AAC Program for Children with Complex Communication

AACcelerating Telehealth Potential: Transformation of a High-Frequency AAC Program for Children with Complex Communication Needs to a Virtual Platform in Response to the COVID-19 Crisis By Mara Jonet , Annabeth Knight

augmentative and alternatvie communication

AACcelerating Telehealth Potential: Transformation of a High-Frequency AAC Program for Children with Complex Communication Needs to a Virtual Platform in Response to the COVID-19 Crisis

Telehealth in the fields of speech language pathology (SLP) and occupational therapy (OT) have been documented to yield equivalent clinical outcomes across practice settings and popula- tions (AOTA, 2018; Baker & Jacobs, 2012; Reifenberg, et. al., 2017). Over the past ten years, telepractice has evolved with technolo- gy advances, and has gained more traction as growing evidence demonstrates that it is a viable, effective service delivery model for SLP and OT services (Hinton, Sheffield, Sanders, & Sofronoff, 2017; Levy et al., 2018). The COVID-19 pandemic resulted in an ac- celerated conversion to telehealth nationwide across therapy dis- ciplines and settings. Providers have worked throughout this time

to adjust their delivery models to follow local, state, and federal agency safety recommendations, while still providing necessary therapy services with best practice in mind. In March 2020, our interdisciplinary team worked to transform the structure of our high-frequency augmentative alternative communication (AAC) program, AACcelerate, as part of our company’s global shift to telehealth. Throughout this process, we encountered many barri- ers to implementation, but were also able to identify new oppor- tunities as a result of this program detour. This unexpected chal- lenge to service provision has resulted in many exciting program evolutions and the addition of permanent program components.

MARA JONET, MA, CCC-SLP, is a speech language pathologist at CI Pediatric Therapy Centers in Madison, WI. She received her Master’s degree from the University of Massachusetts- Amherst. Her clinical interests include children with complex communication needs, including those who use augmentative and alternative communication (AAC), and pediatric feeding. Mara collaborated to develop the AACcelerate high-frequency AAC evaluation and inter- vention program in 2017. She is passionate about using family and child centered care and working collaboratively with an interdisciplinary team. Mara has experience in multiple settings including inpatient and outpatient pediatric settings, and schools. She is trained in the Get Permission Approach to Sensory Mealtime Challenges and Pragmatic Organization Dynamic Display (PODD). She has presented at national and international conferences on the topic of customized alternative augmentative communication, program development, and therapist training programs. ANNABETH KNIGHT, OTD, OTR/L, is an occupational therapist at CI Pediatric Therapy Centers and the Director of Programming. She earned a Master’s degree in Occupational Therapy from the University of Scranton, and her clinical doctorate in Occupational Therapy from Mount Mary University. Annabeth’s role at CI Pediatric Therapy Centers includes program development, continuous quality improvement, and data analysis of clinical outcomes and parent satisfaction. She developed the AACcelerate high-frequency AAC evaluation and intervention program in 2017. Annabeth has had training in customized wheelchair seating, neurodevelopmental treatment, Cortical Visual Impairment, Every Move Counts, PODD, and sensory-behavioral approaches to therapy. She has presented at state, national, and international conferences about OT’s role in creating customized alternative augmentative communica- tion systems, program development, therapist training programs, the importance of family-centered transdisciplinary therapy.

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The AACcelerate Program at CI Pediatric Therapy Centers in Madison, Wisconsin is a high-frequency speech language and occupational therapy program designed to provide extensive evaluation, featuring matching, and AAC immersion to clients with complex communication and access needs

