Augmentative Communication 603

The role of the communication partner in augmentative and alternative communication (AAC)

JOAN MURPHY, IVANA MARKOVA, SARAH COLLINS, FIONA McCALL and ELEANOR MOODIE University of Stirling, UK.

ABSTRACT Comunication is a cooperatiue undertaking a n d t h e successful use of augmenta t ive a n d alternatiue communication (AAC) systems is as dependen t o n t h e communication pa r tne r as it is o n t h e user. This pape r presents findings f rom a two-year research study, funded by the Scottish Office H o m e a n d Heal th Depart- ment , which examined the communication of 93 adolescent a n d adu l t A A C users with cerebral palsy (CP) a n d 186 of their communication partners. This p a p e r fo- cuses o n fou r issues relating to t h e role of the communication partner: range of communica t ion par tners , communication par tners ' knowledge of A A C systems, training of communication partners, coordination between speech a n d language therapists a n d o the r communication partners.

BACKGROUND

Communication is a cooperatiue undertaking and the successful use of AAC systems* is as dependent on the communication partner as it is on the user. (Murphy et a1.,1996)**

This paper presents findings from a two-year research study, funded by the Scottish Office Home and Health Department, which examined the communication of 93 adolescent and adult AAC users with cerebral palsy (CP) and 186 of their communica- tion partners. This paper focuses on four issues relating to the role of the communica- tion partner: range of communication partners, communication partners' knowledge of AAC systems, training of communication partners, coordination between speech and language therapists and other communication partners.

METHODS

For each AAC user, two speaking partners were selected:

'In this paper the term 'AAC system' refers to communication equipment, both high-technology and IowAight-technology. ' T h e role of the communication partner and other issues related to the use of AAC systems are discussed in more detail in Murphy et a1 (1996).

604 Caring to Communicate

The researchers identified a formal communication partner who was the person with main responsibility for training the AAC user in the use of their AAC sys- tem. The AAC users were each asked to select an informal communication partner, as someone seen on an ‘everyday’ basis and with whom they felt comfortable.

The methods of data collection were questionnaires, interviews and fieldnotes. The data for this paper were analysed by use of cognitive mapping (see Jones, 1985).

RESULTS

Figure 1 is a summary ‘map’ of the results:

SLT - 90% Paid staff - 89% Frienddfamily - 11%

Not well - 44%

Key worker Teacher

Communication

Not well - >50%

Self-taught Operation

Need for implementation

Not enough Need for

more sharing

Lack of success Staff turnover

FIGURE 1: ‘Map’ of the results of the study.

Range of communication partners Formal partners were principally speech and language therapists (89.9%), but also included key workers and teachers. Although the AAC users were asked to select peo- ple with whom they were familiar and felt comfortable, the informal partners were mainly day and residential staff with only 11% being family or friends.

Augmentatioe Communication 605

care staff (61.8%) teachers (10.1 YO)

FIGURE 2: Roles of informal partners

These results indicate that many people with severe communication disabilities spend a lot of their time communicating with people who are paid to care for them. Conse- quently, the range of social contacts and the types of communication opportunities available to AAC users are more limited than those available to natural speakers.

Communication partners' knowledge of AAC systems The questionnaire investigated communication partners' knowledge of the respective AAC systems. They were asked to indicate whether they felt that they knew the AAC system for their particular client 'very well', 'moderately well' or 'not well'.

i i

80 -

70 -

90 -c

30

20

10

0 very well mod. well

a not well 1 missing

FIGURE 3: Partners' knowledge of AAC systems.

606 Caring to Communicate

The results indicate that only two-thirds of the formal partners - those responsible for ‘teaching’ the AAC system - felt that they knew the system ‘very well’ and more than half of the informal partners thought that they did not know the AAC system used by the AAC user ‘very well’. This lack of knowledge and corresponding lack of confi- dence was evident in comments from field notes such as:

The staff are afraid of technology (speech and language therapist)

There is a danger that where the communication partner does not have a good knowledge of the AAC system, the AAC user will not have the support required which may ultimately lead to abandonment of the AAC system.

Training of communication partners Participants were asked about the training they had received specifically in relation to the AAC system for their particular AAC user.

100 ;

70 -

90 80

60 - 50 - 40 30 -

V ’

formal self-taught both none I

FIGURE 4: Specific training.

For most partners, training had been self-taught. Moreover, the organised training which did exist focused primarily on operational aspects of AAC and not on its func- tional use. The need for training in communication awareness was also stressed with emphasis on AAC users being more involved in training others. In addition there was a desire for joint training where speech and language therapists and care staff would share their skills. The following comment illustrates the frustration experienced by some speech and language therapists at their attempts to organise training for care staff:

We try to run training sessions but we don’t have much success - there’s such a high turnover of staff (speech and language therapist)

In contrast, informal partners indicated that they were not always aware of training possibilities:

1 did not know there was a n y sort of training available (member of care staff)

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Coordination between speech and language therapists and other communication partners There was evidence of a lack of coordination between formal and informal partners with poor exchange of knowledge about both the AAC user and the AAC system. Therapists complained that day centre and residential staff did not see communication as an important aspect of their job:

The staff th ink they’re only there for his physical needs (speech and language therapist)

This comment from one informal partner illustrates the attitude of some members of care staff:

We don’t use it [communication aid] - we know what he wants anyway (member of care staff)

However, other informal partners complained that therapists did not link with them enough.

IMPLICATIONS

The following implications have relevance not only for AAC but also for other areas of speech and language therapy:

People with communication difficulties need a range of social contacts and types of conversations in order to maximise their communication potential. Informal partners need to be aware of the communication methods used by people with severe communication difficulties in order to be able to support them. There is an urgent need for training, particularly in the areas of functional com- munication and awareness of communication issues. Success in the delivery of speech and language therapy depends largely on coop- eration between speech and language therapists and the significant others who are involved with people with communication difficulties.

REFERENCES

Jones S (1985). The analysis of in-depth interviews. In: R Walker (Ed.). Applied Qualitative Research. London: Gower Publishing. Murphy J, Markova I , Collins S, Moodie E (1996). AAC systems: obstacles to effective use. European Jour- nal of Disorders of Communication 31, 31-44.