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Part 2: Bridging Distance and Expanding Access for Tele-AAC in Action: Best Practices for Effective Service Delivery

Part 2: Bridging Distance and Expanding Access for Tele-AAC in Action: Best Practices for Effective Service Delivery

Published in the September 2025 issue of the ISHA Voice

By Amy Yacucci, member of the Telepractice Committee, and Jennine Harvey-Northrop, chair of the Telepractice Committee

Part One of this series, Bridging Distance and Expanding Access: Student and Clinician Perspectives on AAC via Telepractice in Illinois, explored what graduate students and practicing clinicians' experiences and training using telepractice for augmentative and alternative communication (AAC). Both groups were excited about the possibilities, especially how telepractice can improve access to services, but they also identified some major hurdles. Many graduate students were eager to learn but didn’t feel prepared; only about a third had any formal training in telepractice, and none felt ready to support AAC specifically online. Practicing SLPs shared helpful strategies and agreed that telepractice can make a real difference, particularly for clients in rural or underserved areas. Still, they faced ongoing challenges like keeping caregivers engaged, dealing with technology problems, and finding enough professional development opportunities. Building on these insights, Part Two focuses on turning those challenges into solutions with evidence-based practices clinicians can use in their own work.

What We Know Works in Tele-AAC

Surveyed SLPs and published research (Bekteshi et al., 2022; Biggs et al., 2022; Hurtig et al., 2024; Muttiah et al., 2025; Orel & Licardo, 2025; Simacek et al., 2021) show that many clinicians have developed strong skills when providing AAC services via telepractice. Some of the most effective areas of expertise include:

Partner Coaching

Tele-AAC appears to be most effective when caregivers move beyond passive observation and engage as active partners in intervention. Clinicians consistently emphasize dedicating session time to instructing parents, guardians, educators, and support staff in embedding aided communication within natural contexts. This process often entails modeling the use of a speech-generating device during shared activities (e.g., book reading), followed by real-time coaching as the caregiver practices the strategy. Evidence indicates that this collaborative approach enhances communication outcomes. Bekteshi et al. (2022) reported that structured caregiver coaching via telepractice shows promise for improving AAC implementation, while Biggs et al. (2022) identified partner coaching as a central feature of tele-AAC rather than focusing solely on the child. Likewise, Hurtig et al. (2024), Muttiah et al. (2025), and Orel and Licardo (2025) underscore the importance of clinicians possessing explicit coaching competencies, such as prompting, modeling, and scaffolding, to support caregivers in applying AAC strategies during daily routines. Developing caregiver self-efficacy is critical for sustaining communication opportunities beyond therapy sessions. Across studies, guiding family members, teachers, and support personnel to model AAC and create communication opportunities during meals, play, and other routines is consistently highlighted as best practice. Coaching may be delivered synchronously through live videoconferencing or asynchronously via video feedback or online modules. Documented benefits include enhanced caregiver confidence, improved generalization of AAC strategies, and expanded access to high-quality services, particularly in rural or resource-limited settings.

Hybrid Session Planning

Families often juggle busy schedules, limited technology, and unpredictable routines, making a flexible service delivery model essential in tele-AAC intervention. Many SLPs report success using a hybrid approach, blending live (synchronous) teletherapy with follow-up supports such as pre-recorded video models, written guides, or short check-in calls (asynchronous support). This model increases accessibility and allows caregivers to practice strategies on their own time (Biggs et al., 2022; Orel & Licardo, 2025). Research underscores that tele-AAC is most effective when clinicians thoughtfully plan which elements of assessment, partner training, or device programming are best addressed remotely and which require in-person support (Cason & Cohn, 2014; Simacek et al., 2021). Hybrid planning is particularly valuable for complex tasks, including initial device setup, troubleshooting technical issues, or providing hands-on demonstrations for caregivers or educators (Hall et al., 2018; Bekteshi et al., 2022). Studies also emphasize that hybrid models support caregiver confidence and fidelity of strategy use by combining real-time coaching with opportunities for independent practice and feedback (Biggs et al., 2022; Orel & Licardo, 2025). Across contexts, this integrated approach helps balance efficiency and clinical quality, expands access in rural or resource-limited areas, and sustains communication opportunities for children and adults who rely on AAC (Hurtig et al., 2024; Muttiah et al., 2025).

