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Remote working during COVID-19; Tips and strategies for AAC professionals

20/03/2020

At this time of unprecedented uncertainty and change, we are all trying to keep supporting the individuals who require alternative and augmentative communication methods. Here at the Ace Centre, we are keeping face-to-face contact as minimal as possible and getting inventive about how to work at least 2 metres away from our clients. Providing some form of communication to people is paramount – more than ever, people need to be able to express feelings, communicate their needs and ask questions. 

Ace Centre has had a long history of looking at ways to support teams and individuals remotely. Back in 2001, we were part of the Telenet Project and found that a lot of the work is challenging and carrying out full assessments remotely is nigh on impossible to do. This was often due to the technology being too slow and cumbersome to set up particularly when involving multiple people (Things were only slightly improved in 2013 when a number of AAC services were involved in “Objective 7: Remote delivery of AAC Services” (in The future of AAC services in England document funded by the DfE)). 

Problems occur when we aren’t face-to-face, and we are trying to understand an individual with communication difficulties and observe the subtleties and nuances of their verbal and non-verbal communication. An assessment is often only possible by having a skilled human in the room with the individual to carefully lookout and, at the correct time, react to the individual and their surroundings.

Nineteen years later and things have moved on, the technical set-up for remote sessions with clients is much improved, people generally have better wi-fi at home and often there’s someone in the family who can be called upon to be the ‘techy one’. But, carrying out a full and robust AAC assessment over a remote connection is still unrealistic.

So, how can we support people remotely? There are several aspects of our work we have been assisting individuals and professionals with recently, and we’ve been drawing on both ‘live link-ups‘ and ‘capture, store and forward‘ techniques (more on these below). Our primary focus is making sure all clients (especially new ones who haven’t already had a face-to-face assessment) have correct information about paper-based resources. We have run video calls to work out the best paper-based board/chart for people to use, posted the resources out and then supported them remotely. This support is directed at helping the person and their communication partners to get going – we’re pointing people to our resources, e.g. Getting Started with AAC – Book 1 and some of the videos of our yet to be released book for adults

Although it’s still early, and we’re certainly still finding our feet, we know a lot of professionals are struggling with similar issues so we thought it might be useful to share some tips:

Live link-ups

  • Ask your IT team locally to help choose solutions that you should consider. There may be privacy and Information Governance aspects which may force you to look at several solutions. If you have more flexibility, there is a nice chart detailing features between solutions here
  • Most of these companies are providing trial periods for their software which you can use (and many have extended these periods during COVID-19) some are not limited to a trial (e.g Skype, Teams, Facetime). Just be aware though of aspects like call length time (e.g. in the trial period Zoom provides a maximum of 45 minutes) or the number of people you can have on a call. Be aware that many of these services are under high demand at the moment, and some are capping the amount they can be used to help the whole network. (Microsoft have shared for example that Teams and Skype have downgraded their call quality to help maintain more calls).
  • In choosing an online teleconference solution consider what technology does the client have or what is already available? Is the Internet connection going to be good enough?
  • Consider the person supporting the individual – and who is going to set up the call. Ask questions such as “Do you have Skype already setup? Are you comfortable downloading TeamViewer?“. Try and get a feeling for how confident the person supporting the individual will be about downloading and installing new software.
  • Always consider what will happen if your connection breaks or the quality is not good enough. Always remember the good old telephone! If you need to create a teleconference using the phone, you may have a solution if your organisation uses a VOIP system – or they may have a subscription to a service such as powwownow. Ask around!
  • Consider creating a quick presentation to explain key concepts. Sharing a screen can be more reliable than a video stream – and if all else fails, you can send the presentation over email and talk them through the slides. Can’t send a presentation? Send a PDF. (If you have an Apple device consider Apple’s app Keynote and use the ‘Keynote live’ feature)

Capture, store and forward

As well as ‘live link-ups‘ the other way to work remotely is to use ‘capture, store and forward‘ methods. These could be audio or video recordings, documents and handouts that you make and then pass on. They’re not happening ‘live’ so you can’t be as responsive but they’re great for when you want to be able to review the information and when connection speeds/technology links make live sessions tricky. For example, a client’s family member can take a short video and send it for you to review and then you can put together a list of online support videos for them to watch, post out resources for them to try and perhaps check in later via a live link-up to see how they’re getting on. Some tips:

  • As with live link-ups, the same Information Governance factors apply. Be careful of putting any identifying info in your videos, use fake names!
  • Don’t re-invent the wheel! Lots of the AAC suppliers and websites such as https://praacticalaac.org/ and https://www.aacscotland.org.uk/Home/ already have great how-to videos and help sheets that you can share with clients. (And of course, there’s a stash of videos here) Ring round colleagues to find out if someone else has already done a video that demonstrates the thing you’d be doing if you could visit your client. Give us a bell on our free advice line 0800 080 3115
  • There will be times when you need to make a bespoke video, for example, if you can’t get out to see your client you might want to give them and their communication partners hints on how they can carry on learning at home, perhaps a tour of the key bits of their system would do the job (for example see here) You’ll likely have easier access to paper-based resources for this but remember that lots of AAC suppliers offer free ’emulation software’ for professionals so you can open up the vocabs on your laptop – you don’t need an AAC device to be able to make a video about it.

You might also want to suggest to your clients that they make their own videos. This could be so that they can share with you how things are going at home. Or perhaps they’d like to make a video communication passport of how they use their system (for example see here) It may be reassuring to know that any new carers, hospital staff etc. can quickly understand how they communicate.

  • Keep your videos short and sweet! This helps with file sharing and downloading.
  • Start your video by saying what it’s about – it helps your viewer know what they’re about to learn about! What they’re watching for!
  • Find a way to share your recordings and resources. Files are often too big to be shared by email, so Cloud storage e.g. Dropbox can be useful. YouTube also works well as you can make the video ‘private’ or ‘unlisted’ if needs be – you’ll need to set up a YouTube channel, which requires a Gmail account but just set a new one up with a ‘professional’ login name. There are other video hosting services available if YouTube is not an option, e.g., Vimeo and Dailymotion. Find out what systems your clients are already familiar with and see if you can use the same one to make it as simple as possible for them.
  • Follow-up with a telephone call or email to check that everything’s been received ok!

We know that for many clients, their families and their supporting professionals using remote support is going to be uncharted territory. We’ll all have to adapt and find new ways of working. In past studies patients said that they like remote support to be an added extra to the in-person care they receive (Wicklund, online) but that isn’t feasible right now. Clinical guidelines state that remote healthcare needs to be “equivalent in quality and as satisfying for patients” as face-to-face sessions (RCSLT, 2018) – at this challenging time let’s keep doing our best to provide a quality, satisfying, service.

References:

Wicklund, E. (no date) Store and Forward telemedicine services expand Connected Health [Online] [Accessed 19th March 2020] https://mhealthintelligence.com/features/store-and-forward-telemedicine-services-expand-connected-health

RCSLT (2018) Role of Telehealth [Online] [Accessed 19th March 2020] https://www.rcslt.org/members/delivering-quality-services/telehealth/telehealth-guidance#section-5

Authors:

Katherine Small, Will Wade, Michael Ritson