Blogs

Published in the May 2026 issue of the ISHA Voice.

By Amy Yacucci, Jennine Harvey-Northrop, and Katie Stuepfert, members of the Telepractice Committee

In Parts One (Bridging Distance and Expanding Access: Student and Clinician Perspectives on AAC via Telepractice in Illinois) and Two (Bridging Distance and Expanding Access for Tele-AAC in Action: Best Practices for Effective Service Delivery) of this series, we explored the growing role of telepractice in augmentative and alternative communication (AAC), highlighting both its promise and the persistent gaps in clinician training and confidence. As telepractice continues to evolve, one area demands focused attention: early intervention (EI).

EI represents a unique service delivery context, one that is inherently family-centered, routine-based, and grounded in natural environments. When AAC and telepractice intersect in EI, clinicians are challenged to rethink traditional service-delivery models while remaining grounded in evidence-based practice. The question becomes not whether telepractice can be used in EI, but how to use it effectively to support meaningful communication outcomes for infants, toddlers, and their families.

Telepractice in EI: From Accommodation to Advantage

Telepractice is now an established and permissible service delivery model in Illinois, including within EI systems (Illinois Speech-Language Pathology and Audiology Practice Act, 225 ILCS 110/8.2b., 2024). Live Video Visits (LVV) have expanded access to services for families in rural and underserved areas, while maintaining expectations for equivalent quality to in-person care. Within EI, telepractice aligns naturally with key principles of service delivery: intervention occurs within natural environments, caregivers are active participants, and learning is embedded in daily routines. Rather than limiting practice, tele-AAC in EI can enhance it by shifting the clinician’s role from direct interventionist to coach and collaborator, supporting communication where it matters most, within the child’s everyday life.

What the Evidence Tells Us About Early AAC

The evidence base supporting AAC in early childhood is robust and continues to grow. Research consistently demonstrates that there is no minimum age for AAC use, that no prerequisite cognitive or linguistic skills are required, and that AAC supports, rather than inhibits, speech and language development (Drager, 2023). Early access to AAC has been associated with increased communication attempts, improved expressive language, and gains in social-emotional development. Importantly, AAC should be considered a first-line intervention, not a last resort. For young children, AAC is not simply about device selection; it is about building a foundation for communication, participation, and interaction (Orel & Licardo, 2025).

The Role of Caregiver Coaching in EI Tele-AAC

Across both AAC and early intervention (EI) literature, one principle is clear: intervention is most effective when communication partners, particularly caregivers, are actively engaged in the process. AAC outcomes are not driven solely by the child’s access to a system, but by the consistency and quality of support provided across everyday interactions and routines (Biggs et al., 2022).

Telepractice may actually strengthen this critical component of intervention. Rather than positioning the clinician as the primary implementer, tele-AAC inherently shifts the model toward collaboration, coaching, and shared problem-solving within the child’s natural environment. Emerging evidence supported by Biggs et al. (2022) suggests that telepractice can:

• Enhance family–provider partnerships through ongoing collaboration and communication
• Increase caregiver participation and engagement during intervention sessions
• Promote generalization of AAC strategies within authentic daily routines and contexts

A growing body of tele-AAC research continues to support these outcomes. For example, teleintervention studies have demonstrated improvements in independent AAC use, high satisfaction among families, and strong treatment acceptability (Bekteshi et al., 2022). Importantly, many of these interventions rely on training and coaching communication partners, reinforcing the role of caregivers as central to successful AAC implementation.

More specifically, telemediated caregiver coaching models in EI have been shown to increase caregiver use of evidence-based strategies, improve caregiver confidence, and support meaningful gains in child communication outcomes (Simcoe et al., 2025). Coaching within daily routines is particularly powerful, as it facilitates skill generalization and maintenance beyond structured sessions. Similarly, telepractice frameworks in AAC emphasize the importance of supporting caregivers (often referred to as “eHelpers”) to actively facilitate intervention, highlighting that effective AAC services extend beyond the clinician–child dyad (Simacek et al., 2021).

Taken together, the literature suggests that tele-AAC is not simply an alternative mode of delivery; it is a model that may be uniquely well-suited to operationalize best practices in EI by embedding intervention within family-centered routines and empowering caregivers as primary communication partners.

