practical team working: aac assessment and intervention julie atkinson slt access to communication...
TRANSCRIPT
Practical Team Working: AAC Assessment and Intervention
Julie Atkinson
SLT
Access to Communication & Technology
Introducing ACT
• West Midlands Regional NHS Tertiary Assistive Technology Service: all ages and conditions
• Mission statement:– To empower people with disabilities, using
techniques and technologies which optimize potential for communication and control
– Staff: OT, SLT, Clinical Scientists, Workshop team, Administrators
Contacting ACT
• Main phone number: 0121 466 3050• Referrals / Helpline: 0121 472 0754 (Mon, Wed, Fri)
• Website: http://www.bhamcommunity.nhs.uk/about-us/services-
directory/specialist-services/rehabilitation/services/act
• Email: [email protected] • Address: ACT, West Midlands Rehabilitation
Centre, 91 Oak Tree Lane, Selly Oak, Birmingham, B29 6JA
West Midlands AAC Care Pathway
AAC Needs IdentifiedAAC Needs Identified
Multi Disciplinary TeamMulti Disciplinary Team
Co-ordinatorCo-ordinator
AAC IntroducedAAC Introduced
Review and ExitReview and Exit
Branch BOther agencies
Branch BOther agencies
Branch AA.C.T.
Branch AA.C.T.
Relevant sections in the West Midlands AAC Care Pathway Assessment & Implementation
documentation
• AAC environment sectionWhat are the skills and needs of those around
the client for optimising communication?
• Communication sectionWhat are the person’s present modes of
communication & how effective are they? Rate the different environments the client
attends.
• Co-ordinator’s checklistIs there a shared understanding of the needs
and purpose of AAC?
Specialised AAC provision Commissioning national services Office of the Communication Champion and Council
November 2011 Page 46
Some local services include specialist AAC services. Otherwise regional and national specialist AAC teams sit within the NHS and voluntary sector.
For example teachers, teaching assistants, occupational therapists, social workers, employment support and care workers, etc.
“The future of AAC services in England – A framework for equitable and effective commissioning”
the findings of DfE funded AAC grants 2012-13 http://www.communicationmatters.org.uk/dfe-aac-grants-findings
ACT Team Members
• Client• Parent / spouse / child / other family member / friend• (ACT)• Local SLT & SLTA• Local OT / Physiotherapist• Education: Teacher / Learning Support Assistant / IT co-ordinator / College
Lecturer / SENCO• Day Centre Keyworker• Nursing Keyworker• Case Manager / Social Worker• Other Specialists e.g. Teacher for Visual Impairment, Psychologist,
Consultant• AAC Suppliers• Peers• CO-ORDINATOR IS ESSENTIAL
Creating an AAC Team
Augmentative & Alternative Communication:The Role of the AAC Team
http://www.handyhandouts.com
“It takes a team of specialists and educators to put a communication system in place as well as to learn how to program and implement”
“To facilitate, educate and encourage use of the device throughout the day”
• SLT – language acquisition, interaction with partners, AAC assessment, knowledge of devices, implementation
• OT – muscle control, mobility, seating
• Physio – muscle strength & control, Range of Movement
• Teacher – curriculum & vocabulary identification, basic operations of device
• Parents – current communication skills & needs
• Peers
“Functional AAC Intervention: A Team Approach” Cottier, Doyle & Gilworth (1997)
The AAC Intervention Team• “Providing and encouraging opportunities for student
participation • Reinforcing the use of the AAC system• Encouraging peer interaction• Working on educational goals”
SLT Cottier, Doyle & Gilworth (1997)
– “Evaluating and recommending AAC– Managing vocab selection– Providing initial AAC training (for user)– Troubleshooting complex problems with the system– Collaborating with teachers on strategies to promote
inclusion; also curriculum adaptation– Training instructional assistants [LSAs] and teachers in
AAC– Periodically evaluating the effectiveness of the system– Evaluating and remediating any accompanying language
deficits which interfere with system use”
Assistive Technology Specialist (IT Manager?) Cottier, Doyle & Gilworth (1997)
• “Setting up and maintaining computers used in the educational program
• Providing teachers with computer hardware and software adaptations to help students with disabilities meet their educational goals
• [Informing] teachers, students and parents about computer adaptations and software programs
• Teaching students to use hardware adaptations and software programs
• Understanding how different assistive devices may increase independence and enhance function (e.g. EC)”
