It's A Team Effort
"Successful interventions require a team approach by AAC specialists from a variety of disciplines, including speech-language pathology, education, occupational and physical therapy, rehabilitation engineering, psychology, and medicine. Successful interventions also require that team members be familiar with the basic elements of an AAC system"
(BEUKELMAN D. & MIRENDA P. 1992 page 9)
(BEUKELMAN D. & MIRENDA P. 1992 page 9)
TEAM 2 - Task & Discussion Sheet
Uncover the information. Allow staff time to digest the given definitions of the terms used. Uncover the Tasks. Allow time (15 - 20 minutes is reasonable) to complete the tasks given. Use these notes to work through the discussion topics offered. They offer a number of controversial topics for consideration and debate!
TEAM 3 - Complementary not Antagonistic
"...it is important , that we work in partnership so that we can give adequate training to families and caregivers ..."
(PINNEY S. & FERRIS-TAYLOR R. 1989)
"To achieve effective collaborative working practices we need to understand the basic concepts that underpin the work of our colleagues." (STONE J. & WRIGHT J. 1989)
"The philosophy that AAC users, their carers and SLTs should be genuine partners in communication was seen as fundamental to good practice in direct work. ‘Good practice’ means moving away from the clinic situation and becoming more involved with AAC users needs in the ‘real world’. It means observing AAC users needs in terms of accessing AAC equipment in the everyday environment; it means knowing what AAC users want to talk about in the everyday environment; it means observing the types of interaction which take place in the AAC user’s real life." (MURPHY J. 1996 page 9)
In some establishments, the different specialisms, by not pulling in a unified direction, tend to work to negate each others efforts. It is better to have a mediocre system and a positive team spirit than a brilliant system where everyone works in different directions. Helping people acquire AAC skills is a team effort. It should be stressed that no part of the team is any more or any less important than any other part. Each has a role to play. Indeed, if any part of the team does not cooperate in the joint venture the process is made all the more difficult. The facilitator should undertake a co-ordinating and supporting role.
If the speech professional involved has only a small amount of time available each week, it may be better spent in motivating and mobilising others, supporting their efforts and acting as consultant to a team that is able to give more time. A team approach is essential to success, each section actively supporting the efforts of the others. There is no conflict of role, only unity in the pursuit of one goal (See GODSLAND A. 1990).
"It appears that a team effort is needed, with either the speech‑language pathologist or teacher coordinating the process"
(BRUNO J. 1986)
"Successful integration of the communication system into an educational setting may depend upon the strategies utilized by the
specialists (or service delivery team) involved. The philosophy of integration and implementation for Augmentative Communication
strategies and technology within the educational sector must be one of consultation and cooperation by all professionals involved
in order for the student to be successfully integrated into the academic programming so that reasonable levels of autonomy,
participation and self‑fulfilment are achieved." (FRUMKIN J. & FOLEY C. 1987)
"Developing the most effective communication system for the child with multiple disabilities presents the communication specialist
with a great challenge. The decision making process should incorporate the knowledge available from a diverse set of fields."
(HOOPER J., CONNELL T., & FLETT P. 1987)
"The success of integrated AAC practices stands or falls with the success of collaboration. Thus the AHow” of interdisciplinary
collaboration seems to be one of the emerging issues to address in order to advance the field of AAC."
(SCHLOSSER R. & LLOYD L. 1991)
"Designing and implementing Augmentative and Alternative Communication systems for learners with severe disabilities requires
team work. The composition will depend upon the learner’s personal support network, his or her physical and mental abilities,
and a range of logistical factors, such as the availability of personnel and the array of environments the learner encounters daily."
(REICHLE J. 1991)
"Recent literature, research, and everyday experiences indicate that the use of a team approach in augmentative communication is
essential. Current practices include use of the following types of teams: multi-disciplinary (where professionals assess and make
decisions independently of each other appropriate to their specific profession with a sharing of the independent decisions at a
meeting), transdisciplinary (information is shred with other professionals on a continuing basis and the assessment procedure is
usually collaborative) and interdisciplinary (professionals assess individually, share information and make decisions and then usually
only come together when there is a problem or when a reevaluation needs to be done). No matter what the structure of the team,
each team member has a very important role in the success of the system." (SWANSON B. & COFFEY C. 1994, page 143)
Indeed, there should be much less diversification of role, even in those establishments blessed with full time equivalent speech, physio, and occupational therapists. Many of the skills embodied in the therapist are those that are of great use to the teacher, and many of the skills embodied in the teacher are those that are of great use to the therapist. Their roles are not distinct and disparate and the curriculum should not be allowed to encourage this. The curriculum is a human construct, and has no inalienable rights in the institutional definition of roles. The modern curriculum:
"...requires new ways of working on the part of the professionals. There is a need to collaborate with colleagues, share information,
view pupils’ problems in a comprehensive light, disseminate skills and generally move toward interdisciplinary working."
(HEGARTY S. 1982)
The curriculum can no longer be considered the innocent bystander, acting as witness, in the courtroom drama in which the individual is labelled as deviant. ‘Ironside’ has now turned and nominated this witness as the true culprit. The curriculum must stand trial:
"A curricular approach to learning difficulty must have the interests of the individual as its aim, but its means and its medium must
be potentially appropriate for ALL pupils as a part of the WHOLE curriculum." (CLOUGH P. & THOMPSON D. 1987)
Every parent, carer, teacher, therapist, keyworker, etc., need not be specifically teachers of AAC, but all should be actively engaged in the development of language, communication, and alternative communication skills, as well as in their implicit cognitive sub‑skills.
(PINNEY S. & FERRIS-TAYLOR R. 1989)
"To achieve effective collaborative working practices we need to understand the basic concepts that underpin the work of our colleagues." (STONE J. & WRIGHT J. 1989)
"The philosophy that AAC users, their carers and SLTs should be genuine partners in communication was seen as fundamental to good practice in direct work. ‘Good practice’ means moving away from the clinic situation and becoming more involved with AAC users needs in the ‘real world’. It means observing AAC users needs in terms of accessing AAC equipment in the everyday environment; it means knowing what AAC users want to talk about in the everyday environment; it means observing the types of interaction which take place in the AAC user’s real life." (MURPHY J. 1996 page 9)
In some establishments, the different specialisms, by not pulling in a unified direction, tend to work to negate each others efforts. It is better to have a mediocre system and a positive team spirit than a brilliant system where everyone works in different directions. Helping people acquire AAC skills is a team effort. It should be stressed that no part of the team is any more or any less important than any other part. Each has a role to play. Indeed, if any part of the team does not cooperate in the joint venture the process is made all the more difficult. The facilitator should undertake a co-ordinating and supporting role.