TELEHEALTH & TELE-AAC As telehealth has grown in popularity and utilization in the fields of SLP and OT, there is growing evidence about both its ef- ficacy and barriers to implementation across settings. The Amer- ican Speech and Hearing Association (ASHA) and the American Occupational Therapy Association (AOTA), which govern prac- tice for SLP and OT practitioners, state that practitioners can use the telehealth platform to provide evaluation, consultation, and intervention within their scope of practice, (AOTA, 2018; ASHA, 2020). Research across both professions has demonstrated that as long as telehealth services are performed with clinical reasoning and consideration of ethics similar to those used in in-person care, treatment is just as effective over the telehealth platform, (Baker & Jacobs, 2012; Hwang et al., 2016; Worboys et al., 2017). Research also indicates that unique benefits of the telehealth model include improved access to healthcare spe- cialists and specialty programs, and increased interprofessional collaboration and information sharing through remote consul- tation and training, (Cason, 2012). The utilization of telehealth has also resulted in improved access to care, removing many geographic, socioeconomic, and medical fragility barriers by al- lowing intervention to happen in the client’s own home, (Gard- ner, Bundy, & Dew, 2016; Hinton, Sheffield, Sanders, & Sofronoff, 2017; Levy et al., 2018). In the area of AAC intervention for SLPs, telehealth began with pioneers in the field introducing tele-AAC and establishing its efficacy. Tele-AAC allowed services to be ex- panded to individuals located in more rural areas. For OT practi- tioners, teleconsultation was frequently used in the early years of its implementation in the area of assistive technology (AT), and continues to be a frequent use of this platform today for AT

evaluation and adjustment in areas such as prosthetics, seating and positioning, and home safety and accessibility, (Schein, et al., 2008; Whelan & Wagner, 2011). In order to provide high-quality AAC and AT services over the telehealth platform, the therapist must develop competence in the specialized areas of AAC and AT, as well as telehealth. In the areas of AAC and AT, this includes the knowledge of and ability to use and troubleshoot a variety of low- to high-tech devices and equipment. When therapy is occurring on a virtual plat- form, additional planning is required to train treating therapists and establish confidence with the use of the AT equipment, the telehealth platform, and the interfacing of these two technolo- gies. During synchronous (real time) services, it is necessary to make accommodations for the clinicians to see both the child and device/equipment on the telehealth platform. Practitioners may have intervention activities shared on the screen from their computer, but need to demonstrate quick troubleshooting of technology interfacing in order to navigate switching between screen shares, or multi-tasking by sharing both the virtual activ- ity and modeled communication system through a split screen function. In addition, tele-AAC typically requires an e-helper, in order to best support an individual with complex communi- cation needs. This caregiver assists with interventions such as equipment setup, ensuring access to technology, and facilitat- ing continuous adjustment of the equipment and modeling lan- guage through coaching from the therapist. When considering therapeutic intervention in the area of AAC and AT over the telehealth platform, the therapist training needs are magnified. To provide best practice in these niche areas you must consider the importance of therapist training, observation,

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and mentorship opportunities to build competency. In order to provide effective AAC and AT evaluation and intervention, and services via telehealth, practitioners require more specialized knowledge, training, and skill sets to develop competency in these specialized areas. Prior to COVID-19, our company had de- veloped training programs for each of these specialized areas of practice. In 2018, the authors of this paper completed an internal research project (presented at the Closing the Gap Conference), which identified that skill set and competency in AAC and AT intervention was one of the biggest barriers to provision of high quality of services by generalist practitioners. We then began to develop an AAC and AT therapist training program to improve these competencies and prepare generalists for evaluation and treatment in our specialty program. Similarly, a training series for telehealth including training modules for the Zoom platform and a tiered mentorship program, was created for internal use at our facility for practitioners using telehealth as a service delivery model. COVID-19 PANDEMIC: OUR INITIAL RESPONSE In response to the COVID-19 pandemic, our outpatient pe- diatric clinic converted services across eight clinic locations to the telehealth platform over a period of two weeks. This detour involved quick formulation and implementation of action plans to convert all traditional 1:1 services in the disciplines of SLP, OT, physical therapy (PT), and recreation therapy while maintaining high-quality care. Additionally, we collaborated to establish al- ternative service provision options for clients currently partici- pating in aquatics, group therapy, and intensive and/or high-fre- quency models of therapy. This included the transformation of our high-frequency speech language and occupational therapy AAC program, AACcelerate to the virtual platform. AACcelerate was initially developed in 2017 by an SLP and OT team in response to the growing need for high-frequency AAC services in order to best serve clients with complex communica- tion needs in our community. This evidence-based, 4-week pro- gram involves extended evaluation and intervention by a team of SLPs and OTs, using their combined knowledge and skills to ensure holistic intervention for AAC users. In the traditional clin- ic setting, the program runs 4 days a week, for 3 hours a day to provide individuals with complex communication needs a ro- bust AAC system, or to provide language immersion and prac- tice with complex access needs. At the onset of the COVID-19 pandemic, we initially project- ed that in-clinic services in the AACcelerate program would be put on hold through at least August 2020. Since we already had fully registered participants for the program through August 2020, we conducted a re-assessment of program needs and created an action plan to provide quality, evidence-based ser- vices on the telehealth platform while preserving the integrity of the original program. This initial analysis indicated that tele- AAC intervention in the AACcelerate program could meet our

