Key AAC Issues

Today we are pleased to welcome seven speech-language pathology students from San Jose State University.  As part of their Professional Issues course, they conducted a project identifying key issues regarding Augmentative and Alternative Communication (AAC).  They share their findings in the post below.

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Challenge 1: Paraprofessionals and training

A major issue is that most paraprofessionals do not have the knowledge and/or experience to facilitate and communicate with students that utilize AAC in a school setting. Approximately 40% of state classrooms have more special education paraprofessionals than full time staff such as teachers (Giangreco, Suter, & Doyle, 2010). Paraprofessionals are often communication partners for children with complex communication needs (CCN) in the classroom and various school settings (recess, lunch, after school care, play). Research indicates communication partners frequently exhibit actions that restrict the communication of children using AAC (Douglas, Light, & McNaughton, 2013).

Two specific training program strategies that have been researched with paraprofessionals in a school setting are the IPLAN and MORE strategy. The IPLAN strategy includes: Identifying activities for communication, Providing means for communication, Locating and providing vocabulary, arranging the environment, and the use of iNteraction strategies. The MORE strategy includes: Modeling AAC, Offering opportunities for communication, Responding to communication, and Extending communication. This training has shown to be effective after solely two hours of training. Research has shown that a two hour training on these strategies has increased the amount of communication opportunities presented by paraprofessionals and the children’s number of communication turns (Douglas et al., 2013). These strategies are outlined, researched, and explained in depth in the article (see complete reference in the reference list below).

Finding an AAC specialist: The American Speech-Language Hearing Association (ASHA).  This organization has a separate group (SIG 12) for AAC. ASHA can send you a list of SIG 12 members in your local area who can provide these trainings. Additionally, the organization can send you “Preferred Practice Parameters,” which are standards that guide speech-language pathologists in preparing and administering AAC services. 

Challenge 2: Classroom teachers and training

Another issue that arises is the lack of training provided to classroom teachers of students who utilize AAC devices. According to Baxter, Enderby, Evans, and Judge (2011), the lack of staff training was reported as the significant barrier to positive AAC outcomes. Compared to all staff members, a teacher is one of the most significant communication partners, since they are in frequent contact with students. A teacher must support and facilitate the communication in the classroom for the student’s academic success and participation. Research has show that when instructors are provided with AAC training, it has led to positive AAC outcomes (Lund & Light, 2007). To facilitate communication, a teacher must be trained through a comprehensive and strategic training program.

One program that works well with training educators is the 8 Step Instructional Model (Kent Walsh & McNaughton, 2005). Senner & Baud (2017) used this program to train  staff in partner-augmented input, an approach used to teach individuals how to use AAC devices. The eight steps involved are: (a) pre-testing and training program commitment, (b) strategy explanation (c) strategy demonstration, (d) spoken practice of the strategy steps using a mnemonic, (e) controlled rehearsal of the strategy and feedback, (e) advanced rehearsal of the strategy and feedback, (f) post-testing and commitment to the long-term use of the strategy, and (g) generalization of the strategy across various settings (Kent Walsh & McNaughton, 2005). Additionally, Senner & Baud (2017) include the SMoRRES mnemonic (i.e. Slow rate, Model, Respect and reflect, Repeat, Expand, and Stop) which is used to verbally rehearse the components of successful modeling. One large benefit of this program, is that the training is provided during classroom sessions, which limits the amount of time an educator misses important class time.  Overall, the results from this study shows that participants who were trained in this program increased their familiarity with the students’ devices and increased their modeling across all activities.

Challenge 3: AAC funding

Another issue in the field of AAC is funding for the devices. According to Standal & Rudnicki (2007), finding funding for an AAC device is difficult, lengthy, and time consuming. Some of the key players of getting funding for an AAC devices includes the families, the doctor, the Speech Language Pathologist (SLP), the school, and possibly the manufacture. Some public schools may help fund the device. However, the school then owns the device so the student may not take the device home or elsewhere. There is a large amount of paperwork involved which may take anywhere from 2-6 months to hear back from the insurance company. The main issue is that insurance companies have the right to deny coverage for devices. Once coverage is denied, the financial burden is not placed on the family. We can see a consistent pattern on how difficult it is to get funding for a device.

