Navigating the AAC Roadmap: From Consideration to Implement…

Dec 22/Jan 23 Closing The Gap Solutions - Collaborating With Augmentative and Alternative Communication (AAC) Users Gains A New Perspective To Best Support Clients By Lydia Dawley

augmentative and alternative communication (AAC)

Navigating the AAC Roadmap: From Consideration to Implementation Summary : This article takes you on a journey through the AAC Roadmap, an organized and comprehensive process for considering augmentative and alternative communication (AAC) to support the communication needs of students. This website, developed by the Virginia Department of Education’s Assistive Technology Network, contains free resources meant to empower school based teams to identify, assess, and teach students to use AAC systems using evidence-based practices. We will also bust some popular myths around AAC along the way!

I have worked with many educational teams over the years that have considered augmentative and alternative commu- nication (AAC) to address a student’s communication needs. During this journey, I have encountered a number of roadblocks that are rooted in common myths surrounding AAC. Many times these misconceptions have delayed or even prevented a student from gaining access to a communication system. So, how do we prevent this and make sure that we are supporting the commu- nication needs of our students? Well, I certainly don’t have all the answers, but dispelling these myths is a great place to start. In most cases, teams have the best intentions but it turns out Socrates was right, “You don’t know what you don’t know.” I attended a session at a conference a few years ago where the presenter said that when we make AAC recommendations we are simply “making a guess” on what tool is best. This state- ment stuck with me. I began reflecting on my own practices, talking with fellow SLPs, and researching how teams were con- ducting AAC assessments and making decisions about what supports to implement. I discovered that most teams were piec- ing together a process from various sources and that they lacked a certain level of confidence in their findings. Naturally, the next questions were, “wouldn't it be nice if there was an organized

and comprehensive process all in one location with resources and research to back it up? And wouldn’t it be even nicer if this process was free and available to anyone”? That is exactly what my colleagues and I, from the Virginia Assistive Technology Network, asked ourselves and why we spent the better part of two years creating what we call the AAC Roadmap. This site, put together by a network of SLPs and assis- tive technology stakeholders across Virginia, is located on the Virginia Department of Education’s Assistive Technology Net- work website at https://atnetwork.ttaconline.org/. When you click on the AAC Tab (at the top right) you will find information from consideration all the way through implementation. This process is based on the S.E.T.T. Framework developed by Joy Zabala. S.E.T.T. is an acronym that stands for Student, Environ- ment, Task and Tool. In this model, we look at the student first and gather information on strengths and interests, the various environments they spend time in, and the tasks that they need to be able to participate in throughout their day. It is only after we have gathered all of this information that we begin looking at the tool or tools that match the individual needs, with the goal being more than just a guessing game.

HOLLY LOVE , CCC-SLP, ATP. Holly is a graduate of Radford University where she obtained her Bachelor's degree in communication sciences and disorders and her Master of Science degree in speech pathology. She is an ASHA certified Speech Language Pathologist with a background in school based therapy. She has over 20 years experience serving students from early intervention through high school. She is also a RESNA certified assistive technology professional. Holly joined the Technical and Training Assistance Center (T/TAC) at Virginia Tech in 2011 as a Coordinator of Communication. In her current role, she provides technical assistance to 33 school divisions (132 schools) in southwest VA. She is dedicated to providing educational teams and families with information and assistance to support the success of children with disabilities. Her areas of specialization are autism, literacy, communication, and integration of assistive technology.

