The goal of an Augmentative and Alternative Communication (AAC) assessment is to identify appropriate communication technology for a user with complex communication needs. This may be anything from a low-tech communication board (letters or symbols) to a robust AAC “speech generating device” with communication access options (an app for a tablet computer, an eye-gaze responsive device, etc.) The AAC Specialist (a speech-language pathologist), often in collaboration with an occupational therapist, assesses the end user’s communication needs and abilities to make these recommendations. AAC assessments include consideration of cognition, receptive and expressive language, sensory and motor function, communication partners and environments.
It’s a tall order for a Zoom call.
Yet in this time of Covid-19, increasingly remote AAC assessments are happening. AT3 News and Tips has discussed remote AAC assessments with assistive technology (AT) service providers in Massachusetts and Arizona. They are on the forefront of doing what it takes to get communication needs met despite the pandemic. They are also the first to admit this is not a solution for many consumers and households. What is emerging, however, are some astonishing lessons learned worth sharing. Providers in both states report that already these experiences will impact how they provide AAC assessments well beyond the pandemic.
If your organization is considering providing remote AAC assessments or is acknowledging a pressing need to determine who might benefit, read on!
Thank you to the following speech-language pathologists (SLPs) for your contributions; with Easterseals MA: Kristi Peak Oliveira, Casey McCarthy, Alyssa Savery; with the Institute for Human Development at Northern Arizona University: Staci R. McCauley and Nikkol Kramer Anderson. Also, many thanks to contributions from Jill Pleasant, Associate Director of the Institute for Human Development, NAU.
A Remote Assessment Should Only Be Considered If:
- There is a pressing need to do so (Covid-19 precautions, geographically remote location, etc.)
- The consumer is willing.
- There is sufficient support at the remote location (a family member, personal care attendant, etc. who is available to help with technology and activities as necessary or appropriate for the consumer).
- There is access to broad band internet and sufficient technology (or a way to provide it).
Prepare In Advance
- Develop protocols and agreements for what to expect and use them.
- SLPs should check with their State Licensing Boards to make sure they are following any state-specific guidelines for telepractice.
- Conduct a remote intake first. Use this time to determine if a remote assessment is appropriate and welcome.
- Determine what equipment is available at the remote location (Windows computer? iPad? Smartphone?) and if it is necessary to send equipment and/or activities for the assessment in advance (if your program has that capability).
- Determine what kind of support a consumer may need onsite and if a capable and willing support person is available.
- Expect preparations for a remote assessment to be time-consuming and necessary. Separate intake and preparations from the time slotted for the assessment itself.
“Scheduling, technical support, shipping arrangements, family training, prepping equipment, permission forms provided virtually … all of that takes a lot of time up front. I think the time commitment for that part was a bit of a surprise. Not necessarily more time consuming than traveling somewhere far, but still time consuming.” –Nikkol Kramer Anderson, Clinical Coordinator, Institute for Human Development, NAU
- Ask the support person (or consumer when appropriate) to download trials of any apps under consideration. Work with them to program these appropriately for what you know about the consumer you are working with and/or the activities you are preparing to use for the assessment.
- Test-drive the remote conferencing software you intend to use with the remote location prior to the assessment (such as during intake).
“It’s all about building relationships with families and coaching them through the process. Reading their responses and determining how much they are ready to take on. Also, pre-coaching or front-loading information for them so they understand why we do what we do. Input from families has been overwhelmingly positive and they indicate they feel empowered by being more involved in their child’s evaluation. They know what to do once they receive their device.” –Staci McCauley, AAC Specialist, Institute for Human Development, NAU
Use a HIPAA-Compliant Platform for Providing Remote Services
- SLPs must use a HIPAA-compliant platform.
- HIPAA-compliant remote conferencing platforms include Microsoft Teams, Google Meet, FaceTime and Zoom (if you have a Zoom business account).
Use Zoom Whenever Possible
- The biggest advantage to Zoom is the consumer does not need a Zoom account to conference with you. Google and Microsoft require accounts and FaceTime is Apple-only and more limited in function. Setting up software accounts is a significant additional hurdle to providing remote services with consumers. Zoom, on the other hand, allows the host to send an invitation via email with instructions and participants are more quickly up and running.