Teacher Cottier, Doyle & Gilworth (1997)
• “Helping the SLT select vocab for system• Teaching and adapting curriculum for students• Collaborating with the SLT on strategies to promote inclusion• Creating communication opportunities• Providing SLT with feedback on the utility and benefits of
AAC systems”
OT and Physiotherapist Cottier, Doyle & Gilworth (1997)
OT• “Evaluating motor control, visual acuity and perception• Evaluating wheelchair seating, positioning and mobility (also
Physio)• Providing mobility instruction (also Physio)• Determining optimal physical access to AAC (e.g. direct access,
scanning with 1/2 switches)• Providing functional activities to improve motor control and switch
access (e.g. Single switch toys, computer games)• Determining students’ needs for any adaptive equipment to
improve independence and function (e.g. trays)”• Physio – “Helping the OT and AAC Specialist determine optimal
physical access for students”
LSA / TA (or Rehab Assistant, Day Centre staff?) Cottier, Doyle & Gilworth (1997)
• “Providing device instruction• Helping the student maintain the device• Collaborating with the teacher and SLT on strategies to facilitate
participation and instruction in the classroom• Selecting vocab• Preparing low tech• Providing opportunities to practice retrieving vocab or messages through
structured activities• Providing opportunities for practice in various classroom contexts• Working with students on the use of appropriate pragmatics or social skills• Encouraging students to use the most efficient communication method for
the situation• Maintaining a notebook e.g. instructions for use / programming, device
performance, vocab suggestions”
Students (people who use AAC) Cottier, Doyle & Gilworth (1997)
• “Learning how to use the AAC device• Initiating the use of the device for communication
and academic purposes• Devoting time to learning AAC strategies• Helping maintain the device• Using a variety of communication methods to
indicate needs, ideas and preferences• Being an advocate by letting team members know
when the equipment is not working or is not meeting needs (e.g. vocab)”
Family members Cottier, Doyle & Gilworth (1997)
• “Participating in the AAC evaluation process: specifically indicating where & with whom AAC is needed and describing success with previous communication devices or modalities
• Helping with AAC trials and providing input re: the most appropriate system
• Helping with vocab selection• Helping provide AAC device instruction• Encouraging their child or a sibling to use the AAC system• Maintaining and troubleshooting the AAC device• Providing team members with feedback on the use of the
system at home and in the community”
Characteristics of effective teams Cottier, Doyle & Gilworth (1997)
• “Designate a team leader
• Recognise differences in goals
• Understand the primary goal of increasing the student’s participation...while the student is learning the curriculum
• Come to a consensus on academic and communication goals
• Are sensitive to and appreciate the needs of other team members and collaborate with one another
• Are flexible and open to modifying techniques or strategies that are ineffective
• Are able to evaluate themselves honestly
• Can determine strategies to facilitate the student’s success
• Show respect for the student’s and family’s preferences and decisions
• Are accountable for reaching desired outcomes”
Rocky Bay resources
Suggestions for Team Communication
• Be aware that change can be threatening, and is an ongoing process• Start simple / identify any ‘quick wins’• Collaborate with everyone and try to put yourself in their shoes to
understand any concerns• Is it feasible to set up a communication team?• Joint assessment • How do you cascade information?
– Within the team– To others
• What training does the team need? (Cottier et al page 18 - 21)• What training can the team provide to others? • How can you promote AAC use?• Consider clients’ changing needs• Agree goals
Goal setting
• Means, Reasons, Opportunities• SETT (Student, Environment, Tasks, Tools)• “Functional AAC Intervention: A Team Approach”
Cottier, Doyle & Gilworth (1997)
• Light’s Competencies• AAC Matrix • Rocky Bay resources
Means, Reasons, Opportunities http://www.nottinghamcity.gov.uk/CHttpHandler.ashx?id=2215&p=0
Team working
AAC system(s) Environment
Communication Partners
SETThttp://www2.edc.org/NCIP/workshops/sett/SETT_Framework_article.html
– Student : abilities and needs– Environment: physical; resources – materials,
equipment and people etc– Tasks: what activities do the client (or their peers)
participate in; how can technology support participation in these activities?
