Wednesday, April 1, 2020

Leveraging Chaos Into a Therapeutic Opportunity

Hey Tek-ninjas! So... I just got totally inspired. I was on a company call, and one of my colleagues shared a story which has really got me thinking about how "we" can do tele-therapy.

I reached out to Tobii Dynavox Solution Consultant Christina Carroll, to see if she would share her story with Tek-ninjas. Here it is:

"Before all of the Covid chaos began I had scheduled 3 back-to-back evaluations with a brand new SLP, who had never done an AAC evaluation. Once restrictions were put into place, we decided to do the evaluations remotely, and I sent her a device. 

We began the first evaluation via Facetime and about 5 minutes in my dogs started barking. I was embarrassed, because the child noticed and got distracted. I decided to try to use this and told the kiddo that it was my dog barking. 

I asked the SLP to navigate to the animal page and have the kiddo find dog. The child clicked dog and I told him that my dog barks loud and then explained that I have 2 dogs. We asked if he wanted to see my other dog and the slp modeled how to use the core page to say want dog and we asked him to do the same. He did and I brought my other dog on screen. 

Harley and Duke
I then asked if he could see what color my dogs are and the slp navigated to colors and he proceeded to say black and brown. I asked if he wanted to see my dogs run and asked him to tell us to go! He pushed go and I picked up my dog and ran. 

The SLP showed him stop and we began a game of stop and go. 

We then tried to work on some other things and noticed his interest was not there so the SLP asked if he wanted more dog on the device. He navigated on his own and said “more dog”. I asked him which dog he wanted to play with and he said “I want black dog” which was an 8 step navigation. 

We proceeded to do a stop and go dance party with my dog. This was such a hit, we did it for the next 2 evaluations."

Most of us newly working from home can completely relate to the awkwardness of being on a video conference call and having our animals or children enter into our work abruptly. I love how Christina took the spontaneous events happening around her and adroitly leveraged them into a therapeutic opportunity.  I'd love to hear anyone else's stories about tele-therapy gone right! 

Happy tele-therapy!!

Christina works in the great state of California serving the Orange County area and beyond. Folks who get to work with her are clearly very fortunate. If you live elsewhere and need to find your Solution Consultant, enter your zip-code here

Friday, March 27, 2020

Corona Virus Resources

Hey Tek-ninjas, the folks at Tobii Dynavox are providing various communication resources and supports during this unprecedented time. Here are a few places to check for the most up-to-date offerings:

What you can expect to find on the links above: 

Home Learning for Educators, Parents and Students

Tons of FREE resources are available to promote learning at home including Boardmaker Activities-to-Go, 10 units of ready-made activities that include books, games, communication boards, behavior supports, and more. If you are an educator, and find yourself all of a sudden providing remote education, this site here, might be helpful.

Hospital Intensive Care Unit Communication Resources

Printable communication pages to support caregiver to patient communications in a hospital environment. Available in English (US,UK), Finnish, French, German, Italian, Norwegian, Spanish, Swedish, and more. Printable is ideal, because after use, throwing them out costs little.

Coronavirus Teaching and Communication Resources

A set of activities and resources to support students in learning and communicating about the Coronavirus. Available in English (US,UK), German, Spanish, Swedish, and more.

How to Import the Coronavirus Page Topic into Snap Core First

Learn how you can import the new Coronavirus Topic Page into the Snap Core First app.
Watch now.  Don’t have Snap Core First? Not a problem – download it today for a 60-day FREE trial.

Pathways for Clinicians and Families

Not familiar with Pathways? It is your FREE companion app to Snap Core First and is ideal for those looking for expert guidance and best practices for engaging users.

Clinicians: Watch how to use the Goals Grid to remain focused and organized while supporting your AAC clients.

Families: Watch how to use the Top Tips section in Pathways to effectively implement Snap Core First with your family.

Wash those hands!!

Wednesday, March 25, 2020

Snap Core First and SAPI Voices

Hey Tek-ninjas! Did you know Snap Core First has the capacity to import banked voice files? This is pretty exciting for individuals who’ve taken the time to store their voice prior to it’s loss.

Most, if not all voice banking services provide the user with an install file. The video below demonstrates the loading and installation of a CereVoice file. It’s quick, and easy.

And now, users can choose between Communicator 5 or the newer Text-Based Pageset in Snap Core First, which I blogged about in January.

Clean those hands!!

Remote services, FAPE, and free resources

Hey Tek-ninjas! Monday, in North Carolina, Governor Cooper announced that schools are officially closed for "in-person" education.

Cooper did not specify when or how students will resume "not-in-person" education, but the notion of remote education raises a number of questions for me. If FAPE is now manifesting as remote, homebound instruction:

  1. will NCDPI provide a computer for families who don't have one? 
  2. will NCDPI provide internet for families who don't have access?

Some school districts have long been working towards some type of 1:1 computer/student ratio. I imagine laptop sales may spike in the next few weeks.

The question of wifi still exists. A clinician emailed me some helpful links this morning, which may be beneficial for folks you serve, both for education purposes, as well as delivering tele-health. For qualifying families, Spectrum is offering free access to high-speed Internet service.

  • 30 Mbps Internet speed (wireless speeds may vary) 
  • Free Internet Modem 
  • Free Security Suite 
  • No Data Caps 
  • Parental Controls 
  • No Contracts

In addition, even if you don't qualify for the program above, citing COVID-19, Spectrum is offering special discounts to households affected by this virus. Beginning Monday, March 16, they will offer two free months of internet and WiFi services to new customers in households with Pre-K to 12 or college students who need remote education. This discount will be applied as a credit for your first two months of internet services. They state that they will waive any installation or pre-payment fees to help get you started. 

