Presentation on theme: "Emma J Harris, Sharon Ryder and Lisa Totten"— Presentation transcript:
1Emma J Harris, Sharon Ryder and Lisa Totten The Positive AACtion Kit: An evidence-based information package for parents, teachers and others supporting school-aged children to use AACEmma J Harris, Sharon Ryder and Lisa TottenSpeech PathologistsRocky Bay
2Outline Background All About AAC Working Together Selecting a Communication DeviceTrialing a Communication DeviceFunding for AACSupporting Communication Device Use
3What is AAC? Augmentative and Alternative Communication Assists people with complex communication needs (CCN) to be understood by othersUnaided methods (eg gesture, signs, facial expression)Aided methods:Low tech (eg alphabet or picture boards, communication books)High tech (eg speech generating devices-SGDs)First some background…Estimated 0.12% of population in Victoria have CCN (Bloomberg and Johnson, 1990)High tech uses electronics. SGD – voiceTotal communication – using a combination of AAC methods
4Reported Positive Outcomes Positive outcomes in some young children using a variety of AAC methods have been reported by caregivers and include:Improved communicationMore social opportunitiesImproved quality of lifeMore educational opportunitiesIncreased independence(Angelo, 2000; Bailey et al, 2006; reviewed in Light & Drager, 2007)
5AAC Device Return and Abandonment Estimated 75% of high-tech devices are abandoned by the people who use them (Stevens [Becta] 2006, as cited in Scope, 2007)Impact:Child may not have an effective means of communicationEffect of past negative experience (Pendergrass & Vestal, 2002)Costs (finance & otherwise)HOWEVER…Estimated 75% of high-tech devices are abandoned by the people who use them, due to the lack of available training and supportImpactPeople may be less likely to try againCosts to all involved – child, family, schools, therapy providers & funding bodiesCommonly available AAC devices range from approx. $200 - $15 000Hidden learning cost - as time spent learning AAC may reduce time available to learn other skills. Learning AAC device vs academic classroom learning (Beukelman (1991)
6Commonly Reported Supports and Barriers Ease of AAC device useTechnological barriers, egBreak downResultant frustrationEffective teaming and servicesIneffective teamingFamily involvementBelief user understood without deviceInadequate trainingA complex network of factors appear to be supports and barriers to AAC device use. Commonly reported supports include..Device breakdown barrier*Ford - 70% of devices reportedly broke down at least once*McNaughton and colleagues –breakdown of device reported to lead to temporary abandonment of device due to frustrationInadequate training barrier*Allaire and colleagues - only 67% of caregivers reported receiving training for their child’s SGD ____________________*McNaughton et al. n=7 internet focus group – parents had children ranging from 6 to 30 years of age.*Allaire et al n=18 SGD users who responded to this question. All other participants who did not use electronic AAC devices are not considered here. Ages of total 110 children supported by the caregivers ranged from 2 to 26 years of age.*Bailey interviewed n= 7 caregivers of children using AAC devices.*Johnson et al n=275 ASHA speech pathologists ranking top 5 barriers & supports*Lund & Light n=7 young men with CP who had been using AAC systems for at least 15 years. Also families & professionals associated.Sources: Ford, 2000 as cited in Scope, 2007; McNaughton et al, 2008; Allaire et al, 1991; Bailey et al, 2006; Johnson et al, 2006; Lund and Light, 2007.
