Successful AAC:

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• Successful AAC
• The impact of environments and communication
  partners
• Thursday
• 15th May 2008
• Chris Sherlock SLT ACT
• Nick Cox SLT SBPCT

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Contacting Us

• Helpline 0121 472 0754
• Website http//www.actwmids.nhs.uk/
• Email format Firstname.Secondname_at_sbpct.nhs.uk
• Main phone number 0121 627 8235
• Address ACT, WMRC, 91 Oak Tree Lane, Selly Oak,
  Birmingham. B29 6JA

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New ACT Website
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Timetable

• 9.00 Registration and Coffee
• 9.30 Introduction
• 9.45 Communicative Competence Activity
• 10.45 Tea/Coffee
• 11.00 Hanen
• 12.15 Lunch
• 12.45 Supported Conversation
• 1.45 Tea/Coffee
• 2.00 Other support packages and practicalities
• 3.00 What next?
• 3.30 Close

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Introducing ACT

• 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 about 30 people.
• Other teams in UK are similar but each is unique

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The West Midlands AAC Care Pathway

• Brief history
• About the training packages
• The documentation and how it can be used.
• Sourcing the documentation

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The West Midlands AAC Care Pathway
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The West Midlands AAC Care Pathway
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Learning outcomes

• Delegates will be able to
• Clearly identify successful communication and
  barriers to communication
• Look at an environment and identify if it
  supports individuals who use AAC
• Devise strategies to develop the competencies of
  communication partners and reduce barriers to
  successful communication
• Develop ideas for work within their own setting

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How does this fit with the WM AAC Care Pathway?

• Sections in the documentation
• AAC environment section
• What do staff/carers know about..
• Can you expand on the awareness of the different
  members of staff this person encounters during
  the week?
• Coordinator section
• Are there areas of further assessment or
  intervention required?
• Is there a shared understanding of the needs and
  purpose of AAC?
• Implementation checklist
• Training needs?

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Activity

• Using some AAC
• Including with indirect access Partner Assisted
  Scanning (PAS)
• The aim is to look at what makes the
  communication successful or less so.
• By considering the roles of both communicators.

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Practical exercise around Vocabulary choicesin
AAC

• 2 AAC symbol displays AB
• Please use them in order to role play a
  conversation when out for a simple meal.
• The person with the display can not talk
• but can use their hands, and can signal a clear
  yes and no
• Try doing this exercise using partner assisted
  scanning PAS (do we need to demonstrate this for
  you?)
• You can swap roles for the second (B) experience
• What happened with the conversation with A?
• What happened with the conversation with B?
• Strengths / Weaknesses / Opportunities /
  Challenges
• Which of these ALDs would you take if you had to
  choose? And Why?
• Consider the skills you both need to make it all
  work

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AAC exercise (Mayer-Johnson symbols)
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AAC exercise (Mayer-Johnson symbols)
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Display A - SWOC

• Strengths
• You can choose your meal with it
• You can initiate communication
• May be easier to learn symbolic representation
  for concrete vocabulary
• You can be polite NB display space for please
  etc
• Weaknesses
• It only allows you to talk about food
• It may not have your favourite foods
• Conversation ends rapidly
• Very concrete messages
• Why not use other communication methods e.g.
  point to menu, partner assisted scan of menu

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SWOC Display B -

• Strengths
• Allows you to communicate a greater range of
  communicative functions
• Make choices
• Ask questions
• Be more sociable and chatty
• Longer conversations
• More equitable
• More flexible
• Repair communication breakdowns Oh no! Sorry
• You can pull !!!

