choosing the appropriate system handout

CHOOSING THE APPROPRIATE AIDED LANGUAGE SYSTEM

for a person with CCN

WHICH SYSTEM? WHY?

­For many families, individuals and therapists, the temptation in AAC assessment is to jump straight to the solution­ E.g. Should I get Proloquo2Go or PODD?­ Someone mentioned SpeakForYourself – would that be appropriate for my child/student/client?

­The Participation Model encourages us to look beyond this and identify barriers before we get to solutions.

THE PARTICIPATION MODEL

Endorsed by the American Speech-Language Hearing Association (2004) and the Australian Association of Speech Hearing (2012) as the appropriate model for AAC assessment and intervention

Model initially focuses on the need to identify at participation barriers ­ identify opportunity barriers ­ Identify access barriers

Plan and implement interventions for today and tomorrow based around these barriers

Evaluate intervention effectiveness

IDENTIFY PARTICIPATION BARRIERS

Opportunity Barriers

Access Barriers

OPPORTUNITY BARRIERS

Policy e.g. you can’t get an AAC system until you show “readiness”

Practice e.g. only have 2 weeks trial with a system when we know individuals may need several months (NJC, 2012)

Facilitator skill e.g. if we don’t know how to use an AAC system how can we support it?

Facilitator knowledge e.g. assessor only knows about one form of AAC such as PECS

Attitude e.g. team members don’t believe individual can learn

THIS LEADS TOOPPORTUNITY INTERVENTIONS

ACCESS BARRIERS

Assess current communication including:­Potential to increase natural ability­Potential for environmental adaptations­Potential to use AAC systems

ASSESS CURRENT COMMUNICATION

Important to use a systematic questionnaire based tool to reduce bias (which of course is an opportunity barrier) and to use again later to track progress

Check out these free tools:Communication Matrix (Rowland, 2011) www.communicationmatrix.org

Pragmatics Profile of Everyday Communication Skills (Dewart and Summers, 2012)

“Vygotsky (1978) argued that standardized tests (in which the tester cannot actively intervene to enhance the test taker’s performance) provided data only on the individual’s past history and present functioning, not on his future potential. He sought to find out where (and how) education could optimize each individual’s performance across a variety of skills.”

Olswang, Bain, & Johnson (1992).

ASSESS POTENTIAL TO INCREASE NATURAL ABILITYDynamic Assessment

Using information on current functioning, the examiner interacts with the person providing

­ models, ­ cues, ­ instructions,­ prompts, ­ feedback

to aid the person to successfully complete “tasks” they were unable to achieve alone.

Adapted from Porter, 2016

THE ZONE OF PROXIMAL DEVELOPMENT

“the distance between the actual developmental level as determined by independent problem solving and the level of potential development as determined through problem solving under either adult guidance or in collaboration with more capable peers”

(Vygotsky, 1978, p. 86)

Adapted from Porter, 2016

ZONE OF PROXIMAL DEVELOPMENT VYGOTSKY (1962, 1978)

Zone of proximal development

What child can do in

collaboration with a skilled

other.

What child can do alone

Structured guidance(including the

use of AAC strategies)

The zone of proximal development is jointly determined by the skills of the child and the form of structured guidance provided by the skilled partner

Adapted from Porter, 2016

“the ‘zone of proximal development’,

where children develop language by solving communicative challenges with the help of more competent members of their language environment.”

