Tele-AAC is the use of telepractice service delivery models specifically for AAC intervention, assessment, consultation, training, and other AAC-related services. Tele-AAC is awesome and can be an effective way to support individuals and teams working with AAC.
Tele-AAC can happen in real-time (synchronous) or using store-and-forward methods (asynchronous). Both methods are very powerful in supporting individuals using AAC. Basically, you need ...
a way to connect...
You need to see who you are working with. Also, if you are sharing materials in real-time, the screen needs to be big enough to accommodate this.
You may also want a second camera view to either gather more information from your remote location, or to model certain words, phrases, or programming skills.
a way to share information about AAC...
There are powerful videoconferencing tools that allow you connect in real time. You can demonstrate things by sharing video/picture examples, or by showing the skill yourself.
You can share handouts, videos you have created, videos on the web, quick tips, or visual supports via email, messaging, or by adding content to a shared folder in the cloud before or after you connect with an individual or team.
You can share your screen to share an intervention activity, or to show materials/example/skills.
By having a 2nd camera and your own AAC system (app or language board) you can model target words or phrases.
synchronous tele-AAC
asynchronous tele-AAC
Ideally using Internet plugged in at:
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150 kbps for screen sharing with video thumbnail,
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600kbps for video calling, and
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1.5 mbps for video calling with many people/seats (using a 2nd camera counts as a seat)
Reduce the visual clutter on your screen to make screen sharing as effective as possible.
a way to keep things secure and legitimate...
Tele-AAC is a legitimate service offered by licensed speech language pathologists, and it oftentimes involves talking about people and their protected health information (PHI). It is important to:
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ensure tele-AAC is a good match for the individual and/or team,
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maintain ASHA's Code of Ethics at all times when conducting tele-AAC,
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maintain privacy and use secure, HIPAA-compliant videoconferencing tools, and
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ensure you're following the licensing laws on your end and that of the individual/team.
You likely need to sign a BAA - business associate agreement
It is a good idea to get consent too before starting tele-AAC
Telepractice vs. Tele-AAC
Because the very nature of AAC intervention includes an AAC system or tool, it is essential that the treating clinician is able to “have eyes” on the individual’s AAC system. This means having a second computer or iPad to be able to have a visual of the individual, as well as his her her AAC system.
Who is a Candidate for Tele-AAC?
While tele-AAC is a valuable tool and intervention approach, it may not be for everyone, and depending on the individual, the type of service may vary. For instance, tele-AAC for the purposes of consultation, whether in real-time or using store-and-forward techniques, may be beneficial irrespective of who the individual or student is. However, for students receiving direct intervention services, it is important that they are able to attend to the clinician on the screen, follow directions, respond within a given timeframe, use his or her AAC system independently or, at least be responsive to AAC modeling and prompting presented remotely. We generally access an individual’s candidacy as part of our assessment process and will make suggestions regarding service delivery based on his or her performance during the assessment.
What are Different Tele-AAC Services?
Direct services: where we work directly with the individual through the Internet to work on his or her goals. There would generally be another person (aide, educator, parent or caregiver) with the individual at his or her location for either the whole session or to help set up and break down.
Evaluations: where two of our clinicians work together to do the evaluation, but one works directly with the individual at his or her location, and the other clinician views the session through the Internet. This makes it less overwhelming for the individual, allows us to include specialists who otherwise couldn’t travel to the individual’s location, and enables us to write the report more quickly.
Consultation: where our clinician works with team members that are working with an individual needing our support. Connecting over the Internet allows us to coordinate schedules more easily, save on travel time, and collaborate in effective ways using videos and other tools.
Tele-AAC for Training
Through careful application of a range of telecommunication technologies, clinicians and professionals with expertise in specific domains are able to provide training and consultation to individuals, pre-/professionals, and parents/caregivers regarding intervention, implementation and generalization strategies. This can occur in real-time through Active Consultation or eSupervision, or after an event occurred using store-and-forward techniques involved in eMentoring and training.