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Display B SWOC 2

• Weaknesses
• Cant give definite information about your food
  choices
• You can ask questions but not provide detailed
  responses
• Cant be so polite

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Activity

• What makes Communication successful for a person
  who uses AAC?
• What do both partners in the conversation
  contribute?
• Impact of Partner Assisted Scanning

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Describing successful AAC

• Janice Lights (1988) 4 agendas of communicative
  interactions the successful AAC user needs to be
  able to access and use these purposes
• Expression of wants and needs
• Information transfer
• Social closeness
• Social etiquette

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These successes depend on 4 Communicative
competencies

• Communicative Competenceis the ability to
  communicate functionally in the natural
  environment and to adequately meet daily
  communication needs (Dr. Janice Light, 1989)
• Light 1989 4 competencies
• Linguistic
• Operational
• Social
• Strategic

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AAC Competencies References Light, 1989
Cottier, Doyle Gilworth, 1997 Light Binger,
1998

• Strategic Competence
• Strategic skills refer to compensatory strategies
  that may be utilized by individuals who use AAC
  to overcome functional limitations that restrict
  their effectiveness as communicators.
• For example, individuals who use AAC may have
  difficulty interacting with unfamiliar partners
  and may need to use an introduction strategy, as
  a compensatory strategy, to provide new partners
  with information about how to communicate
  effectively with them.  

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AAC Competencies References Light, 1989
Cottier, Doyle and Gilworth, 1997 Light and
Binger, 1998

•  Linguistic Competence
•  Linguistic skills include receptive and
  expressive skills in the native language spoken
  by the family and broader social community (e.g.
  the skills to understand spoken English or
  Spanish).
• Linguistic skills also include skills in the
  "linguistic" code of the AAC system (e.g.
  learning the symbols of the AAC system, such as
  drawings, words, or signs learning how to
  combine these symbols to represent more complex
  meanings).

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AAC Competencies References Light, 1989
Cottier, Doyle and Gilworth, 1997 Light and
Binger, 1998

• Social Competence
•  
• Knowledge, judgement, and skills in the social
  rules of interaction.
• For example, the skills to initiate, maintain,
  develop, and terminate interactions the skills
  to develop positive relationships and
  interactions with others the skills to express a
  full range of communicative functions (e.g.
  requests for objects, protests, requests for
  information) etc
•  
•  

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AAC Competencies References Light, 1989
Cottier, Doyle and Gilworth, 1997 Light and
Binger, 1998

• Operational Competence
•  Operational skills refer to the technical skills
  required to use the AAC system(s) accurately,
  efficiently, and appropriately.
• For example, operational skills would include the
  skills to produce the hand shapes and movements
  needed to form signs or gestures correctly the
  skills to use a head pointer to indicate items on
  a communication board the skills to use
  row-column scanning with a single switch to
  control a VOCA etc

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Break
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What is the Hanen Approach?

• The Hanen Centre, a charitable organization
  founded more than 25 years ago, is committed to
  making a difference in the lives of young
  children by supporting and collaborating with the
  adults in their lives. Our mission is to
  provide the important people in a young child's
  life with the knowledge and training they need to
  help the child develop the best possible
  language, social and literacy skills
• http//www.hanen.org/ UK supplier Winslow Press

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What is the Hanen Approach?

• A series of training programmes which have key
  features
• Trained facilitators usually SLTs
• Group work
• Use of video
• Use of Hanens own professionally produced
  materials
• Assessment, Goals and Review of progress specific
  to the individual and those around them

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What is the Hanen Approach?

• Certain number of hours involvement in the
  programme
• Expectation of commitment and involvement
• Main focus is on children with communication
  needs
• Very sound theoretical basis in child language
  development research
• Ongoing research and developments by the
  organisation
• Careful attention to how adults learn and change
• Lots resources books, manuals, teaching videos
  for communication partners and trainers
• Can be adapted with permission but need to
  contact Hanen and not call the programme a Hanen

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Other key ideas

• During a Hanen programme participants/communicatio
  n partners
• Make an assessment of the language/communication
  level of the person they are facilitating
• Setting goals for the development of
  communication skills
• Understand more about the level of
  language/communication skill and style of the
  person they are focussing on
• Understand more about the typical communication
  style of themselves as communication partner and
  how this might help or hinder the persons
  development.

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How is change brought about?

• Through group teaching
• Use of core ideas that are presented in an
  accessible way (catch phrases/pictures)
• Materials e.g. books
• Video tapes and discussion
• Activities
• Home coaching sessions 11 with video
• Practice between sessions

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Core ideas

• Depending on the exact programme chosen these may
  vary in terminology
• Noticing all the persons communication
• OWL (Observe, Wait and Listen)
• Client led interaction and communication
• Extending the interaction to more turns
• Extending/expanding language and enriching the
  communication environment

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An example

• Allow Me Irma Ruiter 2000
• A Guide to Promoting Communication Skills in
  Adults with Developmental Delays.
• Does not currently have a video or other
  materials
• Follows the core ideas about promoting
  communication development
• Has a chapter on Augmentative and Alternative
  Communication

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How are these expressed by Allow Me?

