The Positive AACtion Kit:An evidence-based information

package for parents, teachers and others supporting school-aged

children to use AAC

Emma J Harris, Sharon Ryder and Lisa Totten

Speech Pathologists

Rocky Bay

Outline

• Background

• All About AAC

• Working Together

• Selecting a Communication Device

• Trialing a Communication Device

• Funding for AAC

• Supporting Communication Device Use

What is AAC?

• Augmentative and Alternative Communication

• Assists people with complex communication needs (CCN) to be understood by others

• Unaided methods (eg gesture, signs, facial expression)

• Aided methods:

– Low tech (eg alphabet or picture boards, communication books)

– High tech (eg speech generating devices-SGDs)

Reported Positive Outcomes

Positive outcomes in some young children using a variety of AAC methods have been reported by caregivers and include: – Improved communication– More social opportunities– Improved quality of life– More educational opportunities– Increased independence

(Angelo, 2000; Bailey et al, 2006; reviewed in Light & Drager, 2007)

AAC 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 communication

– Effect of past negative experience (Pendergrass & Vestal, 2002)

– Costs (finance & otherwise)

Commonly ReportedSupports and Barriers

Supports Barriers

Ease of AAC device useTechnological barriers, eg• Break down • Resultant frustration

Effective teaming and services Ineffective teaming

Family involvement Belief user understood without device

Inadequate training

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.

Supporting AACDevice Users

Best practice includes:• Working as a team• Integration into everyday routines• Providing meaningful opportunities to use device• Training and supporting communication partners• Ongoing device programming• Providing extensive and long-term support

(Speech Pathology Australia, 2004; Pendergrass and Vestal, 2002)

Perspectives 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 outcomes– roles and responsibilities of team members

Considerations for Service Delivery

Assessment

• Family centred

• Ask about and respect family values

• Clear articulation of what’s involved

• Clearly negotiate roles and responsibilities with all stakeholders

• Show families a range of devices

(Totten and Ryder, 2009)

Considerations for Service Delivery

Collaboration

• Sharing information – a responsibility for all stakeholders

– Regular meetings

– Sharing how child uses SGD in different environments

– Working towards common goals

(Totten and Ryder, 2009)

Developing the Positive AACtion Kit

Goals:

• Increase knowledge about AAC systems

• Provide information in choosing, trialling and/or supporting the use of a SGD

• Promote evidence-based strategies

• Emphasise the importance of teamwork

Developing the Positive AACtion Kit

• Received NGCS Funding• Contracted a speechie with extensive AAC

experience to implement project• Invited stakeholders experienced in AAC to

provide feedback before finalising• Stakeholders advised of kit availability• Final copies distributed• Positive AACtion Kit available on Rocky Bay

website

Feedback Forms

All respondents agreed or strongly agreed:• They now knew more about AAC• They now knew more about communication

devices• Their understanding of strategies to increase

communication device success had improved• Using the Kit would improve their work with

children who use AAC• They would recommend the Kit to others

Online Feedback

• Positive AACtion Kit was also accessed through the Rocky Bay website

• Informal feedback was received from 6 individuals via email

• Feedback was unanimously positive

“What an amazing resource. As a special ed teacher and mum of ASD children using AAC devices it will prove invaluable.”

Use and Layout

• Part of a collaborative team model

• Information sheets given as needed

• Provide basis for further discussion/planning

• Information sheets:– Link to other info sheets and templates– Include a summary of key points– Have links to ‘Find Out More’

1. All About AAC

1.1 AAC – An Introduction

1.2 Communication Development

1.3 AAC Does Not Hinder Natural Speech Development

1.4 Types of AAC

1. All About AAC

• Low-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, 2010)

• Preschoolers used a variety of AAC systems (Binger and Light, 2006)

2. Working Together

2.1 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 Know

2. Working Together

• Team 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)

2. Working Together

3. 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 Device

3. 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)

3. Selecting a Communication Device

4. 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 Trials

4. Trialling a Communication Device

• Lund and Light (2006) noted:

– AAC is not an outcome

– A good outcome needs to be individually defined

• Many parents’ key measure of success was independent communication using AAC device (McNaughton et al, 2008)

4. Trialling a Communication Device

Templates:

• Roles and Responsibilities Checklist

• AAC Goal Setting

• Communication Inventory

• AAC Goal Routine Matrix

• Communication Device Trial Diary

5. Funding for AAC

5.1 Funding for AAC in Western Australia• Government Funding• Non Government Funding (Fundraising and

Charities)• Self Funding• Combinations• Questions to Ask About Funding and

Ownership of a Communication Device

6. 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 Use

6. 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 communicators

– may have a positive effect on speech (Binger et al, 2008)

Appendices

1. Literacy and AAC

2. Transitions and AAC

3. AAC and Children with Autism

4. Core Vocabulary – Australian Word Frequency List

5. AAC Websites

Conclusion

• The Positive AACtion Kit for AAC teams is now available

• Feedback has been positive

• If you use the Kit, please provide feedback

Acknowledgements

Thank you to …Linda Chiu, Director Clinical Services, Rocky Bay

The many people who provided feedback in the planning and development stages of the project

The parents from our 2009 research project who inspired this Kit

NGCS for funding support

Contact Details

Rocky Bay

Sharon Ryder Senior Speech Pathologist sharonr@rockybay.org.au

Ph: 9383 5157

Postal address: PO BOX 53, Mosman Park WA 6912

Website: www.rockybay.org.auKit: Rocky Bay Website Services Clinical Services Directorate

scroll down to Resources AAC Action Pack

References

Allaire, 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), 248-255.

Angelo, D.H. (2000). Impact of augmentative and alternative communication devices on families. Augmentative and Alternative Communication, 16, 37-47.

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, 193-201.

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, 13-20.

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), 50-60.

Binger, C. & Light, J. (2006) Demographics of preschoolers who require AAC. Language, Speech & Hearing Services in Schools, 37 (3), 200-208.

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), 30-43.

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), 101-111.

Bloomberg, K. & Johnson, H. (1990) A statewide demographic survey of people with severe communication impairments. Augmentative and Alternative Communication, 6 (1), 50-60.

Goldbart, J., & Marshall, J. (2004). “Pushes and pulls” on the parents of children who use AAC. Augmentative and Alternative Communication, 20 (4), 194-208.

References

Hunt, 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, 20-35.

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), 85-99.

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), 104-124.

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), 204-216.

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), 323-335.

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), 284-299.

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), 43-55.

References

Millar, 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), 248-264.

Pendergrass, M., & Vestal, J.C. (2002) Making the most of augmentative communication devices. The Case Manager, 13 (1), 44-49.

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, 350-364.

SCOPE. (August 2007). Communication Aids Provision: Review of the Literature. Policy and Government Affairs. Retrieved (04.08.09) from http://www.scope.org.uk/disablism/downloads/scope-commaidprov-litreview07.pdf

Speech Pathology Australia (2004). Augmentative and Alternative Communication-Position Paper. Melbourne, Victoria. Retrieved (17.08.09 ) from http://www.speechpathologyaustralia.org.au/library/AAC_PositionPaper.pdf

Totten, 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.