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But what about those misconceptions that can hinder prog- ress? We also set out to dispel these myths. One of the first roadblocks that we tend to encounter is the myth that AAC is only for nonverbal students. While AAC can be extremely beneficial for our non speaking students, it can also be very effective for supplementing the speech of those with limited verbalizations. Sometimes students can get stuck on a particular word or a scripted phrase. AAC can help these students by giving them access to more words and helping to expand their language. We know that individuals need access to hundreds of words in order to have novel communication and AAC can help bridge this gap. It can also be beneficial for stu- dents who have difficulty being understood due to articulation delays, a phonological impairment, or motor planning issues like apraxia of speech. AAC can aid in times of communication breakdowns and serve as an appropriate model of the correct production. In both of these instances, the AAC device is used as a teaching tool to increase the student’s language skills. Many parents have a fear that the use of an AAC device will prevent their child from speaking. But, the myth that AAC hinders or stops students from developing verbal communication has been completely busted! In fact, research tells us that the incor- poration of AAC in most cases actually increases verbal speech. Providing the user with increased vocabulary helps them during conversations to say longer messages. The use of AAC can also lessen the load of cognitive and/or motor demands allowing the user to free up energy for increased participation. In addition, the immediate auditory feedback that the user receives is instru- mental in providing appropriate language modeling, thus hav- ing positive effects on overall language development. The myth that seems to be the most popular, and the one that gets under my skin the most, is the misconception that there are certain prerequisite skills necessary to use AAC. Let me stand up in my chair and grab a megaphone when I say, “There are no prerequisites for using AAC!” In fact, communication is a basic human right. Too often, a student is asked to “prove” that they have the ability to use a communication system. I have actually read the statement “they aren’t ready” in a number of reports. The truth is that anyone can benefit from AAC no matter their age, motor skills, or cognitive ability. In fact, we can use AAC to teach beginning skills, and there are many access options avail- able. This is why it is so important that AAC assessment and con- sideration be a collaborative and individualized process. Once we gather information and have an understanding of the student, we can begin to trial the various tools. This brings us to the next roadblock which is the myth that AAC is one-size-fits- all. I once had a team tell me the student was using a particular app because the SLP already had it downloaded on her iPad. In another situation, a student was using a device because that was the system their division had adopted for all students. And, if you can believe it, I even had an SLP tell me that a student was using an older model high tech device (that isn’t even manufactured

anymore) because she had found it at a yard sale! Now, I cannot fault any of these teams because at least they were trying, right? But, too often we are retrofitting systems for students because it is what is convenient or what we feel comfortable with rather than looking at each user’s needs individually. The truth is that AAC systems are different in terms of the level of sophistication, the symbol system used, and the amount and organization of vocabulary. There is no one tool that is appropriate for all! When first introducing AAC, there is a dated misconception that you have to start with low tech tools. Some students can benefit from high tech from the start depending on their partic- ular needs and preferences. During the information gathering stage, the team determines the student’s current language skills. We should then match the AAC system at or slightly above this level. There is no evidence to support the myth that students have to work their way up a hierarchy of supports. In fact, this oftentimes makes the process harder for the user because we are constantly teaching them how to use a new language sys- tem. If a student understands hundreds of words then they need access to hundreds of words. I can’t tell you how many times a team has said to me, “we tried AAC but the student wasn’t in- terested in using it”. In most of these instances, it was not being used because the student didn’t find the available words useful. Imagine being nonverbal but understanding everything that is being said to you then given an AAC system that has a very limited amount of vocabulary. What is the chance that a situa- tion would arise where you would be motivated to use one of the few words that you have available? On the flip side, imagine being given a device that has hundreds of words at hand but you have a limited vocabulary. This might be very overwhelming and cause you to shut down. In both of these situations, we may see the user avoid using the device which may seem like they are not interested. Remember that we can’t always predict what others will say. Giving students access to words gives them the ability to say what they want to say when they want to say it, which is the ultimate goal of any communication system. Successful trial implementation is the result of a well devel- oped plan that ensures all team members are on the same page and working together. A good plan includes clearly stated goals, well defined roles and responsibilities and an understanding of how you will collect data. That’s right. I said it. Data is what drives our decision making and is an integral part of the pro- cess. Adopting a collection method that all team members un- derstand and making sure the data is a reflection of the goal(s) is essential. Collecting data just to collect data does nothing to help our decision making. However, when we follow the plan, meet regularly, and analyze our data as we move through the process, we can say with certainty what tools worked and what tools didn’t work. The team can then move forward with getting more long term support in place for a student with the data to back up its effectiveness.

