Author ORCID Identifier

Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation


Health Sciences


Rehabilitation Sciences

First Advisor

Dr. Joneen Lowman

Second Advisor

Dr. Renee Causey-Upton


In the school setting, the telepractice team primarily consists of the clinician and a support person known as a telefacilitator. Though telepractice is an accepted method for delivering school-based speech-language therapy, many barriers to the integration of telepractice as routine care persist. A major barrier is clinicians' acceptance of telehealth. However, there has been limited investigation of factors that influence clinician acceptance. Another barrier is related to support personnel. Telefacilitators have been shown to be an integral part of the telepractice program. Yet there are significant gaps in knowledge regarding the roles and responsibilities, staffing and management, and barriers/facilitators to using these key personnel. Together, these problems make telepractice program implementation more difficult and hinder researchers’ ability to advance telehealth as a field. This dissertation examines three aspects related to telehealth implementation and sustainability. First, we conducted a systematic review and meta-synthesis of factors affecting clinicians’ acceptance of telehealth. Clinicians had positive overall views of telehealth, though most still held reservations about routine use. Telefacilitators were found to be key in managing threats to acceptability. Second, we used survey methods to gather data on the typical profile of school-based telefacilitators. Most telefacilitators were paraprofessionals. Half of the respondents did not receive any training, which negatively affected their confidence and job performance. Third, we described the specific contributions telefacilitators make in school-based telepractice, as well as current practice patterns, using a mixed-methods approach. Current practice patterns were inconsistent due to the absence of guidelines for telefacilitators. However, clinicians described telefacilitators as being “make or break” for telepractice success. School resources and buy-in affected how telefacilitators were implemented. Together, results confirm that telefacilitators play an essential role in building and maintaining a successful telepractice program. Implications, recommendations, and areas for future research are discussed.

Digital Object Identifier (DOI)

Funding Information

–Endowed University Professor in Health Sciences Fund, 2022-2023
–Center for Telehealth Education, Research, and Outreach, 2022-2023
–CSD Department, 2022-2023
–Graduate Student Congress, 2022

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