• Slow down and capture the moment
• Allow your partner to lead
• Adapt activities so that you and your partner can
  share them
• Get the conversation going and keep it going
• Add information and experience

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It takes two to talk 2004

• Let your child lead
• Follow your childs lead
• Take turns to keep the interaction going
• Add language to the interaction
• Then moves on to using these skills in different
  contexts e.g. play, music, books.

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It takes two to talk 2004

• View video?

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AAC in particular

• More than words
• Children with ASD
• Visual timetables
• PECS type approaches
• Allow me
• ALD
• Symbols
• communication books and VOCAs
• It Takes Two to Talk
• Children with language delay
• Visual helpers

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What can Hanen bring to work with people using
AAC?

• The training packages are very suitable for many
  communication partners
• Could use the approach in a 11 way to develop
  skills.
• Could use the approach with a particular focus on
  the persons AAC as part of their communication
  repertoire

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Help to focus on getting use of AAC going

• Following the lead matches well with an error
  free approach to early attempts with AAC and fits
  with providing flexible vocabulary related to
  early meanings that can be mapped on to a lead.
• Taking turns matches well with modelling the use
  of the AAC system to the user.
• Add language matches well with extending AAC use
  with further modelling of AAC into growing room
  in the system

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What are your thoughts and experiences?

• ideas

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What have we tried?

• Working with parents to help them use these
  principles with a child who needs AAC .
• The follow the childs lead and the taking turns
  parts of the ITTT programme allow us to use early
  meaning vocabulary in AAC mode.

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Early Meanings aspects of cognitive structure
that the child may attempt to communicate about
(Leonard, 1984)

• Existence (LOOK)
• Disappearance (GONE)
• Recurrence (AGAIN)
• Non-existence (NO)
• Location (THERE)
• Possession (MINE)
• Rejection (DONT)
• Denial (DIDNT)
• Agent (THAT)
• Object (THIS)
• Action (DOWN etc)
• Attribute (DIRTY etc)
• Communication before Speech - Coupe OKane
  Goldbart

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Video

• Ruby Mae and Mum
• Allowing her to lead
• Map to early meanings

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Lunch
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Supported Conversation
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Social Model of Disability

• Disability does not inevitably stem from the
  functional limitations of impaired individuals
  but from the failure of the social and physical
  environment to take account of their needs
• Pound et al 2000

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What is Supported Conversation in Aphasia (SCA)

• SCA is based on the idea of conversational
  partnerships there is less emphasis on
  independent use of communication strategies by
  the aphasic partner and more emphasis on what the
  dyad achieves interdependently (Kagan, 1998)

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SCA - Principles

• Conversation is a part of everyday life
• Successful communication underlines perceptions
  of competence
• Communication impairment disrupts
  conversational life
• Ability can be revealed by communication ramps

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SCA - Dismantling Barriers

• SCA aims to reveal the inherent competence of
  aphasic people, by creating appropriately
  facilitative environments Pound et al 2000
• Types of barriers attitudinal, environmental,
  internal, structural, informational

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Competence

• Acknowledge
• Show the person you recognise his/her
  intelligence, expertise and skills
• Reveal
• Use techniques to facilitate successful
  conversations in which the individual can show
  his/her intelligence, expertise and skills

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Acknowledging Competence (Kagan, 1995, 1998)

• Think about what behaviour or words could make
  your partner seem less competent
• Share responsibility for breakdown
• Allow the person to choose topics
• Offer suggestions that can be accepted or
  rejected
• Explicitly acknowledge the person with Aphasias
  expertise, knowledge of what they want to say,
  and frustration

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Revealing Competence

• Small Group task
• - Generate a list of resources that might be
  used as conversation ramps
• - It may help to think of resources for the AAC
  user and those used by the conversation partner

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Conversation Ramps

• Quiet surroundings
• Taking your time
• Writing
• Gesture
• Drawing
• Pictures magazines, newspapers, photos, books,
  SCA resource, Google Images
• Communication books/ Communication passports
• Taking turns

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What can SCA bring to work with people using AAC?

