediatric Method: multidisciplinary inpatient and outpatient rehabilitation Location: medical setting Duration: 9 months of inpatient admission Intensity: varied	Required intensive medical inpatient treatment	Case highlights challenges associated with discharge to a remote community where limited support services are available for a high needs patient
18. Anderson et al. (2014)	Australia	Rural and urban	Qualitative	Parents (n = 6) of school-age children with cerebral palsy, ASD and dyspraxia, who use a speech generating device (SGD)	Discipline: SLP Therapy focus: SGD Method: support for families with a new SGD Location: varied Duration: varied Intensity: varied	Rural and urban: Timely, well-coordinated and family-centred support enhanced service experience for families with a new SGD	Rural Intensity of therapy services limited in rural areas (monthly or less) Travel long distances to access therapy centres Therapist expertise is limited in SGD practice
19. Chen et al. (2017)	Taiwan	Rural and urban	Quantitative	Mandarin speaking preschoolers (n = 5; 53–70 months old) with congenital mild to profound hearing loss Parents (n = 5) and Therapists (n = 4)	Discipline: AUD Therapy focus: hearing loss Method: auditory-verbal therapy (AVT) Location: in-person vs. telepractice Duration: mean = 49 mos.; assessed and compared 2 years post-treatment Intensity: unspecified	Rural and urban: No statistically significant difference in the children’s language abilities between telepractice and in-person group outcomes Therapists found in-person assessment of speech production easier than via teleconference	None reported
20. Grogan-Johnson et al. (2010)	United States	Rural	Quantitative	N = 34 students (4–12 years old) with articulation, language and/or fluency disorders as a primary or handicapping condition related to a learning disability Parents (n = 22), educational staff and school administration staff (n = 27)	Discipline: SLP Therapy focus: articulation Method: Group A received telepractice for four months followed by in-person for four months. Group B received in-person for four months followed by telepractice for four months. Measured progress on GFT-A, National Outcomes Measurement System and progress reports. Location: in person (mainly group), telepractice (mainly individual) Duration: 8 months Intensity: IEP	Students’ performance with telepractice was similar to students’ performance in person Satisfaction with services by students, parents, SLPs, principals and e-helpers No difference in session cancellation reasons	The perceived disadvantages of telepractice included: difficulty of collaborating with classroom teachers and of relating therapy to the classroom curriculum
21. Coufal et al. (2018)	United States	Rural and urban	Quantitative retrospective study	ASHAs National Outcome Measurement System (NOMS) client cases (n = 1331) and telepractice client cases (n = 428)	Discipline: SLP Therapy focus: speech sound production in 6–9-year-olds with no communication disorders Method: varied, unspecified Location: in person, telepractice Duration: 4–9 months Intensity: varied, unspecified	Rural and urban: No significant difference between traditional in person treatment and telepractice	None reported
22. Sutherland et al. (2017)	Australia	Rural and suburban	Quantitative	Children (n = 23; 8–12 years old) with reading difficulties attending mainstream schools and referred to a specialist reading centre Parents (n = 13)	Discipline: SLP Therapy focus: assessment, CELF-4 Method: 4 standardized subtests administered via telepractice and 2 subtests in-person Location: in-person, telepractice Duration: 1–2 h Intensity: unspecified	High reliability of scores for in-person and telepractice conditions	None reported
23. Ruggero et al. (2012)	Australia	Rural and urban	Quantitative	Parents (n = 154 of 192 children (age ≤18 years) involved in speech- language pathology services	Discipline: SLP Therapy focus: individual therapy, parent training, home program, group therapy Method: unspecified Location: community health services, school/pre-school, or other. Duration: varied, up to 24 months Intensity: varied, up to 3/week	Rural and urban Parents were keen for alternative methods of service delivery but preferred individual sessions	Compared to urban families Fewer options of services for families Longer travel distances Fewer face-to-face and private sessions Less likely to be given homework