Luckily, there are many organizations available to families to help get funding for a device. Large and local organizations such as the Lion’s Club have funds to donate to families for AAC devices. A high tech AAC device application, Tobii Dynavox, works with families to set up payment plans for the devices if they can not pay up front. Families and professionals are able to join an organization called A Voice Discovered located in Ventura, California. This organization gives professionals resources to give families about finding funding for devices. They also help families find funding available and are able to join a support group. Listed below are some helpful resources:

Challenge 4: AAC & Cultural Competency

As recent trends see a growth in globalization and immigration in America, the linguistically and culturally diverse population of individuals who use AAC systems are becoming more dominant as well (Kena et. al, 2016). With that said, it is important to understand how high-tech AAC devices are designed to provide the necessary support to those who come from a different background and speak a language other than English. Although there are many AAC systems readily available for individuals who may need it, there are only a handful of systems that are available in multiple languages. In addition, AAC systems that offer a variety of languages can also be costly as they range from $200-$300. People from different cultural backgrounds who need an AAC device to communicate should have more options when choosing a system that works for them. With only a handful of multilingual AAC systems, there may not be a device that can allow the individual to communicate at his/her fullest potential. This may lead to AAC device abandonment as well.

To deal with this issue, we need to raise a awareness in designing AAC systems that are more linguistically and culturally diverse to the industries and engineers responsible. The first step to achieving this goal may be to hire more people from a variety of cultural backgrounds or simply fact-check the design with people who know about different cultures. A petition has been made to start raising awareness of this issue to companies and industries that design AAC systems. Click here to show your support and concern in creating a more diverse AAC system for people in need!

Challenge 5: AAC & increasing awareness

Even though a client may benefit from the use of an AAC system, there are many reasons why they may not be utilizing one. The device may be laborious to carry around or constant technological problems may make the device more of a hassle than it is worth. A common issue with AAC devices is that the SLP or caregiver does not want to use the device as they believe that the AAC device will limit the client’s verbal communication. This is a misconception and it is important to educate speech language pathologists (SLP’s), caregivers, and frequent communication partners about how AAC benefits the client and could lead to increased verbal skills. Support from caregivers and communication partners is incumbent for AAC success and is an important issue to address.

Ways to combat this issue include:

  • Educate SLP’s who have been in the field for 5+ years, providing additional trainings at conventions or through your local state CEU events
  • Providing a comprehensive explanation on how to use the AAC device, why this device was chosen in particular and explicit ways it will benefit the client’s communication
  • Continued work and support from SLP’s for the frequent communication partners on how to use the AAC device
  • Destigmatizing the idea that AAC useage inhibits vocal communication

Challenge 6: Stigma and lack of opportunities leading to AAC abandonment

AAC abandonment occurs when an individual decides to stop using  their AAC device even when it is still needed and fully functional. This has become a prevalent issue as it occurs in one-third of client cases (ASHA, 2018). Stigma— a mark of disgrace that sets a person apart from others— towards individuals with disabilities is a factor that can result in AAC abandonment (ASHA, 2018). For individuals with disabilities, stigmatization is often a common occurrence that can lead to poor social treatment, disrupted social relation, distorted self-image, and person avoidance. The use of an AAC device can increase this negative perception on people with disabilities as it creates a stigma that directs attention to the disability rather than the capability (Cook, 2009).  The issue of limited opportunities for communication through AAC devices has also become a prevalent reason for abandonment. Limited opportunities for use has also been shown to stem from issues of  stigma (Mcnaughton, Rackensperger, Benedek-Wood, Krezman, Williams & Light, 2008).

To help decrease the stigma towards individuals with disabilities using AAC and increase opportunities for supportive communication, more AAC social groups should be available to AAC users and their families. These social groups can provide AAC users opportunities for friendships and learning opportunities. SLP’s who specialize in AAC should be incorporated into these groups to help educated family members on how to structure and promote positive communication opportunities for their child using an AAC device.  In initiative to decrease the stigma on using AAC devices in the outer population, planned trips to various community events can be incorporated into these social groups such as attending sports games and going out to restaurants. Creating more AAC social clubs could make a drastic shift in the presence of stigma and provide AAC users with an abundance of opportunities for establishing positive relationships with others in their inner and outer community.

Challenge 7: Home Training

Lack of home training is a common issue for families who have received a new AAC device and must integrate this technology into their everyday lives. According to a study conducted by Angelo (2000), families reported frustration caused by lack of home training, personal involvement, and the complex demands of AAC use, which led to the overall abandonment of their AAC device. Parents have expressed the desire to be trained more extensively in the areas of time management, maintenance, and integration of their child’s AAC device into their home and the community. It is vital that all family members are well educated in the technological functions of the selected AAC device to support successful outcomes. Lastly, parents communicated a need for more professionals to monitor the families’  progress in their home environment. An increase in more frequent home visits allows for the professional to evaluate if the chosen device is suitable for the family, answer any questions, and provide more training in areas of concern.

