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Travel & GIVE Presents:The TAG CaresTelehealth ServicesInitiative and PilotProgram ReviewSupporting Speech and LanguageDevelopment via Telehealth in KenyaMartine Harris, MS, CCC-SLPExecutive DirectorDeon Brown, MS, CCC-SLPSpeech Pathologist Team LeadNailah Smith, CFSpeech Pathologist Volunteer

Table of contentsPHOTO CONSENT NOTICEAll photographs of children includedin this booklet are used with theexplicit consent of their parents orguardians and, where applicable, theschool administration. Travel & GIVEadheres to strict privacy and ethicalguidelines to ensure the respectfuland appropriate use of all images.Letter from Executive Director......................Travel & GIVE (TAG)........................................Programs.............................................................Meet the Team..................................................Partner: Almasi School....................................Disability and SPED in Kenya........................TAG Cares Telehealth Program....................Key Achievements and Milestones...............Barriers to Success...........................................12567913212426363839Reflection, Modifications, and FuturePlanning..............................................................Program Funding..............................................Ways to Support Travel & GIVE...................Case studies.......................................................Daniel KamauDavid KiokoIsrael FadhiliLeonard OmandiJoy Bena

As the Executive Director of Travel & GIVE, I am thrilled to share with you theexciting launch of our TAG Cares Telehealth Services Initiative. Our missionhas always been rooted in the belief that every child deserves access toessential services that empower them to thrive. With this initiative, we aretaking a significant step toward supporting speech and languagedevelopment for children in Kenya, and eventually globally!The TAG Cares Telehealth program aims to bridge the gap in access totherapeutic interventions for children with disabilities. Our pilot program hasshown promising results, demonstrating the positive impact of telehealthservices in fostering communication skills and enhancing the overalleducational experience.We believe that with your continued support, we can make a lastingdifference in the lives of these children and their families. Thank you for beinga part of this journey and for your commitment to creating positive change.Warm regards,Martine Harris Executive DirectorTravel & GIVEThe TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 1

WWW.TRAVELANDGIVE.ORGTravel & GIVETravel & GIVE (TAG) is a 501(c)3 California based non-profit.TAG’s mission is to improve the quality of life of youth, ages birth-21, with speech, learning, mental, and physical disabilities throughdirect services, advocacy, and training-based service projects.Since 2016, TAG volunteers have traveled to underdevelopedcommunities, specifically Haiti, Kenya, and Jamaica, to advocate forpeople living with disabilities by providing quality hands-on-therapy, and educating communities on inclusion throughworkshops. As an IRS approved 501(c)(3) nonprofit organization,we remain committed to our vision to dispel the stigmas aroundpeople living with disabilities.TAG Cares Telehealth Pilot www.travelandgive.orgThe TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 2

Global IssueWithin many rural areas around the world, children with disabilities are labeled as karmafor the parents’ wrong doings and consequently shunned from the typical community.Many villages believe that a person’s disability is contagious, and therefore they avoidinteractions, limit social and educational opportunities, and in turn isolate thechild.Families feel shame in identifying a child with a disability, or label them as poorlybehaved, rather than providing them with necessary support to promote the highest levelof independence possible.According to the World Health Organization, an estimated 1.3 billion people – or 1 in 6people worldwide – experience significant disability. Persons with disabilities die earlier,have poorer health, and experience more limitations in everyday functioning than the restof the population due to health inequities. These health inequities arise from unfairconditions that affect persons with disabilities disproportionally, including stigma,discrimination, poverty, exclusion from education and employment, and barriers facedin the health system itself.The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 3

TAG’s SolutionTo provide in-person and virtual access toquality therapeutic and educational servicesfacilitated by professional volunteers fororganizations caring for people living withdisabilities on a global scale.Problem: TAG’s global partners, which includeschools and orphanages, have limited tono access to licensed service professionalsto address the disparity in education andtherapeutic intervention. These childrenare disadvantaged because they are notexposed to environments that elicit theirlanguage, fine & gross motor skills, andaddress their mental health state at anearly age. Related health services such asspeech, occupational therapy, andmental health services are not commonprofessions and are not accessible to ourpartner organizations in Haiti, Kenya, andJamaica.The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 4

EmpowerED Workshops (2016 - present)TAG-Cares Telehealth Services (2023-present)ProgramsTAG volunteers travel to their partners to facilitate in-person training and workshops forparents, teachers, therapists, and community leaders covering topics around specialeducation, and creating inclusive environments for individuals presenting withdevelopmental delays. TAG's Telehealth program, addresses the lack of access to therapeutic interventions forchildren (ages birth to 21) with disabilities in countries facing inclusivity challenges due tostigmas. This initiative empowers educators to acquire therapeutic skills under TAG'ssupervision, promoting self-sustainability.The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 5

Lawrence MinerGlobal DocumentarianPepper PociaskProject ManagementCatherine NjeruTherapy AidAnne Kenya DubuissonMental HealthTeam LeadNyeesha WilliamsMental HealthSpecialistGinger LarsonResearch DirectorAlvin CreswellBoard Member |TreasurerAmoi AlawoyaBoard Member |Strategic HR Leader Kimmerly HarrellBoard Member |Program ManagerTamara EasleySpeech PathologistExecutive TeamNailah SmithSpeech Pathologist (CF)Dawn SmithTravel CoordinatorDeon Brown, MS, CCC-SLPSpeech PathologistTeam LeadThe TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 6Ana Luna HernandezSpeech Therapy Assistant(SLPa)Meet The TeamTravel & GIVE’s executive team is comprised of allied health professionals (speech languagepathologists and occupational therapists) who are active participants of their professionalcommunities as providers, leaders, and educators. The greater team consists of physicaltherapists, mental health professionals, audiologists, and other skilled professionals activelyworking to create change. Representation matters. When children learn from people who look like them, they are notonly able to relate more easily, they also build self-confidence and long term goals. Travel &Give’s team is composed of a diverse, largely minority, individuals who children can relate toand envision themselves eventually becoming.