7Supporting AAC Device Users Best practice includes:Working as a teamIntegration into everyday routinesProviding meaningful opportunities to use deviceTraining and supporting communication partnersOngoing device programmingProviding extensive and long-term support(Speech Pathology Australia, 2004; Pendergrass and Vestal, 2002)Now for a run down on some related literature and research in the field. Best practice in AAC includes:Working as a team with the AAC user and their communication partnersIntegrating assessment, training and practice into everyday routinesProviding meaningful opportunities to use deviceProviding training and support to communication partners*Ongoing device programming to meet changing needs*Providing extensive and long-term support as necessary
8Perspectives of WA Caregivers Qualitative interview of 12 Western Australian caregivers of school-aged children who had trialed or used SGDs (Totten and Ryder, 2009)To identify caregiver perceptions on:supports and barriers for positive outcomesroles and responsibilities of team membersIn order to add to the research and get a local perspective we aimed to…
9Considerations for Service Delivery AssessmentFamily centredAsk about and respect family valuesClear articulation of what’s involvedClearly negotiate roles and responsibilities with all stakeholdersShow families a range of devices(Totten and Ryder, 2009)*Family centred – include the family in the entire process.*Ask about and respect family values – because they may have an impact on outcomes.*Negotiate roles and responsibilities – because there was variance in caregiver opinions on who should be responsible for particular areas. The findings correlate with the findings of Soto & colleagues.*Show families a range of devices – because that’s what they want.
10Considerations for Service Delivery CollaborationSharing information – a responsibility for all stakeholdersRegular meetingsSharing how child uses SGD in different environmentsWorking towards common goals(Totten and Ryder, 2009)
11Developing the Positive AACtion Kit Goals:Increase knowledge about AAC systemsProvide information in choosing, trialling and/or supporting the use of a SGDPromote evidence-based strategiesEmphasise the importance of teamworkGoals:Increase knowledge about AAC systemsProvide information in choosing, trialling and/or supporting the use of a SGDPromote evidence-based strategies that maximise participation and educational outcomes across a range of environmentsEmphasise the importance of teamwork and how it relates to effectiveness of SGD use
12Developing the Positive AACtion Kit Received NGCS FundingContracted a speechie with extensive AAC experience to implement projectInvited stakeholders experienced in AAC to provide feedback before finalisingStakeholders advised of kit availabilityFinal copies distributedPositive AACtion Kit available on Rocky Bay websiteReceived NGCS (Non-government Centre Support) FundingContracted a speechie with extensive AAC experience to implement projectInvited stakeholders experienced in AAC (eg parents, educators, therapists) to provide feedback before finalisingStakeholders advised of kit availabilityFinal copies distributedPositive AACtion Kit available on Rocky Bay website
13Feedback Forms All respondents agreed or strongly agreed: They now knew more about AACThey now knew more about communication devicesTheir understanding of strategies to increase communication device success had improvedUsing the Kit would improve their work with children who use AACThey would recommend the Kit to othersCDs with feedback forms distributed to 50 organisations and/or individualsFour feedback forms returned, 2 from speechies and 2 from consultants
14Online FeedbackPositive AACtion Kit was also accessed through the Rocky Bay websiteInformal feedback was received from 6 individuals viaFeedback was unanimously positive“What an amazing resource. As a special ed teacher and mum of ASD children using AAC devices it will prove invaluable.”Informal feedback was received from 6 individuals via , some from the Eastern States and one from UK
15Use and Layout Part of a collaborative team model Information sheets given as neededProvide basis for further discussion/planningInformation sheets:Link to other info sheets and templatesInclude a summary of key pointsHave links to ‘Find Out More’
161. All About AAC1.1 AAC – An Introduction 1.2 Communication Development 1.3 AAC Does Not Hinder Natural Speech Development 1.4 Types of AAC1.1 AAC – An IntroductionEveryone has the right and the need to communicate1.2 Communication DevelopmentAAC supports children’s language and communication development1.3 AAC Does Not Hinder Natural Speech DevelopmentChildren need a range of methods to be able to communicate with all people in all situations1.4 Types of AACAll types of AAC should be valued
171. All About AACLow-tech AAC increased speech production for 89% of subjects (Millar et al, 2006)SGD intervention didn’t hinder and often aided speech development (Romski et al, )Preschoolers used a variety of AAC systems (Binger and Light, 2006)Millar et al, 2006 – meta-analysis of research from 1975 to 2003, Low-tech AAC increased speech production for 89% of subjects, 27 subjects from 2-60 years, most with intellectual disability or autism. Speech production in remaining 11% of subjects was unchanged.Romski et al, 2010 – Random allocation of 68 toddlers with developmental delays - SGD did not hinder and often aided speech development, aged from 2 to 3 years old to augmented communication input, augmented communication output or spoken communication interventions. Over 50% of those in augmented communication output group used spoken words (statistically significant compared to spoken communication intervention group)Binger and Light, 2006 – Survey of preschool SPs in Pennsylvania.