client needs, and potentially allow for greater home carryover. Registered families were contacted immediately to gauge their interest in pursuing the program over the telehealth platform. They were provided with both evidence regarding the efficacy of tele-AAC, and our plans for how this would be reflected in the AACcelerate program. We thoroughly considered the partic- ular clients registered for the program in the months of June, July, and August when making this program-wide decision, and did develop criteria for program appropriateness on the tele- health platform based on the decision making guides provid- ed by AOTA and ASHA (AOTA, 2018; ASHA 2020). This program assessment included a SWOT (strengths, weaknesses, opportu- nities, and threats) analysis of three potential program plans: a full transition of the program to telehealth, placing the program on hold until in-clinic services resume, and creating a hybrid ap- proach of both in-clinic and telehealth services. At the time of our SWOT analysis, there was still uncertainty about the necessity or timeline of this transition, as new guide- lines and ordinances regarding COVID-19 from local, state, and national agencies were updated regularly. Therefore, we created potential action plans for each of these options. Our detailed contingency plans for in-person and hybrid programs will en- able us to quickly transition across settings, even mid-program. The plan for in clinic services included continuing the schedule as originally planned, with frequency and duration of services provided in the same way as they were pre-COVID-19. We creat- ed detailed plans for cleaning and sanitization of physical clinic space, materials, and equipment, as well as access to personal protective equipment. We also created guidelines for low-con- tact pick-up/drop-off, with caregiver ability to attend sessions via the telehealth platform. Additionally, we plan to continue to reference and utilize these documents, along with decision mak- ing tools provided by AOTA and ASHA, as we recognize the pos- sibility of needing to quickly adjust between the telehealth and in-clinic models given the evolving circumstances COVID-19. At the time of this authorship, we are planning to move forward with AACcelerate on the telehealth platform through the sum- mer of 2020. Many of the registered clients are medically fragile, and tele-AAC is the safest method of participation. ENCOUNTERING TELEHEALTH IMPLEMENTATION BARRIERS Throughout this tele-AAC program development process we encountered several potential barriers to implementation that we thoroughly addressed in order to offer a telehealth program to our clients and families that had similar clinical efficacy to the in-person program. Primary barriers to implementation of high-frequency tele-AAC consisted of addressing the clinical appropriateness of program dosage on the telehealth platform, AAC equipment availability, caregiver competency with both AAC and the telehealth platform, and therapist competency in telehealth. In response to each of these barriers we established

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new processes and structures to support client, caregiver, and practitioner needs, leaving room for further adjustment as the development of the pandemic could cause a swift transition to or from the telehealth platform for service provision. SCHEDULING The first barrier we addressed while planning this program transition was scheduling, including adjustment of frequency and duration of the program. We determined that three hours of screen time-based therapy consecutively each day for 4 days was too much, and that therapeutic value and efficacy for most cli- ents would begin to decrease after 2 hours of consecutive treat- ment. At the time of initial planning, this was based on a small set of data we collected from AAC users who were beginning to successfully receive and tolerate two hours of consecutive tele-AAC services during the early stages of our company-wide transition to telehealth. We utilized this to create a new baseline schedule of services in the AACcelerate program, while keeping a similar total frequency and duration for continuity and clinical efficacy. The new schedule was adjusted to provide 1 hour of OT and 1 hour of SLP services daily, 5 days per week, for a total of 5 weeks. This adjustment provided 50 total hours of therapy throughout the program, in comparison to the 48 total provided in the original model. Families who were unable to commit to the additional week of time for high-frequency therapy services, were given the option to complete only 4 weeks of the program. With this schedule change came the need to adjust therapist’s treatment schedules as well, which included decreasing the AACcelerate team size to only 2 OTs and 2 SLPs. We also ensured an administrator of each discipline on the treatment team, since they have more flexibility built into their schedules, and could potentially accommodate the changing schedule needs of the family or the program. This was especially crucial to consider due to the dynamic changes and unknown timelines resulting from developing “stay at home” orders, which had the potential to impact both the caregiver’s work schedule and our clinic’s transitions to and from telehealth and in-person therapy with- out much warning throughout the summer based on “safer at home” orders and insurance guidelines. EQUIPMENT: ACCESS AND INTERFACING TECHNOLOGY The second barrier we responded to was the multifaceted challenge regarding caregiver’s access to and proficiency in both the telehealth platform and AAC equipment to be trialed and utilized with their child throughout the program. We used the Zoom for Healthcare telehealth platform, which is HIPAA compliant and accessible to users on a variety of technology in- cluding both tablets and computers by simply downloading the application. At the initiation of the transition to telehealth ser- vices, our company provided families with access to loaner iPad devices to access telehealth services if they did not have one. This applied to families completing the AACcelerate program as