Engagement Strategies

Keeping clients motivated through a screen can be challenging, particularly for individuals with complex communication needs. Evidence across recent studies highlights that effective tele-AAC sessions rely on interactive, individualized activities that sustain attention and promote success (Biggs et al., 2022; Simacek et al., 2021). Experienced clinicians recommend incorporating high-interest materials, such as favorite songs, short videos, or interactive online games, and alternating between active tasks (e.g., making a choice or commenting on a speech-generating device) and more passive moments (e.g., watching a video together) to create a dynamic rhythm and reduce fatigue for both clients and caregivers (Biggs et al., 2022). Engagement is strengthened when caregivers, educators, or support staff participate as facilitators, prompting turn-taking, modeling responses, and helping manage materials during tele-sessions (Hall et al., 2018; Simacek et al., 2021). Additional strategies include optimizing telepresence through clear visuals, appropriate camera angles, and good lighting, and blending synchronous coaching with asynchronous supports like pre-recorded demonstrations, text reminders, or picture schedules (Orel & Licardo, 2025; Sutherland et al., 2018). Across contexts, tailoring content to client interests, scaffolding participation, and providing real-time caregiver coaching are consistently linked to improved engagement, carryover of AAC strategies, and satisfaction with services (Bekteshi et al., 2022; Hurtig et al., 2024; Muttiah et al., 2025).

Troubleshooting and Tech Prep

Technology glitches are an inevitable part of telepractice, making proactive troubleshooting and preparation essential for successful tele-AAC sessions. Research highlights the value of pre-session technology checks, testing internet speed, camera placement, audio quality, and AAC device readiness, to reduce interruptions and maximize therapy time (Cason & Cohn, 2014; Hall et al., 2018). Skilled clinicians also orient caregivers to the platform and equipment, offering clear, step-by-step guidance on logging in, adjusting camera angles, and opening apps, which fosters confidence and minimizes on-the-spot problem solving (Simacek et al., 2021; Muttiah et al., 2025). Sharing simple troubleshooting tip sheets or short videos, along with backup communication supports such as printable boards or low-tech symbols, helps families maintain access if technology fails (Hurtig et al., 2024; Orel & Licardo, 2025). Studies emphasize preparing families to manage multiple visual focus points and to keep the tele-session screen as uncluttered as possible, particularly for children with complex communication needs (Biggs et al., 2022; Simacek et al., 2021). When issues arise despite planning, alternative modes, like phone calls or asynchronous video feedback, can keep services moving forward (Sutherland et al., 2018). Overall, intentional technology preparation paired with caregiver training reduces stress, protects communication access, and allows clinicians to keep the focus on engagement and AAC skill-building rather than technical barriers (Bekteshi et al., 2022; Hurtig et al., 2024).

What Colleagues Are Saying

Practicing clinicians consistently emphasized that intentional modeling and partner coaching are central to effective tele-AAC. As one SLP put it, “Modeling, modeling, modeling—caregivers need to see and hear how to use AAC, even through the screen.” This aligns with evidence that active demonstration and narration of AAC use, whether through screen sharing, virtual symbol boards, or verbal “think-aloud” strategies, support learning and generalization (Simacek et al., 2021; Biggs et al., 2022). Others highlighted the value of pre-session “dry runs”: “Pre-session dry runs with parents save time and reduce stress for everyone.” These practice meetings allow clinicians to test audio/video quality, review device navigation, and troubleshoot platform issues before therapy begins, a step supported by telepractice guidelines as a way to minimize disruptions and support caregiver confidence (Cason & Cohn, 2014; Hurtig et al., 2024).

Clinicians also underscored the need for backup communication supports, such as emailed printable boards or low-tech symbols, noting, “Having printable low-tech backups emailed ahead of time ensures sessions keep moving when tech fails.” Research reinforces this as an evidence-based safeguard to maintain communication access during connectivity failures (Hall et al., 2018; Muttiah et al., 2025). Collectively, these strategies reflect a growing consensus that tele-AAC requires the same rigor as in-person services, with added attention to technology preparation and caregiver coaching.

At the same time, survey data reveal gaps between practice and research. While SLPs and graduate students recognize the potential of telepractice to extend AAC access, many report limited confidence and a lack of formal guidance for integrating modeling, tech-prep, and low-tech contingency plans into therapy (Yacucci & Harvey-Northrop, 2025). Current evidence supports these techniques as effective, but standardized protocols, outcome data, and training resources remain underdeveloped. Continued research is needed to evaluate which modeling formats (e.g., live screen sharing vs. pre-recorded videos), troubleshooting workflows, and hybrid service structures most efficiently build caregiver capacity and sustain client engagement across diverse settings.

Where We Still Need to Grow

While these strengths demonstrate how adaptable SLPs can be, important gaps remain in preparing and supporting clinicians to deliver high-quality tele-AAC services.