182. Working Together2.1 A Family Centred Approach to AAC 2.2 What Families Need to Know 2.3 What Schools Need to Know 2.4 What Service Providers Need to Know2.1 A Family Centred Approach to AACApplying family-centred principles to AAC2.2 What Families Need to KnowFamily involvement is needed for success2.3 What Schools Need to KnowSchools and families must work together2.4 What Service Providers Need to KnowEnter the AAC process with families as a partner
192. Working TogetherTeam collaboration was shown to have positive effects in many areas (Hunt et al, 2002)Lack of team collaboration and lack of home support (Kent-Walsh and Light, 2003)Parents “often seemed to feel that they ought to have known more than they did” (Goldbart and Marshall, 2004)Hunt et al, 2002 – Team collaboration to develop and implement plans was shown to have positive effects in many areas, including social interactions with peers and use of AAC . Study included 3 students in general education classrooms (kindy, grade 1 and grade 5). Teams consisted of general education teacher, inclusion support teacher, instructional assistant, SP and one parent. Multiple baseline design with measures obtained through observation periods. Other positive effects were observed in academic skills and engagement in classroom activities.Kent-Walsh and Light, 2003 – Qualitative interview of 11 general education teachers who had a child who used AAC in their classroom, Teachers named lack of team collaboration and lack of home support as barriers to inclusionGoldbart and Marshall, 2004 – Qualitative interview of 11 parents of children who had a child who used AAC - Parents “often seemed to feel that they ought to have known more than they did”.
213. Selecting a Communication Device 3.1 Communication Devices 3.2 Assessment in AAC 3.3 Words and Messages on a Communication Device 3.4 Operating a Communication Device3.1 Communication DevicesDescribes types and additional features3.2 Assessment in AACThe entire AAC team is involved in AAC assessment3.3 Words and Messages on a Communication DeviceEnsure quick and easy access to core vocabulary3.4 Operating a Communication DeviceTake as much time as needed to find the best access method for the child
223. Selecting a Communication Device Many parents reported no input (McNaughton et al, 2008)Parents wanted increased knowledge (Angelo et al, 1996; Angelo et al, 1995)Caregivers wanted more information (Goldbart and Marshall, 2004)McNaughton et al, – Internet based focus group interview of 7 parents of people aged 6 to 30 years with CP who used AAC. Many parents reported having no input in selecting an AAC device provided to their child .Angelo et al, 1996 – Survey of needs, priorities and preferences of parents of children aged 13 to 21 years who used AAC devices parents from 97 families responded.Angelo et al, 1995 – Survey of needs, priorities and preferences of parents of children aged 3 to 12 years who used AAC devices. 91 parents from 59 families responded.Parents expressed a need for increased knowledge of assistive devicesGoldbart and Marshall, 2004 – Qualitative interview of 11 parents of children who had a child who used AAC. Caregivers wanted more information to increase their involvement in decision making .
