Tele-AAC Case Studies:
Working With What You've Got
Module 4: Engagement in the Virtual Environment
Critical thinking questions and prompts for this module are:
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List three different ways the communication partner can support the learner’s engagement in tele-AAC
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Describe different ways the clinician can create an engaging tele-AAC session.
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Explain what you would possibly do differently in a tele-AAC session than in an in-person AAC session.
Within this module Nerissa and Hillary will provide some tried and true recommendations for supporting different individuals' attention and engagement during a tele-session. Prior to going through these tools, we will reflect back on the importance of identifying an individual’s candidacy for different types of tele-AAC support, while taking into consideration the technology available and the communication partner.
We can all picture some of our students who may be able to sustain attention for smaller bursts of time and others for whom the virtual platform will not pique their interest at all. We have other individuals we can picture sitting down in front of the computer for up to a half hour session with ease. These individuals we may have already built a rapport with, as well as developed the expectation of implementing attention shifting strategies.
In some cases, the individual may need to shift focus to different parts on the shared display; or the individual may need to shift attention from the AAC system to the tele-AAC display screen. Along with shifting focus, our individuals need to inhibit attending to their environment outside of the tele-AAC session (and this can be harder for some than others). This is where the communication partner will come into play. The clinician will need to provide training and support for the communication partner in basic communication partner strategies as well as strategies to support the individual shifting and/or sustaining attention to the task at hand.
This is information is considered in the Initial Tele-Survey and that data is used to identify the best constellation of tele-AAC services (i.e., synchronous, asynchronous, direct service, or consultation). Individuals might require additional tools, such as a visual schedule, reinforcement schedule, timer, token board, or a combination of all of those supports. Within this module you will see a few examples of these tools in use.
Behavior Modification Tools:
Here are some strategies that the clinician can implement or support for increased individual engagement. Let’s start with tools to support behavior modification when following a schedule and reinforcement schedule.
CC HO Visual Schedule Visual Schedule Handout
Some students have access to visual schedules and token boards at home, but most will not. It will be important to share these supports. If an individual doesn’t have access to a visual schedule and needs one, there are some work-arounds, such as drawing one on paper or on a dry-erase board. Some visual schedules and token board images can also be accessed on a tablet or phone, or within applications such as Choice Works by Bee Visual, LLC.
Shifting Attention/Focus Strategies
As mentioned earlier, the ability for an individual to shift their focus or attention to what the clinician is visually referencing in the tele-environment can be a challenge. Within this module Hillary and Nerissa will show some of these tools, such as mapping out the screen to provide additional visual references (for example, “If you look in the orange rectangle I will type in some words” or “in the green rectangle you will see some images popping up”).
Additionally, there are other tools or tricks to draw an individual’s visual focus or attention to the screen such as using exaggerated facial expressions, sounds, or with movement/animation on the screen. Supporting more kinesthetic joint attention can be achieved by sharing remote control or mouse access through the video conferencing program. If the clinician needs to draw the individual’s attention to a specific spot on the screen or word on a language board, you can use zoom or the magnifier to enlarge where you are looking or add movement (e.g.: moving your cursor around) near where they should look. One can adjust their cursor size and color within their laptop settings to provide additional visual feedback. To incorporate the kinesthetic movement with shared mouse control one could use movable game pieces using Lesson Pix downloadable PowerPoint files with tokens, for example.
Tele-engagement - Communication Partner:
An important part of engagement in the tele-AAC session is for the communication partner to feel comfortable in their role and know the expectations of them during a tele-AAC session. Some topics that may seem obvious to us as a clinician may not be obvious to a parent who is not accustomed to being in this role as communication partner during a tele-AAC session.
Some areas that are important to review are the prompting hierarchy, communication partner strategies (such as not talking or interpreting for the individual), and knowing when to provide the speech output for an individual who is using a lite-tech language board. It is important to be clear when reviewing the communication partner’s expectations, and to check for understanding. Be careful to monitor the vocabulary or terminology that you are using to avoid jargon or technical words.
It is helpful for the clinician to give examples of what they want the communication partner to do, such as when the clinician asks to “point toward the icon on the device, please give the individual until the count of three, before pointing toward the icon on their device.” Ideally, one wants to pre-teach the expectations and schedule of the tele-session to the communication partner prior to the actual session in order to facilitate the communication partner’s comfort in the tele-setting. It is important to encourage the communication partner to stay positive throughout the tele-AAC session. It is a learning process for everyone. We recommend sharing some communication partner strategies or suggestions regarding how to engage prior to the tele-AAC session.
Tele-Engagement - Clinician
As clinicians and educators, we are familiar with teaching or instructing in an interactive, hands-on multi-modal context where we can use our hands to direct attention, move, or adjust the physical environment while using multiple modes of engagement.
The individuals with whom we work are also familiar with learning and engaging in an interactive environment where they can manipulate items and have shared interactions. We need to take this into account when preparing for a tele-AAC session. As the clinician, the individual, and communication partner progress through tele-AAC sessions it will be important to revisit the Initial Tele-Survey and see if anything has changed or improved, and to adjust the service delivery accordingly.
It is important for the clinician to prepare for the tele-AAC session as they would for an in-person session. However, there needs to be further effort put towards training of the communication partner, environmental set-up and organization of technology supports. The clinician should organize their therapy session with “book ends” (consistent beginning and endings to their sessions) for predictability and consistency for the individual. The clinician wants to organize their desktop to only show only what they need for the session (reducing visual clutter); they may want to minimize some windows as to not clutter their desktop. Clinicians may want to start with familiar activities to the individual to help them get familiar with the tele-AAC environment before starting anything new. Work on keeping sessions short and successful.
The pace of a tele-AAC session should be at a slightly slower rate to prevent talking over the individual or communication partner. Think ahead of how you will be creating movement and engagement in the session. But remember, the focus is AAC and communication and it is important not to get distracted by adding elaborate software or apps.
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