Spectrum is not national, but certainly covers a lot of states. These may be solid resources for your clients. I cannot speak to how long these programs will be available, or what happens when the program ends, so investigate wisely. They do note in the fine grey print:  "Equipment, activation and installation fees may apply. Services not available in all areas. Restrictions apply."  Still. Might be a boon to some families. 

If you live somewhere that a internet provider is offering similar access please let me know in the comments. 

Clean your hands! 

Tuesday, March 24, 2020

FAQ on Telehealth

Hey Tek-ninjas, this information comes from the source... hopefully it will be useful to some of you navigating the world of Telehealth. 


Medicare has not extended telepractice to audiologists, SLPs, or physical and occupational therapists, despite the publicity regarding alleviation of penalties regarding noncompliance with telepractice requirements. However, Medicare has expanded use of e-visit G-codes—which are not considered telepractice—to more providers in an effort to ease access issues.

The e-visit codes describe specific online communications that require a clinical decision and must meet specific criteria for appropriate billing.
The Medicare G-codes for e-visits are G2061-G2063 and include very specific parameters to determine whether an e-visit can be included on a Medicare Part B (outpatient) claim for payment.
  • G2061: Qualified non-physician healthcare professional online assessment and management, for an established patient, for up to seven days, cumulative time during the 7 days; 5–10 minutes
  • G2062: Qualified non-physician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11–20 minutes 
  • G2063: Qualified non-physician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes 

To correctly report G2061-G2063, the online assessment and management services must be:
  • initiated by an established/existing patient,
  • conducted through a patient portal
  • medically necessary (requires clinical decision-making and is not for administrative or scheduling purposes), and 
  • documented and stored to reflect the clinical decision-making and amount of cumulative time spent providing e-visit services to each patient. 
Clinicians may report an e-visit code only once per seven consecutive days.


Each State Medicaid program is issuing guidance on their decision to allow telehealth. For example, Ohio Medicaid recently release an update to their Administrative rule that allows telehealth to SLPs. If a state allows this, the following billing codes are applicable –

Commercial Insurance

Commercial Insurance Plans typically follow suit with Medicare (CMS). We continue to monitor each commercial insurance plan as they publish guidance and will keep you updated when the information is applicable.

HIPAA Guidance for Telehealth

The Office for Civil Rights (OCR) at the Department of Health and Human Services (HHS) is responsible for enforcing certain regulations issued under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), as amended by the Health Information Technology for Economic and Clinical Health (HITECH) Act, to protect the privacy and security of protected health information, namely the HIPAA Privacy, Security and Breach Notification Rules (the HIPAA Rules).
  • During the COVID-19 national emergency, which also constitutes a nationwide public health emergency, covered health care providers subject to the HIPAA Rules may seek to communicate with patients, and provide telehealth services, through remote communications technologies. Some of these technologies, and the manner in which they are used by HIPAA covered health care providers, may not fully comply with the requirements of the HIPAA Rules.
  • OCR will exercise its enforcement discretion and will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered health care providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency. This notification is effective immediately. 
  • A covered health care provider that wants to use audio or video communication technology to provide telehealth to patients during the COVID-19 nationwide public health emergency can use any non-public facing remote communication product that is available to communicate with patients. 
  • OCR is exercising its enforcement discretion to not impose penalties for noncompliance with the HIPAA Rules in connection with the good faith provision of telehealth using such non-public facing audio or video communication products during the COVID-19 nationwide public health emergency. 
  • This exercise of discretion applies to telehealth provided for any reason, regardless of whether the telehealth service is related to the diagnosis and treatment of health conditions related to COVID-19. 
  • For example, a covered health care provider in the exercise of their professional judgement may request to examine a patient exhibiting COVID- 19 symptoms, using a video chat application connecting the provider’s or patient’s phone or desktop computer in order to assess a greater number of patients while limiting the risk of infection of other persons who would be exposed from an in-person consultation. Likewise, a covered health care provider may provide similar telehealth services in the exercise of their professional judgment to assess or treat any other medical condition, even if not related to COVID-19, such as a sprained ankle, dental consultation or psychological evaluation, or other conditions. Under this Notice, covered health care providers may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype, to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules related to the good faith provision of telehealth during the COVID-19 nationwide public health emergency. Providers are encouraged to notify patients that these third-party applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications. 
  • Under this Notice, however, Facebook Live, Twitch, TikTok, and similar video communication applications are public facing, and should not be used in the provision of telehealth by covered health care providers. 
  • Covered health care providers that seek additional privacy protections for telehealth while using video communication products should provide such services through technology vendors that are HIPAA compliant and will enter into HIPAA business associate agreements (BAAs) in connection with the provision of their video communication products. The list below includes some vendors that represent that they provide HIPAA-compliant video communication products and that they will enter into a HIPAA BAA. 
    • Skype for Business / Microsoft Teams 
    • Updox 
    • VSee 
    • Zoom for Healthcare 
    • Google G Suite Hangouts Meet
Clean those hands!! 

Monday, March 23, 2020

Printing Pagesets made easy!

Hey Tek-ninjas, so here's some good news... if you use Snap Core First, you can now print directly from within the app. And, it's super easy. 

In order for this new function to work, be sure to run the update today. Take a look at the video below.

Happy therapy!!

Sunday, March 22, 2020

Blog referral...

Hey Tek-ninjas, good morning! I was planning on writing a “how-to” for the pragmatics of tele-Therapy... 

Then I read this brilliant blog post at, and thought, why try to write this again. This post is really solid, discussing “how to” and “what to” do.

So, if you are interested in learning about tele-Therapy, check out this excellent and thorough article by Holly Rosensweig of Spiffy Speech and SLP, Lucy Stone of The Speech Express.

Happy therapy!