- Zoom also allows for the use of more than one webcam at the remote location, so the SLP can see the consumer from different angles (if the equipment is available).
- Zoom has an Annotation feature that allows SLPs to see where a remote user has touched a shared screen. This is not available on other remote conferencing platforms.
- Ideally, consumers trial devices and/or software on equipment that is separate from the device used for remote conferencing. This means specialized AAC equipment is shipped prior to the assessment for trial and/or there is a laptop, tablet computer, or smartphone (appropriate with some consumers) available at the remote location for use with AAC apps.
- Ideally, a second webcam is also available, mounted behind the consumer, so the SLP can observe the consumer and support person working with devices and software (via a second Zoom video window). A mounted smartphone (Android or Apple) can be used as a second webcam (old or new).
- Broadband WiFi must be available and adequate (test drive the remote location!) Recommended speeds are: 150 kbps for screen sharing with a video thumbnail, 600 kbps for video calling, and 1.5mbps for video calling with multiple people (or more than one webcam). Easterseals MA is considering bundling WiFi hotspots into remote AAC equipment kits for use with remote consumers in geographically and digitally isolated locations.
Learn Zoom’s Annotating Feature
- Using Annotation with a shared screen allows an SLP to see on-screen selections made at a remote location. This is especially helpful for situations where a remote location has only one computer or tablet available for a remote assessment and apps are under consideration.
- Ideally, Annotation is used with a consumer on a touch-screen device. The SLP can screenshare a window displaying an AAC app and when the consumer or support person touches the screen, Zoom leaves a “sticker” (heart, star, or another icon). The SLP can then mimic that selection directly on the app to trigger the app’s response.
- Without a touchscreen device, a support person at the remote location can shadow a consumer’s touch using a mouse and place Zoom stamps for the SLP to follow.
Remote Assessment Lessons Learned
- Remote AAC assessments are often taxing and dependent on support people, some of whom are juggling working from home with homeschooling or supporting multiple people at a group home.
- However, children often attend better to activities used for remote AAC assessments conducted by parents than a stranger, hugely beneficial for AAC sessions. At home, siblings, too, may be available to help with an activity. These are advantages over assessments conducted at a student’s school or an outpatient clinical setting.
“When it comes to remote evaluations and remote sessions, I want to make sure that support staff and parents feel truly appreciated. They are essential. The parent gives us all the information; they play with the child while we watch behind the screen. We wouldn’t be able to do our job without them.” – Alyssa Savery, AAC Specialist, Easterseals MA
- Intensive teaming with support people often has a profoundly positive effect on the end-user’s AAC learning and device adoption. Support people become more familiar with the AAC technology by helping to program it and by modeling its use. This has led to better onsite knowledge of the equipment and a greater capacity for troubleshooting as well as investment in its use.
“I’ve seen, overall, a lot more independence. Families are more involved and because they are having to do programming that I would ordinarily be inclined to just do, that is building their independence and their mastery.” – Casey McCarthy, AAC Specialist, Easterseals MA
- Separating intake from the assessment is proving dramatically beneficial, allowing for better pacing and preparation for any assessment (activities to prepare in addition to equipment). It also means less screen time all at once and greater stamina for the assessment.
“We began by providing remote intakes for AAC assessments as a stop-gap measure to address a backlog of referrals during the pandemic. Now we’ll never go back. There’s an advantage to breaking it up and going into a household with more information.” –Jill Pleasant, Associate Director, Institute for Human Development, NAU
- Remote AAC assessments allow for matching the consumer with the AAC Specialist most appropriate to their needs, personalities, and circumstances. Regional considerations are no longer important because time is no longer lost to transportation.
“[Remote assessments] during the pandemic are making us re-evaluate ourselves in ways that will make a big difference for our consumers of all ages. It’s also made us really thoughtful about how we provide in-person services, particularly with students. Because now [with remote assessments] we are witnessing these huge gains, even with some families we’ve known for years. There’s so much more empowerment with the technology. So, we need to figure this out and we know it.” –Kristi Peak-Oliveira, AAC Program Manager, Easterseals MA.