24. Anderson et al. (2015)	Australia	Rural and urban	Qualitative	SLPs (n = 13) and parents (n = 7) of children (2–18 years of age) who used speech generating devices (SGD)	Discipline: SLP Therapy focus: SGD Method: Alternative service models: parent-implemented intervention and training, peer-support networks, group services, intensive therapy camps and telepractice Location: varied Duration: varied Intensity: varied	SLPs found that rural families familiar with service limitations were especially supportive of telepractice Remote SLPs used support strategies, such as exchanging USB drives or therapy resources with families by post Rural families were more proactive and less reliant as therapy occurs less frequently Most families prefer in-person services	Rural and urban Parents felt either overwhelmed by the new information or sometimes excluded from learning opportunities Lack of flexible scheduling for learning sessions Text based training and manuals are often too difficult to understand
25. Jones et al. (2018)	Australia	Rural	Qualitative	Caregivers (n = 9) of Indigenous children (0–3 years old) with otitis media (OM)	Discipline: SLP, AUD Therapy focus: speech and language, hearing health, and school readiness Method: LiTTLe program Location: school setting Duration: 40 weeks; 4 h/day Intensity: 5 days/week	Caregivers had generally positive views of the program Caregivers felt that the program helped prepare children for school	Caregivers found strategies, such as baby talk, talking slowly, following along with the child's topic or parallel talk difficult and alien Many caregivers felt uncomfortable in a school setting
26. Gudjonsdottir et al. (2021)	Iceland	Rural and Urban	Quantitative	Families (n = 36) with children (6–18 years old) with physical disabilities (diagnoses of cerebral palsy, spinal muscular atrophy, Charcot-Marie-Tooth disease, spina bifida or Duchenne disease).	Discipline: PT Therapy focus: use and impact of mobility devices, and satisfaction with service Method: Mobility training Location: remote Duration: varied, unspecified Intensity: varied, unspecified	Rural and urban Majority of the parents reported positive effects of the mobility devices on their children’s opportunities for various activities and participation, most commonly: to go on trips, to go shopping, to travel long distances. Majority of parents were satisfied with the service delivery and professional services. No significant difference in the participants’ satisfaction with the type of the mobility device	Rural and urban Few participants reported negative effects of mobility devices on activities and participation, specifically on engaging in sports and/or leisure activities and meeting friends Less satisfaction with repair/maintenance of mobility devices and with follow-up services
27. Grogan-Johnson et al. (2011)	United States	Rural	Quantitative	School-age children (6–11 years of age) with speech sound disorders (n = 6 children who received in person therapy).	Discipline: SLP Therapy focus: outcomes of individual articulation therapy, using computer based intervention materials. It also compared in person services to telepractice services. Method: individual articulation therapy sessions, with pre and post-test measures using GFTA-2. Location: school setting, in private offices Duration: School calendar year; The in-person sessions; had a mean length of 20 min Intensity: unspecified	The in person group made significant improvement in sound production as measured by change in scores on the GFTA-2.	None reported

ASD: autism spectrum disorder; AUD: audiology; DD: developmental disability; OT: occupational therapist; PT: physiotherapist; SLP: speech language pathologist; ABA: applied behaviour therapy; SGD: speech generating device.

Table 3. Studies of services offered via telepractice.

Author and year of publication	Country	Setting	Population characteristics	Type of study	Details of service provision	Positive outcomes in rural settings	Challenges in rural settings
1. Cason et al. (2012)	United States	Rural and urban	IDEA Part C coordinators (n = 27), evaluated the utilization of telepractice for children (age ≤2 years) with disability or developmental delay.	Quantitative	Discipline: SLP, OT, PT, AUD, Early intervention development specialists, teachers of deaf and hearing, behaviour specialists, other (IFSP meeting participation) Therapy focus: unspecified Method: unspecified Location: Early intervention programs via telepractice (platform unspecified) Duration: varied, unspecified Intensity: varied, unspecified	For rural and urban settings: Natural environment (home) for testing Timely services	For rural and urban settings: Security and privacy concerns Concerns about the quality of services via telepractice and that there may be lack of evidence to support the effectiveness of a telepractice service delivery model were expressed by the IDEA part C coordinators.
2. Lee et al. (2018)	United States	Rural	Children (n = 2, 4 and 6 years old) with phonological disorders without any sensory, motoric or intellectual disabilities	Quantitative	Discipline: SLP Therapy focus: phonology Method: Multiple phonological approach Location: Prescencelearning.com teleconference platform Duration: 12–16 weeks; 30 min per session Intensity: 2 times a week	Effective for both participants	One participant dropped out of the study due to poor internet connection.