TAG’s PartnerOrganization:Almasi InternationalChristian School (AICS)Nairobi, Kenya Partner with TAG 2019 - Present# of students enrolled: 75# of students with special needs: 15# of students integrated in general educationclassroom: 2# of students in special education unit: 13Led by Reverend Sophie Mwende Musyoka, Almasi International Christian School(AICS) is one of the few schools in Nairobi that provides inclusive education forlearners with disabilitiesMissionAICS seeks to collaborate withChristian parents and other strategicstakeholders across East Africa inproviding a first class, faith-based,valuable, wholesome educationalexperience and transformational lifetraining for each student.The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 7

Elementary and Middle School - Accelerated Christian Education (ACE) CurriculumThe ACE curriculum has been in use for over 40 years, recognized in more than 100nations both as a home and school-based program. ACE is a learner-centered curriculumin which learners assume full responsibility for their academic progress from the age of 7years. They are taught and expected to set daily work goals and achieve them consistentlyto attain the termly and annual academic projections.The teacher acts as a trusted ally,guide, and mentor who keeps each learner accountable for achieving set goals.Grade 9-12 Ignitia Online CurriculumIgnitia is a versatile online Christian curriculum and learning management system withdynamic, Christ-centered lessons and interactive features designed to serve teachers andstudents in elementary, middle, and high school.Online curriculumImmediate feedback and grading for their effortsStudent works at his own paceWide range teaching and learning resourcesOver 100 core subjects and electives to choose from.Special EducationIn January 2019, AICS opened a special unit class forLearners with Learning Deficiency & Difficulties (LDD).Under this unit they offer Learning Difficulties Assessment(LDA) services for families with special needs children bytheir in –house special needs education specialist. Inconjunction with relevant health providers and parents,they craft an Individual Education Plan (IEP) for learnerswho have the capacity to learn within their school context.Integrated StudentsIntegrated students are special needs children who canbe integrated with the other students.The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 8AICS CurriculumAges 3-4 Step By Step ProgramStep By Step is a kindergarten program that helps the child To make the big transitionfrom home to elementary school. It is very friendly and the child gets to learn new skillse.g., sounds ,number, art and craft ,colors, and music.

Disability and SpecialEducation in KenyaEducation system in Kenya: Education is provided via public or privateinstitutions, monitored by the Ministry ofEducation. The national languages include English andKiswahili, with over 40 native languages (Kiru,2018).Public and private institutions share the samesystem and curriculum, however differ in tuitionfees and student-teacher ratios (Kiru, 2018). International schools are also present in thecountry that operate under a different system. Disability Facts and Statistics in Nairobi, Kenya01Prevalence of Disability: According to the Kenya National Bureau of Statistics (KNBS), about 2.2% of Kenya'spopulation has some form of disability. In Nairobi, the prevalence is slightly lower, but theurban environment poses unique challenges for people with disabilities.02Access to Education: Many children with disabilities in Kenya still face barriers to accessing education. The 2019Kenya Population and Housing Census reported that only about 39% of children withdisabilities aged 3 to 17 years were attending school.03Disability Types: The most common types of disabilities reported in Kenya include physical disabilities(34%), visual impairments (33%), hearing impairments (15%), and intellectual disabilities(11%).The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 9

04Government Initiatives:The Kenyan government, through the Ministry of Education, has implemented policies topromote inclusive education. The Basic Education Act (2013) and the Special NeedsEducation Policy Framework are some of the key documents guiding these efforts.05Challenges:Despite these initiatives, challenges such as inadequate resources, lack of trained teachers,and societal stigma continue to hinder the full implementation of inclusive education inNairobi and across Kenya. Those with disabilities are more likely to experience adversesocioeconomic outcomes than persons without disabilitiesAccess to a multidisciplinary special education team (e.g. speech, physical, andoccupational therapies) within schools is limited.Along with the Kenya Institute of Special Education (KISE) formed in 1986, Kenyaparticipates in many treaties and amendments to provide and protect equalopportunities in employment, education, and recreation for people with disabilities. KISE was also formed to provide training for teachers and instructional materials forstudents with disabilities (Kiru, 2018). The Special Needs Education (SNE) framework policy is the main guiding documentfor special education services in the country (Republic of Kenya, 2009). Theframework includes objectives for assessment, intervention, awareness, advocacy,development, research, documentation, and the use of specialized technology andfacilities (Republic of Kenya, 2009). Special units are classrooms in regular schools dedicated to students withdisabilities and special needs who would not otherwise benefit from a generaleducation setting.(Republic of Kenya Ministry of Education Basic EducationStatistical Booklet, 2020). According to Elder, Damiani, & Oswago, 2016, students with mild learning deficitsare integrated into general population classrooms, while students with intellectual,physical, visual and hearing impairments are primarily placed in specialized schoolsor special units. The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 10

