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Tele-AAC Case Studies:

Working With What You've Got

Module 3: Indirect Service Delivery via Tele-AAC 

Tele-AAC IM in School.jpg

Critical thinking questions and prompts for this module are:  

  • List differences between direct and indirect service delivery via Tele-AAC

  • Describe how you could provide synchronous indirect service through Tele-AAC 

  • Describe why asynchronous indirect service may be more beneficial for an individual Tele-AAC

Indirect services or consultation are a powerful and effective way to support generalization of skills across communication partners and environments, as well as support a more multidisciplinary delivery model, incorporating other specialists and team members. This type of indirect service delivery model works well within tele-AAC sessions, and can offer flexibility by using either synchronous service delivery (real-time) or asynchronous delivery (store and forward), or a combination of the two. The focus is on the communication partner/team members, and to build up competencies in supporting communication, especially through lite-tech and high-tech AAC.


Indirect Synchronous Tele-AAC Services:

Intervention services occur during live, real-time tele-AAC sessions. Some may include just the communication partner and the clinician, and other times this may also include other team members on the team to incorporate a multidisciplinary approach. This type of consultation service may be to: review the handouts or training materials that were shared previously with the communication partner; model how to troubleshoot or program an AAC system; or brainstorm different ways to integrate use of the AAC system throughout an individual’s day at home. 

  • The clinician was able to consult with the school SLP, outpatient SLP, as well as the parent through tele-AAC synchronous consultation session to brainstorm vocabulary adjustments to the student’s Proloquo2Go overlay. It was important for consistent understanding and buy-in that all parties be a part of the consultation to incorporate both home vocabulary needs and school vocabulary needs. Once the clinician initiated the video conference meeting, she connected her iPad with the student’s Proloquo2Go overlay screen casting to her computer through a cable and QuickTime. As the clinician made selections on the iPad the navigation was shown on the shared desktop with the other clinicians to view the current set up of the individual’s vocabulary.  

  • This screen shot is an extension of the consult that occurred above. The clinician took a screen shot of the home page on her iPad. She then opened the photo to use annotating features of the video conferencing software to more clearly illustrate to the other clinicians watching her screen what they were keeping and what they were changing. She was then able to share this screen shot to the team with her consultation notes. Incorporating both the mother and the SLPs supported their understanding of the navigational changes to support their participation in programming as well as support their understanding when navigating during aided language stimulation.

  • Here is an example of synchronous consultation through tele-AAC. This is in the car as there was an emergency Bluetooth switch glitch that was frustrating a student and preventing access to his communication system. The team was able to quickly use video conferencing to show the clinician what exactly was going on with the equipment. Given the live video feed the clinician was able to diagnosis the problem with  the blue tooth switch interface.  The clinician then seamlessly troubleshooted the error while simultaneously supporting the paraprofessional’s troubleshooting knowledge/experience by being the ‘hands-on’ for the fix. 

  • Sometimes consultation can be humorous! Here the individual is out with his paraprofessional playing with Snap Chat Filters. Earlier in the week the clinician had asked the paraprofessional to reach out whenever she felt “stuck” with how to incorporate AAC into an activity. The paraprofessional reached out to the clinician to see if she was available. The clinician was able to join in through video conferencing to brainstorm different vocabulary and language to target (comments, silly sentences, asking questions) during the fun interaction. Within ten minutes the paraprofessional had a better idea of communication skills and vocabulary to target while goofing around. 

  • This photo is from a family who is homeschooling their child with complex needs including motor, communication, and health. The family is highly invested in their child’s communication growth and success. They are hands-on parents who are incorporating communication and learning through functional naturalistic opportunities. The student accesses a larger lite-tech version of vocabulary through direct (gross movement) selection while trialing an eye gaze system for more independent communication. In order to make the lite tech supports and work on creating environmental labels the mother wanted some training on PRC PASS software as well as programming training on the newer PRC Empower software that was running on the eye gaze device.  During a synchronous tele-AAC consultation session with the mother the clinician modeled Writing with Symbols as well as reviewing vocabulary within Empower through the emulating software that was shared on the clinician’s desktop. It was important to the clinician that she shared her full desktop to allow the view and comparison of both programs and still leave room for a Word doc to create notes. The clinician shared mouse control with the mother so she could also add notes and interact with the emulating software. The goal was also to identify what vocabulary additions or adjustments were need. This allowed the mother to copy the clinician as she practiced programming on the eye gaze system.  

Indirect Asynchronous tele-AAC Services:

Intervention services follow the consult delivery model but occur asynchronous. This model facilitates a more flexible schedule for the communication partner and for the clinician. For some communication partners this delivery model better meets their learning needs. As it is not in the moment but allows for repetition of information and allows the communication partner to go back and reference the material when they have the moment to focus on the learning. Some examples of Asynchronous consultation would be the clinician creating a screen casting video of programming a button and sharing it with the communication partner to reference while programming the individual’s AAC system. The communication partner can then also video tape there programming to forward to the clinician to review. Another example of Asynchronous tele-AAC services would be when the communication partner video tapes an activity at home, such as going for a walk and forwards it to the clinician for feedback and ideas on how they could better support communication during that activity. The clinician could follow up with asynchronous support through a video or put material together to reference for a synchronous (real time) tele-AAC session to review the recommendations. Asynchronous indirect service is very similar to the idea of video modeling. It is important to keep in mind what you are trying to illustrate in your videos to identify if you should screencast or video you accessing the AAC system to support modeling and visual attention to what buttons you are selecting. Screen casting you can show mouse clicks, but this can be difficult for some to see, especially when viewing on a smaller device, such as a phone. 

  • This is a follow up asynchronous consult with the mother of the previous story. She was having some difficulties troubleshooting errors with the new high-tech device. She knew to share photos of the screen and type out what she had already tried given previous feedback and recommendations from the clinician. With that information the clinician was able to create some video guides with her device to send back to the mother to successfully trouble shoot when she was able to sit down in front of the device.

  • Here is an example of the power of translation. This individual’s mother’s primary language is Spanish. The clinician used google translate to support her text messages to the mother paired with Spanish resources on aided language stimulation. For troubleshooting as seen in the screen shot from the text message the clinician shared a video modeling the strategy to use to correct the error and then followed up with simple bulleted instructions in Spanish for the mother to reference. When the mother sent a text message back in Spanish the clinician would then use google translate to translate the message. Given some errors in translation the clinician worked hard to pair written responses with a visual picture or video to support comprehension through translation. 

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