1. AAC EBP Group The many environments of AAC - Which are most effective? Presented by: Trisha Khatri (ADHC Hurstville) Clare Thomson (ADHC Parramatta)

2. How we decided what to CAT ●2013: Investigated the barriers and facilitators to AAC use, but did not do a CAT. ●2014: o Group members all conduct AAC intervention in different environments. o Decided upon an extension of 2013’s topic as it covered a large area of research that is of interest to all members of the group. o Investigated environmental factors in more detail ●We also investigated some of the benefits of AAC, but did not do a CAT for this topic.

3. Clinical Question In children learning to use Augmentative and Alternative Communication, which environment is most conducive to successful implementation? http://www.marion.k12.fl.us/ dept/ssp/trn/ https://picasaweb.google.com/Soniasnucelo/ManualD eLaMaestraPreescolar#5405287584932050786 http://web.up.ac.za/Default.asp?ipkCategor yID=9751&subid=9751 http://becuo.com/nice-beach- houses-clipart

4. Literature Search ●Databases used: Medline, Proquest, ERIC, Psychinfo, OVID, EBSCO, Google Scholar, Scopus, Cinahl and Pubmed. ●Search terms used: clinic, school, home, respite, community access, preschool, child care, early intervention, AAC, augmentative and alternative communication, low technology AAC, high technology AAC, multimodal, functional approach, clinical approach, successful implementation. ●36 papers were summarised.

5. ●Light (1989) proposed that “communicative competence is the ability to functionally communicate within the natural environment and to adequately meet daily communication needs” ●The World Health Organizations’ (WHO) International Classification of Functioning, Disability and Health ●Many barriers and facilitators to AAC implementation are environmental factors. Main points from literature search and clinical experience

6. Main points from background reading and clinical experience ●“Lots” of low level evidence in a number of environments. ●Very little evidence comparing environments. ●Is there a particular environment that appears to be most conducive to AAC implementation based on barriers and facilitators within it? ●Do different environments encourage the development of particular skills?

7. Results 6 papers were CAPped to answer the clinical question. ReferenceEnvironmentAAC methodLevel of Evidence Van Der Schuit, Segers, Van Balkhom, Stoep & Verhoeven (2010). Home and day careManual sign systems, combination of speech and manual signs, graphic symbols, and VOCAs. Level IV Cosbey & Johnston (2006). Inclusive ClassroomSingle switch voice output communication aid (VOCA). Level III-3: (Multiple baseline probe design across 3 subjects) Stoner, Angell & Bailey, (2010). Inclusive schoolDynawrite (VOCA)Single case study Dodd & Hagge. (2014). Intensive 2 week AAC camp. Nonelectronic communicator displays, communication books, static display speech generating devices, manual signs, and picture symbols. Level III-3 Clarke, McConachie, Price & Wood. (2001). Participants only interviewed in school setting. VOCAs, low-tech AAC including at least 20 symbols, pictures or written words. Level IV: qualitative interviews Brady, Thiemann- Bourque, Fleming & Matthews, (2013). School and homeSpeech, Sign, PECS and Speech Generating Devices (SGD) Level IV

8. Strengths & Limitations of Research Strengths: ●A broad range of disabilities were presented ●A broad range of AAC was discussed ●Stage of schooling of participants across the board Limitations: ●Low level evidence ●Small sample sizes ●Limited statistical analysis ●No cross comparative studies (ie: comparison of environments) http://sample.campusmag.in/2014/03/20/invest-in-your-strengths-and- delegate-your-weakness/

9. ●There has been no research that compares the most suitable environment for AAC intervention in children, however there has been low level research conducted in but not across a variety of environments with successful outcomes. ●It was noted that there were a range of other factors that appeared to impact successful implementation including a collaborative team approach, adequate communication partner training and input from AAC user. Clinical Bottom Line

10. Recommendations ●There is no concrete evidence from articles appraised that would warrant using one environment over another for AAC intervention in children. ● More research evidence and evidence on clinical practice is required before further recommendations can be made. http://sidelinesportsreport.com/this-weeks-thumbs-up-and-thumbs-down-in- sporting-news/

11. Questions? http://computerwallpapers.org/question-mark-wallpaper-11.html

12. Next Year In 2015 we will be trialling use of video conferencing in place of face to face meetings For more information contact: ●Ashleigh Colombini: acolombini@cerebralpalsy.org.auacolombini@cerebralpalsy.org.au ●Mitchel Hurdis: mhurdis@gmail.commhurdis@gmail.com

13. References Included in the CAT: Brady, Nancy C; Thiemann-Bourque, Kathy; Fleming, Kandace & Matthews, Kris (2013) ‘Predicting Language Outcome for Children Learning Augmentative & Alternative Communication: Child and Environmental Factors’ Journal of Speech, Language & Hearing Research 56 (5) pp. 1595-612 Clarke, M., McConachie, H., Price, K., & Wood, P. (2001). Views of young people using augmentative and alternative communication systems. International Journal of Language and Communication Disorders, 36, 107-115. Cosbey, J.E., Johnston, S., (2006). Using a single switch voice output communication aid to increase social acces for children with severe disabilities. Research and Practice for Persons with Severe Disabilities, 31(2), 144-156. Dodd, Janet. L & Hagge, Darla. K (2014) ‘AAC camp as an alternative school-based service delivery model: A retrospective survey’ Communication Disorders Quarterly 35 (3) pp. 123-132. Stoner, JB, Angell, ME & Bailey, RL (2010) ‘Implementing augmentative and alternative communication in inclusive educational settings: a case study’ AAC: Augmentative and Alternative Communication 26 (2) pp. 122-35 Van der Schuit, M., Segers, E., van Balkom, H., Stoep, J., and Verhoeven, L. (2010). Immersive communication intervention for speaking and non-speaking children with intellectual disabilities. Augmentative and Alternative Communication, 26, 203-220. References for background question available on request.