well. After chart reviews of our incoming clients, we realized that the preparatory phase of the program would involve more at- tention to technology access over the telehealth platform. The team would need to work closely with the family to determine the AAC equipment that the participant may need to access throughout the program. Typically, we would have access to ma- terials and equipment to trial in the clinic. In order to overcome this barrier, we created a robust planning document which in- cluded inventory of available equipment in-clinic, anticipated needs of new equipment for the overall program, and project- ed equipment required to trial with the client during the pro- gram. This document also included instructions and tutorials of each piece of equipment (e.g., switch interfaces, overviews of switches, etc.) which could be used by both treating therapists and caregivers when they are introduced to equipment. We also created an equipment loan contract, as we anticipate loaning equipment out to our clients. These are now documents that we have readily available for our practitioners to use, which will al- low for therapist training and use with families as needed. After reviewing patient history, consulting with the family about current physical status, developing general goal areas, and comparing these to our equipment inventory, we then worked to create a box of AAC equipment and tools to be delivered to them before the start of the program. When feasible we also provided treating therapists with matched similar equipment in order to allow for modeling, demonstration of setup and use, and troubleshooting over the telehealth platform. Throughout the months leading up to our first summer AACcelerate client on the telehealth platform, we have been able to trial this remote intervention system within 1:1 SLP and OT sessions focused on AAC and AT. This practice has allowed us to troubleshoot pro- cesses such as interfacing high-tech equipment over the Zoom platform (e.g., utilizing a switch interface system on the client end of a telehealth session to access a switch adapted comput- er game that the therapist shared on their screen). Though we realized the unique equipment utilized by each client had the potential to pose a number of unique technological challeng- es throughout the program, these months were instrumental in building a baseline of tele-AAC intervention skills among treat- ing therapists.

HIPAA COMPLIANCE: PROGRAM COMPONENT ADJUSTMENTS

A handful of program components required adjustments to remain HIPAA compliant over the telehealth platform. Since a video home exercise program is a critical component of the AACcelerate program, we needed to take additional measures to ensure HIPAA compliance related to capturing a video record- ing over the Zoom platform. We created a video recording con- sent form in response to this, which was added as an addendum to the program intake forms. Additionally, the physical home

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SILVER LININGS AND NEW DISCOVERIES Through the process of tele-AAC program planning and im- plementation, we discovered many unanticipated opportunities and quality improvement measures for our AAC program. The necessity to relook at all of our existing program processes, ma- terials, and services to meet the needs of our clients and families over the telehealth platform, resulted in overall quality improve- ment.v