If the speech professional involved has only a small amount of time available each week, it may be better spent in motivating and mobilising others, supporting their efforts and acting as consultant to a team that is able to give more time. A team approach is essential to success, each section actively supporting the efforts of the others. There is no conflict of role, only unity in the pursuit of one goal (See GODSLAND A. 1990).
"It appears that a team effort is needed, with either the speech‑language pathologist or teacher coordinating the process"
(BRUNO J. 1986)
"Successful integration of the communication system into an educational setting may depend upon the strategies utilized by the
specialists (or service delivery team) involved. The philosophy of integration and implementation for Augmentative Communication
strategies and technology within the educational sector must be one of consultation and cooperation by all professionals involved
in order for the student to be successfully integrated into the academic programming so that reasonable levels of autonomy,
participation and self‑fulfilment are achieved." (FRUMKIN J. & FOLEY C. 1987)
"Developing the most effective communication system for the child with multiple disabilities presents the communication specialist
with a great challenge. The decision making process should incorporate the knowledge available from a diverse set of fields."
(HOOPER J., CONNELL T., & FLETT P. 1987)
"The success of integrated AAC practices stands or falls with the success of collaboration. Thus the AHow” of interdisciplinary
collaboration seems to be one of the emerging issues to address in order to advance the field of AAC."
(SCHLOSSER R. & LLOYD L. 1991)
"Designing and implementing Augmentative and Alternative Communication systems for learners with severe disabilities requires
team work. The composition will depend upon the learner’s personal support network, his or her physical and mental abilities,
and a range of logistical factors, such as the availability of personnel and the array of environments the learner encounters daily."
(REICHLE J. 1991)
"Recent literature, research, and everyday experiences indicate that the use of a team approach in augmentative communication is
essential. Current practices include use of the following types of teams: multi-disciplinary (where professionals assess and make
decisions independently of each other appropriate to their specific profession with a sharing of the independent decisions at a
meeting), transdisciplinary (information is shred with other professionals on a continuing basis and the assessment procedure is
usually collaborative) and interdisciplinary (professionals assess individually, share information and make decisions and then usually
only come together when there is a problem or when a reevaluation needs to be done). No matter what the structure of the team,
each team member has a very important role in the success of the system." (SWANSON B. & COFFEY C. 1994, page 143)
Indeed, there should be much less diversification of role, even in those establishments blessed with full time equivalent speech, physio, and occupational therapists. Many of the skills embodied in the therapist are those that are of great use to the teacher, and many of the skills embodied in the teacher are those that are of great use to the therapist. Their roles are not distinct and disparate and the curriculum should not be allowed to encourage this. The curriculum is a human construct, and has no inalienable rights in the institutional definition of roles. The modern curriculum:
"...requires new ways of working on the part of the professionals. There is a need to collaborate with colleagues, share information,
view pupils’ problems in a comprehensive light, disseminate skills and generally move toward interdisciplinary working."
(HEGARTY S. 1982)
The curriculum can no longer be considered the innocent bystander, acting as witness, in the courtroom drama in which the individual is labelled as deviant. ‘Ironside’ has now turned and nominated this witness as the true culprit. The curriculum must stand trial:
"A curricular approach to learning difficulty must have the interests of the individual as its aim, but its means and its medium must
be potentially appropriate for ALL pupils as a part of the WHOLE curriculum." (CLOUGH P. & THOMPSON D. 1987)
Every parent, carer, teacher, therapist, keyworker, etc., need not be specifically teachers of AAC, but all should be actively engaged in the development of language, communication, and alternative communication skills, as well as in their implicit cognitive sub‑skills.
TEAM 4 - Parents & Carers
"Families of children who are severely visually, cognitively, and physically impaired may either be sceptical of using communication technology with their children or overly optimistic about the Amiracle making” changes afforded by technology." (VAN TATENHOVE G. 1990)
"The idea behind the new nursery unit for children with severe speech and language delay, which was officially opened in Cambridge today, is based on two assumptions. One is that the earlier the intervention the better the outcome for children with language problems. The other is that there is no point in working with children unless you also work with their parents" (GOLD K. 1995 page 13)
Although everyone on the team is important, parents and carers are vital members. Everything should be done to ensure they are willing partners in this venture (See KOPCHICK G., ROMBACH D. & SMILOWITZ R. 1975; BAKER B. L. 1976; GRINNELL M., DETAMORE K. & LIPPKE B. 1976; KIERNAN C. 1977; BRICKER D. & CASUSO V. 1979; KLEIN S. & SCHLEIFER M. 1980; O’BRIEN L. & ANDERSON J. 1983; McCONKEY R. 1985; BERRY J. 1987; DUNST C., TRIVETTE C. & DEAL A. 1988; BEVERIDGE S. 1989; SCOTT J. & BOA S. 1989; ANDREWS J. & ANDREWS M. 1990; HAMBLIN-WILSON C. & THURMAN S. 1990; KEARNS T. 1990; REIDER CUTRONE L. 1990; UDWIN O. & YULE W. 1991; DONAHUE-KILBURG G. 1992; DUNST C., TRIVETTE C., STARNES A., HAMBY D., & GORDON N. 1993; JONKER V. & HEIM M. 1994; KALMAN S. & PAJOR A. 1994; ANGELO D., JONES S., & KOKOSKA S. 1995; GASCOIGNE E. 1995; ANGELO D., KOKOSKA S., & JONES S. 1996; BUTCHER J. 1996; HORNBY G. 1996; LONG S. & REED J. 1996). It is not impossible to proceed without their co-operation but the gradient is much steeper and the path is longer.
Significant others’ understanding of an individual’s unaided communicative attempts is directly proportional to the period they have been in contact with the individual and will eventually tend towards the intuitive and psychic:
"It was concluded that relatives’ claims to understand minimal or unintelligible language were not without foundation."
