Determining an Effective Communication System for Students with Autism Spectrum Disorder

>>DAWN HENDRICKS: Hi, my name is Dawn Hendricks
and I’m the Director of Training for the VCU Autism Center for Excellence. I’m presenting
today on determining an effective communication system for students with autism spectrum disorder.
At VCU-ACE, we created what we call a state goal. The reason why we call this a state
goal is because we realize that there are certain concerns and issues that impact every
child with Autism Spectrum Disorder across the state and certainly enhancing communication
is one of those issues. So before you on this slide you will see our state goal and I’m
certainly not going to read the whole thing to you but I’m going to point out some of
the key elements. So we have VCU-ACE which will develop guidelines and resources. These
guidelines and resources you actually can find on our website. We have been well underway
developing these so that we provide access to different resources that will assist educational
teams in enhancing communication of students with autism.
We want to improve the communication capabilities of all students; and that’s really key looking
at all students with ASD so that each is able to effectively communicate across environments
and for a variety of purposes. We know there are different reasons why we communicate.
There are different functions and so this was an important part of this goal as well.
And finally if you drop on down to the bottom you will see that we have addressed a variety
of different areas. So identification of communication goals for students with ASD. Implementation
of communication learning opportunities. In other words, the student can’t learn if there
are not opportunities to learn and different learning trials. It’s like any other goal.
It’s like teaching reading or math. They cannot learn if they do not have the opportunity.
Implementation of strategies and supports. So these are the evidence based practices
that we need to teach communication. Development application of a systematic plan for enhancing
communication capabilities. We can’t do it if we don’t have a plan. And then finally,
commitment to developing an individualized long-term mode of communication, and this
is what we’ll be talking about today. As part of the state goal we have been developing
tools to help educational teams to do just this, to identifying a mode of communication
that’s effective for the student with autism and a mode that becomes long-term and that
that person can use across his or her lifetime. As part of this work, we had a committee of
experts in autism and in communication so here on this slide you’ll see the names of
individuals who were a part of this initiative and we want to thank each one. Each one gave
tirelessly, volunteered a lot of hours, and spent a lot of time helping us to develop
tools as well as pilot those tools. So before we get started on the tools that
we have developed to really enhance communication and really focus on augmentative and alternative
communication systems, I want to make sure we’re all on the same page. So I want to ask
the question to each of you and I want you each to think about these as I talk about
them. Can we agree learning to communicate and enhancing
skills is considered to be a profound and indisputable individual right? This is part
of our human rights, to be able to communicate effectively. And really when we change our
mindset to think about this as a human right, just like literacy is something we consider
in education to be one of our rights, just like a public education is one of our rights,
learning to communicate and being more independent with it and more effective with it is again
an indisputable right. If we consider this, if we change our mindset,
then this becomes a focus of our education that we provide for our students with autism.
As this becomes a focus we see that this is reasonable. We see that it’s achievable, and
we see that we can really impact outcomes for all of our students with autism.
Next, can we agree the use of augmentative and alternative communication is a way to
enhance communication for all students and it is not dependent on communicative ability?
We can see that when considering the mode there is a continuum of communication abilities
with our students with autism, and so if we think about variable communication and we
think about augmentative and alternative communication systems such as sign language, picture exchange,
verbal output systems, all those different systems there’s a continuum here, so let’s
go through those items. We can have an individual who is very adept
with this system. Perhaps we have someone who is very verbal and can meet all of their
needs and have reached their optimum potential with that system whether it’s sign language,
verbal, picture exchange, whatever it might be.
Next, we can have an individual who has a system but is currently unable to use that
system to meet his or her full potential. So in other words, maybe that person is able
to verbally request one or two items, or maybe that person is able to ask for help using
sign language, however, that person is unable to meet other needs and use communication
for other functions. And so we’re seeing that there’s a limitation here for that particular
student. And then finally we have an individual who
has no communication system and little or no unaided communication capability. Now very
often with AAC we think about the person who fits the description at the bottom of this
slide. One of the things we have to think about is AAC can and may be appropriate for
anyone here on this continuum so we really have to think about the abilities of the students
and whether this will help enhance the communication abilities. Again, it’s an individual right
and this is something very important for our outcomes of our students.
