Tele-AAC Case Studies:
Working With What You've Got
Case 1: Evan and Levi
Levi is an active young boy who can struggle with transitions and staying on task during work. His dad, Evan, is looking for support with behavior modification and engagement during structured tasks. Levi often will get up and walk away or hide under the table when demands are placed. Evan reported that Levi does not use his AAC system that much in the home setting. Hillary and Evan worked together to identify some of Levi’s motivating reinforcers (one being the iPad and another being dogs). Evan did remember where he had placed the token board and visual schedule the school had sent home at the beginning of the school year.
Evan completed an initial intake survey that Hillary had sent to determine details pertaining to the technology, AAC system, environment, communication partner and the individual. In summary it was determined that:
With respect to the “tele-tech” email, live video conferencing, and videos tutorials were preferred and that they would be able to use a phone or Chromebook for conferencing (with a webcam). Evan reported that he is comfortable with technology and open to training on how to use more than one piece of technology at a time. He is familiar with Zoom and his Internet connection is good.
When it comes to his son’s use of AAC and his “AAC tech,” he does have access to his device but not an alternative lite-tech options. He expressed that he is not familiar nor very comfortable with the AAC system, or with supporting Levi’s use of the system. This was consistent with his feelings regarding troubleshooting the device.
When asked about the “tele-environment,” Evan said that they would work in a designated space at a table in the office. He did note that Levi’s older sibling would be around during the session but that he wasn’t concerned about any disruptions due to that. With respect to scheduling, he shared that they were flexible.
Regarding “communication partner” Evan honestly shared that he felt terrified about supporting Levi’s engagement during structured sessions that included demand tasks. When asked more specifically about this questions, Evan explained that Levi is always full of energy and struggles with directed tasks at home he is custom to having full access to his toys and less structured activities. Evan felt he would be able to focus his attention on the tele-session, without distractions.
Lastly, regarding Levi the “learner”it was noted that his attention span was around five to ten minutes, that he benefitted from a visual schedule and reinforcement schedule. It was added that Levi loves animals, dogs, and Legos. He does best learning and participating with hands-on and visual activities.
Based on the initial intake, it was determined that Evan was open to trying direct synchronous tele-AAC sessions with support using a schedule and token board. The session would be held through Zoom. Both Evan and the clinician agreed they would start small with shorter successful sessions to build on Levi’s endurance and attention. These sessions would also be supported through synchronous and asynchronous tele-AAC consultation with Evan to support his comfort level with both the behavioral supports and the AAC System.
The initial consultation occurred prior to Levi’s first tele-AAC session. The tele-AAC consult focused on reviewing how to use and implement the token board with encouragement from Hillary (she would let Evan and Levi know when a token was earned and when the reinforcement was to occur). Evan shared that he felt the iPad with a Lego App was a motivating reinforcer for Levi and that the program would support his engagement and attention. Hillary also worked with Evan on how to use the visual schedule prior to the tele-session to support Levi’s transition to the table for work, pairing sitting at the table with a small animal figurine. Hillary shared some pre-recorded videos on the basic vocabulary organization of Unity, prompting hierarchy, and communication partner strategies with Evan prior to the session, to look at on his own time.
During the session, Hillary connected with Levi and his dad, Evan, through a Zoom meeting on their Chromebook. Hillary shared her desktop which had both a screen shot of the Unity 84 core page and an engaging funny PowerPoint book about dogs. Hillary had her iPhone ready to screen share to her camera to demonstrate navigation with her laptop with the emulator software. Help was provided around using Word Finder (which was used during the session to find the word ‘clown’). This supported Evan’s comfort with navigation, as well as modeling a strategy for searching for words to use when he was not sure where they were located.
To support the use of the token board and visual schedule , Hillary had a version of the token board at her location that she referenced during the Zoom meeting. The engaging, humorous dog PowerPoint book was used to entice Levi’s engagement while they worked on creating two-word utterances using modifiers. The session was kept short, and Hillary made sure to end on a positive note.
Hillary was concerned that Evan might be over-prompting or navigating for Levi when she compared the support Levi needed during the session relative to the support he had needed in school. However, without a second camera she was unsure. She recommended for their next session for Evan to sign into Zoom on his phone and set it up behind him (aimed at Levi’s AAC system to ensure she could support Evan’s prompting skills in real time during their session). Hillary also provided Evan with a recorded video, modeling the use of ‘wait time’ and point prompts to look at prior to their next tele-AAC session.
Although Hillary had reviewed the objectives of the tele-AAC session with Evan prior to the session, some of the over prompting revealed to Hillary that she might not have been explicit enough in her explanation of the goals of the task, and how to best support AAC use. The focused objectives were on initiation, language expansion, and Levi practicing the motor patterns for navigation. Hillary scheduled a consultation time with Evan to review these details.
Clinician modeling using emulator software.
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