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So, we made it through the S.E.T.T. and identified the most optimal system. Now what? The myth that implementation of AAC is going to somehow “cure” communication deficits can be yet another roadblock for many teams. Many users will become fully independent in the use of their device over time. In fact, for those that have the capability to produce verbal speech, they may eventually drop the device all together. But for others, they may always need some level of partner assistance. I consider all three of these examples a success! The true measure in the suc- cessful implementation of an AAC system is an increase in the level of independence and improved communication for the user. One of the most unfortunate misconceptions at this juncture is that this process is finished once we get a communication sys- tem in place. However, the existence of AAC doesn’t mean the user will automatically start using it. It has to be taught! While this sounds like a daunting task, the good news is that there are evidence based practices (EBPs) that have been proven to be effective when teaching students to use AAC. These EBPs can be incorporated into everyday routines and activities. When we teach the use of AAC during these meaningful and naturally oc- curring opportunities throughout the day, we increase the like- lihood that the student will see the system as a powerful tool. There’s no better way to introduce AAC than for wants and needs. The ability to make a request and have it appear is such a powerful thing! Just like the opportunity to make a preferred choice between two items gives a sense of control. We often start with these types of tasks because they are highly motivat- ing and reinforcing. But the mistake we make far too often is let- ting ourselves get stuck here! If we buy into the myth that AAC is only for making requests or choices, we are greatly limiting the user’s interactions. We know that communication is so much more! Our goal with any communication system is authentic communication, the ability to say what is on our mind. There- fore, a robust system should allow the user to communicate for a variety of reasons including requesting, protesting, describing, asking and answering questions, commenting, and expressing feelings. This is so important to remember in selecting what words to target when teaching the use of AAC. Multiple oppor- tunities to use their system for various purposes throughout the day should be part of every implementation plan. Another important part of the implementation plan that we tend to skip is teaching the adults who will be supporting the student! Don’t assume that team members are comfortable and knowledgeable with AAC. For many, this might be their first in- teraction with a communication system. Lack of understanding from adults can sometimes hinder the success of the student. This notion can be overwhelming to teams because they think they are expected to be experts. But, the thought that everyone has to know everything about the system right off the bat is an- other misconception. Those working with the student should be familiar with device features, basic set up and programming and

how to maintain the system. Many times, this training is provid- ed by the manufacturer. I have also found manufacturer web- sites and YouTube pages very helpful. Making sure that team members feel comfortable enough to model on the device and ensure that it is accessible at all times is a great place to start. Adults will then learn the system alongside the user as it is im- plemented in real life situations. Let’s not forget that this whole process hinges on the fact that this is a collaborative approach! The idea that an AAC system is only used during speech therapy sessions is also a myth! An AAC device is a unique language system that has to be taught (as previously stated). Research tells us that the average AAC user receives between 16,000 - 24,000 models of words per week as opposed to their typical speaking peers that receive an average of 125,000 models of words per week. Therefore, it is essential to model and teach the use of the system as much as possible throughout the student’s day in a variety of settings, during a va- riety of activities for many different purposes, and with a variety of communication partners. This generalization is an essential part of being a successful communicator. While the process of selecting and teaching a student to use an AAC device might seem like a daunting task, it is essentially the same process as teaching any student how to understand and use language. This means we need to expose them to lan- guage the same way we do other children. We do this first of all by making sure that their AAC device is accessible at all times. Modeling is also key. Remember when you or someone you know had young children? From the time they are born, we talk to them. We name things, describe things, and talk about every- thing we do throughout the day. We do this for quite some time before they ever offer any verbal communication back. This is also the same process for our AAC users. We need to talk to them and model on their device, using their language, as much as possible. Be sure the things you are asking them to do with their system are meaningful! Especially when first starting out with AAC, focus on areas of interest and highly motivating messages. Most importantly, provide ample opportunities for students to practice their communication in everyday routines. AAC users need someone to talk to, something to talk about, and many op- portunities for communicative exchanges throughout the day. An AAC device can be life changing for a student with a com- munication impairment. As good communication partners, we need to be patient and understand that this process takes time. Be prepared to give a lot of receptive input before we get any expressive output. We should always presume competence in our AAC users and believe that each student is unique and has something to say. Don’t buy into the common myths surround- ing AAC! When students are properly identified, matched with optimal tools, and taught using best practices, AAC can increase social and emotional skills and enhance overall daily living. As part of a student’s educational team, we need to be informed and empowered and trust the process!

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