Renner, 2003 p 82

Adapted from Porter, 2016

DYNAMIC ASSESSMENT

Is Qualitative­ Identify processes or factors that interfere with the

person’s successful completion of task

­ Identify processes or means that enable the person to learn to successfully complete task

­ Identify how the person solves problems and suggests specific strategies

­ Bridges assessment – intervention gap

Not Quantitative­ Determine amount of change in test-teach-test­ Ready to learn a skill

Adapted from Porter, 2016

THIS LEADS TONATURAL ABILITY INTERVENTIONS

ASSESS POTENTIAL FOR ENVIRONMENTAL ADAPTATIONSFrequently the environments, including communication partners, can change HUGELY when we provide sufficient practice, training, resources and coaching

THIS LEADS TOENVIRONMENTAL ADAPTATION

INTERVENTIONS

ASSESS POTENTIAL TO USE AAC SYSTEMS AND/OR DEVICESThis is where feature matching comes in!­ Motor skills­ Sensory perceptual needs­ Literacy­ Linguistic skills­ Check out http://praacticalaac.org/praactical/aac-assessment-corner-by-vicki-clarke-is-aac-feature-

matching-still-relevant/

THIS LEADS TOAAC SYSTEM INTERVENTIONS

INTERVENTIONS

Opportunity Interventions

Plan and Implement Interventions for Today and Tomorrow

Natural Ability Interventions

Environmental Adaptation Interventions

AAC System Interventions

Provide instruction to individual who uses AAC AND their facilitators/team

Provide instruction to individual who uses AAC AND their facilitators/team

JOHN

OPPORTUNITY BARRIERS 2011

HUGE opportunity barriersPolicy – no speech pathologist support at his school and limited funding for AAC in his state, which can only be accessed through a speech pathologist

Practice – very little knowledge of AAC

Facilitator skill – very low

Facilitator knowledge – no knowledge in family and limited knowledge at school

Attitude – highly valued as a communicator but not seen as a learner

OPPORTUNITY INTERVENTIONS

Policy - Principal of school funded a speech pathologist to consult school-wide

Speech Pathologist targeted Facilitator skill, Facilitator knowledge and Attitude through education workshops, modelling and individual conversations

Practice – through targeting these other areas, aided language stimulation was provided

ACCESS BARRIERS

Current communication - uses facial expression, body language, natural gesture, vocalisations and behaviour.

Potential to increase natural ability - HUGE with aided language stimulation

Potential for environmental adaptations – School – HUGE with fabulous exec support

Potential to use AAC systems – no motor or sensory additional requirements, emergent language and literacy skills

ACCESS INTERVENTIONS

Natural ability Interventions

Environmental Adaptation Interventions

AAC system interventions

Introduction of lots of aided language stimulation and balanced literacy!

ACCESS BARRIERS

Current communication - uses facial expression, body language, natural gesture, vocalisations and behaviour.

Potential to increase natural ability - HUGE with aided language stimulation

Potential for environmental adaptations – School – HUGE with fabulous exec support

Potential to use AAC systems – no motor or sensory additional requirements, emergent language and literacy skills

AAC SYSTEM SELECTION

Need a system with:­ A range of language­ Ability to develop linguistic competency ie combining symbols­ Ability to be used for aided language stimulation throughout the day­ Ability to be used to communicate throughout the day­ Ability to be used for a range of communicative functions­ Ability to support the user to develop communication autonomy

Feedback from team was that they felt Proloquo2Go was the best option and it met all of our criteria

EVALUATION

End of 2011 – now paying attention to aided language stimulation and texts; reduction in challenging behaviour

Recommendation: Continue ALS with Proloquo2Go 5x9 and balanced literacy

End of 2012 – continuing to attend to aided language stimulation and starting to use Prolouqo2Go to babble and developing some alphabet knowledge

Recommendation: Continue ALS with Proloquo2Go 5x9 and balanced literacy

End of 2013 – using 1 - 2 cells in Proloquo2Go 7x11 to communicate in a range of settings; has consolidated most emergent literacy skills; huge reduction in challenging behaviour

Recommendation: Continue ALS and balanced literacy

EVALUATION

End of 2014 – now using Proloquo2Go 7x11 independently and autonomously; late transitional or early emergent literacy learner;

Recommendation: Continue ALS and balanced literacy.

SUMMARY

Good assessment + Good intervention = Great outcomes