Table 4.6 represents the amount of primary schools that include special needs learnersfrom 2017-2020. The amount of SNE learners in public schools increased by 144% from2019-2020. This increase includes students enrolled in integrated and special units. Table 4.7 represents the amount of special needs learners by category of schools (public orprivate), class, and sex. Over 97% of special needs learners are enrolled in public schools. The following tables from Republic of Kenya Ministry of Education Basic EducationStatistical Booklet let 2020 represent special education statistics available for primaryand secondary education settings. The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 11

Table 5.5 presents the amount of public secondary schools with special needs learnerscount included. Table 9.4 demonstrates the share of spending allocated to primary and secondaryprograms. Special needs was not considered a key priority area of funding. The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 12

TAG Cares Telehealth Services LAUNCHED JANUARY 2023Key health services such as speech therapy, occupationaltherapy, and mental health services are notably absent inmost school settings, leaving many students without thesupport they need to succeed academically and socially.IntroductionThe TAG Cares Telehealth Services program was initiated to provide access to qualitytherapeutic interventions and specialized education for individuals with disabilitiesglobally through virtual services. Run by professional educators and therapists based inthe United States, the program bridges the gap in care for those with limited access to in-person services.Identified ProblemIn Kenya, particularly within the school environment, there is a significant lack of access toessential therapeutic services. Children with speech and language deficits, among otherdisabilities, often struggle without the necessary interventions, which adversely affectstheir academic performance and overall development.The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 13

Program ImplementationStep 1: Initial Assessment and ObservationIdentify students with potential speech and language deficits that may impact theiracademic performance.01Team Deployment:Send a team of TAG Speech and Language Pathologists (SLPs) to Almasi School inNairobi.The SLPs work closely with school staff to identify students who may have speechand language difficulties based on their academic performance and classroombehavior.02Informal Assessments:Conduct informal assessments of the identified students to understand the natureand extent of their speech and language deficits.Use observational techniques during classroom activities and interactions to gatheradditional insights into the students' communication challenges.03Stakeholder Interviews: Interview teachers and parents to gain a deeper understanding of the students'communication needs and how these deficits affect their learning and socialinteractions.04Data Collection:Document observations and assessment findings to form a baseline for eachstudent. This data will guide the development of individualized intervention plans.The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 14

01Analysis of Assessment Data: Analyze the data collected from the initial assessments, observations, andinterviews to identify each student's strengths, weaknesses, and specificcommunication needs.02SEP Creation:Develop a Student Education Plan (SEP) for each student, modeled after anIndividualized Education Plan (IEP).Include specific, measurable goals related to speech and language development,along with detailed intervention strategies.Step 2: Development of Student Education Plans (SEPs)Create tailored intervention plans that address the specific needs of each student.03Collaboration with Teachers and Parents:Work with teachers and parents to ensure the SEPs are practical and can besupported both in the classroom and at home. Provide guidance on how they can reinforce the strategies outlined in the SEPduring daily interactions with the student.04Resource Allocation:Identify and allocate any additional resources or tools needed to implement theSEPs effectively, such as visual aids, communication devices, or specialized learningmaterials.The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 15

01Hiring an In-Country Therapy Aide Recruit and train a local therapy aide to deliver weekly communication therapysessions to the students, guided by the SEPs, and supervised by TAG SLPvolunteers. 02Therapy Sessions:The therapy aide conducts regular, in-person therapy sessions tailored to eachstudent's SEP. These sessions focus on improving the specific speech and languageskills identified in the assessment.Sessions may include techniques to enhance articulation, language comprehension,social communication, and other relevant areas.03Coordination with School Staff: Maintain close communication with teachers to integrate therapy goals into thestudents' daily learning activities. Encourage teachers to support therapy efforts by using recommended techniquesduring classroom interactions.Step 3: Implementation of In-Person TherapyDeliver consistent, hands-on speech and language therapy to students based on theirSEPs04Parental Involvement: Provide parents with activities and strategies to reinforce therapy goals at home,ensuring continuity of care and practice outside of school.The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 16

01Regular Data Collection: The therapy aide collects data during each session, documenting the student'sprogress toward the goals outlined in their SEP. Use objective measures, such as frequency counts, accuracy percentages, andobservational notes, to track improvements.02Progress Reports: Every six months, compile the data into a comprehensive progress report for eachstudent. The report should detail the student's achievements, areas of ongoingdifficulty, and any emerging needs. Include recommendations for any adjustments to the SEP based on the student'sprogress.Step 4: Ongoing Student Progress MonitoringTrack and evaluate each student's progress to ensure the effectiveness of theintervention and make necessary adjustments.03Review Meetings: Hold monthly review meetings with the therapy aide to discuss the progress reportsand determine if any changes are needed in the SEP or therapy approach. Use these meetings to address any challenges or concerns from the school staff orparents.04Continuous Improvement:Adjust therapy techniques and goals as needed based on the student's progress andany new challenges that arise.Ensure the SEP remains dynamic and responsive to the student's evolving needs.The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 17