Knowledge Gaps

Many SLPs report learning tele-AAC “on the job” rather than through structured coursework or pre-service practice. Simacek et al. (2021) noted that most providers had to pivot rapidly to telepractice during the COVID-19 pandemic without substantial training or guidance. Similarly, Biggs et al. (2022) found that SLPs valued tele-AAC but often lacked clear models for how to coach caregivers or structure sessions effectively. Across reviews, few graduate programs or continuing education offerings focus specifically on AAC in virtual contexts, leaving clinicians underprepared to address technical, coaching, and cultural considerations (Cason & Cohn, 2014; Hall et al., 2018).

Practice Gaps

Even where evidence-based tele-AAC strategies are available, such as partner modeling, pre-session tech checks, and hybrid coaching, implementation is uneven. Factors like heavy caseloads, administrative barriers, or limited access to reliable technology can reduce fidelity (Hurtig et al., 2024; Muttiah et al., 2025). Surveys also highlight variability in how clinicians integrate low-tech backups or asynchronous supports, despite evidence that these safeguards improve participation and continuity (Biggs et al., 2022; Orel & Licardo, 2025).

Research Gaps

Although studies consistently report positive outcomes for tele-AAC, much of the literature relies on single-case designs, pilot studies, or small samples (Bekteshi et al., 2022; Sutherland et al., 2018). More robust research is needed to answer questions SLPs face daily: How well do tele-AAC gains maintain over time? Which caregiver-coaching formats best serve families from diverse cultural and linguistic backgrounds? What standardized protocols for assessment, intervention, and troubleshooting could ensure consistent quality across providers? And how might emerging tools, such as AI-enhanced AAC software or adaptive coaching platforms, support, rather than complicate, care (Hall et al., 2018; Hurtig et al., 2024).

Tele-AAC has advanced rapidly, and many clinicians are delivering innovative, client-centered care despite limited guidance. Strengthening pre-service and in-service training, supporting consistent application of best practices, and investing in rigorous, inclusive research will help make tele-AAC a reliable, equitable, and sustainable service model for individuals with complex communication needs and their families.

Steps for Building a Strong Tele-AAC Framework

A successful tele-AAC program starts with intentional planning, family involvement, effective tools, and a sprinkle of creativity. Here’s how to bring all the components together in everyday practice:

Step 1: Conduct a Comprehensive Needs Assessment

  • Meet with the family before starting services to discuss their setup and routines.
  • Evaluate internet stability, available devices, and caregiver comfort with technology.
  • Ask about daily schedules and potential barriers so you can anticipate and prevent disruptions during sessions.

Step 2: Establish Clear, Shared Goals

  • Collaboratively set goals that align therapy priorities with what is most meaningful to the client and family (e.g., a child requesting a toy, a student using AAC in online classes).
  • Use measurable telehealth metrics such as device activations during natural routines or caregiver prompting frequency.

Step 3: Prepare Technology and Tools

  • Set up your workspace thoughtfully
    • Use a second monitor or tablet to manage materials and multiple windows.
    • Position a document camera or extra webcam to clearly display AAC tools.
    • Mirror tablets or use screen sharing for live modeling.
    • Explore creative supports like a background core vocabulary board to reference during sessions.
  • Always have printable low-tech boards or offline strategies ready as backups in case of technical failures.

Step 4: Coach Caregivers as Active AAC Partners

  • Provide short pre-session training to orient caregivers to strategies.
  • Model AAC use during sessions, explaining your thought process.
  • Offer real-time coaching (“Now you try…”) and feedback.
  • Send follow-up video reminders or written tips to reinforce learning between sessions.

Step 5: Implement Evidence-Based Intervention Approaches

  • Combine synchronous therapy with asynchronous supports:
    • Embed AAC practice into familiar routines (mealtime, play, morning prep).
    • Share short video clips showing correct modeling.
    • Review progress remotely and adapt plans, using hybrid methods to promote engagement and generalization.

Step 6: Address Equity and Access Barriers

  • Connect families with lending libraries or assistive technology loan programs.
  • Use culturally and linguistically appropriate visuals, vocabulary, and examples.
  • Advocate for local broadband expansion, AAC funding, and other systemic supports.

Step 7: Assemble an AAC Teletherapy Toolkit

  • • Prepare each session with a ready-to-use kit:
    • Technology checklist (devices, monitor, camera).
    • Session script for setup (screen share, iPad mirroring, background board).
    • Coaching prompts and follow-up video plan.
    • Low-tech backups and phone-based scripts to ensure continuity if tech issues arise.