244. Trialling a Communication Device 4.1 Trialling a Communication Device 4.2 Planning for a Communication Device Trial 4.3 Setting Goals in AAC – The Basics 4.4 Setting Specific Goals for Communication Device Trials4.1 Trialling a Communication DeviceTrial of a communication device is necessary4.2 Planning for a Communication Device TrialWaiting times are not wasted times4.3 Setting Goals in AAC – The BasicsClear and specific goals support positive outcomes4.4 Setting Specific Goals for Communication Device TrialsHaving only one or few clearly defined goals will keep the team focused
254. Trialling a Communication Device Lund and Light (2006) noted:AAC is not an outcomeA good outcome needs to be individually definedMany parents’ key measure of success was independent communication using AAC device (McNaughton et al, 2008)Lund and Light (2006) noted:AAC is not an outcome, it is a tool for end goals of communication and increasing participationA good outcome needs to be individually defined by key stakeholders – critical to include AAC user and familyMany parents in an internet focus group reported their key measure of success for their child was independent communication using their AAC device (McNaughton et al, 2008) – Internet based focus group interview of 7 parents of people aged 6 to 30 years with CP who used AAC
264. Trialling a Communication Device Templates:Roles and Responsibilities ChecklistAAC Goal SettingCommunication InventoryAAC Goal Routine MatrixCommunication Device Trial Diary
275. Funding for AAC 5.1 Funding for AAC in Western Australia Government FundingNon Government Funding (Fundraising and Charities)Self FundingCombinationsQuestions to Ask About Funding and Ownership of a Communication Device
286. Supporting Communication Device Use 6.1 Valuing ALL Forms of Communication 6.2 Teaching Strategies – Modelling in Everyday Activities 6.3 Creating Opportunities for Communication 6.4 Prompting Techniques to Support AAC Use6.1 Valuing ALL Forms of CommunicationA range of communication methods ensures the child can communicate with all people in all environments6.2 Teaching Strategies – Modelling in Everyday ActivitiesInput before output!6.3 Creating Opportunities for CommunicationThe best opportunities occur in daily routines6.4 Prompting Techniques to Support AAC UseWorking towards maximising independence
296. Supporting Communication Device Use AAC modelling assisted preschoolers to produce multi-symbol messages (Binger and Light, 2007)Aided AAC intervention:can teach students to become more effective communicatorsmay have a positive effect on speech (Binger et al, 2008)Multi-symbol messages were produced consistently by 4 of 5 preschoolers receiving aided AAC modelling (Binger and Light, 2007). 3 children used voice output communication systems and 2 used communication boards. One child using a voice output communication system did not show consistent gains. The 4 children who produced multi-synbol messages generalised the skill to other play routines.A review of current research indicated that aided AAC intervention can teach students to become more effective communicators and may have a positive effect on speech (Binger et al, 2008)
30Appendices Literacy and AAC Transitions and AAC AAC and Children with AutismCore Vocabulary – Australian Word Frequency ListAAC Websites
31Conclusion The Positive AACtion Kit for AAC teams is now available Feedback has been positiveIf you use the Kit, please provide feedbackThe Positive AACtion Kit for AAC teams is now available on CD or from the Rocky Bay websiteFeedback from people using the kit has been positiveIf you use the Kit, please provide feedback, as it will be used to review and update the Kit in the future
32Thank you to … Acknowledgements Linda Chiu, Director Clinical Services, Rocky BayThe many people who provided feedback in the planning and development stages of the projectThe parents from our 2009 research project who inspired this KitNGCS for funding support
33Contact Details Rocky Bay Sharon Ryder Senior Speech Pathologist Ph:Postal address: PO BOX 53, Mosman Park WA 6912Website:Kit: Rocky Bay Website Services Clinical Services Directorate scroll down to Resources AAC Action Pack