01Professional Follow-Up Visits: A team of TAG professionals, including speech and language pathologists and otherrelevant specialists, conducts follow-up visits to Almasi School. These visits occursemi-annually or annually, depending on the program's needs.During these visits, the team observes therapy sessions, conducts additionalassessments if necessary, and consults with the in-country therapy aide to provideguidance and professional development.02Review and Adjust SEPs: The TAG team collaborates with the therapy aide, teachers, and parents to revieweach student's progress. Based on the findings, they adjust the Student EducationPlans (SEPs) to better align with the students' current needs and goals.This may include updating goals, modifying therapy techniques, or introducing newinterventions.Step 5: Professional Follow-Up and Program EvaluationTo ensure the continuity and quality of services provided, and to evaluate the overalleffectiveness of the TAG Cares Telehealth Program.03Program Evaluation: The effectiveness of the telehealth programis evaluated during these visits. Thisincludes assessing the impact on students'academic performance, communicationskills, and overall well-being.Feedback is gathered from all stakeholders,including students, parents, teachers, andthe therapy aide, to identify areas forimprovement and ensure the program'scontinued success.The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 18

04Capacity Building:To build local capacity, the TAG team provides additional training and resources tothe in-country therapy aide and school staff. This helps ensure that high-qualitytherapy can be sustained even between TAG visits.The training may cover new therapy techniques, data collection methods, and bestpractices for monitoring student progress.05Reporting and Recommendations: After the follow-up visit, the TAG team prepares a detailed report summarizing theirobservations, adjustments to SEPs, and overall program evaluation.The report includes recommendations for the next steps, potential expansions of theprogram, and any additional support needed.The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 19

Initiation date: January 2023Speech Therapy weekly sessions began: March 2023Pilot program end date: July 31st, 2024Goal: By August 2024, 13 students attending Almasi School and enrolled in the TAGCares Telehealth program will have received weekly speech therapy sessions from alocally hired therapy aide, supervised by a US-based speech-language pathologist(SLP). Objective data will demonstrate the students' progress toward their annualspeech therapy goals.In January 2023, speech pathologists, mental health specialists, and occupationaltherapists from the United States traveled to Nairobi, Kenya to facilitate Empower-EDworkshop on inclusive education and multidisciplinary teams in special education forlocal parents and educators. Following the workshop, two speech-language pathologists(SLPs) screened sixteen students referred by parents and teachers at Almasi School forsuspected speech and language disabilities. Thirteen out of sixteen students wereenrolled in the pilot program of the TAG Cares Telehealth Program.Each enrolled student received a Student Education Plan (SEP) outlining backgroundinformation, results from parent and teacher interviews, as well as the students' speechand language strengths, weaknesses, and goals for the one-year pilot program.Psychologist and Nairobi resident Catherine N. was hired as TAG’s therapy aid to providein-person speech therapy under the supervision of Tamara Easley, MA, CCC-SLP, withsupport from two SLP graduate students, and 1 speech therapy aide (SLPA).Launch of TAG Cares TelehealthServices in Kenya 2023In March 2024, Deon Brown, MS, CCC-SLP, took over as the supervising SLP. Ms. Brownconducts bi-monthly meetings with Catherine to provide support, analyze data, provideprofessional development classes, and revise treatment plans. The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 20

Key Achievements and MilestonesLaunch of TAG Cares Telehealth Services in Kenya 2023Initiation Date: January 2023Weekly Speech Therapy Sessions Began: March 2023Pilot Program End Date: July 31st, 2024Goal: By August 2024, the TAG Cares TelehealthProgram aimed to provide weekly speech therapysessions to students at Almasi School, withobjective data demonstrating their progresstoward annual speech therapy goals.JANUARY 2023:Empower-ED Workshop: US-based specialists (speech pathologists, mental healthprofessionals, and occupational therapists) traveled to Nairobi to conduct a workshopon inclusive education and multidisciplinary approaches in special education for localparents and educators.Student Screenings: Two TAG Speech-Language Pathologists (SLPs) screened 16students at Almasi School, identified by parents and teachers as having suspectedspeech and language disabilities.The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 21

FEBRUARY 2023:Enrollment: 13 out of 16 students were enrolled in the TAG Cares Telehealth Program.SEP Development: Each enrolled student received a customized Student EducationPlan (SEP), outlining their speech and language strengths, weaknesses, and goals forthe pilot program.MARCH 2023:Therapy Aide Hiring: Catherine N., a psychologist and Nairobi resident, was hired asthe in-country therapy aide to provide in-person speech therapy under the supervisionof Tamara Easley, MS, CCC-SLP.Weekly Sessions Commence: Weekly speech therapy sessions began for all 13enrolled students, focusing on the goals outlined in their SEPs.Monthly TAG Team Meetings: Monthly meetings were held with the TAG speechteam to discuss individual clients’ goals, therapy techniques, and progress. Monthly Meetings: Tamara Easley, MS, CCC-SLP conducted monthly meetings withCatherine to provide ongoing support, analyze student progress data, offer professionaldevelopment, and revise treatment plans as needed.SEPTEMBER 2023:First Progress Report: The first progress report was completed, marking initial studentimprovements and necessary adjustments to therapy plans.Second Progress Report: MARCH 2024:Supervision Transition: Deon Brown, MS, CCC-SLP, assumed the role of supervisingSLP, overseeing the therapy program and ensuring its continued effectiveness.Bi-Monthly Meetings: Deon Brown conducted bi-monthly meetings with Catherine toprovide ongoing support, analyze student progress data, offer professionaldevelopment, and revise treatment plans as needed.Second Progress Report: The second round of progress reports was completed,providing further insight into student progress and fine-tuning SEPs.JULY 2024:Program Evaluation: An assessment of the program’s effectiveness was conducted,with data demonstrating measurable progress in the students' speech and languageabilities.The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 22