Following these steps helps clinicians plan, deliver, and troubleshoot tele-AAC services in a structured, flexible way, ensuring sessions remain meaningful, engaging, and resilient even when unexpected challenges occur.

Conclusion: Looking Ahead

Tele-AAC is no longer just a temporary solution; it’s a powerful, sustainable way to connect with individuals who rely on AAC, no matter where they live. When we, as SLPs, use evidence-based practices, actively involve caregivers, and push for better training and research, we make sure these services aren’t just available, they’re effective, equitable, and life-changing.

However, this work isn’t done. We’ve made great strides in building strong tele-AAC programs, yet there’s still more to learn, especially when it comes to supporting our youngest clients and their families. That’s why Part 3 of this series will dive into telehealth and early intervention, exploring how we can best engage families of infants and toddlers, integrate coaching into daily routines, and ensure every child has a strong start.

We’ll also be continuing this important conversation at the 2026 ISHA convention in February, where we will join a panel of experts to share practical strategies, lessons learned, and what’s next for telehealth in SLP practice. Stay tuned, there’s more to come, and the future of telepractice is bright.

References

Biggs, E. E., Rossi, E. B., Douglas, S. N., Therrien, M. C. S., & Snodgrass, M. R. (2022). Preparedness, training, and support for augmentative and alternative communication telepractice during the COVID-19 pandemic. Language, Speech, and Hearing Services in Schools, 53(2), 335–359. https://doi.org/10.1044/2021_LSHSS-21-00159

Cason, J., and Cohn, E. R. (2014). Telepractice: An overview and best practices. Perspectives on Augmentative and Alternative Communication, 23(1), 4-17. https://doi.org/10/1044/aac23.1.4

Chua, E.C.K., Manansala, J.R.G., Tee, D.A.G., Lirio, M.J.A., Masa, M.K.P., and Garcia, F.D.S. (2024). A scoping review of augmentative and alternative communication (AAC) telepractice research (2002-2021).  Philippine Journal of Health Research and Development, 28(20), 20-33.

Crouse, S. (2024, June 9). AAC in Teletherapy: A guide to getting started. https://www.stacycrouse.com/post/aac-in-teletherapy

Empower your AAC sessions: Top teletherapy tools for Success. (n.d.). https://quicktalkerfreestyle.com/blog/aac-communication-teletherapist/

Hurtig, R., Blackstone, S., & Goldman, A. (2024). Bridging the gap: Insights from telepractice augmentative and alternative communication services in the digital age. Perspectives of the ASHA Special Interest Groups (10). 249–260. https://doi.org/10.1044/2024_PERSP-24-00209.

Muttiah, N., Tonsing, K. M., Blackwell, A., Bornman, J., Armendariz, K., & Drager K. D. R. (2025). Speech-language therapists perspectives on tele-augmentative and alternative communication (tele-AAC) across three low- and middle-income countries. Augmentative and Alternative Communication. 1–12. https://doi.org/10.1080/07434618.2025.2476143

Orel, M., & Licardo, M. (2024). Systematic review of telepractice for early intervention with families of children with autism spectrum disorder. Advances in Autism, 11(1), 19-37. https://doi.org/10/1108/AIA-08-2023-0045

Simacek, J., Wattanawongwan, S., Reichle, J., Hyppa-Martin, J., Pierson, L., & Dimian, A. (2021). Supporting aided augmentative and alternative communication interventions for individuals with complex communication needs via telepractice: A tutorial. Perspectives of the ASHA Special Interest Groups. (6). 1170-1181. https://doi.org/10.1044/2021_PERSP-21-00050.

Sutherland, R., Trembath, D., & Roberts, J. (2018). Telehealth and autism: A systematic search and review of the literature. International Journal of Speech-Language Pathology, 20(3), 324-336. https://doi.org/10/1080/17549507.2018.1465123

Weidner, K., & Lowman, J. (2020). Telepractice for adult speech-language pathology services: A systematic review. Perspectives of the ASHA Special Interest Groups, 5(1), 326–338. https:// doi.org/10.1044/2019_PERSP-19-00146

Yacucci, A., & Harvey-Northrop, J. (2025, June). Bridging distance and expanding access: Student and clinician perspectives on AAC via telepractice in Illinois. ISHA Voice. Illinois Speech-Language-Hearing Association. https://www.ishail.org/bridging-distance-and-expanding-access-student-and-clinician-perspectives-on-aac-via-telepractice-in-illinois