AAC- Yikes! You Want Me To Do What? June Maranville MSP, CCC-SLP Palmetto Language & Speech Center, LLC Email: [email protected] Website: www.plsclex.com I don’t even know what I don’t know “The only disability in life is a bad attitude.” Scott Hamilton ALL Individuals Can and Do Communicate! -National Joint Commission for the Communication Needs of Persons with Severe Disabilities. (1992) “If all my possessions were taken from me with one exception, I would choose to keep the power of communication, for by it I would soon regain all the rest” -Daniel Webster We’ve come a long way, baby. Who remembers… O Cut and paste pictures from notebooks O Hand coloring each picture O Glue with no Velcro! O No Boardmaker O Contact paper instead of lamination O Heavy-bulky systems that took weeks to program Present Day Where are we now? O Boardmaker O Lamination O Velcro O Over 200 Apps for high-tech devices O AAC App Comparison Chart (SCATP) O http://www.sc.edu/scatp/apps.html O Light weight, durable, intuitive systems What has not changed? O As professionals, practice due diligence O O O O when choosing AAC for client. Team Approach Client and caregiver as active participants Best fit- low/medium/high tech Feature matching O a process that involves matching the skills of the AAC user with the features of the given AAC systems. What is Augmentative and Alternative Communication (AAC)? O “AAC involves attempts to study and when necessary compensate for, temporarily or permanently, the impairments, activity limitations, and participation restrictions of individuals with severe disorders of speechlanguage production and/or comprehension. These may include spoken and written modes of communication.” (ASHA 2005) AAC is the bridge that enables children with severe communication difficulties to learn higher-level language skills and to interact with individuals outside the family. ~ Page and Quattlebaum (2012) Handbook of Children with Special Healthcare Needs The Goal of AAC O Empower AAC user to O express wants and needs O exchange information O develop social closeness with others O engage in social etiquette routines. O MULTIMODAL approach most effective in order to be able to communicate for different purposes in a variety of contexts. (ASHA, 1991) Multimodal Communication O Objects O Signs O Gestures O Facial Expressions O Pictures O Speech O Nurture residual speech O Written Word O Symbols O Voice output devices Feature Matching O Which system is the best match to fit user’s abilities, needs and skills? O Dx does not determine need for specific device O Consider: O Current Skill Level O ADLs and associated wants/needs O Current Communication system/strategies O Future Communication needs O System growth with development and skills O Degenerative/Deteriorating skills Feature Matching Cont. O Objective / Feature / Selection Criteria O Shared symbol system O Development of language system O Construction of messages to interact with others O Meaningful Vocabulary O http://aac.unl.edu/vocabulary.html O Access to communication symbols O Access to communication device ~Page and Quattlebaum (2012) Handbook of Children with Special Health Care Needs Is it a good fit? Would you ever get the gift box before you purchased the gift? ~ Dr. Carol Page O No! ~ Let’s not do it with AAC either. O O Evade “flavor of the month” devices based on marketing, promotion and popularity. O AbleData: AAC products and features http://www.abledata.com/abledata.cfm?pageid=19327&ksectionid=19327 Why Assess? O Will use of AAC… O Maximize client’s abilities and decrease challenges of disabilities O Help improve condition or prevent from getting worse. O Help person function in their environment O Help improve independence O How will team find the best fit? O Is a formal assessment needed and required by funding source? O Is use of AAC a medical necessity? Medical Necessity O Medicare defines as O “Service or supplies that are needed for the diagnosis or treatment of medical condition and must meet best practice standards.” O Buzz words O Correct deficits O Ameliorate