AUGUST 2024:Final Progress Report: The final progress report was completed, summarizing theachievements and areas of improvement for the remaining students.Student Retention: The program began with 13 students and concluded with 5, asseveral students left the school due to barriers such as inaccessibility and lack oftransportation.Goal Achievement: The remaining 5 students showed progress toward their speechtherapy goals, as evidenced by the collected data.Program Review and Future Planning: The success of the pilot program wasreviewed, with considerations for addressing barriers and planning potentialexpansions to support more students in the future.The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 23

Barriers to SuccessBarriers to Success in the TAG Cares Telehealth ProgramHere’s a structured overview of the barriers to success for the telehealth program,focusing on various aspects that impact the implementation and effectiveness of speechtherapy services:Culturally and Linguistically Appropriate Assessment{01}Language Diversity: Students come from multilingual backgrounds,leading to challenges in accurate screening and assessment.Limited Resources: Lack of assessment tools available in theprimary languages spoken at home, impacting the understanding ofstudents' needs.Service Limitations{02}Frequency of Therapy: Limited to 30-minute sessions once a week,which may not be sufficient for students with moderate to severecommunication disorders.Severity and Comorbidity: Most referred students have moderate tosevere needs, necessitating more intensive therapy than currentlyprovided.Knowledge and Training of Therapy Aide{03}Limited Knowledge Base: The therapy aide's lack of knowledgeregarding communication disorders and effective interventions canhinder service delivery.Need for Professional Development: Insufficient trainingopportunities for the therapy aide to enhance skills and culturalcompetence.Resource Constraints at the Host Site{04}Availability of Materials: Limited access to books, therapy supplies,and culturally relevant resources necessary for effectiveintervention.Support for Language-Rich Environments: Lack of resources tocreate a language-rich educational environment that fosters speechand language growth.The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 24

Referral and Support Processes{05}Referral Process for Health Concerns: Inefficient processes forreferring students with health issues (e.g., vision, hearing) that mayaffect speech development.Mid-Year Referrals: Absence of a clear process for handling mid-year referrals, leading to delays in service provision.Collaboration and Goal Setting{06}Teacher Collaboration: Limited processes to collaborate withteachers on setting and aligning speech therapy goals witheducational outcomes.Linking Speech Goals to Outcomes: Lack of established proceduresto connect speech therapy goals with overall student educationalobjectives.Data Collection and Tracking{07}Objective Data Collection: Insufficient knowledge about effectivedata collection and documentation practices to monitor studentprogress.Tracking Organization: Need for development of a systematicapproach to organize data and track goal achievement over time.Family and Community Involvement{08}Parent Engagement: Limited involvement of parents in the therapyprocess, which is crucial for reinforcing skills at home.Lack of Psychological Support: Need for psychological support toaddress cognitive assessment, attention, and behavioral issues thatmay impact communication.Institutional Challenges{09}High Student Attrition Rates: Frequent turnover of students due toinaccessibility and lack of transportation affects program stabilityand continuity of care.Professional Turnover: High turnover rates for professionals(teachers, school administrators) can disrupt service delivery andimpact program effectiveness.The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 25

On 1/12/23 Daniel was observed by a TAG volunteer licensed speech pathologist:CASE STUDYMarch 2023-July 2024Daniel Kamau13 year old male Exposed to English and his native language inthe homeDown Syndrome Characterized as a happy teen who enjoys thetrampoline, and enjoys watching soccer andcartoonsUses sound vocalizations and gestures toexpress feelings, wants, and needsPositive relationships with family and friends,and is primarily understood best by his cousins“Daniel was able to attend to a beading activity with this clinician. He was able torespond to simple directions (i.e. come here, sit down, all done, throw it in thetrash, can I have a hug). He was also able to identify some vocabulary by nounand function (which one do you eat?). He did not respond to “tell me your name”.When asked, “does the cow say oink or moo”; he was able to repeat, “moo”. Thatwas the only verbal approximation word observed in 30 minutes. He does notknow all of his colors. Daniel responds to his name and engages with picturebooks, pictures, and activities.” The photos used in the case studies do not depict the actual students mentioned.One 60-min speech therapy session/weekThe TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 26

Speech Goals: By August 2024, Daniel will be able toincrease vocabulary by being able toidentify 5 words from the followingcategories: colors, body parts, classroomitems, home items, and food with 60%accuracy in 4 out of 5 sessions. By August 2024, Daniel will be able toincrease vocabulary by communicating 5requests (i.e. bathroom, food, greetings,requests) by using multimodalcommunication (sign, pictures, words,word approximations) with 80% accuracyin 4 out of 5 sessions. Goal #1: Goal #2: Daniel received speech therapy from March 2023 - August 2024Speech Goal 1: Daniel is able to:Identify body parts with 80% accuracywith minimum prompts. Daniel is ableto identify body part functions with 40%accuracy provided moderate prompts. Identify colors with 100% accuracyprovided a field of 3. Identify classroom objects with 100%accuracy from the 0% accuracy baseline. Speech Goal 2: Daniel is able to: Imitate word approximations such as “hee”for head, “ees” for ears, and “ss” for eyes. Expand oral motor movements and exercisesfor him to be aware of his articulators(mouth, tongue). Since Daniel has lower tonewith his tongue muscle it impedes hisintelligibility when forming words. Daniel’sbaseline was 10% accuracy of speechintelligibility and has progressed with 40%accuracy of speech intelligibility. Imitate some signsMake requests (i.e. using the bathroom)verbally and with gestures with 60%accuracy.Verbally states the names of pictures with82% accuracy ( categories include: bodyparts 100%, classroom items 100%, colors42%, home items 70%, foods 100%). By August 2024, Daniel madeprogress in the following areas:The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 27