(DAVIES P. & MEHAN H. 1988 page 141)
At the first few meetings with people with poor vocal skills, others may spend a long time in interacting, using various strategies to try to uncover the meaning of what it is the person is attempting to say. As time passes, various strategies are developed to ease the communication process. Often, these strategies are idiosyncratic and are not transparent to the outsider. Such idiosyncratic strategies may become a real obstacle in the tuition of a system of AAC. However, why change when the user and the significant others involved already have a communicative system, albeit an idiosyncratic one, that already works? Idiosyncratic communication systems cannot, by definition, be used with the person in the street. If people who use idiosyncratic systems cannot communicate with such a person, how are they going to move beyond the small group of people who have the knowledge of what they are saying? That is not to say that idiosyncratic strategies should not be valued or are to be discontinued. They should not, however, be allowed to negate the efforts of the team to develop a communication strategy that is open to the outsider. For it is only when a user can communicate with a stranger that s/he may truly take her/his place, fully integrated, in society. Other paths may lead to passivity, learned helplessness, and long-term care.
Parents and other significant others may feel resentful as well as guilty that another (the facilitator and his/her team) is taking over the role of primary ‘language giver’ to their child. This may be seen as yet another of their failings and facilitators must be careful to ensure a positive and supportive relationship with parents:
"It is part of the clinician’s task, when directly involved with other members, to enhance communication within families and thus
help relationships to grow or to be healed," (DALTON P. 1994 page 53)
A subconscious resentfulness, guilt, anxiety, low expectations, the increased stigmatisation of the individual, and a concern that the provision of an augmentative communication system will delay if not destroy (the onset of) the ability to communicate verbally (amongst others) may all contribute to a parental rejection of an augmentative communication aid:
"It would seem that these frustrated families would welcome augmentative and alternative communication techniques and the
professionals who seek to provide them with open arms. Instead, they are likely to be surprised, bewildered, or even adamantly
against the proposal. There are two primary reasons for parental bewilderment, and in some cases, parental rejection of alternative
modes of communication. These are the fear that use of the system will mean an end of all hope for the development of speech,
and fear that use of the system will further stigmatize the child or heighten society’s perception of the child as different."
(BERRY J. 1987)
"At first, my husband and I were adamantly opposed to the suggestion that Jonathan be taught to use sign language ... we wanted
nothing to do with it. We wanted Jonathan to speak, and feared that signing would discourage the development of spoken language.
We also feared it would reinforce for him and for other children the fact that he has a disability. Not only would he look different,
we thought, but he’d also act differently." (DERR J. 1983)
Parents and other significant others will generally welcome any help with their child’s communication through augmentative communication if their fears and anxieties can be allayed. Counselling has a vital role to play:
"The parents of young children and those caring for people with acquired speech disorders may need extensive counselling before
they can contribute to their family member’s difficulty. where parental anxiety or hostility, or a spouse’s anger or despair are forming
a barrier to progress, time will be well spent in building a relationship of trust and cooperation. the relatives may be demanding
‘results’, but forging ahead with a programme of structured work could prove fruitless, unless the implications of what is being
attempted are made clear and the likely outcome prepared for." (DALTON P. 1994 page 34)
A technique is to ask parents (significant others) to express their hopes for the future of their child. Sometimes these will be expressed in abstract terms - ‘happiness’, ‘security’, ‘independence’, and ‘stability’ for example. If this is the case, parents should be encouraged to specify the conditions (in concrete terms) that will promote the ‘happiness’ or ‘independence’ of their child. Parents are then asked to rate the role of communication (5 is vitally important, 1 is trivial) in each of the expressed hopes. There are few conditions that can be specified for which an ability to communicate is not a central factor (rated 3 or higher). Communication professionals involved could show by word and deed that the goals they seek to achieve are the same as those of the parents. They might share strategies for the child’s development and point out any additional benefits:
"Parents should be informed that there can be other desirable gains when a nonspeech system is used." (BERRY J. 1987)
There is a potential danger that user, parental, and significant other aspirations for the future, post tuition and training in AAC, may be set either too low or too high:
"He or she will have lost a set of assumptions and a self-concept which, although limiting of his or her existence, had also served
to define that existence. This sense of loss may be intensified by the fact that the client had always presumed that once through
this difficulty, life would be like the fairytales." (MEARNS D. 1993, page 38)
In order to avoid this, users’, parents’ and others’ goals, aspirations, and wishes should be made explicit and, if likely to be problematic, counselled. Parents, carers, and others should be involved and supported right from the start. They should feel that they are a vital part of the team:
"One of the best ways to provide support for parents is to let them know that they are crucial members of the team."
(BERRY J. 1987)
"At the same time, the parents, without whose understanding and cooperation professional help will be ineffective, may need to be
supported in their ongoing task of facilitating their child’s development." (DALTON P. 1994 page 66)
Parents (and carers) should understand the goal(s) set and the route that has been mapped out to enable their son or daughter to reach that goal. They must be involved in the planning as well as in the action itself for there is a real danger, if they remain on the periphery, that, once the course is over, they will return to old ways of interacting which may have the effect of promoting reliance and passivity:
"So called ‘independence training’ for handicapped children has proved ineffective, as the aim is to make a sharp change from one
extreme to the other. When the course is over they and their families go back to their old ways of dealing with things."
(DALTON P. 1994 page 58)
As to the fear that the introduction of an AAC system will delay or destroy their child’s ability to communicate orally, there is a growing body of evidence to the contrary (See SILVERMAN F. 1980 page 45; BERRY J. 1987; SACKS O. 1989; MARCH J. 1990 page 98; REICHLE J. 1991; BEUKELMAN D. & MIRENDA P. 1992 pages 142 - 145; ROMSKI M. & SEVCIK R. 1993; DALTON P. 1994 page 120; TULLMAN J., MITCHELL M., & SHANE H. C. 1994; ZANGARI C., LLOYD L., & VICKER B. 1994; WEINRICH M., McCALL D., WEBER C., THOMAS K., & THORNBURG L. 1995):
(AAC is) "a means of facilitating both communication and speech" (SILVERMAN F. 1980 page 45)
"extensive research has demonstrated that the use of nonspeech communication systems does not reduce motivation for speech
communication and, in fact, seems to facilitate speech" (BERRY J. 1987)
"There is no evidence that signing inhibits the acquisition of speech. Indeed the reverse is probably so." (SACKS O. 1989)
"An exciting development, incidental to the training, has been his increase in oral speech." (MARCH J. 1990 page 98)
"The bulk of the available literature suggests that implementing a gestural or graphic system does not decrease, impair, or impinge
on the acquisition of vocal mode skills. In fact, there is some evidence to suggest that, in some cases, implementing a graphic or
gestural system may actually facilitate the comprehension and/or production of spoken communication." (REICHLE J. 1991)
"These reports suggest that artificial speech technology may play a role in the emergence of receptive and expressive spoken
language skills, particularly for individuals who exhibit difficulties processing the natural speech signal."