And finally can we agree the use of AAC does not stifle verbal communication but in many
cases can actually assist in its development. Very often we find that individuals, that
teams, that teachers, that parents may be hesitant to use an AAC system whether its
sign language, picture exchange, verbal output, whatever it might be because they feel like
they want the student to learn verbal communication versus using this AAC system however, we have
a lot of research, a lot of information says this simply is not true but in many cases
it can actually assist in its development. In other words, for some students, for some
individuals, beginning to use an AAC system will actually facilitate or foster that verbal
communication. I personally have a philosophy that we should
try to teach verbal communication to our students with autism. We have great strategies now
where we can be successful in many, many instances but certainly AAC does not stifle that growth
but instead can sometimes accelerate it or add other options so that they have multiple
modalities. So let’s now turn our attention to the tools
that the VCU Autism Center for Excellence have developed in order to help educational
teams to address this issue. How do we create a long-term system of communication for the
student with autism? We are going to be talking about the following documents. First of all,
we have an augmentative and alternative communication consideration flow chart. We next have an
AAC inventory and what is also called the AAC inventory guidance document. So for the
inventory, which is basically a screening, I don’t want to call it an assessment tool,
but an informal assessment tool. There’s a guidance document that provides directions
on how to use it. And then finally we have the AAC system feature analysis and also the
supplemental guidance document. Now before I continue on, these documents
are available on the website so if you’ve not had a chance to download those, they will
be helpful as you view this webcast to actually have those tools with you so that you can
look at them, read through them as I explain each document and piece of the document.
So the next question I want to answer is why we develop these tools? The reason why we
decided to spend so much time and energy is it related to this goal because communication
is big. There are so many different components to it. It’s because we wanted to empower teams.
We wanted educational teams to say I have the knowledge and I have the skills to make
decisions to really be able to identify a system or systems that appropriate for a student.
We find very often in school divisions across the state that sometimes teams do not feel
empowered. They feel very hindered by not having all the information or feeling that
they do not have enough information to make a decision and very often we get this paralysis
that occurs because maybe they don’t feel like they have enough information or they
don’t know every single tool that’s available therefore they’re not able to make a decision,
then that student continues to go on without a communication modality whatsoever and that
is not the right answer. The whole wait and see or let’s have someone else do it is not
the right answer when it comes to communication for our students so we want to empower teams
to say you do have the information, you do have the ability to make these decisions.
Certainly with AAC, one of the things I want to stress is there’s not a perfect system
for every student. I think that’s part of the paralysis, that very often we think there’s
going to be the perfect system and what we want to show you through our tools is that
there is a good match. There is a way that you can make a strong match and that you can
really move that student forward with the appropriate tool.
So if you work with a student, or if you have a son or a daughter, an AAC is warranted.
Remember we go back to that continuum where we have some students who might not have a
modality whatsoever to communicate and you have some who need it enhanced to be more
effective. Then what we can do is we can look at two different approaches. One is having
a practical approach and that’s what we’re going to talk about today. The practical approach
is an informal approach. Again it’s using the tools developed by VCU-ACE to say I can
take enough information about this person, this student, his or her characteristics,
his or her needs and priorities, I can match it to the systems out there and we can make
a decision and move forward. This can be an educational team decision.
And then finally in some occasions you will find that you may need a more formal approach.
Many of you in your school divisions will have a formal approach set up. In other words,
you might have an AT team, an assistive technology team, or perhaps you have an AAC team, or
maybe there’s an area help facility that provides some sort of formal evaluation. But as you
find that you have a student in need of AAC, then there’s a formal procedure. You make
a referral, a team comes in, does a formal evaluation and then a recommendation is made.
And certainly in some instances we don’t want to say that this is not needed because in
some instances it is. And in some instances you might go through the practical approach
and still not be able to come to a good consensus and then move to the formal, but again this
is about empowering you. This is about saying you do have tools and you do have the ability
to make these decisions so that student can communicate tomorrow, not six months from
tomorrow. So who is the team? When we talk about this
— let’s go back here. When we talk about this practical approach, who is the team?
Well first of all, we want to include the student of course this is going to be important.