– Tools: what strategies or systems could be introduced to assist the student participate in the activity?
Functional AAC InterventionA Team Approach
Cottier, Doyle & Gilworth (1997)
• Develop an AAC intervention plan (page 10)
• Strategies for Changing the [Classroom] Environment
Activity / duty Date Person responsible
Frequency Comments Follow-up date
Identify vocab for science topic
2/5/13 Teacher with SLT support
Every half term
Program on vocab for science topic
5/5/13 LSA Every half term
Dependent upon teacher
Situation Problem Identified
Date Solution Person Responsible
Completion date
Lunchtime VOCA removed so unable to communicate verbally
1/5/13 Create communication placemat
SLTA
Light’s Competencies
• Communicative Competence is the ability to communicate functionally in the natural environment and to adequately meet daily communication needs” (Light, 1989)
• Light defined 4 competencies: • Linguistic • Operational• Social• Strategic
Competence ChecklistsCottier, Doyle and Gilworth (1997)
Skill Date Date Date Date Date
Linguistic Competencee.g. Able to choose desired food item on food page
Operational Competencee.g. Rests device on counter top when ordering food
Strategic Competencee.g. Informs cafe staff that he is using a VOCA and it may take a minute to order his food
Social Competencee.g. Uses “Please” and “Thank you” when requesting food
Skills Goal SheetCottier, Doyle & Gilworth (1997)
Skill Area / Goal Instructional Method / Technique
Team Member Responsible
Date Completed
Linguistic Competencee.g. Able to choose item of food from selection on page
Copies modelMake choice during role play SLT
LSA
Operational Competencee.g. Charges the battery daily
Copies modelVerbal prompt
MumMum
Strategic Competencee.g. Able to repeat message if not understood
Repeats message when promptedMinimal tactile prompt
SLT
SLT
Social Competencee.g. Says “Please” when ordering food
Follows modelRole playPrompted
SLTLSAMum
http://doe.k12.hi.us/specialeducation/assistivetechnology/Resource%20Materials/
AAC_Handbook.pdf
Ro
References & Resources
• http://www.asha.org/NJC/faqs-interdisciplinary.htm (Interdisciplinary team working American Speech-Language Hearing Association)
• http://doe.k12.hi.us/specialeducation/assistivetechnology/Resource%20Materials/AAC_Handbook.pdf (AAC Matrix)
• http://aac.unl.edu/yaack/c1.html#top (AAC Connecting Young Kids)• http://www.bhamcommunity.nhs.uk/about-us/services-directory/specialist-services/rehabilitation/services/act
(ACT website)• http://www.nottinghamcity.gov.uk/CHttpHandler.ashx?id=2215&p=0 (Means Reasons Opportunities) • http://www.rockybay.org.au/go/services/clinical-services-directorate/resources/information-kit-for-aac-teams
(Rocky Bay AAC team - nice handouts on team working and goals with focus on family-centred approach)• http://www.communicationmatters.org.uk/sites/default/files/downloads/standards/
aac_services_standard_aug_2012.pdf (Communication Matters AAC Services Quality Standards)• http://www2.edc.org/NCIP/workshops/sett/SETT_Framework_article.html (Students, Environment, Tasks, Tools)
• Cottier, Cynthia; Doyle, Molly & Gilworth, Kimberley (1997) “Functional AAC Intervention: A Team Approach” Imaginart
• Glennen, Sharon L & DeCoste, Denise C (1997) “The Handbook of Augmentative & Alternative Communication” • Light, Janice (1989) “Toward a definition of communicative competence for individuals using Augmentative &
Alternative Communication” Augmentative & Alternative Communication Vol 5 No 2: 137-144 • “Specialised AAC provision Commissioning national services “ (November 2011) Office of the Communication
Champion and Council
Contacting ACT
• Main phone number: 0121 466 3050• Referrals / Helpline: 0121 472 0754 (Mon, Wed, Fri)
• Website: http://www.bhamcommunity.nhs.uk/about-us/services-
directory/specialist-services/rehabilitation/services/act
• Email: [email protected] • Address: ACT, West Midlands Rehabilitation
Centre, 91 Oak Tree Lane, Selly Oak, Birmingham, B29 6JA