choosing the appropriate system handout
TRANSCRIPT
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