The parent, special ed teacher, if you’re an early interventionist, we want the speech
pathologist, and then I have under the category of other, other team members who may be a
part of this as well. Certainly those four are critical to the decision making of the
communication modality. Others include the administrator and often an administrator can
help to identify the resources that are available and help with that component of determining
the communication system, perhaps an occupational or physical therapist. This might be especially
important for a student who has any sort of motor delays of any kind whether that’s fine
motor or gross motor, it might be an important consideration as we’ll see a little bit later
on with our selection. And then finally, if that student is accessing
general ed, the general ed teacher. And you want to think about other environments. Where
will the student be? Where will he or she be using this system, which the answer should
be every environment he or she is participating so you want to think about those professionals
and those individuals and those family members who also might be able to provide some information?
So let’s look at our first tool. The first tool that we’re going to look at is really
a very simple tool. It’s a way to get you started. I want to stress, it’s a way to get
you started. This tool that we’re going to look at, the AAC consideration flow chart,
is not the end-all, be-all but it is a way to get you started. It is a way to break things
down into some pretty simple decisions to say this might be a route for us to explore
so let’s look at this tool. It really breaks our decision making down
into looking at do we want to consider a low-tech system? A low-tech system can include exchange
system so whether that’s object exchange, picture exchange, icon exchange. A low-tech
system also includes a single page such as a go-talk so one single page showing icons
or pictures or a touch screen device such as a smart phone or a tablet or something
of that nature. A high-tech speech generating device is the
other option, so we’re going to consider low-tech, high-tech which includes speech generating
devices, voice output systems. So here it is and again if you have these documents,
if you had the chance to download them I would encourage you to take a look at the one you
have in front of you. So again this is the AAC communication consideration flow chart
and you will see at the very top we have asked two questions and these two questions will
guide you through the hierarchy down the right path. So the first question, the student is
not able to use picture symbols to request desired items, objects or actions. So you’re
going to answer that question. Or the student is able to independently use picture symbols
to do these things, to make the request for desired items, objects and actions.
If the student is not, then you’re going to answer the question, is he or she able to
discriminate pictures? So very often we will try to use a picture based system for children
who are not able to discriminate pictures and so if that student is not yet able to
discriminate pictures then we’ll want to think about doing some other things. Number one,
picture discrimination is one of those life skills that we will want to focus on and begin
targeting for that student, but we’ll also want to consider the use of sign language
and consider the use of an object exchange system.
On the other side of this equation, if he or she is able to discriminate pictures then
we’re going to consider one of those low-tech systems so again remember this is a picture
icon exchange or a tablet or some sort of single page device. I will scroll down to
the bottom of this document in just one second so we can consider looking at the rest of
our flow chart. Now if we flip over to the other side again,
that student is able to independently use picture symbols to request, if he or she is
not, it’s going to take us to the other side of the flow chart and take us back into those
low-tech system options. So here are our considerations on either side
of the flow chart so let’s again start on the left hand side. This is a person who is
currently unable to use pictures to make request. So let’s look at some of the questions we’re
going to ask. Some questions related to the student. Does the student have difficulty
holding or picking up pictures? Does the student lack mobility and unable to approach other
people? Will the use of technology provide motivation to the student? Look at those three
questions. If the answer is no to all of those, then
we’re going to consider a picture exchange system. If it’s yes to any of those, then
we might want to consider a single page device, like a go-talk or something of that nature,
or a touch screen tablet or smart phone or some sort of device of that nature.
Other things that we want you to think about, and this is where it gets a little tricky
because I think it’s a little easier for us to think about the student characteristics,
but we also have to think about some of the maintenance factors. One of the things that
I think becomes a barrier to AAC and its selection and implementation and continued use is the
maintenance of it, and so we’ll want to consider some questions here such as is the student’s
team unable to print pictures and maintain materials needed for picture based systems?
That’s a reality in some places, that printing of pictures is not possible or printing of
colored pictures may not be possible and if that’s the case you will want to think long
and hard as far as what kind of system you select because what you do not want to do
is limit that child’s communication because you simply cannot print the pictures or give
him or her access to new icons, new photographs and things as that student is learning.
