Facilitated Communication

Facilitated Communication

Standards and Best PracticeChristi Kasa-Hendrickson

Darlene HansonDon Cardinal

Cardinal, D., 2006 Facilitated Communication Training Standards 2000

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Best Practice Elements of Facilitated Communication fall

into three categories

PracticePractice

AttitudeAttitude StructureStructure


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FC FC USERUSER

AttitudeAttitudeStructureStructure

Elements of FC

PracticePractice

PracticePracticeAttitudeAttitude

StructureStructure


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Attitude ElementsAttitude ElementsCitizenship

Presumption of Competence

The Right to Communicate

Empowering the Facilitated Communication UserTotal Communication


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Principles &Best Practice:

Attitude Citizenship and Presuming Competence• Citizenship is membership in a

community

• Citizenship carries with it a presumption that a person's interests and those of her or his community are somehow intimately linked with each other.


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Right to communicate

• That all people have a means of communication which allows their fullest participation in the wider world

• That people can communicate using their chosen methodand that their communication is heeded by others.


Attitude


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Empowering FC user -- Questions to ask:• "Am I determining the pace or am I allowing the

facilitated communication user to determine the pace?",

• "Am I getting a third person's attention or am I teaching the facilitated communication user how to do that?”

• "Am I determining who reads or hears what the facilitated communication user has typed, or am I letting the facilitated communication user determine who receives his or her communication?"


Attitude


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Total communication approach

• Not meant to replace current successful communication methods

• Meant to enhance and expand current communication opportunities

• Many people who type also use some speech, sign, prepared communication boards


Attitude


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Practice ElementsPractice ElementsPointing Ergonomic Setup

Communication Partner Establish a regular schedule

Physical Support Use challenging material

Prompts and Cues Activities to Maximize Success

Encouragement and Emotional Support

Varied and open ended activities

Monitoring Treat the person as a competent

Saying each letter as it is indicated Avoid interrupting verbal and typed echoes

Device correction strategies Control difficult behavior

Reliability Check Patient, positive, and persistent attitude


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Elements of Facilitated Communication TrainingElements of Facilitated Communication Training

Created by Cardinal 2006

Monitoring (look at keyboard)

Comm. Partner

Physical Support

Ergonomics

Emotional Support

Device Correction StrategyStructured

Activities Pointing

Control Difficult Behavior


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Elements of FC Training: Physical Support

• Physical support may include the following: – Assistance in isolating the index finger; – Stabilizing the arm to overcome tremor;– Backward resistance on the arm to slow the pace of

pointing or to overcome impulsiveness; – A touch of the forearm, elbow, or shoulder to help the

person initiate typing; or pulling back on the arm or wrist to help the person not strike a target repetitively.


Practice


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Elements of FC Training: Emotional Support• Emotional support involves providing

encouragement, but not direction, as the person points to communicate.

Elements of FC Training: Communicative Support• Various forms of prompts and cues to assist the

FC user to stay focused in the communication interaction, to provide feedback to the FC user on the content of their message, and to assist the FC user in clarifying unclear messages.


Practice


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Introducing the Technique• Follow the recommendations of the assessment

regarding choice of hand, type of support, and seating.

• Plan in advance the choice and position of device(s), and appropriate activities for getting started.

• Establish a regular schedule by which the practice of pointing through facilitation can develop.

• Clearly explain to the communicator what is being done and why, and have the use of the technique demonstrated either by an experienced facilitated communication user, or through use of a video.


Practice


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Introducing the Technique• Use challenging material that is meaningful to the

communicator.• Structure activities to maximize the success of the

communicator. ･ Provide varied and open ended activities, allowing for the opportunity for complex communication.

• Treat the person as a competent communicator, one who has ideas and feelings to share.

• Support the communicator in avoiding or interrupting verbal and typed echoes when they interfere with communication which accurately expresses the communicator's intent.

• Support the communicator in controlling difficult behavior.• Work with a patient, positive, and persistent attitude.


Practice


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Structure ElementsStructure ElementsAssessment

Independence

Competency-based Facilitator Training

Multiple Facilitators

Technical Assistance

Documentation

Portfolio Approach

Validation, Authorship and Authenticity

Sensitive Information


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Assessment • An individual needs to be identified as a

candidate • Those who support that individual need

to show commitment to the training process. Both of these elements begin with the assessment.

Principles &Best Practice: Structure


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Questions that drive the Assessment• What are the current communication

strategies? (candidacy)• How have people developed the

communication to this point? (environment)• How does this person interact with the

printed word? (starting point for the exploration)

• Does support make a difference? (benefit)



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Determining Candidacy? • Facilitated communication is a type of

Augmentative/Alternative Communication (AAC) for people who do not speak or whose speech is highly limited and disordered, and who cannot point reliably

• The method has been used by people with autism, Down syndrome, cerebral palsy, pervasive developmental disorders, and other developmental disabilities



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Collaborative Team ApproachSupport and commitment from an aid user's team (program planning team, circle of support, etc.) is critical to long term success with augmentative/alternative communication (AAC) and facilitated communication training.



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Independence • A primary, long-term goal of facilitated communication

training is independent communication. • This goal involves ･ being able to access

communication aids without physical support;• being able to initiate the process of communication

with others; and ･ exercising control over the content of one's communication.The fading of physical support should begin at the outset of the training process, with both facilitators and facilitated communication users aware of the importance of this goal.



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Competency Based Facilitator Training• All facilitators should participate in on-going training

and supportMultiple Facilitators--Each FC user should haveseveral facilitators• to reduce dependence on a particular facilitator,• to increase independent communication, and• for there to be sufficient examples of valid and

authentic communication to document in a portfolio.Technical Assistance• Team problem solving with experienced facilitators



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Documentation • Portfolio Approach• The portfolio documents over time instances of novel

communication. It is important to note that validation represents a set of skills to be learned in the process of becoming a competent, responsible communicator; it is not a test of the user's abilities.

• In addition to the facilitated communication user's portfolio, a portfolio of the facilitators' training, skills, and abilities should be kept, documenting each facilitator's progress through competency training. This documentation should be used to determine the facilitator's level, and which supports he or she is prepared to provide for the facilitated communication user.



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Validation, Authorship• If the use of more formal validity testing is

pursued, careful consideration needs to be given to such factors as the types of tasks used, the familiarity and naturalness of the test environment, the experience level of the facilitator, and both the facilitator and facilitated communication user's feelings about doing the test.



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Sensitive Information • Any sensitive information should be

verified through clarification across multiple facilitators.

• Sensitive information should be discussed carefully with a team of skilled facilitators.

• It is important that the FC user develop an independent strategy for yes/no as quickly in the training process as possible.



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Learning to type and to use all of the best practice elements is complex. Remember the following:• Set goals• Work and problem solve with a team• Stay focused and positive• Create games and strategies that can be

successful each time your practice• Set aside time to practice as well as

remembering to use typing in the thousand opportunities that come up throughout the day.

Best Practice: Concluding Thoughts

Facilitated Communication

Documents

Transcript of Facilitated Communication