Practical Team Working: AAC Assessment and Intervention

Julie Atkinson

SLT

Access to Communication & Technology

Introducing ACT

• West Midlands Regional NHS Tertiary Assistive Technology Service: all ages and conditions

• Mission statement:– To empower people with disabilities, using

techniques and technologies which optimize potential for communication and control

– Staff: OT, SLT, Clinical Scientists, Workshop team, Administrators

Contacting ACT

• Main phone number: 0121 466 3050• Referrals / Helpline: 0121 472 0754 (Mon, Wed, Fri)

• Website: http://www.bhamcommunity.nhs.uk/about-us/services-

directory/specialist-services/rehabilitation/services/act

• Email: julie.atkinson@bhamcommunity.nhs.uk • Address: ACT, West Midlands Rehabilitation

Centre, 91 Oak Tree Lane, Selly Oak, Birmingham, B29 6JA

West Midlands AAC Care Pathway

AAC Needs IdentifiedAAC Needs Identified

Multi Disciplinary TeamMulti Disciplinary Team

Co-ordinatorCo-ordinator

AAC IntroducedAAC Introduced

Review and ExitReview and Exit

Branch BOther agencies

Branch BOther agencies

Branch AA.C.T.

Branch AA.C.T.

Relevant sections in the West Midlands AAC Care Pathway Assessment & Implementation

documentation

• AAC environment sectionWhat are the skills and needs of those around

the client for optimising communication?

• Communication sectionWhat are the person’s present modes of

communication & how effective are they? Rate the different environments the client

attends.

• Co-ordinator’s checklistIs there a shared understanding of the needs

and purpose of AAC?

Specialised AAC provision Commissioning national services  Office of the Communication Champion and Council

November 2011 Page 46

Some local services include specialist AAC services. Otherwise regional and national specialist AAC teams sit within the NHS and voluntary sector.

For example teachers, teaching assistants, occupational therapists, social workers, employment support and care workers, etc.

“The future of AAC services in England – A framework for equitable and effective commissioning”

the findings of DfE funded AAC grants 2012-13 http://www.communicationmatters.org.uk/dfe-aac-grants-findings

ACT Team Members

• Client• Parent / spouse / child / other family member / friend• (ACT)• Local SLT & SLTA• Local OT / Physiotherapist• Education: Teacher / Learning Support Assistant / IT co-ordinator / College

Lecturer / SENCO• Day Centre Keyworker• Nursing Keyworker• Case Manager / Social Worker• Other Specialists e.g. Teacher for Visual Impairment, Psychologist,

Consultant• AAC Suppliers• Peers• CO-ORDINATOR IS ESSENTIAL

Creating an AAC Team

Augmentative & Alternative Communication:The Role of the AAC Team

http://www.handyhandouts.com

“It takes a team of specialists and educators to put a communication system in place as well as to learn how to program and implement”

“To facilitate, educate and encourage use of the device throughout the day”

• SLT – language acquisition, interaction with partners, AAC assessment, knowledge of devices, implementation

• OT – muscle control, mobility, seating

• Physio – muscle strength & control, Range of Movement

• Teacher – curriculum & vocabulary identification, basic operations of device

• Parents – current communication skills & needs

• Peers

“Functional AAC Intervention: A Team Approach” Cottier, Doyle & Gilworth (1997)

The AAC Intervention Team• “Providing and encouraging opportunities for student

participation • Reinforcing the use of the AAC system• Encouraging peer interaction• Working on educational goals”

SLT Cottier, Doyle & Gilworth (1997)

– “Evaluating and recommending AAC– Managing vocab selection– Providing initial AAC training (for user)– Troubleshooting complex problems with the system– Collaborating with teachers on strategies to promote

inclusion; also curriculum adaptation– Training instructional assistants [LSAs] and teachers in

AAC– Periodically evaluating the effectiveness of the system– Evaluating and remediating any accompanying language

deficits which interfere with system use”

Assistive Technology Specialist (IT Manager?) Cottier, Doyle & Gilworth (1997)

• “Setting up and maintaining computers used in the educational program

• Providing teachers with computer hardware and software adaptations to help students with disabilities meet their educational goals

• [Informing] teachers, students and parents about computer adaptations and software programs