(ROMSKI M. & SEVCIK R. 1993)
"And there is at least anecdotal evidence to show that, with the emphasis off the struggle for accurate production of speech and
language, dysphasic people often verbalize more freely, quite spontaneously." (DALTON P. 1994, page 120)
"Results indicated that AAC has the effect of increasing speech production." (TULLMAN J., MITCHELL M., & SHANE H. C. 1994)
"As more and more professionals became aware of AAC options, there was considerable concern that use of AAC could be
detrimental to the development of speech. Silverman (SILVERMAN F. 1980) was among the first to summarize findings that
would help dispel the myth that AAC intervention would impede speech development." (ZANGARI C., LLOYD L., & VICKER B. 1994)
"Based on participants’ reports of gradual increases in speech production, and as demonstrated in long term case studies, it is
important to provide information and to counsel consumers who use AAC and their families that AAC intervention should not lead
to decreased speech production over time." (TULLMAN J. 1996 page 3)
Indeed, the development of oral skills (if realistic) may still be a primary goal for many individuals. Parental fears may be allayed if facilitators:
- make the goal of the continuing development of a user’s present oral skills explicit (without making categorical promises);
- point out that the use of an AAC system will not impede the development of speech (see, for example, SILVERMAN F. 1980;
SHAW-CHAMPION G. 1986);
- help them to understand that the introduction of an AAC system may increase speech production (BERRY J. 1987;
MARCH J. 1990; TULLMAN J., MITCHELL M., & SHANE H. C. 1994) and aid its development (if any improvement in
oral skills is at all feasible).
"Understandably, parents are unlikely to encourage their children to use augmentative communication systems if they themselves
are not fully convinced of their value or fear that they will interfere with future speech development. The present findings therefore
suggest that teachers and clinicians will need to work much harder at ‘selling’ the systems to families and helping them to
understand and accept these methods of communication and, furthermore, that such training and counselling is likely to constitute
a long-term process." (UDWIN O. & YULE W. 1991 page 161)
It is my belief that it is more likely a person with a significant speech impairment will develop or improve (or both) natural speech (if it is at all possible) with an augmented communication system than without. The AAC system can help an individual to organise, understand, and communicate experience. We may:
"... see deprivation as lying not in a lack of stimulating experience but in the lack of a symbolic system by which to organize it."
(WILKINSON A. 1971)
The goal of development of speech may be enhanced through:
- a reduction of the pressure on an individual to ‘speak’;
- a reduction of the anxiety levels of the individual;
- a reduction of the anxiety levels of significant others;
- the acceptance of understandable vocalisations if and when they do occur.
"Speech and word approximations are the primary goal whenever possible. The difference is that the pressure to speak is reduced
and speech is encouraged to develop in a non-threatening manner." (BURKHART L. 1990, page 12)
Parents and other Significant Others may also gain from:
- counselling (See DALTON P. 1994);
- meeting other parents in similar circumstances;
- meeting users of augmentative communication systems.;
- watching videos about AAC, the system in question, and users of the system;
- attending workshops. Parents and carers are often concerned that they will be overwhelmed if they attend a workshop with the
‘professionals’ involved in the field of AAC. However, it has been both my colleagues and my experience that they often do as
well, if not better, than others on courses (See also BERRY J., ASHBAUGH J., THOMPSON A., & LOSONCY M. 1984)
To maximise a person’s potential for the development of speech, AAC intervention should take place as soon as it is recognised that the person is at risk of a significant speech impairment (See HUNTLEY R., HOLT K., BUTTERFILL A., & LATHAM C. 1988). Eric Lenneberg (LENNEBERG E. 1967) has proposed that there is a critical period for language acquisition between the ages of two and twelve. If this is correct, AAC intervention should not be put off until all avenues of improving the quality and quantity of vocalisations have been explored because at this point it may prove to be too late:
"...alternative nonspeech interventions will be attempted only after the child has persistently failed to learn functional vocal
behaviour. This is unfortunate, for not only does the child remain without a means of communicating during the entire training
period, but as the child gets older, the probability that he will acquire functional communication skills may be reduced/"
(ALPERT C. 1980)
CASE STUDY: A man in his fifties was assessed at his day centre for a VOCA. He proved to be an excellent candidate and took to the device without problem. When asked if his facilitator should pursue the funding for the device he said that he would have to ask his mother! When ‘mother’ (she was in her eighties) arrived to collect him from the Day Centre at the end of the day she said that he wouldn’t need such a piece of equipment because ‘he will never learn to use his voice with one of them’!
"The idea behind the new nursery unit for children with severe speech and language delay, which was officially opened in Cambridge today, is based on two assumptions. One is that the earlier the intervention the better the outcome for children with language problems. The other is that there is no point in working with children unless you also work with their parents" (GOLD K. 1995 page 13)
Although everyone on the team is important, parents and carers are vital members. Everything should be done to ensure they are willing partners in this venture (See KOPCHICK G., ROMBACH D. & SMILOWITZ R. 1975; BAKER B. L. 1976; GRINNELL M., DETAMORE K. & LIPPKE B. 1976; KIERNAN C. 1977; BRICKER D. & CASUSO V. 1979; KLEIN S. & SCHLEIFER M. 1980; O’BRIEN L. & ANDERSON J. 1983; McCONKEY R. 1985; BERRY J. 1987; DUNST C., TRIVETTE C. & DEAL A. 1988; BEVERIDGE S. 1989; SCOTT J. & BOA S. 1989; ANDREWS J. & ANDREWS M. 1990; HAMBLIN-WILSON C. & THURMAN S. 1990; KEARNS T. 1990; REIDER CUTRONE L. 1990; UDWIN O. & YULE W. 1991; DONAHUE-KILBURG G. 1992; DUNST C., TRIVETTE C., STARNES A., HAMBY D., & GORDON N. 1993; JONKER V. & HEIM M. 1994; KALMAN S. & PAJOR A. 1994; ANGELO D., JONES S., & KOKOSKA S. 1995; GASCOIGNE E. 1995; ANGELO D., KOKOSKA S., & JONES S. 1996; BUTCHER J. 1996; HORNBY G. 1996; LONG S. & REED J. 1996). It is not impossible to proceed without their co-operation but the gradient is much steeper and the path is longer.
Significant others’ understanding of an individual’s unaided communicative attempts is directly proportional to the period they have been in contact with the individual and will eventually tend towards the intuitive and psychic:
"It was concluded that relatives’ claims to understand minimal or unintelligible language were not without foundation."