34ReferencesAllaire, J.H., Gressaard, R.P., Blackman, J.A., Hostler, S.L. (1991) Children with severe speech impairments: Caregiver survey of AAC use. Augmentative and Alternative Communication, 7 (4),Angelo, D.H. (2000). Impact of augmentative and alternative communication devices on families. Augmentative and Alternative Communication, 16,Angelo, D.H., Jones, S.D., Kokoska, S.M. (1995) Family perspective on augmentative and alternative communication: Families of young children. Augmentative and Alternative Communication, 11,Angelo, D.H., Kokoska, S.M., Jones, S.D. (1996) Family perspective on augmentative and alternative communication: Families of adolescents and young adults. Augmentative and Alternative Communication, 12,Bailey, R.L., Parette,H.P., Stoner,J.B., Angell,M.E., & Carroll, K. ( 2006). Family members’ perceptions of augmentative and alternative communication device use. Language, Speech & Hearing Services in Schools, 37 (1),Binger, C. & Light, J. (2006) Demographics of preschoolers who require AAC. Language, Speech & Hearing Services in Schools, 37 (3),Binger, C. & Light, J. (2007) The effect of aided AAC modeling on the expression of multi-symbol messages by preschoolers who use AAC. Augmentative and Alternative Communication, 23 (1),Binger, C., Berens, J., Kent-Walsh, J. & Taylor, S. (2008) The effects of aided AAC interventions on AAC use, speech and symbolic gestures. Seminars in Speech and Language, 29 (2),Bloomberg, K. & Johnson, H. (1990) A statewide demographic survey of people with severe communication impairments. Augmentative and Alternative Communication, 6 (1),Goldbart, J., & Marshall, J. (2004). “Pushes and pulls” on the parents of children who use AAC. Augmentative and Alternative Communication, 20 (4),
35ReferencesHunt, P., Soto, G., Maier, J., Müller, E. & Goetz, L. (2002) Collaborative teaming to support students with augmentative communication needs in general education classrooms. Augmentative and Alternative Communication, 18,Johnson, J.M., Inglebret, E., Jones, C., & Jayanti, R. (2006) Perspectives of speech language pathologists regarding success versus abandonment of ACC. Augmentative and Alternative Communication, 22 (2),Kent-Walsh, J.E. & Light, J.C. (2003) General education teachers’ experiences with inclusion of students who use augmentative and alternative communication. Augmentative and Alternative Communication, 19 (2),Light, J. & Drager, K. (2007) AAC technologies for young children with complex communication needs: State of the science and future research directions. Augmentative and Alternative Communication, 23 (3),Lund, S.K., & Light, J. (2007). Long-term outcomes for individuals who use augmentative and alternative communication: Part III – contributing factors. Augmentative and Alternative Communication, 23 (4),Lund, S.K. & Light, J. (2006). Long-term outcomes for individuals who use augmentative and alternative communication: Part I – what is a “good” outcome? Augmentative and Alternative Communication, 22 (4),McNaughton, D., Rackensperger, T., Benedek-Wood, E., Krezman, C., Williams, M.B., Light, J. (2008) “A child needs to be given a chance to succeed”: Parents of individuals who use AAC describe the benefits and challenges of learning AAC technologies. Augmentative and Alternative Communication, 24 (1),
36ReferencesMillar, D.C., Light, J.C. & Schlosser, R.W. (2006) The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: A research review. Journal of Speech, Language and Hearing Research, 49 (2),Pendergrass, M., & Vestal, J.C. (2002) Making the most of augmentative communication devices. The Case Manager, 13 (1),Romski, MA, Sevcik, R.A., Adamson, L.B., Cheslock, M., Smith, A., Barker, R.M., Bakeman, R. (2010) Randomized comparison of augmented and nonaugmented language interventions for toddlers with developmental delays and their parents. Journal of Speech, Language and Hearing Research, 53,SCOPE. (August 2007). Communication Aids Provision: Review of the Literature. Policy and Government Affairs. Retrieved ( ) from litreview07.pdfSpeech Pathology Australia (2004). Augmentative and Alternative Communication-Position Paper. Melbourne, Victoria. Retrieved ( ) fromTotten, L., & Ryder, S. (2009). Parental perspectives on the responsibilities of team members involved in supporting AAC devices for school aged children. Research findings presented at the 2009 More than Gadgets Conference, Perth, WA.