• Teaching students to use hardware adaptations and software programs

• Understanding how different assistive devices may increase independence and enhance function (e.g. EC)”

Teacher Cottier, Doyle & Gilworth (1997)

• “Helping the SLT select vocab for system• Teaching and adapting curriculum for students• Collaborating with the SLT on strategies to promote inclusion• Creating communication opportunities• Providing SLT with feedback on the utility and benefits of

AAC systems”

OT and Physiotherapist Cottier, Doyle & Gilworth (1997)

OT• “Evaluating motor control, visual acuity and perception• Evaluating wheelchair seating, positioning and mobility (also

Physio)• Providing mobility instruction (also Physio)• Determining optimal physical access to AAC (e.g. direct access,

scanning with 1/2 switches)• Providing functional activities to improve motor control and switch

access (e.g. Single switch toys, computer games)• Determining students’ needs for any adaptive equipment to

improve independence and function (e.g. trays)”• Physio – “Helping the OT and AAC Specialist determine optimal

physical access for students”

LSA / TA (or Rehab Assistant, Day Centre staff?) Cottier, Doyle & Gilworth (1997)

• “Providing device instruction• Helping the student maintain the device• Collaborating with the teacher and SLT on strategies to facilitate

participation and instruction in the classroom• Selecting vocab• Preparing low tech• Providing opportunities to practice retrieving vocab or messages through

structured activities• Providing opportunities for practice in various classroom contexts• Working with students on the use of appropriate pragmatics or social skills• Encouraging students to use the most efficient communication method for

the situation• Maintaining a notebook e.g. instructions for use / programming, device

performance, vocab suggestions”

Students (people who use AAC) Cottier, Doyle & Gilworth (1997)

• “Learning how to use the AAC device• Initiating the use of the device for communication

and academic purposes• Devoting time to learning AAC strategies• Helping maintain the device• Using a variety of communication methods to

indicate needs, ideas and preferences• Being an advocate by letting team members know

when the equipment is not working or is not meeting needs (e.g. vocab)”

Family members Cottier, Doyle & Gilworth (1997)

• “Participating in the AAC evaluation process: specifically indicating where & with whom AAC is needed and describing success with previous communication devices or modalities

• Helping with AAC trials and providing input re: the most appropriate system

• Helping with vocab selection• Helping provide AAC device instruction• Encouraging their child or a sibling to use the AAC system• Maintaining and troubleshooting the AAC device• Providing team members with feedback on the use of the

system at home and in the community”

Characteristics of effective teams Cottier, Doyle & Gilworth (1997)

• “Designate a team leader

• Recognise differences in goals

• Understand the primary goal of increasing the student’s participation...while the student is learning the curriculum

• Come to a consensus on academic and communication goals

• Are sensitive to and appreciate the needs of other team members and collaborate with one another

• Are flexible and open to modifying techniques or strategies that are ineffective

• Are able to evaluate themselves honestly

• Can determine strategies to facilitate the student’s success

• Show respect for the student’s and family’s preferences and decisions

• Are accountable for reaching desired outcomes”

Rocky Bay resources

Suggestions for Team Communication

• Be aware that change can be threatening, and is an ongoing process• Start simple / identify any ‘quick wins’• Collaborate with everyone and try to put yourself in their shoes to

understand any concerns• Is it feasible to set up a communication team?• Joint assessment • How do you cascade information?

– Within the team– To others

• What training does the team need? (Cottier et al page 18 - 21)• What training can the team provide to others? • How can you promote AAC use?• Consider clients’ changing needs• Agree goals

Goal setting

• Means, Reasons, Opportunities• SETT (Student, Environment, Tasks, Tools)• “Functional AAC Intervention: A Team Approach”

Cottier, Doyle & Gilworth (1997)

• Light’s Competencies• AAC Matrix • Rocky Bay resources

Means, Reasons, Opportunities http://www.nottinghamcity.gov.uk/CHttpHandler.ashx?id=2215&p=0

Team working

AAC system(s) Environment

Communication Partners

SETThttp://www2.edc.org/NCIP/workshops/sett/SETT_Framework_article.html

– Student : abilities and needs– Environment: physical; resources – materials,

equipment and people etc– Tasks: what activities do the client (or their peers)

participate in; how can technology support participation in these activities?

