Introductions Emily Lakey, Ph.D., CCC-SLP Meredith Bowles, SLP - - PDF document

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Complex Communication Needs and AAC: Best Practice for Serving Students who are Minimally Verbal

NCSHLA Conference April 12, 2019 Session #33

Introductions

• Emily Lakey, Ph.D., CCC-SLP
• Meredith Bowles, SLP Graduate Student
• Olivia Varner, SLP Graduate Student
• Dept. of Communication Sciences and Disorders

Learning Objectives

• Describe considerations for language assessment in

students who use AAC

• Explain intervention techniques to teach functional

communication skills using AAC

• Provide examples of how unaided and aided AAC

systems can be used in school settings

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Session Agenda

• AAC Myths
• Practical strategies for AAC assessment
• Practical strategies for AAC intervention

Augmentative and Alternative Communication (AAC)

Communication systems, methods, strategies and tools that replace or supplement natural speech

• Augmentative
• Alternative
• Unaided
• Aided

Myth #1

AAC should be introduced only after it has been determined that a child cannot use natural speech

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Myth #2

High-tech AAC is always the goal

What’s the purpose?

The most effective interactive communication possible

https://www.asha.org/public/speech/disorders/CommunicationDecisions/

SNUG

Spontaneous Novel Utterance Generation

Presuming competence

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Myth #3

AAC is not appropriate for children with severe cognitive impairment

Myth #4

AAC is not appropriate for children with severe motor impairment

If a child can’t use his/her hands to touch the device/pictures...

• Eye tracking
• Using another part of the body

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AAC Assessment

• Who are likely candidates for AAC?
• What should be assessed?
• When should you use high tech or low tech? (What is the

best “tool”?)

• Where should an assessment take place?
• Why should a student be assessed for AAC?

AAC Assessment

World Health Organization’s International Classification of Functioning, Disability and Health (ICF) framework (ASHA, 2016; WHO, 2014)

• Impairments in body structure and function
• Effects on activities and participation
• Contextual factors: barriers or facilitators

Comprehensive Assessment for AAC

• Case history
• Ecological inventory
• Self-report
• Sensory and motor status
• Spoken language assessment
• Written language assessment
• Social communication assessment
• Cognitive communication assessment
• Symbol assessment
• Feature-matching assessment
• Identification of contextual facilitators and barriers

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Sample AAC Assessment Tools

• Augmentative & Alternative Communication Profile (AACP): A

Continuum of Learning

• Communication Matrix
• Functional Communication Profile Revised (FCP-R)
• Student-Environment-Task-Tools (SETT) Framework
• Test of Aided-Communication Symbol Performance (TASP)
• Wisconsin Assistive Technology Initiative (WATI)

Assessment → Intervention

• Meaningful Contexts for Communication
• Effective means to Communicate (mode,

“access”)

• Appropriate Vocabulary
• Environment Supports Communication
• Appropriate Interaction Strategies

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Effective Communication

• ccurs when the intent and

meaning of one individual is understood by another person Vocabulary

Words, short phrases, sound effects Watch and listen

• What does the child need/want to communicate?
• Opportunities to connect and be playful?

Watch and listen to other children in the environment Talk to communication partners Review vocabulary lists or questionnaires CORE Vocabulary

Light & Drager, 2012

Core Vocabulary

High-frequency, multi-purpose, commonly

• ccurring words from a range of word classes

that are a central part of an individual's AAC system

http://www.project-core.com/core-communication-systems/

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Intervention Approaches to Teach and Support Communication Using AAC

• Environmental Arrangement
• Embedded Opportunities
• Modeling
• Prompting
• Responsive Interaction

Environmental Arrangement

• Manipulating aspects of the physical

environment to promote communication

Embedded Opportunities

Intentional, systematic opportunities for meaningful communication and participation in a variety of everyday activities and routines

• Blocked response/interrupted behavior chain
• Expectant delay/time delay
• Contrastive examples

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Modeling

• Aided language input
• Focused language stimulation

Prompting

• Scaffolding levels of support

○ Most-to-least ○ Least-to-most

• Independence

Prompting: Start with Errorless Learning

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Least-to-Most Prompting

Responsive Interaction

• Respond to attempts to communicate
• Recasts/expansions

How do we know it’s working?

Functional…. Communication…. SNUG Progress monitoring

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COMMUNICATION BILL OF RIGHTS

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The right to interact socially, maintain social closeness, and build relationships

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The right to request desired objects, actions, events, and people

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The right to refuse or reject undesired objects, actions, events,

• r choices

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The right to express personal preferences and feelings

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The right to make choices from meaningful alternatives

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The right to make comments and share opinions

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The right to ask for and give information, including information about changes in routine and environment

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The right to be informed about people and events in one’s life

Brady et. al (2016). Communication services and supports for individuals with severe disabilities: Guidance for assessment and intervention. American Journal on Intellectual and Developmental Disabilities, 121(2), 121-138.

COMMUNICATION BILL OF RIGHTS

9. The right to access interventions and supports that improve communication

• 10. The right to have communication acts acknowledged and responded to

even when the desired outcome cannot be realized

• 11. The right to have access to functioning AAC (augmentative and alternative

communication) and other AT (assistive technology) services and devices at all times

• 12. The right to access environmental contexts, interactions, and opportunities

that promote participation as full communication partners with other people, including peers

• 13. The right to be treated with dignity and addressed with respect and

courtesy 14. The right to be addressed directly and not be spoken for or talked about in the third person while present

• 15. The right to have clear, meaningful, and culturally and linguistically

appropriate communications

Brady et. al (2016). Communication services and supports for individuals with severe disabilities: Guidance for assessment and intervention. American Journal on Intellectual and Developmental Disabilities, 121(2), 121-138.

Resources

North Carolina Augmentative Communication Association (NCACA): https://ncaca.info/ North Carolina Assistive Technology Program: https://www.ncdhhs.gov/divisions/vocational-rehabilitation-services/north-carolina- assistive-technology-program Exceptional Children's Assistance Center (ECAC) https://www.ecac- parentcenter.org/ AAC Institute: https://aacinstitute.org/ International Society for Augmentative and Alternative Communication (ISAAC): https://www.isaac-online.org Rehabilitation Engineering and Assistive Technology Society of North America (RESNA): https://www.resna.org PrAACtical AAC: https://praacticalaac.org/ A.T.TIPSCAST: https://attipscast.com

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Questions?

Thank you! Email: lakeyer@appstate.edu