Inspirational (& functional) AAC Therapy

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In honor of Dr. King, and all of the inspirational contributions he has made – I would like to share some  inspiring therapy I happened upon a few weeks ago. For those who don’t know, my mentor and blogging role model is Ruth Morgan of Chapel Hill Snippets.

I always learn from the many AMAZING therapists I work with in my school district. This is one example of some awesome therapy targeting FUNCTIONAL COMMUNICATION by the talented Ruth Morgan.

Ruth was working with a student using an AAC device. She provided the student with several motivating activities, but did not provide all of the materials (e.g markers) so the student could complete the activity. Ruth modeled (aided language input) the target item on the device for the student, then helped the student go into to classroom and ask the classroom staff for the needed materials. The classroom staff provided the student with the needed materials and all was well. WOO HOO for natural consequences! WOO HOO for motivation! 

I think as a school based speech and language pathologist, I have the privilege to see students in several different contexts (in the class, at lunch, at recess, one-on-one…). I have access to so many team members, that I feel like I am prime to deliver some truly functional (best practice) therapy. Yes – it looks different from “traditional” pull-out therapy, but that’s good. Maybe we’ve been hanging onto “traditional therapy” for too long, and it’s time to really think about changing our models to promote best practice.

What do you think?

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Camp for Individuals Using AAC

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I have THE BEST news: I have been accepted to intern at CAMP CHATTERBOX this summer!!!!!

Check out the website here: http://www.campchatterbox.org 

During the last ASHA conference, I had the incredible fortune to sit next to Joan Bruno – founder of this amazing camp (not to mention several other AAC tools, like the TASP) . We chatted on our way to our next session, and I was hooked. I came back from Chicago, and immediately applied to intern this summer. I’ve been officially accepted and I CAN’T WAIT!!!!

According to the website:
“Camp Chatterbox is a therapy camp for nonspeaking or severely speech-impaired children, ages 5 -16, who functionally use synthesized augmentative and alternative communication (AAC) devices. It is sponsored by the Children’s Specialized Hospital in Mountainside, NJ.” 

This is an AMAZING opportunity! If you know someone who would benefit (AAC user, family member, or therapist) – I highly encourage you to share this information.

Come join us at Camp Chatterbox. I know it will be a great time!

Who’s in?

Personalizing the AAC Device

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Here is a form I came up with to help personalize AAC communication systems in my district. I really wanted a way to get parent input as to the best ways to customize devices to fit their needs. My hope is that this will help families “buy in” to the idea that AAC is meant to be with the child at all times and serve as that person’s voice.

I based this form off of the PODD system, but these questions could easily apply to any device. I refer to the AAC user as “student” because I’m in a school. The more collaboration you have (including the AAC user to whatever extent possible) in choosing vocabulary, the better.

There are a couple of questions that I wouldn’t typically include – for example asking whether or not a parent would want undergarments or religion included on their device – but because I work in a school, I want to make sure that I’m not making parents uncomfortable or crossing any legal boundaries. That being said, my true belief is that we should never omit words because they are uncomfortable (we can’t unteach that swear word to a toddler). Best practice says to keep them in.

Here it is – let me know what you think. Are there other tools out there to help customize vocabulary selection? AACPersonalizationForm

 

Pillars of PODD

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I want to share another tool I have added to my district’s AAC tool kit. It’s called the Pragmatically Organized Dynamic Display (PODD) – created by Gayle Porter. Disclaimer: I have not been formally trained in the PODD system. This is information I have learned through attending various conferences and reading through the PODD Manual.

I’m not going into too much detail about the PODD, but I will say it’s a light tech, multi-leveled, systematically organized communication tool. Check it out here: http://www.mayer-johnson.com/podd

Here are some of (what I like to call) the Pillars of PODD:

* Vocabulary is systematically organized. It is key for individuals using AAC to have access to vocabulary that is always in the same place. This promotes motor memory and saves cognitive resources so individuals can focus on generating their message. This goes back to increasing Operational Competence for users (refer back to my post on AAC Assessment and Janice Light’s Theory of Communicative Competence).

* This is the student’s voice. I first learned about the PODD system when Linda Burkhart spoke at the 2013 NCACA conference in Durham, NC. During a question and answer session, someone said something like, “You can print off one book for home, and one book for school.” Linda Burkhart responded with a resounding, “No.” We have to value this as the child’s one, true voice. It goes EVERYWHERE with the student. Check out the PODD manual for more information on methods of access.

* Aided Language Stimulation is KEY. We cannot expect a person to just pick up an AAC device and start generating messages. We need to input the system for that person (think about how we narrate the life of a baby). We have to ensure that each person develops Linguistic Competence for his/her device. If you screw up – that’s ok!!! You should model what to do when you mess up (oops!). You are building that skill of Strategic Competence!

* Implement the PODD within a natural communicative context. Linda Burkhart said, “What fires together, wires together.” So, make sure that individuals using AAC have opportunities to practice in real world environments. Interactions must be genuine and provide natural consequences. You’ve got to make sure communication is functional!

There are many, many more and this post is not meant to be an exhaustive list of all of the key points of PODD.

We started implementing the PODD with several students in my school district. I am excited to see how this rolls out and I’ll keep you posted.

Is anyone else out there using this system? How’s it going?

Assessment and Communicative Competence for the AAC User

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Lately, I’ve been thinking a lot about AAC evaluation. What makes a good AAC eval? How can you sift through all of the apps and devices out there to feature match the best device for each individual client? There’s so much to consider and there’s no one size fits all tool.

