Beginning communicators: Where does AAC intervention start

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Beginning communicators Where does AAC
intervention start?
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Communication

• is the most important thing we have. It makes
  us a person and not a thing. No one should ever
  have to be a thing
• (Joseph, 1986)

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Beginning communicators are

• individuals across the age range who do not yet
  demonstrate communicative intentionally
• individuals who rely primarily on pre-linguistic
  communication means
• individuals who are learning to use aided or
  unaided communication means to represent basic
  communication functions (e.g. rejecting,
  requesting, etc.)
• individuals who use low technology AAC systems
  (e.g. basic communication boards) for
  participation.

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Why is this important for speech language
pathologists?

• Increasing incidence of disability (particularly
  in developing countries)
• Impact of disability is profound. It is
  permanent, placing high financial and care
  demands on the family and community.
• Positive impact of early intervention
• Move away from institutionalization to inclusion
• Partnership between parents and SLP view her as
  concerned and approachable advisor
• Shortage of health professionals parents become
  more active

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BCIP philosophy

• For use by SLP when training non-professionals or
  other professionals
• Empowerment model
• Focus on beginning communicators / individuals
  with severe intellectual impairments
• Use principles of adult training
• Culturally sensitive
• Focuses on both knowledge and skills

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Use ICF to determine individuals functioning

• International classification of functioning,
  disability and health (ICF). WHO
• In alignment with the social model rather than
  the medical model
• Functioning is umbrella term to indicate positive
  aspects at 3 levels of the ICF
• Disability is umbrella term for the negative
  aspects (problems) at 3 levels.
• Disability is thus seen as a multi-dimensional
  phenomenon resulting from the impaired
  interaction between individuals and the
  environment
• ICF highlights the importance of environmental
  and personal factors that impact functioning,
• Thus focus on ability not on disability

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ICF

• Health condition
• (disorder or disease) 
•  
• Body Function Activity
  Participation
• Structure
•  
•    
• Environmental Personal
• factors factors

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Use a milieu teaching approach

• Naturalistic strategy for teaching functional
  communication skills within routines occurring
  every day
• Focus on providing a strong receptive language
  foundation
• Follow and expand individual's lead and/or
  interest
• Use multiple, naturally occurring examples to
  teach simple communication skills
• Provide logical stimuli and naturally occurring,
  real consequences
• Facilitators (SLP / Parents) should identify
  potential communication contexts and use a number
  of specific techniques to deliberately create
  these opportunities
• Specific techniques time delay, incidental
  teaching and mand model

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Use activities of daily living (ADL)

• Environment in which individual learns, lives and
  functions must provide opportunities for
  interaction.
• Typical routines and activities (ADL) offer
  repeated opportunities to learn to anticipate
  events and to respond to needs or changes within
  these events
• Individuals with severe disabilities spend
  significantly more time in daily care routines
  (such as eating, dressing and bathing) than their
  typically developing peers.
• ADL can take a long time to complete and often
  the day consists of little other than these fixed
  routines
• Routines conducted within natural environments
  offer reasons for communication that cannot be
  recreated in simulated places.
• Parents are familiar with ADL, and dont view it
  as threatening or extra work.

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Use an integrated communication approach
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Beginning Communication Intervention Protocol
(BCIP)
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Use deliberate communication opportunities

• Individuals with severe disabilities communicate
  at a low rate
• Due to few reasons to communicate and fewer
  opportunities for interaction than speaking peers
  
• Some partners also have little or no expectations
  that these individuals can or will participate in
  interaction, with the main focus of interaction
  often being exclusively on caring and nurturing.
• Few demands are thus placed on them, leading to
  reduced communication opportunities and little
  motivation to develop more effective
  communication skills
• Deliberate interaction opportunities should be
  created

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Deliberate opportunities(based on ACE Rowland
Schweigert, 1994)

• Choice-making
• Making desired items inaccessible
• Providing small portions or brief turns
• Selecting materials that require assistance
• Deliberately withholding attention
• Offering non-preferred items
• Violating expectations / Creative stupidity     

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Future scenarios

• Publish BCIP
• Make further inroads into health sector (part as
  in-service training of all community health
  nurses
• Apply to other contexts, e.g. Education

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Contact details

• Juan Bornman
• Centre for AAC
• University of Pretoria
• 0002 Pretoria
• SOUTH AFRICA
• E-mail Bornman_at_Libarts.up.ac.za
• Tel [phone]
• Fax [phone]