3. Guiberson, M. (2016)	United States	Rural	Spanish speaking toddlers (n = 63; 24–35 months-old; n = 22 with developmental delay) and their parents	Quantitative	Discipline: SLP Therapy focus: screening language development Method: PLS-4 Spanish; Nicoladis’ gesture system; SPS symbolic system; Linder’s complexity of play subscale; SALT; 2 parent report measures: INV and RM3L. Asynchronous feedback. Location: telepractice platform unspecified. Duration: unspecified Intensity: n/a Video recorded parent facilitated play activities and a parent pen and paper report measure of vocabulary	For rural and underserved areas: Best results with parent pen and paper survey in combination with the video recorded parent facilitated play activities	For rural and underserved areas: Video recorded play activities without the pen and paper vocabulary measure not likely a promising screening measure.
4. Constantinescu, G. (2012)	Australia	Rural	Families (n = 33) and therapists (n = 5) accessing auditory verbal therapy (AVT) program for children (6 months to 6.6 years old) with hearing loss	Quantitative	Discipline: AUD (AVT) Therapy focus: teaching listening and spoken language Method: AVT Location: AVT therapy by telepractice, using skype 5.5 and high-speed broadband access Duration: unspecified Intensity: biweekly therapy and planning sessions between therapist and parent; monthly themed ‘lesson boxes’ provided to families	Parents and therapists felt comfortable participating in the sessions via teleconferencing	Internet connection issues Therapists found it challenging to judge the child’s speech production Video quality sometimes required troubleshooting Therapists less satisfied than parents with the child’s level of interaction with the therapist via video conferencing
5. Little et al. (2018)	United States	Rural	Families (n = 17) and children (n = 18; 2–6 years old) with ASD.	Quantitative	Discipline: OT Therapy focus: child’s participation in play and social activities Method: Occupation-Based Coaching process where caregivers identified 2–3 goals, and the therapist helped the family generate their own solutions Location: zoom platform Duration: 12 weeks Intensity: unspecified	Parents and child engaged in more play activities, greater variety of skill development activities Children’s performance in activities and in goal attainment improved Increased parental satisfaction with intervention goals	N/A
6. Barr et al. (2018)*	Australia	Rural	Children (n = unspecified; 0–16 years old) with hearing impairments	Systematic review of quantitative and qualitative studies	Discipline: AUD Therapy focus: unspecified Method: unspecified Location: telepractice; platform unspecified Duration: unspecified Intensity: unspecified	Parents satisfaction with audiology services offered via telepractice, would recommend the service to other parents	N/A
7. White et al. (2016)*	Australia	Rural	A 14-year-old aboriginal boy with neurological meliodosis.	Mixed methods	Discipline: SLP, OT, PT Therapy focus: inpatient and outpatient rehabilitation Method: multidisciplinary inpatient and outpatient rehabilitation via telepractice Location: telepractice consultation and services during and after transition to rural home; platform unspecified Duration: 9 months Intensity: unspecified	Use of telepractice services enabled discharge of client to home Collaboration with other therapists in rural community	N/A
8. Chen et al. (2017)*	Taiwan	Rural and urban	Mandarin speaking preschoolers (n = 5; 53–70 months-old) with congenital mild to profound hearing loss, enrolled in auditory verbal therapy (AVT) as well as five parents’ and four therapists’ satisfaction with telepractice.	Quantitative	Discipline: AUD Therapy focus: hearing loss Method: auditory-verbal therapy (AVT) Intensity: unspecified Location: telepractice using Vidyo Protal version1.3.0.21, videoconferencing Duration: mean = 49 months; assessed and compared 2 years post-treatment Intensity: unspecified	Urban and rural: Telepractice just as effective as in-person services No significant difference between parents’ and therapists’ satisfaction on specific aspects of the programme or specific items Less travel time for majority of the families	Urban and rural: Therapists expressed difficulty in assessing the children’s speech production when using telepractice Some children had difficulty focusing on the teaching materials during telepractice sessions
9. Grogan-Johnson et al. (2010)*	United States	Rural	N = 34 students (4–12 years old) with articulation, language and/or fluency disorders as a primary or handicapping condition related to a learning disability Parents (n = 22), educational staff and school administration staff (n = 27)	Quantitative	Discipline: SLP Therapy focus: articulation, language and /or fluency Method: followed the goals in child’s IEP; individual sessions with SLP; e-helpers to provide support with telepractice equipment Location: four school districts; using an educational network and minimum bandwidth of 10 mbit/s Duration: 4 months Intensity: unspecified	Student performance with telepractice was similar to student performance in person Satisfaction with services by students, parents, SLPs, principals and e-helpers. No difference in session cancellation reasons	The perceived disadvantages of telepractice included: difficulty of collaborating with classroom teachers and of relating therapy to the classroom curriculum