(DAVIES P. & MEHAN H. 1988 page 141)
At the first few meetings with people with poor vocal skills, others may spend a long time in interacting, using various strategies to try to uncover the meaning of what it is the person is attempting to say. As time passes, various strategies are developed to ease the communication process. Often, these strategies are idiosyncratic and are not transparent to the outsider. Such idiosyncratic strategies may become a real obstacle in the tuition of a system of AAC. However, why change when the user and the significant others involved already have a communicative system, albeit an idiosyncratic one, that already works? Idiosyncratic communication systems cannot, by definition, be used with the person in the street. If people who use idiosyncratic systems cannot communicate with such a person, how are they going to move beyond the small group of people who have the knowledge of what they are saying? That is not to say that idiosyncratic strategies should not be valued or are to be discontinued. They should not, however, be allowed to negate the efforts of the team to develop a communication strategy that is open to the outsider. For it is only when a user can communicate with a stranger that s/he may truly take her/his place, fully integrated, in society. Other paths may lead to passivity, learned helplessness, and long-term care.
Parents and other significant others may feel resentful as well as guilty that another (the facilitator and his/her team) is taking over the role of primary ‘language giver’ to their child. This may be seen as yet another of their failings and facilitators must be careful to ensure a positive and supportive relationship with parents:
"It is part of the clinician’s task, when directly involved with other members, to enhance communication within families and thus
help relationships to grow or to be healed," (DALTON P. 1994 page 53)
A subconscious resentfulness, guilt, anxiety, low expectations, the increased stigmatisation of the individual, and a concern that the provision of an augmentative communication system will delay if not destroy (the onset of) the ability to communicate verbally (amongst others) may all contribute to a parental rejection of an augmentative communication aid:
"It would seem that these frustrated families would welcome augmentative and alternative communication techniques and the
professionals who seek to provide them with open arms. Instead, they are likely to be surprised, bewildered, or even adamantly
against the proposal. There are two primary reasons for parental bewilderment, and in some cases, parental rejection of alternative
modes of communication. These are the fear that use of the system will mean an end of all hope for the development of speech,
and fear that use of the system will further stigmatize the child or heighten society’s perception of the child as different."
(BERRY J. 1987)
"At first, my husband and I were adamantly opposed to the suggestion that Jonathan be taught to use sign language ... we wanted
nothing to do with it. We wanted Jonathan to speak, and feared that signing would discourage the development of spoken language.
We also feared it would reinforce for him and for other children the fact that he has a disability. Not only would he look different,
we thought, but he’d also act differently." (DERR J. 1983)
Parents and other significant others will generally welcome any help with their child’s communication through augmentative communication if their fears and anxieties can be allayed. Counselling has a vital role to play:
"The parents of young children and those caring for people with acquired speech disorders may need extensive counselling before
they can contribute to their family member’s difficulty. where parental anxiety or hostility, or a spouse’s anger or despair are forming
a barrier to progress, time will be well spent in building a relationship of trust and cooperation. the relatives may be demanding
‘results’, but forging ahead with a programme of structured work could prove fruitless, unless the implications of what is being
attempted are made clear and the likely outcome prepared for." (DALTON P. 1994 page 34)
A technique is to ask parents (significant others) to express their hopes for the future of their child. Sometimes these will be expressed in abstract terms - ‘happiness’, ‘security’, ‘independence’, and ‘stability’ for example. If this is the case, parents should be encouraged to specify the conditions (in concrete terms) that will promote the ‘happiness’ or ‘independence’ of their child. Parents are then asked to rate the role of communication (5 is vitally important, 1 is trivial) in each of the expressed hopes. There are few conditions that can be specified for which an ability to communicate is not a central factor (rated 3 or higher). Communication professionals involved could show by word and deed that the goals they seek to achieve are the same as those of the parents. They might share strategies for the child’s development and point out any additional benefits:
"Parents should be informed that there can be other desirable gains when a nonspeech system is used." (BERRY J. 1987)
There is a potential danger that user, parental, and significant other aspirations for the future, post tuition and training in AAC, may be set either too low or too high:
"He or she will have lost a set of assumptions and a self-concept which, although limiting of his or her existence, had also served
to define that existence. This sense of loss may be intensified by the fact that the client had always presumed that once through
this difficulty, life would be like the fairytales." (MEARNS D. 1993, page 38)
In order to avoid this, users’, parents’ and others’ goals, aspirations, and wishes should be made explicit and, if likely to be problematic, counselled. Parents, carers, and others should be involved and supported right from the start. They should feel that they are a vital part of the team:
"One of the best ways to provide support for parents is to let them know that they are crucial members of the team."
(BERRY J. 1987)
"At the same time, the parents, without whose understanding and cooperation professional help will be ineffective, may need to be
supported in their ongoing task of facilitating their child’s development." (DALTON P. 1994 page 66)
Parents (and carers) should understand the goal(s) set and the route that has been mapped out to enable their son or daughter to reach that goal. They must be involved in the planning as well as in the action itself for there is a real danger, if they remain on the periphery, that, once the course is over, they will return to old ways of interacting which may have the effect of promoting reliance and passivity:
"So called ‘independence training’ for handicapped children has proved ineffective, as the aim is to make a sharp change from one
extreme to the other. When the course is over they and their families go back to their old ways of dealing with things."
(DALTON P. 1994 page 58)
As to the fear that the introduction of an AAC system will delay or destroy their child’s ability to communicate orally, there is a growing body of evidence to the contrary (See SILVERMAN F. 1980 page 45; BERRY J. 1987; SACKS O. 1989; MARCH J. 1990 page 98; REICHLE J. 1991; BEUKELMAN D. & MIRENDA P. 1992 pages 142 - 145; ROMSKI M. & SEVCIK R. 1993; DALTON P. 1994 page 120; TULLMAN J., MITCHELL M., & SHANE H. C. 1994; ZANGARI C., LLOYD L., & VICKER B. 1994; WEINRICH M., McCALL D., WEBER C., THOMAS K., & THORNBURG L. 1995):
(AAC is) "a means of facilitating both communication and speech" (SILVERMAN F. 1980 page 45)
"extensive research has demonstrated that the use of nonspeech communication systems does not reduce motivation for speech
communication and, in fact, seems to facilitate speech" (BERRY J. 1987)
"There is no evidence that signing inhibits the acquisition of speech. Indeed the reverse is probably so." (SACKS O. 1989)
"An exciting development, incidental to the training, has been his increase in oral speech." (MARCH J. 1990 page 98)
"The bulk of the available literature suggests that implementing a gestural or graphic system does not decrease, impair, or impinge
on the acquisition of vocal mode skills. In fact, there is some evidence to suggest that, in some cases, implementing a graphic or
gestural system may actually facilitate the comprehension and/or production of spoken communication." (REICHLE J. 1991)
"These reports suggest that artificial speech technology may play a role in the emergence of receptive and expressive spoken
language skills, particularly for individuals who exhibit difficulties processing the natural speech signal."