I want to share what I’ve found to be most helpful so far:

1. The AAC Evaluation Genie app for iPad

*This app has 14 subtests that measure different skills like: visual identification skills, visual discrimination skills, vocabulary, category recognition and other skills. At the end of each session you get a nice summary that you can print out and add to your assessment report. While I think AAC assessment is largely a qualitative process, it’s nice to have some “numbers” to support the recommendations I am making.

2. Janice Light’s Framework of Communicative Competence for individuals using AAC (Light, 1989).

*This article is a good one – easy to read and really seemed to set the stage for how people think about competence in using an AAC device. It’s worth a read, but here are the highlights that I want to keep in mind for future AAC assessment:

There are 3 components to the definition of communicative competence:

1. Functionality of Communication = Is the system functional for the individual? This will change based on the context. Yesterday, I was working with a student during a craft activity. He needed more glue, so I modeled asking for glue using his communication notebook. He followed my model and I handed him a crayon (my ultimate goal was to expose him to “different”). He happily began to color on his paper. Palm to forehead – I did not make this communication opportunity functional for him (or very motivating for that matter). He didn’t care about the glue or the crayon. Functionality of communication is ever-changing – make sure to look at the different environments and communication partners in addition to the person you are evaluating.

2. Adequacy of Communication = This means the student can adequately communicate what he/she needs in any given environment, at any given time. Adequacy does NOT mean mastery. Does anybody really have mastery over language?

3. Sufficiency of Knowledge, Judgement, & Skill in using the device = This component has four subcomponents to evaluate.

a. Linguistic competence = I think of this as the form and content of language. Don’t forget that an individual using an AAC device not only has to master the language of their device in order to express themselves (more on this later), but they also have to master the language that others are using around them (probably spoken) to understand what others are saying. That’s an important point to keep in mind…

b. Operational competence = can the individual operate the device? Some devices are pretty comprehensive and tech heavy. My AAC professor explained that we all have a set amount of cognitive resources. If you are devoting a lot of resources to just working the device, then you have less resources to devote towards using existing language skills to generate a message. For example, I cannot figure out how to type in this blog and carry on a conversation at the same time – just not happening.

c. Social Competence = There are two prongs to this one.

*Sociolinguistic – The use of language (pragmatics)

* Sociorelational – I will admit that I need to be reminded of this. Light (1988) states that these skills are important to the sociorelational characteristics of someone using AAC:
– positive self-image
– interest in others
– desire to communicate
– active participation in conversations
– responsiveness to partners
– ability to put partners at ease

I, for one, definitely need to look more into this, but it’s obvious that confidence is key.

d. Strategic Competence = If you’ve ever been to a country that you do not speak the language, you know this feeling. You don’t know how to say what you need to say, so you mime, give single words, and just do whatever you can to get the point across. It’s important that individuals using AAC are able to make the best of what they can do.

Whew… One last point – these skills CANNOT happen in isolation. A student may be able to whiz through a device, but if they are not functionally communicating with it – they are NOT a competent communicator.

I’m curious to hear what others are using for AAC assessment. Please share!

References:
Light, J. (1989). Toward a Definition of Communicative Competence for individuals using augmentative and alternative communication systems. Augmentative and Alternative Communication, 137-144.

Light, J. (1988). Interaction involving individuals using augmentative and alternative communication systems: State of the art and future directions for research. Augmentative and Alternative Communication, 4, 66-82.

Bridge to the IEP

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Before I had my own blog to share ideas, I did some guest blogging with the help of my colleague and AT guru – Jim Tignor. I wanted to explore the topic of related services and how we fit into the IEP. Here’s what I think:

Basically, the IEP is a bridge to close the gap between where the student is functioning and the Common Core standards (in most cases). Related services (including SLP, PT, OT, and AT) are needed when a student can’t even access the bridge. These services are the on-ramp to the bridge. Once a student is on the bridge, these supports can be removed. A student may still have language deficits, but these deficits may not keep him/her from getting on that bridge.

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Check out the full-length feature (with pictures!) here: http://www.tek-ninja.org/2012/12/the-role-of-related-service-provider-in.html

I’m curious as to how other school based professionals view related service supports. Are there any other theories out there?

Getting Started…

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I’ve been talking about doing this for a while. I even went so far as to purchase the domain name and talk to some superstar bloggers about my plans (http://chapelhillsnippets.blogspot.com, http://www.tek-ninja.org), but this list of doubts kept playing in my head. Things like: “you have nothing to write about” (not true – I’ve been keeping a running list of things to write about for weeks), “you don’t have enough experience or knowledge to compete with the many AMAZING speech language pathology and AAC blogs out there” (that was never my intention), and lastly, “I don’t know how to start.” All very weak points, so I’m getting started.

I graduated from UNC-Chapel Hill in the spring of 2011. Being from Michigan, I never intended to stay in NC, but we had made some amazing friendships and I thought I had a pretty good shot at getting hired in Chapel Hill Carrboro City schools (CHCCS) – a good gig for a new graduate. There were three openings that year. One position was a split position: part-time traveling between a high school and middle school and also working as half of the assistive technology team in our district (working with http://www.tek-ninja.org). I enjoyed my AAC class in grad school, but I had no idea what direction my career would go. During the interview, the lead SLP explained that the middle/high/AT position would not be ideal for someone completing their Clinical Fellowship. The interview progressed and I detailed all of my “AAC experience.” This consisted of observing and working with my awesome mentor – Ruth Morgan (http://chapelhillsnippets.blogspot.com) and bringing copies of reports and goals I had written in my AAC class. The interview went well, but I was ecstatic when CHCCS called to offer me an interview for the middle/high/AT position!

Fast forward 2.5 years and I truly believe I have found my passion in all things AAC. This blog is a way for me to share what’s worked for me and what hasn’t. I’m also looking forward to any constructive feedback and resources. Who knows where it’ll go?