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/servicesdirectory/specialist-services/rehabilitation/services/act
• Email: julie.atkinson@bhamcommunity.nhs.uk
• Address: ACT, West Midlands Rehabilitation
Centre, 91 Oak Tree Lane, Selly Oak, Birmingham,
B29 6JA
West Midlands AAC Care Pathway
AAC Needs Identified
Multi Disciplinary Team
Co-ordinator
Branch B
Other agencies
Branch A
A.C.T.
AAC Introduced
Review and Exit
Relevant sections in the West Midlands AAC Care
Pathway Assessment & Implementation
documentation
• AAC environment section
What are the skills and needs of those around
the client for optimising communication?
• Communication section
What are the person’s present modes of
communication & how effective are they?
Rate the different environments the client
attends.
• Co-ordinator’s checklist
Is 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
For example teachers, teaching
assistants, occupational therapists,
social workers, employment support
and care workers, etc.
Some local services include
specialist AAC services.
Otherwise regional and
national specialist AAC teams
sit within the NHS and
voluntary sector.
“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
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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)
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“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)
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“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
SETT
http://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 Intervention
A Team Approach
Cottier, Doyle & Gilworth (1997)
• Develop an AAC intervention plan
Activity / duty
Date
Person
responsible
Frequency
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
(page 10)
Comments
Follow-up
date
Dependent
upon teacher
• Strategies for Changing the [Classroom] Environment
Situation
Problem
Identified
Date
Solution
Person
Responsible
Lunchtime
VOCA removed so
unable to
communicate
verbally
1/5/13
Create
communication
placemat
SLTA
Completion
date
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 Checklists
Cottier, Doyle and Gilworth (1997)
Skill
Linguistic Competence
e.g. Able to choose desired food item on food page
Operational Competence
e.g. Rests device on counter top when ordering food
Strategic Competence
e.g. Informs cafe staff that he is using a VOCA and it
may take a minute to order his food
Social Competence
e.g. Uses “Please” and “Thank you” when requesting
food
Date Date Date Date Date
Skills Goal Sheet
Cottier, Doyle & Gilworth (1997)
Skill Area / Goal
Linguistic Competence
e.g. Able to choose item
of food from selection on
page
Instructional Method /
Technique
Copies model
Make choice during role play
Team Member
Responsible
SLT
LSA
Operational Competence
e.g. Charges the battery
daily
Copies model
Verbal prompt
Mum
Mum
Strategic Competence
e.g. Able to repeat
message if not
understood
Repeats message when
prompted
Minimal tactile prompt
SLT
Social Competence
e.g. Says “Please” when
Follows model
SLT
SLT
Date
Completed
http://doe.k12.hi.us/specialeducation/assistivetechnology
/Resource%20Materials/AAC_Handbook.pdf
Ro
References & Resources
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http://www.asha.org/NJC/faqs-interdisciplinary.htm (Interdisciplinary team working American SpeechLanguage 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/servicesdirectory/specialist-services/rehabilitation/services/act
• Email: julie.atkinson@bhamcommunity.nhs.uk
• Address: ACT, West Midlands Rehabilitation
Centre, 91 Oak Tree Lane, Selly Oak, Birmingham,
B29 6JA