1. ACE Centre Rachel Moore Speech and Language Therapist
Jackie Ayre Occupational Therapist
Does everyone know about the ACE Centre?

2. Communication
“Communication is crucial. Communication is a fundamental human right. Communication is a key life skill. Communication is at the core of all social interaction.”
From "A Review of Services for Children and Young People (0–19) with Speech, Language and Communication Need" (Bercow July 2008).

3. The ACE Centre
Assessment of children with complex communication difficulties
Multi-disciplinary team
Training
Information
Research and Development
This is what the centre is involved in.
Technology for communication and learning
We recognised that we were not getting early referrals, tending to see children at points of transition, either as they entered school, or moved up into secondary education - Children rarely seen prior to years in full time education.
Learnt from the children we have seen - missed such valuable time for intervention.
We have long known that parents are the experts on their children, this was emphasised by the Look2Talk project where colleagues worked with parents of young eye pointing children, developing their communication systems. (Please talk to us afterwards if interested…).

4. But we were not seeing children early enough…
“Communication starts with interaction and the earliest behaviours of children – there are no prerequisites.” Cress 2000
“What are we waiting for” Kangas & Lloyd 1988
We recognised that we were not getting early referrals, tending to see children at points of transition, either as they entered school, or moved up into secondary education - Children rarely seen prior to years in full time education.
Learnt from the children we have seen - missed such valuable time for intervention.
to go with 1st quote AAC: Anything that helps children or adults to communicate when traditional strategies are not sufficient to accomplish a communication goal”

5. The political picture
“Early identification and intervention are essential”.
From: "A Review of Services for Children and Young People (0–19) with Speech, Language and Communication Need" (Bercow July 2008).
During this time we cannot afford to get things wrong.
The early years are critical in children’s development. Children develop rapidly during this time
– physically, intellectually, emotionally and socially.
From "Curriculum Guidance for the Foundation Stage" (Foreword by Margaret Hodge, Parliamentary Under Secretary of State for Employment and Equal Opportunities, 2000)
Many people have known this for a long time, however, the government is now aware too
Political drive to support special needs in the early years
There is acknowlegement of the significant development during the early years and a major move towards early identification and intervention of special needs.

6. So much happening…
It is well documented that from conception to first day of school development proceeds at a pace exceeding that of any other stage of life.
“Children are active participants in their own development, reflecting the intrinsic human drive to explore and master the environment” Shnokoff & Philips
“Human Development is shaped by a dynamic and continuous interaction between biology and experience” Shnokoff & Philips
Play is a motivational tool

7. Play!
“Through play children learn about the world around them. They learn to communicate, interact with others, develop their own identity and build on their social skills…”
From ‘Play Talks’, SCOPE
“Children find out about the world around them through a process of observing, exploring, speculating and making discoveries.” Mary D Sheridan (1999). Play in Early Childhood. From birth to 6 years.
References on play early development
So much learning and development should happen at this time.

8. Play is !! Having fun Communicating Developing skills Taking control
Physical difficulties can reduce opportunities for exploration and play
A child with complex disabilities needs tools at every stage.
Tool needs to be pitched at the right level.
Modelling

9. Toys2Talk Project
Early Intervention (The youngest child we saw was 11 months)
Children with a wide range of diagnosis and difficulties
Support for both families and professionals
Information, strategies, equipment.
TOys2Talk Project…… fundraised for money in order to run a pilot project for a year.
Our aim is to use ACE Centre expertise to support pre-school children with complex physical and communication disabilities and their families through the use of toys, adapted computers and simple communication resources and strategies. The pilot project will be mainly based in Oxfordshire and will involve working with local families and early years professionals
By working with local early years professionals, a dedicated team (speech and language therapist, occupational therapist, teacher and technician) will be able to offer:
loan of equipment, including adapted toys, access devices for early computer play and communication resources
advice as to how the equipment can be used by the child. This includes children whose physical difficulties make it particularly hard for them to control any equipment for play.

10. Support for both families and professionals
Parents are experts on their children.
Experiences and expectations tend to be based on the “normal” developing child / no previous experience of a disabled child.
Parents are looking for information, advice and support
Limited intervention from local services at early stage
We have long known that parents are the experts on their children, this was emphasised by the Look2Talk project where colleagues worked with parents of young eye pointing children, developing their communication systems. (Please talk to us afterwards if interested…).

11. What did Toys2Talk involve?
Referral
Information collection
Contact visit
Loan of equipment and information provision
Visits to children In the morning, we will visit children who find it difficult to travel to the Centre. Also, visits to pre-school settings at this time.
In practise, mostly visited children in their own homes. Familiar surroundings, practical issues.
Most referrals from parents. Often services just starting to get involved.
We did not actually visit any pre schools although many discussion with pre school teachers and councellors.