10. Coufal et al. (2018)*	United States	Rural and urban	ASHAs National Outcome Measurement System (NOMS) client cases (n = 1, 331) and 428 telepractice client cases. Clients (6–9 years old) with speech sound production issues with no co-occurring communication disorders	Quantitative	Discipline: SLP Therapy focus: unspecified Method: unspecified Location: telepractice in the school setting, using a custom-built videoconferencing platform, with desktops or laptops with dual core processors and broadband internet of at least 1mbps or higher for download and upload speeds Duration: 4–9 months Intensity: unspecified	Rural and urban: Effective: no significant difference in treatment outcomes between in person services and telepractice for children (each group improved two levels as a result of therapy)	Rural and urban: SLPs were trained in the use and scoring of NOMS. The internet use was high speed (at least 1.0 mps or higher), which may be challenges for SLPs and families in rural settings. In some cases, USB sound adapter card was also needed
11. Sutherland et al. (2017)*	Australia	Rural hubs	Children (n = 23; 8–12 years old) with reading difficulties attending mainstream schools and referred to a specialist reading centre	Quantitative	Discipline: SLP Therapy focus: standardized language assessment Method: 4 standardized subtests administered via telepractice and 2 subtests in-person Location: hubs Duration: 1–2 h Intensity: one visit	Effective: telepractice can be used to assess children’s language Parents felt “somewhat comfortable” or “definitely comfortable” with the telepractice assessment	Parents were generally satisfied
12. Ruggero et al. (2012)*	Australia	Urban and rural (16 families)	Parents (n = 154 of 192 children ≤18 years old) with speech and language disorders	Quantitative	Discipline: SLP Therapy focus: individual therapy, parent training, home program, group therapy Method: unspecified Location: community health services, school/pre-school, or other Duration: varied, up to 24 months Intensity: varied, up to 3/week	Rural and urban families: Parents were keen for alternative methods of service delivery to fill the gap between assessment and treatment wait times	Rural and urban families: Families expressed a strong preference for individual therapy once they were eligible for therapy When individual therapy sessions were not possible, telehealth was not utilized extensively Rural families: 10 families from rural and remote areas travelled hundreds of kilometers each to access services
13. Anderson et al. (2015)*	Australia	Rural and urban	SLPs (n = 13) and parents (n = 7) of children (2–18 years old) who used speech generating devices (SGD) SLP in rural area (n = 1)	Qualitative	Discipline: SLP Therapy focus: SGD service delivery Method: unspecified Location: telepractice; platform unspecified Duration: unspecified Intensity: varied SLPs and parents experimented with alternative service delivery models including telepractice	Rural and urban families: Alternatives viewed as viable and useful by parents and SLPs All SLPs used telepractice or remote strategies to some extent Remote support strategies, such as exchanging USB drives or therapy resources with families by post Remote families more proactive and less reliant as therapy occurs less frequently	Rural and urban families: SLPs felt that telepractice is an appropriate supplement but not a replacement for in person therapy. Parents had limited experience with telepractice Parents preferred in person therapy
14. Sutherland et al. (2021)	Australia	Rural and urban	27 SLPs in pediatric practice (added 116 CELF-5 ax)	Mixed methods	Discipline: SLP Therapy focus: use of standardized language assessment CELF-5 Method: a post-assessment questionnaire was completed each time the SLP completed a CELF-5 assessment via telepractice Location: Telehealth platform “Coviu” Duration: 3 month trial Intensity: varied (a mean of 4.3 assessments per SLP)	Ease of using telehealth Telehealth makes it easier to provide services Effective interactions with the child on most occasions Visual and audio quality: over 92% of assessments were rated to have “ok,” “good enough,” or “perfect” visual and audio quality	Technical difficulties including internet connections Integrating CELF-5 tool in a telehealth platform Telehealth platform functionality issues