David has difficulty with turn taking, socializing with peers, and initiatingactivities with peers and maintaining it. He also has difficulty with identifyingbody parts and colors. He has minimal verbal communication. David is able tovocalize some words when he is alone. He uses gestures and facialexpressions to express himself. David reportedly hums when he is upset. Heunderstands instruction when talked to and exhibits a delay in responding tofollow directions.”CASE STUDYDavid Kioko16 year old male Diagnosed with Cleft Palate, Physical Disability,and Autism Spectrum Disorder. Friendly and sociable with children he is familiarwith. Enjoys playing with objects with wheels and gamesthat involve throwing balls. Lives at home with his parents, three siblings, and Exposed to English, Swahili, and their nativelanguage. Born premature at 35 weeks Delayed in certain development milestones such assitting, walking, and speaking. On 1/12/23 David was observed by a TAG volunteer licensed speech pathologist:The photos used in the case studies do not depict the actual students mentioned.One 60-min speech therapysession/weekThe TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 28

By August 2024, David made progress in the following areas:Goal 1: David is able to: Identify colors with 75% accuracy in a field of 3. Identify body parts with 60% accuracy in a field of 3. Identify classroom items with 67% accuracy in a field of 3. Identify home items with 100% accuracy in a field of 3.Goal 2: David is able to: Reply “hi” and “bye” without prompting. Put his hands together to indicate that he has to go to the bathroom.Imitating with increasing independence. For example, he is able to voice 'nana' forbanana after 2 prompts and ‘apple’ after three prompts. David’s speech goals wereformed as follows: By August 2024, David will be able toincrease vocabulary by being able toidentify 5 words from the followingcategories: colors, body parts, classroomitems, home items, and food with 60%accuracy in 4 out of 5 sessions.By August 2024, David will be able toincrease vocabulary by communicating 5requests (i.e. bathroom, food, greetings,requests) by using multimodalcommunication (sign, pictures, words,word approximations) with 80% accuracyin 4 out of 5 sessions.Goal #1:Goal #2: The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 29

Israel presents with delays in receptive and expressive language, socialcommunication, and speech sound articulation compared to same aged peers.Deficits in receptive language include following multi-step directions,answering wh-questions, understanding inferences, concept relationships andmemory recall. Expressive language deficits include answering yes/noquestions, forming sentences, using pronouns and describing vocabulary.Social communication deficits include playing well with others, making andkeeping friends, initiating greetings and farewells, and turn taking inconversations. Speech sound articulation deficits vary, however /p/ and /b/ inall word positions was noted as important.”CASE STUDYIsrael Fadhili8 year old male Diagnosed with Autism Can complete Activities of Daily living (ADLs)independently Characterized as happy, friendly, energetic andjovialEnjoys playing football, blowing balloons, riding hisbike, and playing with animals. Exposed to English and native language in the homeMother experienced preeclampsia at childbirthOn 1/12/23 Israel was observed by a TAG volunteer licensed speech pathologist:The photos used in the case studies do not depict the actual students mentionedOne 60-min speech therapysession/weekThe TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 30

Israel’s speech goals were formed as follows:By August 2024, Israel will answer yes or no answers correctly with minimal cues at75% accuracy.By August 2024, Israel will increase his vocabulary by identifying colors, shapes, bodyparts, and foods at 60% accuracy.Goal #1:Goal #2: By August 2024, Israel made progress in the following areas:Goal 1: Israel is able to:Answer yes/ no questions with 50% accuracy. Label colors and fruits. Goal 2: Israel is able to:Identify colors and classroom items with 100% accuracy.Identify home items with 83% accuracy.Notes: Israel is very active and exhibits disruptive behaviors during sessions that impact his progressoutcomes. In addition, Israel was moved into a different classroom setting and is reported to have increasedevents of echolalia. Progress may be impacted by short attention span and impulsive behavior. Goals willbe updated and added, as well as behavior interventions and strategies to support productive sessions. The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 31

Leonard is able to respond to noises, sounds, and his name being called. He isable to identify body parts, and follow directions. He is not able to recallinformation of increasing length and complexity without multiple redirectionsbeing given. He does not know how to independently reference a readingpassage to answer concrete and abstract questions. He has the biggestdifficulty with comprehension as he doesn’t know how to read a sentence.When reading a sentence, he reads one word at a time, and not forcomprehension. Per teacher report, he is shy and not sure of how to make hiswords come out. He also speaks with a very low volume. Per teacher report,this is possibly contributed to him not being sure of himself. CASE STUDYLeonard OmandiLeonard, 19Enjoys music, playing card games, and assistingwith chores such as cleaning utensils Plays pianoFavorite subject is Math Understands basic concepts, prepositions Comprehends facial expression and bodylanguageResponds to simple directions and questionsUnderstands humor and sarcasm On 1/12/23 Leonard was observed by a TAG volunteer licensed speech pathologist:The photos used in the case studies do not depict the actual students mentionedOne 60-min speech therapysession/weekThe TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 32