12. Information Collected about the child
Individual approach to all children referred
Collect information from Parents and professionals,
For example:
Communication
Physical abilities and difficulties
Level of play and interaction, sensory through to imaginative play.
Attention
Likes and dislikes

13. Contact with the Child Sessions at ACE Centre
Visits to children at home
Visits to pre-school professionals
Always with parents present sometimes also with referring professional.

14. Following a visit with a child
Loan Boxes
adapted toys, access devices for early computer play and communication resources
whatever is necessary for the child to use the equipment, including advice and guidelines
CD of photos and video clips
First and third Monday of the month.
Sessions at ACE Centre Ideally a pre-arranged appointment, in the afternoon.
Visits to children In the morning, we will visit children who find it difficult to travel to the Centre. Also, visits to pre-school settings at this time.

15. Contents of a typical toy box
First and third Monday of the month.
Sessions at ACE Centre Ideally a pre-arranged appointment, in the afternoon.
Visits to children In the morning, we will visit children who find it difficult to travel to the Centre. Also, visits to pre-school settings at this time.
Contents of a typical toy box

16. How did we go about it?
Picture/video of child
Mention flyers etc.

17. Identify appropriate tools for the individual
Identify appropriate tools for the individual. Different types of play required different tools
Exploratory play
Constructive play
Pretend play
Social interaction
(types of play Sheridan 1999)
Developing control skills
Motivation
Solitary play
Spectator play
Parallel play
Associative play
Co-ocperative play
Learning to use bodies

18. Exploratory Play (Edward) Constructive Play (Oscar)
Picture/video of child
Picture/video of child

19. Cooperative play (Poppy)
Pretend Play (Tamsin)
Picture/video of child
Cooperative play (Poppy)
Picture/video of child

20. Parents aware need for tools to enable children to play.
Were often unaware of what tools were available.
The need for Communication tools to support play were not as evident This will be discussed later.

21. Tools Control devices Switches Touch screen Joystick
Children with range of difficulties
In the majority of cases introduced switches. Focus on switch control

22. Switch Control Switches Stick Latching box
Activity- toy / Simple communication device/ environmental control
For children key thing was reward, for the majority of activites the reward was one mainly of interaction with another.
Switches were introduced for different reasons. Physical difficulties, Cognitive and also the way they controlled the activities they were linked to.

23. Introducing Switches Experience Show Offer (time) (respond to them)
Opportunity
A child learns to control using their body. (movement of whole body or specific parts eg the hand etc, sound production, eye movement)
Learn to interact at different levels
What ever level of activity you go in at. Background information will tell you how and guide to appropriate activities.

24. Why Switches
Different reasons for introducing switches, strategies and techniques.

25. Touch Screen
Different reasons for introducing touch screens, strategies and techniques.

26. Joystick
Different reasons for introducing joysticks, strategies and techniques.

27. An integral part of play.
“Communication starts with interaction and earliest behaviours of children – there are no pre-requisites” Cress 2000
Communication is integral within a child’s development and learning from the earliest stage …..
An integral part of play.
Communication is crucial. Communication is a fundamental human right.
Communication is a key life skill. Communication is at the core of all social interaction.
Within Toys2Talk we wanted to support communication in play where possible within confines of project.

28. Communication Issues Young age of children
Communication difficulties may not have been considered
Some normally developing children may not yet be speaking
Within Toys2Talk project, limited potential for long term support.
Difficulties: This area was at times difficult deal with
Ongoing support needed as communication is a very sensitive and complex area. Needs discussion time, modelling to parents etc
In some cases we could make a significant contribution to the cild’s communication system, sometimes, just were part of the discussion process

29. Communication issues Sometimes there was no SLT involved
Always liaised with a SLT if one was involved
Sometimes keen for any suggestions
Sometimes they asked for specific input
E.g. Equipment,
Discussion / introduction of ideas
Liaise with SLT: information about child and their input. Helped to establish our potential role.
Sometimes SLT asked forspecificinput frmous
Sometimes keen for any suggestions – highlighted - SLT often not experienced in working with complex children / or no SLT

30. Parental approach
Parents recognition of communication issues varied widely
Required flexible approach
Some parents are keen to support communication as early as possible
Some parents concerned whether alternative communication methods will delay speech development?
Parental approach – key
First point: regardless of whether they are going to develop speech or not.
Second point: keen to support speech with AAC but worried about the effect ,
Generally, parents who came forward to the project had an open approach and were looking around for ideas to support their children

31. Where an SLT was not yet involved, parents required advice and discussion
Saarah. On a 6 month waiting list.
Discussed strategies
for encouraging sound
production, loaned a
signing dictionary and a
LITTLEmack
Picture/video of child
Saarah’s mother keen for any information to develop her input with Saarah.