15. Johnsson et al. (2019)	Australia	Rural	Parents (n = 11), local support team members including speech pathologist, educators and learning support coordinators (n = 6), and teletherapists (n = 4) working with children on the autism spectrum (2–12 years old). 16 children were involved.	Qualitative	Discipline: support team members including SLP, OT, psychologist, education staff, teletherapists Therapy focus: Individual treatment sessions SLP, OT, psychologist and special educator Method: Teleconference treatment sessions led by SLP, OT, psychologist and special educator on one site, and a rural local support team with the client and parent at the rural site. Semi-structured interviews were conducted by phone following the interventions, to evaluate the services Location: Telehealth zoom platform Duration: One initial session to gather information followed by six teletherapy sessions Intensity: Not specified	Allows for access to specialists in rural communities The development of a competent telehealth support team takes significant number of hours initially, but the number of hours needed for training and practice get reduced over time Importance of the understanding the role and collaboration and capacity building within a teletherapy service	Establishing the need for in-person contact as part of tele-therapy program was expressed Scheduling and local staff changes Limitations on goals requiring physical interaction
16. Hayes et al. (2012)	Guam	Rural	Infants (n = 9), ages between two to three months.	Quantitative	Discipline: AUD Therapy focus: diagnostic audiological evaluations (auditory-evoked potentials and otoacoustic emissions) Method: audiological assessment via telepractice Location: remote, telehealth platform Duration: unspecified Intensity: unspecified	The paper describes how they addressed professional issues associated with the delivery of audiology services via telepractice, according to ASHA guidelines. Audiological evaluation can be offered via telepractice, in compliance with the ASHA standards	Technological problems, such as internet connectivity Logistical problems including scheduling challenges due to different time zones between Colorado and Guam
17. Grogan-Johnson et al. (2011)*	United States	Rural	School-age children (6–11 years of age) with speech sound disorders (n = 13). Seven received telepractice and six received in-person service.	Quantitative	Discipline: SLP Therapy focus: individual articulation Method: individual sessions with SLP; e-helpers to provide support with telepractice equipment Location: school setting, remote Duration: School calendar year; 20–40 min sessions Intensity: unspecified	Articulation therapy via telepractice is just as effective as in-person therapy. It was shown as being more effective than in-person therapy (when quarterly progress reports were used as a measure of progress on Individualized Education Plans (IEP)	Need for a private room for telepractice services, equipment and dedicated aide for technical support
18. Fairweather et al. (2016)	Australia	Rural	Children with communication skills difficulty (n = 19) and parents (n = 5). Children’s ages ranged from 3 to 12 years.	Mixed methods	Discipline: SLP Therapy focus: speech therapy Method: Abdobe Connect, Facetime or Skype Location: school or early childcare site- remote Duration: Twelve week period. 3–6 telepractice sessions Intensity: every two weeks	Quantitative results: Effectiveness of telepractice intervention, as the majority of the treatment goals were attained at a level expected by the SLP Qualitative results: parents viewed the therapy as feasible, practical and convenient. They reported positive effect on their child’s and their own learning	Difficulties with technology, such as internet loss, loss of sound and freezing of vision). Communication between stakeholders
19. Hines et al. (2019)	Australia	Rural	Children (n = 4; 5 years 1 month to 8 years 6 months), with a diagnosis of ASD. Their mothers and one teacher also participated in the study.	Mixed methods	Discipline: SLP, OT Therapy focus: individual therapy Location: remote varied based on the child’s need and their optimized energy levels (school, family home, library, holidays). They also changed for each child over time, based on the child’s and family’s needs. Duration: varied, up 12 weeks maximum Intensity: varied	Telepractice was highly acceptable to parents and/or teachers, especially due to access to timely and regular therapy without the cost of travel. Parents built confidence over time. Each child demonstrated improvements in specific, functional goals Effective therapeutic relationships with children were developed	Technology barriers (internet problems, platform connectivity, video) reported. Participants did not consider these occasional technology issues as obstacles to intervention. Therapists worked with parents and educators to identify solutions and alternatives.

SLP: speech language pathologist; OT: occupational therapist; PT: physiotherapist; SGD: speech generating device; AVT: auditory verbal therapy; AUD: audiology.

*Denotes studies which also included in-person services, but this chart extracted data on telepractice. The in-person results for these studies are noted in Table 2.