AAC Program for Children with Complex Communication

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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