(ROMSKI M. & SEVCIK R. 1993)
"And there is at least anecdotal evidence to show that, with the emphasis off the struggle for accurate production of speech and
language, dysphasic people often verbalize more freely, quite spontaneously." (DALTON P. 1994, page 120)
"Results indicated that AAC has the effect of increasing speech production." (TULLMAN J., MITCHELL M., & SHANE H. C. 1994)
"As more and more professionals became aware of AAC options, there was considerable concern that use of AAC could be
detrimental to the development of speech. Silverman (SILVERMAN F. 1980) was among the first to summarize findings that
would help dispel the myth that AAC intervention would impede speech development." (ZANGARI C., LLOYD L., & VICKER B. 1994)
"Based on participants’ reports of gradual increases in speech production, and as demonstrated in long term case studies, it is
important to provide information and to counsel consumers who use AAC and their families that AAC intervention should not lead
to decreased speech production over time." (TULLMAN J. 1996 page 3)
Indeed, the development of oral skills (if realistic) may still be a primary goal for many individuals. Parental fears may be allayed if facilitators:
- make the goal of the continuing development of a user’s present oral skills explicit (without making categorical promises);
- point out that the use of an AAC system will not impede the development of speech (see, for example, SILVERMAN F. 1980;
SHAW-CHAMPION G. 1986);
- help them to understand that the introduction of an AAC system may increase speech production (BERRY J. 1987;
MARCH J. 1990; TULLMAN J., MITCHELL M., & SHANE H. C. 1994) and aid its development (if any improvement in
oral skills is at all feasible).
"Understandably, parents are unlikely to encourage their children to use augmentative communication systems if they themselves
are not fully convinced of their value or fear that they will interfere with future speech development. The present findings therefore
suggest that teachers and clinicians will need to work much harder at ‘selling’ the systems to families and helping them to
understand and accept these methods of communication and, furthermore, that such training and counselling is likely to constitute
a long-term process." (UDWIN O. & YULE W. 1991 page 161)
It is my belief that it is more likely a person with a significant speech impairment will develop or improve (or both) natural speech (if it is at all possible) with an augmented communication system than without. The AAC system can help an individual to organise, understand, and communicate experience. We may:
"... see deprivation as lying not in a lack of stimulating experience but in the lack of a symbolic system by which to organize it."
(WILKINSON A. 1971)
The goal of development of speech may be enhanced through:
- a reduction of the pressure on an individual to ‘speak’;
- a reduction of the anxiety levels of the individual;
- a reduction of the anxiety levels of significant others;
- the acceptance of understandable vocalisations if and when they do occur.
"Speech and word approximations are the primary goal whenever possible. The difference is that the pressure to speak is reduced
and speech is encouraged to develop in a non-threatening manner." (BURKHART L. 1990, page 12)
Parents and other Significant Others may also gain from:
- counselling (See DALTON P. 1994);
- meeting other parents in similar circumstances;
- meeting users of augmentative communication systems.;
- watching videos about AAC, the system in question, and users of the system;
- attending workshops. Parents and carers are often concerned that they will be overwhelmed if they attend a workshop with the
‘professionals’ involved in the field of AAC. However, it has been both my colleagues and my experience that they often do as
well, if not better, than others on courses (See also BERRY J., ASHBAUGH J., THOMPSON A., & LOSONCY M. 1984)
To maximise a person’s potential for the development of speech, AAC intervention should take place as soon as it is recognised that the person is at risk of a significant speech impairment (See HUNTLEY R., HOLT K., BUTTERFILL A., & LATHAM C. 1988). Eric Lenneberg (LENNEBERG E. 1967) has proposed that there is a critical period for language acquisition between the ages of two and twelve. If this is correct, AAC intervention should not be put off until all avenues of improving the quality and quantity of vocalisations have been explored because at this point it may prove to be too late:
"...alternative nonspeech interventions will be attempted only after the child has persistently failed to learn functional vocal
behaviour. This is unfortunate, for not only does the child remain without a means of communicating during the entire training
period, but as the child gets older, the probability that he will acquire functional communication skills may be reduced/"
(ALPERT C. 1980)
CASE STUDY: A man in his fifties was assessed at his day centre for a VOCA. He proved to be an excellent candidate and took to the device without problem. When asked if his facilitator should pursue the funding for the device he said that he would have to ask his mother! When ‘mother’ (she was in her eighties) arrived to collect him from the Day Centre at the end of the day she said that he wouldn’t need such a piece of equipment because ‘he will never learn to use his voice with one of them’!
TEAM 5 - Take that silly machine off...
The cartoon emphasises the point about team awareness. Mr. Speekrite’s comments cannot be criticised if he:
- has had no training;
- is unaware of the AAC system’s potential;
- is unaware of the vocabulary contained in the system;
- is unaware of Sam’s knowledge of the system;
- has not been shown how he can help.
it is up to us to make him aware:
“The first problem encountered in school settings is a general lack of understanding about the technology, purpose, and role of
augmentative systems in the communication and educational processes. There are generally three levels of instructional
competency when integrating voice output communication systems into classrooms. At the Awareness Level individuals know little
about technology, especially as an educational tool, and may need to acquire a positive attitude about the use of technology. The
goal of the Knowledge Level is to provide a personal orientation to involved professionals so they can approach the device with
relative comfort and have some understanding of its capacity. The Utilization Level seeks to provide the skills needed by the
educators to implement techniques for management and establish an understanding of the device’s communicative and
instructional value. A problem exists when systems are introduced without regard for the competency level of the staff and/or a
plan is not developed or implemented to facilitate their level of understanding.” (SCROGGS D. & CLIPPARD D. 1990)
“Communication partners greatly affect the communication of people who do not speak orally, even when they speak through a
voice output system. Their skill in fostering communication opportunity, and their attitude toward the communicator and the
communication tools used, has a great deal to do with the quality and quantity of the user’s communication.” (ZABALA J. 1990)
“This example underlines the fact that it is important to understand the behaviour of (care) staff and to train them well.”