32. Some parents required information and support with specific situations:
e.g. Morgan, had lost ability to communicate and his mother wanted to investigate a small, lightweight single message communication device

33. Some parents were actively seeking support for their child’s communication, open and interested in any ideas.
Sienna
Discussed signing, loan of a signing dictionary
Discussed how to use core symbols, provided these
Cameran
Discussed eye pointing to symbols. Provided core symbols and an E Tran frame. Eye Gaze Folder discussed. Loan of Boardmaker software
Picture/video of child
Picture/video of child
Check Sienna Cameran and LITTLE mack
Sienna: Developmental delay / physical difficulties
Cameran: cerebral palsy

34. Poppy
Thomas
Eye points to either side for Yes/No. Communication book is under development. Lent an E tran frame, core Symbols,
Loaned Boardmaker. Already has a LITTLEmack
Talked about eye pointing to symbols, lent E tran frame with core symbols to support activities provided. Already has a LITTLEmack
Picture/video of child
Picture/video of child
Poppy and Thomas, both physically complex

35. Case Study: Tiago Age 16 months Cognitively bright Cerebral palsy
Physically complex
Attends the Bobath, moves through a variety of positions through the day
Picture/video of child

36. Tiago was placed in a variety of positions during our initial visit:
Picture/video of child
Tiago is a very small boy, using toys, computer etc will take place in this way.

37. ..and more positions at home…
Picture/video of child

38. Tiago was interested in everything!
He particularly loved the computer
Picture/video of child

39. Equipment loaned after initial visit
2 Jelly Bean switches
Ruler with Velcro
Maxess Wedge
Mouser
Powerlink
Ablenet single switch latch and timer
Range of simple cause and effect software
Tape recorder
List of books with repeated lines
Guidelines on how to use equipment
E tran frame
Core Symbols
A CD of photos and video clips taken during the visit will be included

40. Communication Resources Provided
Tiago produces a range of sounds, 2 syllable babble including some consonants, no words.
Good eye pointing skills developing
LITTLEmack already in place
Toys2Talk provided E Tran frame, core symbols, yes/no symbols

41. Alison provided feedback soon after initial contact
Request for further visit
lots more symbols: for meal times, nursery rhymes etc
Mounting switch so that Tiago could play with the computer independently
Trial of a joystick
Further loan of toys
Very Proactive mother

42. Developed a bank of symbols in a short time, used throughout the day

43. Toys Control Choice Picture/video of child Picture/video of child
Control through physical and communication. Opportunity to discover different types of play Exploratory cooperative play

44. Fun! Picture/video of child
Step on with switches moving on with switch control. Switches have very different actions that have appropraite timing. Here it matters which switch he presses.
Fun favourite toy meal times

45. Use of Computer Picture/video of child
Computer will be an essential tool for Tiago in his education
Cause effect introduction and excitement
Switch Mounted, mother could move away
Introduce joystick as another access method. Experience and learn about pointer. control may develop these physical skill to control joystick pressing switch to join in (looking into powered mobility)

46. Bercow considers that failure to intervene at an early age has far reaching effects
“If a child does not benefit from early intervention,
there are multiple risks, which may become apparent over a number of years – of lower educational attainment, of behavioural problems, of emotional and psychological difficulties, of poorer employment prospects, challenges to mental health ….”
From: "A Review of Services for Children and Young People (0–19) with Speech, Language and Communication Need" (Bercow July 2008).
"Every child is a competent learner from birth who can be resilient, capable, confident and self-assured." (The Early Years Foundation Stage, 2000)
From "Curriculum Guidance for the Foundation Stage" (Foreword by Margaret Hodge, Parliamentary Under Secretary of State for Employment and Equal Opportunities, 2000)
During this time we cannot afford to get things wrong. The early years are critical
in children’s development. Children develop rapidly during this time –
physically, intellectually, emotionally and socially.
"All children should be given the opportunity to experience the very best
possible start to their education. We need to ensure that our children enter
school having established solid foundations on which they can build. This
will help to ensure that they continue to flourish throughout their school
years and beyond.“
From "A Review of Services for Children and Young People (0–19) with Speech, Language and Communication Need" (Bercow July 2008).
Early identification and intervention are essential. In addressing delay and disorders,
the most important principle is the value of early intervention and the danger of its
absence. If a child receives the right help early on, he or she has a better chance of tackling
problems, communicating adequately and making progress. If a child does not benefit
from early intervention there are multiple risks, which may become apparent over a
number of years – of lower educational attainment, of behavioural problems, of emotional
and psychological difficulties, of poorer employment prospects, of challenges to mental
health and, in some cases, of a descent into criminality.
Government policy places a strong focus on the importance of early identification to ensure
that all children get the best start possible in the vital early years.

47. Rachel Moore - Speech and Language Therapist
Jackie Ayre – Occupational Therapist