In practice, this means tele-AAC sessions in EI should prioritize:

• Coaching over direct, clinician-led instruction
• Real-time feedback embedded within everyday routines and activities
• Intentional empowerment of caregivers as the primary facilitators of communication

For clinicians, this shift requires moving from a mindset of “doing therapy” to one of “building capacity.” When implemented effectively, tele-AAC does not dilute intervention. In fact, it amplifies it by extending learning opportunities across the child’s entire day.

What Effective EI Tele-AAC Looks Like

Evidence and clinical experience converge on several key practices that support effective tele-AAC in EI.

1.      Be Strategic About Service Delivery

Planning is critical. Telepractice requires intentional preparation, not only of materials, but of how technology and routines will be used. Clinicians report that successful tele-AAC sessions depend on structured planning and the thoughtful use of synchronous and asynchronous supports (Biggs et al., 2022). Similarly, setting goals collaboratively before the sessions increased family buy-in and achieved effective outcomes for the children.

2.      Embed AAC Within Natural Routines

AAC intervention should occur during meaningful activities, such as mealtime, play, and dressing, rather than isolated tasks. This aligns with EI principles and supports generalization. These meaningful opportunities allow caregivers to demonstrate the use of the AAC system and receive feedback from the clinician while engaging in reflection and self-assessment.

3.      Prioritize Communication Functions

The intervention should extend beyond simple requests to include commenting, protesting, greeting, and social interaction. Functional communication drives engagement and development. Supporting the child's engagement with the caregiver during AAC use prioritizes functional communication outcomes.

4.      Use Hybrid and Flexible Models

A combination of live sessions and follow-up supports (e.g., video models, written guides) allows families to practice strategies at their own pace and in their own contexts (Orel & Licardo, 2025). These hybrid or flexible models may allow for the clinician to be an active listener who provides relevant feedback in a way that can be understood and accepted by the family.

5.      Prepare for Technology…But Don’t Depend on It

Pre-session technology checks, caregiver orientation, and low-tech backups are essential to maintaining service continuity.

Bridging Research to Practice: An EI Tele-AAC Toolbox

To support clinicians in translating evidence into practice, the following framework synthesizes research and clinical strategies into actionable steps.

Before the Session

• Identify meaningful routines with the caregiver
• Ensure AAC system (or low-tech alternative) is accessible
• Conduct a brief technology and environment check

During the Session

• Model AAC use within the routine
• Narrate actions to make language visible
• Coach caregivers in real time (wait, prompt, respond)
• Provide specific, actionable feedback

After the Session

• Share 1–2 clear carryover strategies
• Provide simple visual or video supports
• Reflect on successes and next steps

These strategies align with clinician-reported best practices and emerging tele-AAC guidance.

Common Challenges and Practical Solutions

Despite its promise, tele-AAC in EI is not without challenges. However, many of these barriers can be addressed through intentional practice.

Notably, research suggests that telepractice may actually increase caregiver involvement, even when child engagement presents challenges (Orel & Licardo, 2025).

Key Takeaways for EI Clinicians

• AAC should be introduced early and proactively
• Telepractice can enhance family-centered intervention
• Caregiver coaching is the intervention in EI tele-AAC
• Embedding AAC into routines supports generalization and participation
• Effective tele-AAC requires intentional planning, flexibility, and collaboration

Looking Ahead

Telepractice is no longer an emerging model; it is a permanent and powerful component of service delivery. For EI clinicians, it offers an opportunity to strengthen family-centered practice and expand access to AAC for our youngest communicators. At the same time, continued efforts are needed to improve clinician training, develop standardized tele-AAC protocols, and expand research in the early childhood populations. As we move forward, the goal is not simply to deliver services at a distance, but to ensure those services are equitable, effective, and deeply connected to the lives of the children and families we serve.

If you would like more information or are interested in joining the Telepractice Committee, please contact Jennine Harvey at jmharv2@ilstu.edu​.

For additional questions regarding EI, AAC, and Telepractice, please contact Amy Yacucci at ayacucc@ilstu.ed or Katie Stuepfert at katie@aspiretherapyil.com​.