• Underlying Philosophy Social not Medical
• Acknowledging Competence
• Revealing Competence
• Equal responsibility in a conversation
• Rejection of AAC is an option, not a failure but
  a choice.(social needs and info)
• Conversation is essential not a luxury.

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Communication partners very important

• Watch the video
• What do you think this person is like?
• Can you think of any words to describe him?
• Now watch the second part
• Has your opinion changed?

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What are your thoughts and experiences?

• ideas

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break

• 15 minutes

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The Physical Practicalities of AAC

• We have concentrated effectively on
• Social and strategic competence for communication
  partners
• Now we will look more at operational competence.

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Operational Competence

• The actual basics of making AAC happen
• Charging an aid
• Adding new words/symbols to a communication book
• Positioning / Access
• Communication Partner Role

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Practical What is your experience?

• 1. A complex high tech VOCA
• DynaVox V Max
• 2. Low and high tech Augmentative and
  Alternative Communication.

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What is your experience?

• What are the things
• That need consistent input/support?
• That can go wrong?
• Need to happen to create success?
• That everyone needs to know?
• We need to look at factors that will help to
  develop operational success and identify how we
  ensure this happens.

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AAC systems have aspects in common

• For EVERY AAC user they/those around them need to
  know
• What vocabulary is already in the system and
  where it is stored?
• How to add more vocabulary?
• How the user will reach/hold the system?
• How the user will access the system?
• How to back them up?
• How the system is powered/charged?
• How to get help if things go wrong?

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Feedback - Vocabulary

• What vocabulary is already in the system and
  where it is stored?
• How do you support vocabulary development?
• Who decides what vocabulary to add
• How to add more vocabulary?
• How do you support this?

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Feedback reaching / holding the system

• How the user will reach/hold the system?
• Physical environment will impact

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Feedback - Access

• How the user will access the system?
• How do you support this?
• Setting up the system in same way each time.
• Photograph.

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Feedback Back-up

• How to back them up?
• How do you support this?
• Try to use a system - date
• CS20080516

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Feedback - Charging

• How the system is powered/charged?
• How do you support this?

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Feedback If things go wrong

• How to get help if things go wrong?
• High tech freezes
• Book gets lost
• How do you support this?

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• The issues are the same for high and low tech .

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Physical Environment

• We have looked at Social, strategic and
  operational competence for communication partners
  and those in a support role for an AAC user in a
  environment.
• The physical environment has an effect
• Light
• Noise
• Wet / damp
• Partners Position
• Size / set up of display

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How do we record share information about
operational / environmental issues..

• Communication passport or dictionary
• The front page in a communication book
• A symbol etc on wheelchair tray/arm.
• A speech on a VOCA / Talking Photo album
• A film
• Talking photo albumn

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Communication PassportShow as a Power Point
http//www.communicationpassports.org.uk/ -CALL
cente website
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NHS Information Toolkit
http//www.dh.gov.uk/en/Publicationsandstatistics/
Publications/PublicationsPolicyAndGuidance/ DH_407
0141
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A mind map of possible environment issues

• Split in to groups of 4-5
• Have a look at 2 or more of the issues on the
  mind map.
• What do you think might be the issues and
  possible solutions around these topic areas?
• What are your experiences?
• Add some notes to the map. We will incorporate
  these to the handout and put an amended version
  on the website.

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• Have we fulfilled learning outcomes?
• Have you fulfilled your objectives for today?
• Is there anything to be done to provide further
  support?

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Contact details

• Chris.Sherlock_at_sbpct.nhs.uk
• victoria.lundie_at_sbpct.nhs.uk
• Julie.atkinson_at_sbpct.nhs.uk
• Nick.Cox_at_sbpct.nhs.uk
• Telephone at ACT helpline or main number

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Close

• Questions?
• Feedback form
• We would like plenty of feedback as this is a
  rewrite
• Thank you