TELECONSULTATIONS AND SYNCHRONOUS FOLLOW-UP

We initiated the use of a teleconsultation with the family and caregivers of participating AACcelerate clients two weeks prior to the beginning of the program in order to check in about the families’ current status. This includes the location of the thera- peutic services, and the current level of comfort with videocon- ferencing and AAC technology. We also used this consultation to check in about goal areas of interest in conjunction with the AACcelerate intake paperwork. During this, we discussed expec- tations for family involvement, as a high level of involvement of family support is indicative of success outcomes. Additionally, the opportunity to see the client communicating by video prior to their initial evaluation allows for more guided clinical deci- sion making related to equipment and treatment planning. We will be continuing to utilize teleconsultation after the return to in-person services. We also plan to utilize the telehealth plat- form to ensure increased continuity of care post-program, es- pecially for those clients and families who live in more remote geographic areas. CONTINUITY OF CARE Initiation of the use of the telehealth platform in the AACcel- erate program has already had a positive impact on continuity of care before, during, and after program participation. Virtual consultations have improved not only the processes of screen- ing for program fit and equipment planning as described above, but have also allowed for ease and efficiency of access to con- sultations for both new and existing CI clients. Prior to the use of this platform, new families completed a quick phone consul- tation and then scheduled a free consultation in the clinic. This sometimes took weeks to schedule, and the consultation was frequently with an intake coordinator only, as the AACcelerate program directors’ schedules did not always allow for them to be present in the clinics where the consultations took place. The use of telehealth has allowed the program directors to almost always be at least virtually present in a consultation. The capa- bilities of telehealth have also helped to increase the number of appropriate program referrals from CI therapists who are seeing clients for 1:1 SLP or OT services. The program directors are now able to easily complete virtual consultations with both thera- pists and caregivers during a scheduled telehealth treatment session. Previously, this was challenging due to scheduling and

program will be saved on a flash drive as a .pdf file along with embedded videos, and mailed to families upon program com- pletion. We emphasize celebration of both small victories and long term achievements in the AACcelerate program, so both clients and therapists look forward to the program completion party on the last day of AACcelerate. To maintain this important part of our program on the telehealth platform we made plans to celebrate virtually, sending favorite treats and decorations to our clients and giving them the option to invite other family and friends to celebrate their achievements virtually. TRAINING: THERAPIST AND CAREGIVER COMPETENCY In order to ensure the clinical success of the virtual AACcel- erate program we needed to ensure that both caregivers and treating clinicians knew how to utilize the telehealth platform. All therapists at our company were provided with training on the utilization of the platform when we began our broader tran- sition to telehealth services. Throughout the months leading up to summer, those treating in the program were also provided with additional specialized training in tele-AAC. Caregivers were also provided with video tutorials about the use of the Zoom telehealth platform, and the first telehealth session was spent learning how to utilize features such as screen share, annotate, and microphone and video functions as appropriate. Addition- ally, in order to ensure baseline caregiver competencies regard- ing AAC equipment to be utilized in the program, we included written instructions and access to how-to equipment videos pri- or to the start of the program. Assistive technology equipment boxes being packed for delivery prior to the beginning of AACcelerate to allow for virtual at home trials during the program.

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Clients who use switch access can remotely engage in switch adapted computer games on platforms such as HelpKidzLearn Games & Activities, while the therapist shares their screen and initiates remote mouse control for the user to play using a switch interface tool.

ADDITION OF ASYNCHRONOUS CONTENT Prior to the conversion of our AACcelerate program to the telehealth platform, each participant would receive a home pro- gram and communication roadmap which included general AAC implementation tips and strategies for caregivers and commu- nication partners. All home programs were supplemented with video content specific to these strategies and recommended equipment. Over the course of the program’s first year running, we have developed a sizable library of asynchronous content that can be used by therapists for training and as additions to a client’s home program. As we prepared for telehealth, we were forced to more quickly create equipment specific videos about setup, use, and troubleshooting for all AAC and AT equipment utilized in the program to provide to families along with their equipment kits. This expansion of resources has helped to speed the growth of our AAC and AT therapist training program as well. We are continuing to explore options for a virtual platform to house all of our asynchronous content that is both accessible and HIPAA compliant. CI CONNECT: AACTIVITY HOUR In the first few months of transition to the telehealth platform for all services at our clinic, our specialty, high-frequency pro- grams were put temporarily on hold while we developed plans for service provision. During that interim period when we were not registering new clients for AACcelerate, we began to create innovative and alternative methods of serving this population. This included free and low cost AAC outreach programs and classes, on our company’s new classroom platform, CI Connect.