(REMINGTON B. 1994)(My brackets around the word ‘care’ to emphasise that this is equally true of all significant others.)
To err is human: If there is a problem - fix the problem, don’t apportion blame.
- has had no training;
- is unaware of the AAC system’s potential;
- is unaware of the vocabulary contained in the system;
- is unaware of Sam’s knowledge of the system;
- has not been shown how he can help.
it is up to us to make him aware:
“The first problem encountered in school settings is a general lack of understanding about the technology, purpose, and role of
augmentative systems in the communication and educational processes. There are generally three levels of instructional
competency when integrating voice output communication systems into classrooms. At the Awareness Level individuals know little
about technology, especially as an educational tool, and may need to acquire a positive attitude about the use of technology. The
goal of the Knowledge Level is to provide a personal orientation to involved professionals so they can approach the device with
relative comfort and have some understanding of its capacity. The Utilization Level seeks to provide the skills needed by the
educators to implement techniques for management and establish an understanding of the device’s communicative and
instructional value. A problem exists when systems are introduced without regard for the competency level of the staff and/or a
plan is not developed or implemented to facilitate their level of understanding.” (SCROGGS D. & CLIPPARD D. 1990)
“Communication partners greatly affect the communication of people who do not speak orally, even when they speak through a
voice output system. Their skill in fostering communication opportunity, and their attitude toward the communicator and the
communication tools used, has a great deal to do with the quality and quantity of the user’s communication.” (ZABALA J. 1990)
“This example underlines the fact that it is important to understand the behaviour of (care) staff and to train them well.”
(REMINGTON B. 1994)(My brackets around the word ‘care’ to emphasise that this is equally true of all significant others.)
To err is human: If there is a problem - fix the problem, don’t apportion blame.
TEAM 6 - Reasons for leaving the device behind
Removing an AAC system, when the purpose of the endeavour is negated by that action, is futile. Are vocal chords temporarily removed for any reason? While people may choose to be silent from time to time that is their choice and not necessarily the whim of some other person. There may be times when one form of an augmented communication system is an inappropriate means of communicating. Swimming is one example; a water-proof symbol board might be a useful low tech addition to the communicative system for some users. Some people may not be able to access their system when seated in something other than a wheelchair. A large symbol board may prove difficult for a person to use while in the bath. However, a symbol board can be displayed on the wall by the bath (See Environment 7).
Some people may not be able to feed themselves with a VOCA in the way. However, ask the staff what the majority of people do, apart from eating, at the dining table - they talk!
For many students with severe multiple disabilities, mealtime can be a highly motivating and reinforcing opportunity for communication. .... Featured will be case examples involving a group of multi-handicapped students whose participation in a school ALunch Bunch” communication program has significantly enhanced their symbolic communication and interaction skills. (BURKE C. 1991, page 11)
One strategy, to facilitate talking at the dining table, is to leave the AAC system in place, so the user may chat with the other people, up to the point of eating or feeding. At this time, if absolutely necessary, the VOCA is removed but replaced after the user has finished the meal. The user does not immediately leave the table but remains in place in order that the chatting can continue. Personally, I would make every effort not to remove the augmentative system at all but, I understand that, in some special circumstances, this may prove necessary.
CASE STUDY: Stuart is a fluent augmented communicator. However, he uses a feeding aid at meal times and is thus able to feed himself. However, he cannot do both things at the same time. He attempts to vocalise his messages but if this fails he will use an idiosyncratic finger spelling technique with his carer to make his point of view known.
The use of low-tech symbol boards strategically placed on the table top may also help to facilitate communication:
Symbol communication boards were initially positioned by each of the four students at the main table. However, this arrangement posed a problem with regard to available space for lunch trays and drinks as well as general seating comfort for the students (especially as additional students joined the group). This dilemma was solved by positioning boards between students for them to share, which promoted more peer modelling and interaction, as well as creating an increase in available space. (BURKE C. 1991 page 15)
Can staff think of other strategies to permit and encourage continuing communication at the dining table? Simple technology might be used to draw a care-givers attention to the fact that a user wants to communicate. Using a single-phrase system (such as the Big Mac from AbleNet, for example) the user can easily call up a message, AHey I’d like to say something”, which prompts the care-giver to stop feeding for a second and allow the person to communicate using his or her augmentative system. When the communication ends, feeding can resume. People normally don’t talk and eat at the same time, indeed, it is considered rude to talk with a full mouth. We stop eating, chat a bit, eat some more, then chat some more. An augmented communicator should be able to do the same (See CARLSON F., HOUGH S., LIPPERT E. & YOUNG C. 1988; BURKE C. 1991; SCHUSSLER N. & SPRADLIN J. 1991; BALANDIN S. 1996 for work on facilitating interaction at the dining table/ meal times).
Are there other situations where augmented communication systems are removed in your place of work? Ask the staff to brain-storm alternatives.
That are often cited as ‘the practical aspects of a situation’ (AIt's not practical”) should not be allowed to prevent an individual’s right to communicate. Look for ways around the problem. Creativity is the key.
Look at the list of reasons given for removing a system. Are they valid? Isn’t there a way to avoid system removal? Isn’t there an alternative?
Note: All of the ‘reasons’ listed under the cartoon are real-life excuses given to one of my colleagues or myself for the removal of a user’s system.
Leaving a user’s system behind without an alternative strategy in place shows scant regard for the importance of communication and the rights of an individual. If significant others show little respect for communication then why should the user?
The answer to the question posed at the bottom of the cartoon is ANO!” It is not best locked in the cupboard. However, if it ends up in the cupboard who is to blame?
Some people may not be able to feed themselves with a VOCA in the way. However, ask the staff what the majority of people do, apart from eating, at the dining table - they talk!
For many students with severe multiple disabilities, mealtime can be a highly motivating and reinforcing opportunity for communication. .... Featured will be case examples involving a group of multi-handicapped students whose participation in a school ALunch Bunch” communication program has significantly enhanced their symbolic communication and interaction skills. (BURKE C. 1991, page 11)
One strategy, to facilitate talking at the dining table, is to leave the AAC system in place, so the user may chat with the other people, up to the point of eating or feeding. At this time, if absolutely necessary, the VOCA is removed but replaced after the user has finished the meal. The user does not immediately leave the table but remains in place in order that the chatting can continue. Personally, I would make every effort not to remove the augmentative system at all but, I understand that, in some special circumstances, this may prove necessary.