Leonard displays the following challenges:Give eye contact or look at the speakers face when being spoken to. He does not play well with other children as he often times plays by himself. He reportedly doesn’t have friends and prefers to work on tasks independently. difficulty making and keeping friends. He does not initiate greetings or take turns inconversation. Leonard will verbalize, “bye” when leaving. You have to initiate and hewill respond with 1 word. Leonard exhibits difficulty with expressive language. He will imitate, but will rarely speakspontaneously. He does not ask questions, uses limited vocabulary, doesn’t usepronouns, or initiate conversations. Per parent report, at home Leonard initiatesconversation. He is also not able to put language together in a logical order to retellinformation. Leonard will imitate. He will not raise his hands to get help and he does notlike to be corrected.By August 2024, Leonard will retell information. By August 2024, Leonard will be able to use proper volume when communicatingwith peers or staff using minimum visual cues with 80% accuracy. Goal #1:Goal #2: Leonard has made progress in the following areas:Goal 1: Leonard is able to:Increase volume for the initial trial, however reverts to a whisper or becomesinaudible Leonard’s progress is inconsistent Exhibits tension in the jaw by speaking with a clenched jaw. Future goals should target speech sound awareness Further assessment is needed to rule out a physical obstruction of jaw movement. Goal 2: This goal was not attempted during this period. Leonard’s speech goals were formed as follows:The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 33

Joy is a kind individual who enjoys working independently. Joy responds to hername inconsistently and provides fleeting eye contact. She follows single step (e.gclose the door), and multi-step directives (e.g touch your nose, then touch your ears)inconsistently. She is able to identify common nouns, verbs, and emotions in a fieldof two by pointing (e.g. hungry, mad, bread, cake). She uses gestures (e.g. pointing).She uses echolalia - she repeats sentences up to 5 words or the last 2 words. Shehas difficulty answering yes/no questions and wh-questions. She answers basicquestions (e.g. hello, how are you, what's your name, what's your age) correctly(e.g. “my name is Joy”, “I am 9-10 years old”). When prompted, she named numbersand letters and some nouns. She responded “I am 9 years old” to some wh-questions (e.g. What day is it?”). According to her classroom teacher, Joy does notplay well with others, she prefers to work alone on tasks, she has difficulty makingand keeping friends, and she does not take turns in conversation.CASE STUDYJoy Bena11yrs, female Exposed to English and Swahili in the home Diagnosed with Autism, Attention DeficitHyperactvivity Disorder, and delayed speech Characterized as happy but withdrawn Lives with her mother, father, brother, andcaregiver Has previous history receiving occupationaland speech therapy services A TAG volunteer licensed speech pathologist observed Joy on 1/12/23 and thefollowing was noted on her Student Education Plan:One 60-min speech therapysession/weekThe TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 34The photos used in the case studies do not depict the actual students mentioned.

Expressive language: By August 2024, during structured language activities, Joy willformulate 3-word phrases to label (e.g. “it’s a ____”) common nouns in 80% ofopportunities provided with moderate verbal and visual support across 3 sessions. Goal #1:Joy made progress in the following areas: Goal 1: Joy is able to: Formulate 3 word phrases with 67% accuracy with moderate prompts.She is not yet responding using 3 word phrases consistently. Joy continues to exhibit echolalia. Goal #2: Expressive/Receptive: By August 2024, during structured language activities,Joy willanswer yes/no questions to label (e.g. is this a ___?), or answer a personal question(e.g. are you hungry?) in 80% of opportunities provided with moderate verbal andvisual support across 3 sessions. Goal #3: Pragmatic language: By August 2024, Joy will interact with peers in an appropriatemanner through maintaining personal space, seeking attention appropriately wheninterrupting/asking students to play (e.g. “excuse me”) with 60% accuracy givenminimal verbal reminders from the teacher/therapist over 3 consecutive therapysessions.Goal 2: Joy is able to: Answer yes/no questions with as high as 75% accuracy. However, her progress isinconsistent.Exhibits a preference for yes responses.Goal 3: Joy is able to: Engage in brief exchanges with the SLP aide such as answering the question, e.g.: “What did you have for breakfast?” Joy continues to prefer to play alone. She is prompted on ‘how’ to interact with peers.Joy’s speech goals were formed as follows:The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 35

Reflection, Modifications, and FuturePlanningThe TAG Telehealth Program was initiated in 2023 with the goal of providing speechand language services to children at Almasi School. The first year presented challengesas we launched services with a therapy aide supported by a United States Speech-Language Pathologist (SLP). Due to the time zone difference, direct telehealth serviceswere not feasible. However, the program has evolved over the year, and we have gainedvaluable insights.Monthly collaborations with Almasi leadershipand weekly communications with the therapyaide allowed us to stay informed about theschool’s current needs, including new studentconcerns, as well as the progress of both thestudents and the program. These interactionswere crucial in ensuring the program'seffectiveness. We also conducted Zoom meetingswith the therapy aide for mentoring, training, andsupport, and provided materials and lessons tobe implemented in a pull-out model.While we made significant progress with theavailable staff and resources, it became evidentthat additional support was necessary to achievethe program's envisioned success. Some criticalneeds identified include:Culturally Relevant Materials: Increasingaccess to culturally appropriate books andresources at the host site.Language-Rich Environment: Creating anenvironment that promotes languagelearning to help students practice andgeneralize their skills effectively.Improved Collaboration: Enhancingcollaboration among school personnel andteachers to ensure that speech services alignwith overall educational outcomes.The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 36