– Tools: what strategies or systems could be introduced to assist the student participate in the activity?

Functional AAC InterventionA Team Approach

Cottier, Doyle & Gilworth (1997)

• Develop an AAC intervention plan (page 10)

• Strategies for Changing the [Classroom] Environment

Activity / duty Date Person responsible

Frequency Comments Follow-up date

Identify vocab for science topic

2/5/13 Teacher with SLT support

Every half term

Program on vocab for science topic

5/5/13 LSA Every half term

Dependent upon teacher

Situation Problem Identified

Date Solution Person Responsible

Completion date

Lunchtime VOCA removed so unable to communicate verbally

1/5/13 Create communication placemat

SLTA

Light’s Competencies

• Communicative Competence is the ability to communicate functionally in the natural environment and to adequately meet daily communication needs” (Light, 1989)

• Light defined 4 competencies: • Linguistic • Operational• Social• Strategic

Competence ChecklistsCottier, Doyle and Gilworth (1997)

Skill Date Date Date Date Date

Linguistic Competencee.g. Able to choose desired food item on food page

Operational Competencee.g. Rests device on counter top when ordering food

Strategic Competencee.g. Informs cafe staff that he is using a VOCA and it may take a minute to order his food

Social Competencee.g. Uses “Please” and “Thank you” when requesting food

Skills Goal SheetCottier, Doyle & Gilworth (1997)

Skill Area / Goal Instructional Method / Technique

Team Member Responsible

Date Completed

Linguistic Competencee.g. Able to choose item of food from selection on page

Copies modelMake choice during role play SLT

LSA

Operational Competencee.g. Charges the battery daily

Copies modelVerbal prompt

MumMum

Strategic Competencee.g. Able to repeat message if not understood

Repeats message when promptedMinimal tactile prompt

SLT

SLT

Social Competencee.g. Says “Please” when ordering food

Follows modelRole playPrompted

SLTLSAMum

http://doe.k12.hi.us/specialeducation/assistivetechnology/Resource%20Materials/

AAC_Handbook.pdf

Ro

References & Resources

• http://www.asha.org/NJC/faqs-interdisciplinary.htm (Interdisciplinary team working American Speech-Language Hearing Association)

• http://doe.k12.hi.us/specialeducation/assistivetechnology/Resource%20Materials/AAC_Handbook.pdf (AAC Matrix)

• http://aac.unl.edu/yaack/c1.html#top (AAC Connecting Young Kids)• http://www.bhamcommunity.nhs.uk/about-us/services-directory/specialist-services/rehabilitation/services/act

(ACT website)• http://www.nottinghamcity.gov.uk/CHttpHandler.ashx?id=2215&p=0 (Means Reasons Opportunities) • http://www.rockybay.org.au/go/services/clinical-services-directorate/resources/information-kit-for-aac-teams

(Rocky Bay AAC team - nice handouts on team working and goals with focus on family-centred approach)• http://www.communicationmatters.org.uk/sites/default/files/downloads/standards/

aac_services_standard_aug_2012.pdf (Communication Matters AAC Services Quality Standards)• http://www2.edc.org/NCIP/workshops/sett/SETT_Framework_article.html (Students, Environment, Tasks, Tools)

• Cottier, Cynthia; Doyle, Molly & Gilworth, Kimberley (1997) “Functional AAC Intervention: A Team Approach” Imaginart

• Glennen, Sharon L & DeCoste, Denise C (1997) “The Handbook of Augmentative & Alternative Communication” • Light, Janice (1989) “Toward a definition of communicative competence for individuals using Augmentative &

Alternative Communication” Augmentative & Alternative Communication Vol 5 No 2: 137-144 • “Specialised AAC provision Commissioning national services “ (November 2011) Office of the Communication

Champion and Council

Contacting ACT

• Main phone number: 0121 466 3050• Referrals / Helpline: 0121 472 0754 (Mon, Wed, Fri)

• Website: http://www.bhamcommunity.nhs.uk/about-us/services-

directory/specialist-services/rehabilitation/services/act

• Email: julie.atkinson@bhamcommunity.nhs.uk • Address: ACT, West Midlands Rehabilitation

Centre, 91 Oak Tree Lane, Selly Oak, Birmingham, B29 6JA