feasibility of clinic-to-clinic travel time. During the program, the telehealth platform will allow for ease of observation opportuni- ties and for collaboration with outside school, community, and hospital providers. The platform will also allow us to overcome two of the largest barriers we have faced regarding AAC client recruitment and participation: geography and illness/medical fragility. Clients from any geographic area within the state will no longer have to physically travel to our clinic in order to re- ceive services in the AACcelerate program. Additionally, since the population we serve in the program has highly complex medical profiles and increased medical fragility, we project that we will see a decreased number of cancellations due to illness. Telehealth also allows for ease of follow-up, and our continued collaboration with family and outside providers following pro- gram participation. PARENT AAC COMPETENCY AND HOME CARRYOVER Both inside and outside of the AACcelerate program, a silver lining of AAC intervention via telehealth is that caregivers and family are more involved in direct treatment. Practitioners are able to provide strategies and implementation tips in real time and provide critique and feed- back to meet the needs of the family where they are. The necessary detour to tele-AAC provided us with the opportunity to provide more frequent and meaningful parent training, to troubleshoot challenges with equipment in real time, and to see improved generalization of skills in the home environment. We have also seen improved parent confidence with AAC equipment and modeling, and plan to survey participating AACcelerate families on their perceived AAC competen- cies after full program completion this summer.

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AACtivity Story Time brings symbol and sign language infused stories to life for AAC users of all ages and abilities. This class, along with AAC Accessible Yoga and AACtivity WOW! (Word of the Week) are open to the public. Check out www.ciconnectclasses.com for more information and updated class schedules!

We developed three weekly classes for AAC users. Curriculum was designed and facilitated by both SLP and OT practitioners who treat in the AACcelerate program. Our AACtivity Hour class- es include a core word of the week class, an AAC story time, and AAC infused adapted yoga. CI Connect classes will continue to be prevalent as part of the services at our facility. The classes will allow us to supplement the therapy services provided in AAC- celerate, to provide short respite opportunities to families, and to increase our geographic reach as all classes are open to the public. THERAPIST TRAINING OPPORTUNITIES Adoption of the telehealth platform for both traditional and high-frequency AAC has already vastly improved the interdisci- plinary training opportunities for the generalists practitioners in our company. The ease of access to both online training materi- als and opportunities for remote observation in the AACcelerate program has the potential to result in a larger pool of service providers across our company who demonstrate the competen- cies required for treatment in this specialized program. This has positive implications for program PTO coverage and the expan- sion of the program to a larger variety of clinic locations. Anoth- er silver lining of tele-AAC during the COVID-19 pandemic is the increasing frequency of AAC co-treatment sessions provided by

SLP and OT pairs via telepractice, and the opportunity to pair novice AAC practitioners with a seasoned therapist regardless of physical clinic location. This natural interdisciplinary mentorship opportunity will improve the quality of our AAC services both in and out of the AACcelerate program.

FUTURE DIRECTIONS: LASTING PROGRAM DEVELOPMENT IMPACT

The unexpected challenges created by the COVID-19 crisis have resulted in many exciting long-term program evolutions and potentially permanent program component additions. Throughout the summer months, we will be continuing with our typical data collection for the AACcelerate program, which includes utilization of goal attainment scaling to determine clin- ical program success, parent satisfaction feedback surveys, and treating therapist feedback surveys and interviews. This data will be utilized to determine the pros and cons of the AACcel- erate program on the telehealth platform, and will contribute to continuous quality improvement measures implemented in the future. As we look towards the growth and movement of the program throughout the fall and beyond, we are excited to have the opportunity to integrate telehealth components we have developed as a result of this crisis to supplement and improve upon the AACcelerate program as it is offered in the clinic set-

