Practical Team Working AAC Assessment and Intervention Julie

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/servicesdirectory/specialist-services/rehabilitation/services/act • Email: julie. atkinson@bhamcommunity. nhs. uk • Address: ACT, West Midlands Rehabilitation Centre, 91 Oak Tree Lane, Selly Oak, Birmingham, B 29 6 JA

West Midlands AAC Care Pathway AAC Needs Identified Multi Disciplinary Team Co-ordinator Branch B Other agencies Branch A A. C. T. AAC Introduced Review and Exit

Relevant sections in the West Midlands AAC Care Pathway Assessment & Implementation documentation • AAC environment section What are the skills and needs of those around the client for optimising communication? • Communication section What are the person’s present modes of communication & how effective are they? Rate the different environments the client attends. • Co-ordinator’s checklist Is 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 For example teachers, teaching assistants, occupational therapists, social workers, employment support and care workers, etc. Some local services include specialist AAC services. Otherwise regional and national specialist AAC teams sit within the NHS and voluntary sector.

“The future of AAC services in England – A framework for equitable and effective commissioning” the findings of Df. E 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/CHttp. Handler. ashx? id=2215&p=0

Team working AAC system(s) Environment Communication Partners

SETT http: //www 2. 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 Intervention A Team Approach Cottier, Doyle & Gilworth (1997) • Develop an AAC intervention plan (page 10) Activity / duty Date Person responsible Frequency Identify vocab for 2/5/13 Teacher with science topic SLT support Every half term Program on 5/5/13 LSA vocab for science topic Every half term Comments Follow-up date Dependent upon teacher • Strategies for Changing the [Classroom] Environment Situation Problem Identified Date Lunchtime VOCA removed so 1/5/13 unable to communicate verbally Solution Person Responsible Create communication placemat SLTA Completion date

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 Checklists Cottier, Doyle and Gilworth (1997) Skill Linguistic Competence e. g. Able to choose desired food item on food page Operational Competence e. g. Rests device on counter top when ordering food Strategic Competence e. g. Informs cafe staff that he is using a VOCA and it may take a minute to order his food Social Competence e. g. Uses “Please” and “Thank you” when requesting food Date Date

Skills Goal Sheet Cottier, Doyle & Gilworth (1997) Skill Area / Goal Linguistic Competence e. g. Able to choose item of food from selection on page Instructional Method / Technique Copies model Make choice during role play Team Member Date Responsible Completed SLT LSA Operational Competence e. g. Charges the battery daily Copies model Verbal prompt Mum Strategic Competence e. g. Able to repeat message if not understood Repeats message when prompted Minimal tactile prompt SLT Social Competence e. g. Says “Please” when Follows model SLT

http: //doe. k 12. hi. us/specialeducation/assistivetechnology /Resource%20 Materials/AAC_Handbook. pdf

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References & Resources • • • http: //www. asha. org/NJC/faqs-interdisciplinary. htm (Interdisciplinary team working American Speech. Language Hearing Association) http: //doe. k 12. hi. us/specialeducation/assistivetechnology/Resource%20 Materials/AAC_Handbook. pdf (AAC Matrix) http: //aac. unl. edu/yaack/c 1. 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/CHttp. Handler. 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: //www 2. 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 & De. Coste, 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/servicesdirectory/specialist-services/rehabilitation/services/act • Email: julie. atkinson@bhamcommunity. nhs. uk • Address: ACT, West Midlands Rehabilitation Centre, 91 Oak Tree Lane, Selly Oak, Birmingham, B 29 6 JA