Tele-AAC Case Studies:

Working With What You've Got

Module 2: Direct Service Delivery via Tele-AAC 

Critical thinking questions and prompts for this module are:

  • Describe how an individual can participate in intervention services synchronously 

  • Describe how an individual can participate in intervention services asynchronously 

  • List three reasons why an individual may be better suited for asynchronous intervention services

Direct services via tele-AAC refer to can be effective ways of connecting with an individual for the purposes of intervention. Services can happen in real-time (synchronously) or over a period of time using various store-and-forward techniques (asynchronous service delivery). Both synchronous and asynchronous services can be powerful and effective in supporting an individual’s AAC skill advancement. 

 

Direct synchronous tele-AAC services:

Direct services occur with the individual using AAC in real-time. Oftentimes, individuals receiving direct intervention services via tele-AAC are fairly comfortable using their own AAC systems, following a model/instruction, and managing the technology necessary for tele-AAC at the same time. However, it is also possible that a skilled/trained communication partner in the same environment as the individual may be able to facilitate the interaction between the clinician and the individual in the shared virtual environment. 

Modeling with Cursor Movement​

  • This example shows how an individual can participate in intervention services in real time with the clinician. The clinician is able to screen-share a replica of the individual’s AAC system to demonstrate target skills pertaining to the individual’s goal. When the clinician makes a selection on her iPad it is presented to the individual as a cursor movement. There is a shared activity or referent about which the individual and the clinician are communicating.The clinician has a computer with video-conferencing software to facilitate the real-time interaction, and is screen-sharing an activity and the replicated AAC system at the same time.

Modeling with Finger Movement​

  • For some individuals it is hard to follow a cursor movement on the screen as a form of prompting. So, instead of sharing a replica on a tablet, the clinician is able to share the camera feature instead, of a phone or additional tool. This creates a projector-like set-up and the individual can rather follow the clinician’s hand as she makes selections on the replicated AAC system. The clinician has an extra piece of equipment (the smart phone) in addition to the computer with video-conferencing software, and replicated AAC system. Rather than sharing the activity and the replicated AAC system, the clinician is rather sharing the activity and the camera/projector view.

​Working with Multiple Cameras with Relative Independence

  • For some individuals, once the tele-environment is set-up for them they are able to engage with minimal support from an on-site communication partner. With the equipment set up to ensure that the clinician is able to see the individual as well as their system at the same time, the two are able to interact with relative independence. There is a lot of equipment needed to make this scenario work. A laptop is connected to an external camera to offer the view of the device (and should be turned so as not to distract the individual, unless it is being used to share an activity). The white iPad is used for the face-to-face interaction between the clinician and the individual. 

​Working with Multiple Cameras with Help

  • For others, they may be able to attend to the clinician through the computer, but may need a little more support from a communication partner on their end (which is also a great opportunity to support generalization). In this set-up the individual has access to two display options (a computer connected to the external camera, and another laptop for the real-time interaction between the clinician and the individual). The external camera allows the clinician to “see” how the duo is interacting with the AAC system, and the computer display is larger enough to show the clinician as well as their shared activity. 

​Working with Text and Word Processing

  • When an individual is able to read using a word processing program as the joint activity, the clinician and the individual are able to supplement their video interaction with text messaging back and forth. Less equipment is needed in this scenario. One computer (with a large enough display) shows the shared document, as well as the video image of the two participants. The individual is able to connect their high-tech AAC system to the computer and the AAC device then serves as a secondary keyboard that can input text into the document. With many videoconferencing programs, the clinician is able to control who has control of the screen to support the back-and-forth messaging component. 

Simultaneous Modeling and Demonstration

  • In some instances, and with the right equipment, the clinician and the individual are able to simultaneously see each other, as well as AAC systems in both of their respective locations. For this to happen, both the clinician and the individual need to have two display options. One to share their faces and another to share their systems. The individual needs to be able to follow the modeling offered by the clinician in this virtual, 2D environment. It is important that the system on the clinician’s end mirrors the individual’s system as best possible. 

For each of these scenarios the equipment varies, as does the involvement of the communication partner on the side of the individual. The common factor is the ability to share information about how to use an AAC system. The clinician needs to demonstrate as well as get information about how the individual is using their system on their end. 

Direct asynchronous tele-AAC services:

Thinking about a “flipped classroom” can help us think about asynchronous direct service delivery. The clinician is able to share information or activities for the individual to complete. The individual completes the assigned task and shares it back with the clinician. The clinician and the individual then meet to review the work completed. Put simply, it is:

  1. Assign and share

  2. Complete and share

  3. Meet to review

 

This combination of store-and-forward paired with a real-time meeting can be particularly effective for individuals for a number of reasons. For some, the pace can be controlled in that individuals may be better able to focus on a specific target before addressing another. For those who need to build up their tolerance, interest or engagement working in a virtual environment shorter more focused sessions may be more successful. 

 

This kind of intervention support is similar to a service schedule of 3x15 minutes a week, in comparison to 1x45 minutes, and may work better to support generalization and more widespread implementation. It may also be easier to schedule, or to involve important communication partners. 

  • For some individuals they can share a completed assignment (such as a set of worksheets, a writing assignment or some other activity) with the clinician. The clinician is then able to coordinate a time with the individual to review the completed work, offer input and guidance, as well as modeling, and offer a refined task from there. 

  • In some instances, it is really important for the clinician to be able to “see” how the individual is engaging with the assignment and/or using their AAC system. By sharing video recordings of the individual’s use, the clinician is better able to address specific targets when they meet in real-time. 

There is a lot of flexibility when it comes to asynchronous direct service delivery. Remembering that it is like a flipped classroom, the idea is to present the individual with tasks and information related to their goals for them to do on their own time. The individual then shares their work back to the clinician. When the clinician and the individual meet, they are able to discuss the work completed, provide and receive feedback, and advance to the next stage. 

 

This form of service delivery also offers a unique opportunity for important communication partners to be involved in the process, learn from the time together, and support generalization of skills beyond the session. 

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