deficits - to make better or tolerable O Palliate- to make less severe or unpleasant without removing the cause. O Letter of medical necessity and physician order with high- tech AAC purchases Who can assess formally? O Licensed and credentialed in related field O PT, OT, SLP, Rehab Engineer O AT specialization certification O Other Team members—as warranted O Vision specialist O Nurse O Psychologist O Educators O Hearing specialist Who pays for AAC? Funding sources consider AAC dedicated communication devices O Private Pay O Babynet (0-3) O IFSP Team, parents and professionals O Schools (3-21) FAPE O Private insurance- appeal if denied O CRS O Medicaid O Medicare O VA O Vocational Rehab O Community O Service organizations O Church and local charities Who really pays for AAC? We all do! Components of Successful Assessment O Team Assimilation O Medical Information O History O Functional Goals O Technology that has been tried in the past and results O Clear communication among team members O Trials with AAC O Time is your best friend! Assessment Help O There are no standardized AT assessments. O Ecological Inventory ~ Nalty and Quattlebaum (1998) O Joy Zabala SETT Framework O It’s not about technology or device O It’s about matching O The Student O The Environment O The Task O The best Tool O Communication Matrix O Every Move Counts, Clicks and Chats Trials with AAC O Low-tech O Examples: Communication boards, booklets. O Can start immediately O Boardmaker is your friend! O Backup system-as needed if high-tech device malfunctions Trials with AAC O Mid-tech O Examples: BigMack, iTalk 2, Go talk series. O Typically requires a battery to operate. O Human voices recorded on device Trials with AAC O High-tech O Examples: Dynavox, Prentke Romich, Tobii- SGDs O Increase vocabulary opportunities O Digitized, synthesized speech O iPads and Tablets Purpose of Trials O What works. O What does not work. O Show evidence of optimal fit for individual communication need. O System not to be used or recommended just because only one tried, most popular, or most promoted. AAC Intervention O If we’re using pictures do we call it AAC? O AAC vs. other types of learning activities Picture Identification vs. Functional Communication O Picture ID- END O Receptive Skills and Knowledge O Touch the “____” O Teaching Format-Get response O Match, sort, reinforce O Academic Achievement Picture Identification vs. Functional Communication O Functional AAC Communication- MEANS to END O Demonstrates desire to engage with communication partner to share wants, needs and ideas. O Nurtures social interactions O Empowers O Beyond Requesting Powerpoint Message Sets O Vocabulary linked to social/emotional development O Feelings O Decrease behavioral problems with appropriate vocabulary selection O Vocabulary Selection O Provides means to interact O Motivating vocabulary imperative O Consider user’s interest first O Variety of word types Core Vocabulary http://aac.unl.edu/vocabulary.html Typical Peer 5-minute Conversation Sample More than Nouns Rich language experiences Increase message set expansion Generalizes across communication settings Teaches rules of Syntax Language to Literacy Expansion O juice, want juice, no juice, more juice, write or type juice –Page and Quattlebaum 2012 O Quick Hits/Urgent messages O One Icon to represent message O O O O O O O O Example: “I need help” “I feel sick” Prognostic Indicators O Extrinsic Factors O O O O O O O O O Skin in the game Buy into use Switch gears from basic needs to anticipating needs Co-treating Chain of cues Model, model, model! Enable vs. Empower 15x per day Intrinsic Factors O O O Knowledge is power User grasps that power is in communication Motivation O O Active participant Engage 15x per day using AAC device O O Example: Music variety Present and Possible Changes O O O O Medical condition status Plan implement ahead of time Monitor and adjust to assess wants/needs Dynamic and ever-changing process O ~ Page and Quattlebaum (2012) Parent/Caregiver Roles O Active participants O Ongoing programming O Vocabulary