In efforts to decrease AAC abandonment, forming parent support groups can be beneficial by connecting with other families who have encountered the same experiences. Support groups are a great way to express difficulties regarding an AAC devices in a safe environment. AAC advocacy websites are another valuable source of information as they provide free information discussing topics such as funding, privacy, training, etc… A resource section has been provided at the end of this project which has links to an advocacy newsletter page (SunStar Media, n.d.). Hopefully this page will allow insight and promotes awareness to issues that are often overlooked. Much research has been gathered on the technological aspects of AAC devices, although not much research has been gathered on the perspectives of families. Research regarding families’ outlook on their experience in training and implementing AAC devices at home may provide future strategic methods to successful AAC usage outcomes.

Thank you for taking the time to read the key issues we have identified regarding AAC and their proposed solutions. We hope that the information will increase awareness to families, educators, and other professionals who interact with individuals who use AAC.

References

Angelo, D. (2000). Impact of augmentative and alternative communication devices on families. Augmentative and Alternative Communication, 16(1), 37-47.doi:10.1080/07434610012331278894

Augmentative and Alternative Communication: Key Issues. (2018). Retrieved from https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589942773§ion=Key_Issues

Bailey, R. L., Parette, H. P., Stoner, J. B., Angell, M. E., & Carroll, K. (2006). Family members’ perceptions of augmentative and alternative communication device use. Language, Speech, and Hearing Services in Schools, 37(1), 50-60. Retrieved from http://go. galegroup.com.libaccess.sjlibrary.org/ps/i.do?&id=GALE|A168090669&v=2.1&u=csusj&it=r&p=PPNU&sw=w

Cook, A. M. (2009). Ethical Issues Related to the Use/Non-Use of Assistive Technologies. Developmental Disabilities Bulletin,37(1&2), 127-152. Retrieved from https://files.eric.ed.gov/fulltext/EJ920692.pdf

Douglas, S. N., Light, J. C., & McNaughton, D. B. (2013). Teaching paraeducators to support the communication of young children with complex communication needs. Topics in Early Childhood Special Education, 33(2), 91-101. doi:10.1177/0271121412467074

Giangreco, M. F., Suter, J. C., & Doyle, M. B. (2010). Paraprofessionals in inclusive schools: A review of recent research. Journal of educational and psychological consultation, 20(1), 41-57. doi:10.1080/10474410903535356

Kena, G., Hussar, W., McFarland, J., de Brey, C., Musu-Gillette, L., Wang, X., & Ossolinski, M. (2016). Conditions of education 2016: Racial/ethnic enrollment in public schools. Retrieved August 05, 2018 from https://nces.ed.gov/pubs2017/2017144.pdf

Kent-Walsh, J., & McNaughton, D. (2005).  Communication partner instruction in AAC: Present practices and future directions. Augmentative and Alternative Communication, 21, 195-204. doi: 10.1080/07434610400006646

Light, J. & McNaughton, D. (2015). “Designing AAC research and intervention to improve outcomes for individuals with complex communication needs.” Augmentative and Alternative Communication, 31(2), 85–96. doi:10.3109/07434618.2015.1036458.

McNaughton, D., Rackensperger, T., Benedek-Wood, E., Krezman, C., Williams, M. B., & Light, J. (2008). “A child needs to be given a chance to succeed”: Parents of individuals who use AAC describe the benefits and challenges of learning AAC technologies. Augmentative and Alternative Communication, 24(1), 43-55. doi:10.1080/07434610701421007

Positive AACtion. (2010). Retrieved 2010, from https://i.pinimg.com/originals/5f/32/2b/5f322b1ffba3e1e4987f8859e2c0920b.jpg

Senner, J., & Baud, M. (2017). The use of an eight-step instructional model to train school staff in partner-augmented input. Communication Disorders Quarterly, 38(2), 89-95. doi: 10.1177/1525740116651251

Standal, J. & Rudnicki, T. (2007). Fundamentals of funding an AAC device. Assistive       Technology. 24-25. doi:10.1080/07434610701553668

SunStar Media. (n.d.). ACI Links. Retrieved August 07, 2018, from http://www.augcominc.com/index.cfm/aci_links.htm

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Merrett Brown, Amy Nguyen, Shareen Dhillon, Kathryn Cordero, Analisa Church, Stephanie Firme, and Abigail Gavens are graduate students studying speech and language pathology at San Jose State University. We are conducting a project identifying key issues regarding Augmentative and Alternative Communication (AAC) devices for our professional issues course. Throughout this project, each student has identified issues in a specific area of AAC and proposed possible solutions/resources on these complex topics. We hope our project brings awareness to the ongoing difficulties families may experience in the AAC community.

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Jill E Senner, PhD, CCC-SLP
SpeakUP
Editor-in-Chief

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