Early Augmentative and Alternative Communication (AAC) Intervention Delivered via Hybrid Telehealth

项目总结 增强和替代沟通(AAC)干预可以提高语言、识字、社交和 严重沟通障碍儿童的适应技能。然而，AAC在语音方面没有得到充分利用- 智力和发育障碍(IDD)幼儿的语言治疗。混合式远程医疗模式 可以通过扩大与言语语言病理学家的接触来改变早期AAC干预的交付 (SLP)具有AAC专业知识，并减少服务不足社区的地理和交通障碍。 这项建议的目的是为幼儿开发和试行一种混合式远程保健AAC干预 与IDD及其家人在一起。我们采用了实施科学的方法，使用系统的定性 确定照顾者和SLP偏好的方法和评估单病例试验设计的方法 瑞声介入的可行性。中心假设是，干预将改善照顾者的 使用AAC策略，这将导致儿童表达能力的提高。三 提出了具体的目标。目标1：确定利益相关者对两个关键AAC的偏好和需求 干预内容：(A)提供服务和(B)加强治疗依从性的战略。我们 将与照顾者和SLP进行访谈，以评估他们对 干预。面谈结果将为服务提供模式和治疗的初步修改提供信息 目标2和目标3中研究的坚持策略。目标2：通过迭代开发AAC干预 测试周期。我们将在行为上进行六个多基线设计，以完善AAC干预 并使用面对面服务交付展示初步效果。这项研究的发现将告诉我们 对AAC干预的混合式远程保健交付的适应，包括面对面和远程保健 在目标3中评估的会议。目标3：进行混合型远程保健AAC干预的试点测试。我们会 在参与者之间使用组合多探头设计对混合式远程医疗AAC干预进行试点测试 和行为。9个亲子二人组将接受24次干预，其中8次提供给 家庭面对面，16个家庭通过远程医疗提供。主要结果是照顾者使用AAC干预 战略，次要结果是儿童交流行为。这项建议具有创新性，因为它 使用实施科学方法开发一种新的混合式远程医疗AAC干预，即 可行、可接受且适合最终用户，从而增加了在 常规的临床实践。该项目意义重大，因为它满足了对早期AAC的迫切需求 为家庭使用而设计的语言干预。我们的预期结果是开发出AAC 为R01应用程序进行大规模应用做准备的干预和实施策略 临床试验。

PROJECT SUMMARY Augmentative and Alternative Communication (AAC) intervention can increase language, literacy, social, and adaptive skills for children with severe communication impairments. However, AAC is underutilized in speech- language therapy for toddlers with intellectual and developmental disabilities (IDD). Hybrid telehealth models can transform the delivery of early AAC interventions by expanding access to speech-language pathologists (SLPs) with AAC expertise and reducing geographic and transportation barriers in underserved communities. The purpose of this proposal is to develop and pilot test a hybrid telehealth AAC intervention for toddlers with IDD and their families. We employ an implementation science approach, using systematic qualitative methods to identify caregiver and SLP preferences and single-case experimental design methods to assess the feasibility of the AAC intervention. The central hypothesis is that the intervention will improve caregivers’ use of AAC strategies, which will lead to increases in children’s expressive communication skills. Three specific aims are proposed. Aim 1: Determine stakeholders’ preferences and needs for two key AAC intervention components: (a) service delivery and (b) strategies to enhance treatment adherence. We will conduct interviews with caregivers and SLPs to assess their needs and preferences regarding the intervention. Interview findings will inform initial modifications to the service delivery model and treatment adherence strategies investigated in Aims 2 and 3. Aim 2: Develop an AAC intervention through iterative testing cycles. We will conduct six multiple baseline designs across behaviors to refine the AAC intervention and demonstrate preliminary efficacy using an in-person service delivery. Findings from this study will inform adaptations for a hybrid telehealth delivery of the AAC intervention, involving both in-person and telehealth sessions evaluated in Aim 3. Aim 3: Conduct a pilot test of a hybrid telehealth AAC intervention. We will pilot test the hybrid telehealth AAC intervention using a combination multiple-probe design across participants and behaviors. Nine parent-child dyads will receive 24 intervention sessions, eight sessions provided to families in-person, and 16 provided via telehealth. The primary outcome is caregivers’ use of AAC intervention strategies, and the secondary outcome is child communication acts. This proposal is innovative because it uses implementation science methods to develop a novel hybrid telehealth AAC intervention that is feasible, acceptable, and appropriate for its end-users, increasing the likelihood of widescale adoption in routine clinical practice. The project is significant because it addresses a critical need for early AAC language interventions designed for home use. Our expected outcomes are to have developed the AAC intervention and implementation strategies in preparation for an R01 application to conduct a large-scale clinical trial.