CASE STUDY: Stuart is a fluent augmented communicator. However, he uses a feeding aid at meal times and is thus able to feed himself. However, he cannot do both things at the same time. He attempts to vocalise his messages but if this fails he will use an idiosyncratic finger spelling technique with his carer to make his point of view known.
The use of low-tech symbol boards strategically placed on the table top may also help to facilitate communication:
Symbol communication boards were initially positioned by each of the four students at the main table. However, this arrangement posed a problem with regard to available space for lunch trays and drinks as well as general seating comfort for the students (especially as additional students joined the group). This dilemma was solved by positioning boards between students for them to share, which promoted more peer modelling and interaction, as well as creating an increase in available space. (BURKE C. 1991 page 15)
Can staff think of other strategies to permit and encourage continuing communication at the dining table? Simple technology might be used to draw a care-givers attention to the fact that a user wants to communicate. Using a single-phrase system (such as the Big Mac from AbleNet, for example) the user can easily call up a message, AHey I’d like to say something”, which prompts the care-giver to stop feeding for a second and allow the person to communicate using his or her augmentative system. When the communication ends, feeding can resume. People normally don’t talk and eat at the same time, indeed, it is considered rude to talk with a full mouth. We stop eating, chat a bit, eat some more, then chat some more. An augmented communicator should be able to do the same (See CARLSON F., HOUGH S., LIPPERT E. & YOUNG C. 1988; BURKE C. 1991; SCHUSSLER N. & SPRADLIN J. 1991; BALANDIN S. 1996 for work on facilitating interaction at the dining table/ meal times).
Are there other situations where augmented communication systems are removed in your place of work? Ask the staff to brain-storm alternatives.
That are often cited as ‘the practical aspects of a situation’ (AIt's not practical”) should not be allowed to prevent an individual’s right to communicate. Look for ways around the problem. Creativity is the key.
Look at the list of reasons given for removing a system. Are they valid? Isn’t there a way to avoid system removal? Isn’t there an alternative?
Note: All of the ‘reasons’ listed under the cartoon are real-life excuses given to one of my colleagues or myself for the removal of a user’s system.
Leaving a user’s system behind without an alternative strategy in place shows scant regard for the importance of communication and the rights of an individual. If significant others show little respect for communication then why should the user?
The answer to the question posed at the bottom of the cartoon is ANO!” It is not best locked in the cupboard. However, if it ends up in the cupboard who is to blame?
TEAM 7 - Too many cooks spoil the broth
The cartoon shows the staff arguing about the location for storing a new item of vocabulary into Sally’s system. This is counter-productive. A team approach does not imply that all the members of the team have to undertake every responsibility. Rather, individual members should be delegated individual responsibilities by the co-ordinator. In this way the load is lowered and the task does not become a chore. Indeed, if the task is a chore someone is doing something wrong.
If everyone is allowed to add new vocabulary, the likely result is that the system will become confusing with many different logics used for the positioning of symbols or the storage of vocabulary. It is better that a single member be designated the ‘adder of new vocabulary units’. This member, in conjunction with the person using the AAC system (the best scenario is that it is the user who adds new vocabulary), is responsible for storing new items as requested by other team members. One idea is to provide the user with a notebook into which staff can write new requirements. When this book reaches the person with responsibility for the addition of vocabulary the new words and/or phrases can be added using a consistent and logical approach. If the location is written alongside the vocabulary, the notebook becomes an ‘update dictionary’ and may be used as a reference.
Other team duties might include (if not undertaken by the user):
- updating user wall charts or information sheets;
- ensuring system component functionality. Charging electronic devices; maintaining
care and cleanliness of system, etc;
- ensuring correct mounting of switches and other components of the system;
- explaining the system to visitors;
- creating labels for items in the environment;
- specialist support to an individual user.
Note: Responsibility for charging vocas or for the cleanliness of a system is best given to the user. While an individual may not be physically able to clean a system, she or he can be tasked with the responsibility of asking someone who is. Responsibility is important.
If everyone is allowed to add new vocabulary, the likely result is that the system will become confusing with many different logics used for the positioning of symbols or the storage of vocabulary. It is better that a single member be designated the ‘adder of new vocabulary units’. This member, in conjunction with the person using the AAC system (the best scenario is that it is the user who adds new vocabulary), is responsible for storing new items as requested by other team members. One idea is to provide the user with a notebook into which staff can write new requirements. When this book reaches the person with responsibility for the addition of vocabulary the new words and/or phrases can be added using a consistent and logical approach. If the location is written alongside the vocabulary, the notebook becomes an ‘update dictionary’ and may be used as a reference.
Other team duties might include (if not undertaken by the user):
- updating user wall charts or information sheets;
- ensuring system component functionality. Charging electronic devices; maintaining
care and cleanliness of system, etc;
- ensuring correct mounting of switches and other components of the system;
- explaining the system to visitors;
- creating labels for items in the environment;
- specialist support to an individual user.
Note: Responsibility for charging vocas or for the cleanliness of a system is best given to the user. While an individual may not be physically able to clean a system, she or he can be tasked with the responsibility of asking someone who is. Responsibility is important.
TEAM 8 - Support is essential
The Cartoon depicts a person who requires immediate support and another, able to give the support, thumbing his nose in what may prove to be a life threatening situation.
Support takes three forms:
Support for the person using the system. Without such support the chances of failure are high. The team must commit to such
support and all it involves.
Support for the team. The facilitator or co-ordinator is charged with the responsibility for this. Everyone must know their role and
how they may help the user. Training, team meetings and regular dissemination of information are suggested strategies.
Support for the facilitator. Even managers need support! It is a reciprocal relationship. The team will be involved in supporting the
facilitator as the facilitator is involved in supporting the team. However, there are times when and issues where the team will not be
able to offer support. This may be sought from:
- the higher management team of the establishment;
- the producer of the AAC system in question;
- your local Communication Aids Centre or other similar establishment;
- ISAAC.
- Search the web for information.
Support takes three forms:
Support for the person using the system. Without such support the chances of failure are high. The team must commit to such
support and all it involves.
Support for the team. The facilitator or co-ordinator is charged with the responsibility for this. Everyone must know their role and
how they may help the user. Training, team meetings and regular dissemination of information are suggested strategies.
Support for the facilitator. Even managers need support! It is a reciprocal relationship. The team will be involved in supporting the
facilitator as the facilitator is involved in supporting the team. However, there are times when and issues where the team will not be
able to offer support. This may be sought from:
- the higher management team of the establishment;
- the producer of the AAC system in question;
- your local Communication Aids Centre or other similar establishment;
- ISAAC.
- Search the web for information.