Push-in/Pull-out Model: Implementing a literacy-based push-in/pull-out model thatprovides in-class support and modeling for classroom teachers.Retention Strategies: Developing strategies to retain both staff and students toensure consistency in service delivery.Parent Involvement: Finding ways to engage parents in therapy outcomes, especiallyduring school breaks.Assessment Process Improvement: Enhancing our current screening andassessment processes to account for the multiple languages spoken by students athome, in addition to English.Service Delivery Model: Creating a speech service delivery model thataccommodates students based on severity and comorbidity of their needs.Professional Development: Offering a variety of professional development tools,training, and mentoring to enhance the therapy aide's knowledge base.Referral Process: Developing a streamlined referral process for mid-year referralsand addressing health/physical concerns, including vision, hearing, and dental issues.Funding Acquisition: Seeking additional funding to support in-person services,staffing needs, and resource acquisition.By addressing these areas, we aim to improve the effectiveness of the TAG TelehealthProgram and ultimately enhance student outcomes.The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 37

Annual Cost Program FundingTAG Travel/ 5 Professionals$17,500U.S Based Speech Pathologist Supervisor$8,000Nairobi Based Therapy Aid$4,000Resources & Therapy Materials$3,500Marketing/Videographer/Social Media, etc$4,000Operations (Email, Video Conference Software)$1,000Total:$38,000The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 38

Here are several ways companies and individuals can support the TAG CaresTelehealth Program:Ways to Support Travel & GIVE1. FINANCIAL CONTRIBUTIONSDirect Donations: Individuals and companies canmake one-time or recurring financial contributionsto support program expenses, such as hiringqualified staff, acquiring resources, and providingtherapy materials.Sponsorships: Businesses can sponsor specificinitiatives within the program, such asprofessional development workshops or resourceacquisition, helping to cover associated costs.2. IN-KIND DONATIONSTherapy Materials: Companies can donate therapy supplies, books, audiobooks, andculturally relevant educational materials that support speech and language development.Technology Support: Donations of technology, such as tablets, computers, or softwarefor telehealth services, can enhance the program's effectiveness.3. VOLUNTEER SUPPORTSkill-Based Volunteering: Professionals withexpertise in speech-language pathology,education, or mental health can volunteer theirtime to provide training, mentoring, and support tolocal staff and therapy aides.Fundraising Events: Individuals and groups canorganize fundraising events (e.g., charity runs,auctions, or benefit concerts) to raise awarenessand funds for the program.The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 39

4. AWARENESS AND ADVOCACYSocial Media Campaigns: Individuals and organizations can leverage social mediaplatforms to raise awareness about the program and its impact, encouraging others toget involved.Community Engagement: Companies can promote the program within their networks,encouraging employees and customers to support the initiative.5. PROFESSIONALDEVELOPMENT AND TRAININGWorkshops and Seminars: Organizations with expertise in educationor special needs can offer workshops orseminars to enhance the skills andknowledge of local staff and volunteers.Mentorship Programs: Establish mentorship opportunities whereexperienced professionals guide andsupport the development of local therapyaides and educators.6. PARTNERSHIPS AND COLLABORATIONSCorporate Partnerships: Companies can form partnershipswith TAG to align their corporate social responsibility (CSR)initiatives with the program’s goals.Educational Institutions: Universities and colleges cancollaborate by providing student interns or volunteers tosupport the program while gaining practical experience.The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 40

7. RESOURCE SHARINGNetworking Opportunities: Facilitateconnections between TAG Cares andother organizations that can provideadditional resources or support, such ashealth services, educational tools, orcommunity programs.Access to Facilities: Companies can offertheir facilities for training sessions,workshops, or events related to theprogram.8. RESEARCH ANDDEVELOPMENT SUPPORTGrant Writing: Organizations withexperience in grant writing can assistin identifying and applying for fundingopportunities that support telehealthand special education initiatives.Program Evaluation: Companiesspecializing in program evaluation canoffer their expertise to assess theeffectiveness of the telehealthprogram and suggest improvements.By engaging in these various ways, companies and individuals can make a meaningfulimpact on the TAG Cares Telehealth Program and help improve access to therapeuticservices for children with disabilities in Kenya.Donate at www.travelandgive.orgThank youCopyright Travel & GIVE 2024The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 41

RESOURCESElder, B. C., Damiani, M. L., & Oswago, B. O. (2016). From attitudes to practice:Utilising inclusive teaching strategies in Kenyan primary schools. InternationalJournal of Inclusive Education, 20(4), 413-434. Republic of Kenya, Ministry of Education. (2020). Basic education statistical booklet.https://africacheck.org/sites/default/files/Kenya-Basic-Education-Statistical-Booklet-2020.pdfKiru, E. W. (2018). Special education in Kenya. Sage Journals, 54(3),https://journals.sagepub.com/doi/10.1177/1053451218767919 This report is the property of Travel & GIVE. Unauthorized use, distribution, orreproduction is strictly prohibited.© 2024 Travel & GIVE. All rights reserved.The TAG Cares Telehealth Services Initiative and Pilot Program Review Pg 42

Visit our website www.travelandgive.orgContact us: Team@travelandgive.orgTravel_Give Travel and GiveThe TAG Cares Telehealth Services Initiative and Pilot Program ReviewDonate: www.travelandgive.org/donate