Is Tele-AAC Comparable to On-site Services?
Yes and no as it depends on the individual. There is a growing number of research studies detailing instances in which services are comparable. It is important to know that it will be better for some individuals over others. For those who are good candidates for AAC, we find that the use of the computer is motivating and engaging, and that students are better able to attend to the intervention targets. We also find that generalization of skills taught during tele-AAC intervention is sometimes better, as team members are more involved in tele-AAC sessions than when we are there in person.
With respect to consultation we find that it really depends on the team. Some team members are overwhelmed by technology, and adding the “hardware” associated with tele-AAC adds to that dynamic. However, oftentimes, once we have provided some initial onsite training and the team is more comfortable with the procedures related to tele-AAC, the team really likes it. Tele-AAC helps address scheduling challenges. With the appropriate permissions, sessions can be recorded and shared with team members who could participate or who want to review the information. Tele-AAC empowers parents to “tune in,” and it is possible to engage in screen-sharing techniques that allow team members to practice in real-time.
Is Tele-AAC an Option for Initial Assessments?
Yes. We find that using telepractice for assessments helps us better collaborate with team members, and bring in necessary expertise. It is important that there is an on-site clinician or team member that is comfortable interacting with different AAC tools either presented via the computer, or in-person with the student (i.e., a trial or sample device). In some cases where intensive behavioral support is needed an assessment via telepractice is not appropriate. As with intervention, it is important to do a preliminary candidacy assessment.
What Equipment Do You Need?
A large enough computer to view the clinician/student and the intervention materials. In some cases, a touch screen computer is necessary (but screensharing and shared presenter controls are oftentimes sufficient). We use a specialized webcam set-up to support our tele-AAC services. This is usually attached to a secondary computer or laptop to help us view how the individual is using the AAC system. Additionally, in some cases, it is important to have emulation software or a second AAC system for the purposes of AAC modeling.
A Tele-AAC Solution:
The Adjustable J-Mount
The Adjustable J-Mount is designed to support synchronous and asynchronous telepractice services for individuals using augmentative and alternative communication (AAC) and assistive technology. The flexibility of the J-Mount arm allows the mounted webcam to capture a clear image of the AAC screen. Furthermore, the J-Mount can be adjusted to survey the surrounding environment, or be positioned as to allow for observation of a range of behaviors.
What are Good Settings?
We use AAC in the school and at home. We find both settings to be conducive for successful application of tele-AAC. We love working in the homes and being able to involve the families without placing the travel demands oftentimes associated with outpatient services. We also find that leveraging technology in these ways supports some really effective collaboration, which is essential for our students using AAC.
What About Security?
We take security seriously. It is important to use HIPAA compliant online videoconferencing tools (like GoToMeeting and Zoom - note: you oftentimes need to sign a business associate agreement (BAA) to ensure this). HIPAA compliant services are encrypted and only people who are authorized to view the content are allowed to.
In addition, the clinician conducts the session from a private area making sure that nobody else can view their computer screen. The clinician also where headphones to ensure that nobody can hear what is being said.
It is important to ask permission to record the video or take pictures (consent). Recording can be important to review a session and/or share with team members who couldn't join.
What about the Internet for Tele?
A strong Internet connection is essential to ensure the service is equivalent to that received in person.
Ideally using Internet plugged in at:
150 kbps for screen sharing with video thumbnail | 600kbps for video calling
1.5 mbps for video calling with many people/seats (using a 2nd camera counts as a seat)
Platforms for Tele-AAC
HIPAA compliance is important, so check the security and compliance options of the tools you are exploring. It is important to have the following features:
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Ability to video chat with more than 2 people/seats at once
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Messaging features
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Screen sharing capabilities
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The ability to record if necessary (although this may conflict with BAAs)
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Easy interface and controls
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Whiteboard or annotation
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Presenter control options
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Various call in options