selection O Facilitate carryover of device to all settings O Model use of device with motivating activity for user O Troubleshoot problems O Recognize when message sets changes needed O Attend training Carryover O Functional O Motivating O Means-End O Efficient O Effective O Interactive O All Environments O At least 15 opportunities per day O Update AAC system when change occurs O Transition Strategies for Adolescents and Young Adults Who Use AAC Resources O SC Assistive Technology Program O Apps that make life easier O Apps comparison chart. O SC Equipment Distribution Program O SC Vocational Rehabilitation Resources Cont. O CRS- Children's Rehab Services O SCATP- Device Loan Program O SC Independent Living Program O CDR- Centers for Disabilities Resource Library O Loaner programs through vendors. O Key Technologies O Dynavox O Tobii O Prentke Romich Prize Time! Q and A Wrap it Up! When you know better, you do better ~ Maya Angelou O Use the resources O Celebrate great resources in your backyard O Don’t be afraid to ask for help O Enjoy the journey and be inspired! O Heart of the Ravens! Superbowl 2013 Champs! O http://espn.go.com/video/clip?id=8815080 Bibliography Works Cited AAC and Speech Devices from PRC. N.p., n.d. Web. <http://www.prentrom.com/>. "AAC Messaging and Vocabulary." AAC References. N.p., n.d. Web. <http://aac.unl.edu/vocabulary.html>. "AbleData: Products." AbleData: Products. N.p., n.d. Web. <http://www.abledata.com/abledata.cfm?pageid=19327>. "Apps That Make Life Easier." Apps That Make Life Easier. South Carolina Assistive Technology Program, 7 Jan. 2013. Web. ASHA. "Goal of AAC." (1991): n. pag. Print. "Augmentative and Alternative Communication (AAC)." American Speech-Language-Hearing Association. N.p., 2005. Web. <http://www.asha.org/public/speech/disorders/AAC/>. "Beyond Requesting." Beyond Requesting. N.p., n.d. Web. <http://www.slideshare.net/slpwendy/beyondrequesting-presentation>. CDR Library, School of Medicine Library, University of South Carolina. N.p., n.d. Web. <http://uscm.med.sc.edu/cdr/>. "Communication Assessment for Parents & Professionals." Communication Matrix. N.p., n.d. Web. Bibliography Cont. DynaVox: Communication Devices – Speech Devices. N.p., n.d. Web. <http://www.dynavoxtech.com/>. "EMC, Inc. Home." EMC, Inc. Home. N.p., n.d. Web. <http://www.everymovecounts.net/>. ESPN. ESPN Internet Ventures, n.d. Web. <http://espn.go.com/video/clip?id=8815080>. "Independent Living." South Carolina Department of Social Services. N.p., n.d. Web. <http://www.state.sc.us/dss/independent/index.html>. Key Techonologies. N.p., n.d. Web. <http://www.gokeytech.com/>. Nalty, L., and P. Quattlebaum. "A Practical Guide to Augmentative and Alternative Communication: Assessment and Intervention Strategies." Greenville:Super Duper (1998): n. pag. Abstract. Severe Communication Disorders (2012): 32. Print. National Joint Commission for the Communication Needs of Persons with Severe Disabilities. Guide-lines for Meeting the Communication Needs of Persons with Severe Disabilities (1992): n. pag. Print. Page, C. A., and P. D. Quattlebaum. "Severe Communication Disorders." Ed. D. Hollar. Handbook of Children with Special Health Care Needs (2012): 23-46. Print. Bibliography Cont. SCATP Device Loan Program. N.p., n.d. Web. <http://www.sc.edu/scatp/loan.htm>. "SCATP." South Carolina Assistive Technology Program (SCATP). N.p., n.d. Web. <http://www.sc.edu/scatp/>. "Sharing the SETT Framework." Joy Zabala SETT Framework. N.p., 2005. Web. South Carolina Department of Health and Environmental Control. N.p., n.d. Web. <http://www.scdhec.gov/health/region5/crs.htm>. "South Carolina Equipment Distribution Program." SCEDP. N.p., n.d. Web. <http://www.scedp.org/>. South Carolina Vocational Rehabilitation Department (SCVRD). N.p., n.d. Web. <http://scvrd.net/common/index.php>. Tobii Technology Global. N.p., n.d. Web. <http://www.tobii.com/>. "Transition Strategies for Adolescents and Young Adults Who Use AAC." ASHA Online Store Details. N.p., n.d. Web. <http://www.asha.org/eweb/OLSDynamicPage.aspx?Webcode=olsdetails>.