AAC Program for Children with Complex Communication

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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