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REFERENCES Anderson K, Boisvert MK, Doneski-Nichol J, Gutmann ML, Hall NC, Morelock C, Steele R, Cohn ER. (2012). Tele-AAC resolution. International Journal of Telerehabilitation. 4:79–82. American Occupational Therapy Association. (2016). Assistive technology and occupational performance . American Journal of Occupational Therapy, 70. American Occupational Therapy Association. (2010). Special- ized knowledge and skills in technology and environmental inter- ventions for occupational therapy practice . American Journal of Occupational Therapy, 64. American Occupational Therapy Association. (2018). Tele- health in occupational therapy . American Journal of Occupation- al Therapy, 72(Suppl. 2), 7212410059. American Speech-Language-Hearing Association. (2005). Speech-Language Pathologists Providing Clinical Services via Telepractice: Position Statement. American Speech-Language-Hearing Association. (2020) Telehealth. Available from https://www.asha.org/PRPSpecificTo- pic.aspx?folderid=8589934956&section=Overview Beukelman DR, Mirenda P. (2012). Augmentative & Alternative Communication: Supporting children and adults with complex com- munication needs. Baltimore: Paul H. Brookes Publishing Company. Cason, J. (2012). Telehealth opportunities in occupational ther- apy through the Affordable Care Act. American Journal of Occu- pational Therapy, 66, 131–136. Cormack, C. L., Garber, K., Cristaldi, K., Edlund, B., Dodds, C., & McElligott, L. (2016). Implementing school based telehealth for children with medical complexity. Journal of Pediatric Rehabilita- tion Medicine, 9, 237–240. Costigan, F.A., & Light, J. (2010). Effect of seated position on up- per-extremity access to augmentative communication for children with cerebral palsy: preliminary investigation. American Journal of Occupational Therapy, 62, 596-604.

ting. We also envision the potential for the program to run with a hybrid service delivery model, with both in-person high-fre- quency treatment and tele-AAC. This will include increased use of asynchronous content in the program including video models of specific strategies and interventions, creation of even more robust home programs, and a platform for access to parent education videos on equipment use and troubleshooting. We also project using the telehealth platform to provide synchro- nous follow-up appointments to all families who participate in the program, whether in the home or remote clinic settings, to improve home carryover and care coordination with other pro- viders on the AAC user’s interdisciplinary team. For more information on the AACcelerate program or other therapy services offered at CI Pediatric Therapy Centers, visit our website at www.citherapies.com. We offer free phone, tele- health, and in-person consultations. If you would like to try out one of our free or low-cost AAC classes on CI Connect, visit www. ciconnectclasses.com.You can also follow us on Facebook, Insta- gram, and YouTube for updated information about our special programs and classes.

PRODUCT INFORMATION:

Zoom for Healthcare Zoom for Healthcare is a telehealth platform designed spe- cifically for healthcare providers, which provides consistent, high-quality video and audio, HIPPA/PIPEDA compliance, AES encryption, and medical device and EMR integrations. Plans be- gin at $200.00 per month per account. https://zoom.us/docs/ doc/Zoom%20for%20Healthcare.pdf HelpKidzLearn Games & Activities HelpKidzLearn Games & Activities is an accessible online computer gaming platform that can be utilized with alternative access methods including switches, touch screen, joy stick, and eye gaze. It is appropriate for use with a variety of learners with diverse developmental and access needs. A subscription for a clinical site costs $265.00 per year, with options for single user accounts beginning at $10.99 per month. https://www.helpkid- zlearn.com/shop/online-software/games-and-activities CI Connect Classes CI Connect is an online learning platform developed by CI Pe- diatric Therapy Centers, which provides classes and clubs run by occupational, physical, speech language, and recreation thera- pists for children and young adults of all ages and abilities. Class- es, which are open to the public, cost $5.00 each. All classes are free on Fridays! You can sign up at www.ciconnectclasses.com.

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Orentlicher, M., Handley, M., Ehrenberg, R., Frenkel, M., & Markowitz, L. (2014). Interprofessional collaboration in schools: a review of current evidence. AOTA Early Intervention & School Spe- cial Interest Section Quarterly, 21(2), 1-3. Reifenberg, G., Gabrosek, G., Tanner, K., Harpster, K., Proffitt, R., & Persch, A. (2017). Feasibility of pediatric game-based neurore- habilitation using telehealth technologies: A case report. American Journal of Occupational Therapy, 71, 7103190040. Schoonover, J.W. (2014). Interdisciplinary collaboration with assistive technology in schools. AOTA Technology Special Interest Section Quarterly, 24(7), 1-3. Skuller, J. (2017). Interprofessional education in an assistive technology program for children with special needs. OT Practice, 22(14), 12–16. Sutherland, R., Trembath, D., & Roberts, J. (2018). Telehealth and autism: A systematic search and review of the literature. Inter- national Journal of Speech-Language Pathology, 20(3), 324–336.

Topia, M., & Hocking, C. (2012). Enabling development and par- ticipation through early provision of augmentative and alternative

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