The other maintenance factor is the student’s team able to program and maintain a technology
based system? Again, I have seen this issue hinder teams very frequently that we have
a technology based system and the team does not know how to keep it up or perhaps there’s
only one technological expert on the team whose able to maintain it in some sort of
way. So these are just a couple of maintenance factors that you’ll want to think about as
you determine might a picture exchange system be more appropriate or might something like
a single page or touch screen tablet be more appropriate. Again, I mentioned this is a
pretty simple document here so some really basic considerations to help steer you in
one direction. Now let’s go to the other side and this is
for a student who is able to use pictures independently to communicate. If we look at
our very first consideration at the top, is the student able to use the low-tech system
to request at least 30 items, objects or actions? I will tell you as a sub-committee, we looked
at that number 30 long and hard so that is not an arbitrary number, but instead it does
have some meaning to our group and we want you to apply that meaning as you’re making
decisions for your students. If you have a student who is using for example
an icon or a picture based exchange system, once you get to 30 items, I’m sure you can
agree that system becomes pretty unwieldy. You have multiple pages. You’ve velcroed them
in the books. The pictures are getting lost. They’re falling out of the book, so that’s
one of the pieces is just it becomes cumbersome. It becomes hard for that student to carry
and move from place to place. Again if he’s going from music class to PE to the general
ed. classroom, wherever that might be, that becomes a very big cumbersome system so that’s
another reason. But we also have the issue of growth. If that
student is now requesting at least 30 items, then he or she is probably moving along pretty
quickly and learning new nouns, verbs and maybe even sentences and those kinds of things
pretty quickly and so it’s time for us to move on. It’s time for us to grow and to allow
that student to grow. The next consideration, actually the next
two considerations, have the student’s communication skills grown in complexity and then will a
high-tech speech generating device promote use of a variety of communicative functions?
In other words, is that student’s communication ability growing? You can look at that and
you can look at IEP goals and objectives and you can look at his or her abilities and make
those determinations pretty readily to say okay this will help us to know it’s time to
move into something more complex such as a speech generating device.
One of the things that we have as a committee agrees on is we need students to communicate
today and that’s really important. I know sometimes it’s tempting to think about a system
that might be appropriate for that student two or three years down the road and I don’t
want to dissuade you from doing that but I do want to strongly encourage you to think
about what will help that student to communicate today and so these types of questions can
help you do that. Has that student’s communication abilities grown so that we know that if we
use a complex speech generating device that has multiple pages and a lot of icons and
abilities to put them together into phrases and sentences and questions that that student
is ready to move into something like that and be able to use it with our teaching and
instruction of course. And then finally just as we had student factors
on the other side, maintenance factors, we also have that here and this is really more
important for us to think about those technology issues, is the student’s team able to program
and maintain a complex system? Again, making sure that you have individuals who perhaps
are not ready to do that today but they can be trained and they can have the ability to
keep that system up should something happen to it.
And so we can see the determinations there based on how you answer these questions to
say we should consider staying with a low-tech system or at this point we should move on
to a high-tech speech generating device. And then finally I want to draw your attention
to the bottom with item number three. The student has a visual or hearing impairment
which will impact the system selected and if that’s the case we have another document
I’m going to talk about later which is called the feature match analysis and you should
address that document to help with students who might have those complex needs.
The next two documents I’m going to draw your attention to, the augmentative and alternative
communication inventory, and then as I mentioned earlier the AAC inventory guidance document,
in other words, the directions. How do you use the inventory? So if you have those in
front of you, pull those out and we’ll take a look at those. With the AAC inventory, we
have broken this process, this tool down into three steps. Step one, the information gathering
phase. Step two, the decision making phase. Step three, the trial implementation phase.
I’m going to talk about all three of these. This is a quick look at the actual guidance
document. I’m not going to pull that out today and go through it in detail. Again, it is
there for your use so as you’re using the inventory itself, you will have the guidance
document that can provide the directions and details. This front page that you see is kind
of a real quick checklist to help you be organized and to help you be ready when you actually
use this inventory. And so for example on this page you will see
step one, which is the information gathering phase. Part one is we’re going to discuss
the present communication modalities. We’re going to talk about communication history,
so there’s a quick little note here that says it would be a good idea to review the student’s
records before we get into this meeting and use this inventory so that we can answer these
questions appropriately and accurately. Part three is the student considerations and
AAC feature analysis. For this, there’s a document called the feature analysis. You’ll
need to make sure you have copies of that for all team members participating in this
particular inventory. And then you’ll also want chart paper to list the results. And
so again, this is the checklist to make sure you have the tools you need, the materials
you need and that you’re ready to use this inventory with the team.
So now on to the inventory itself and again I’m going to go back to that slide I had earlier
about the team. This is something to be completed by the team, so again we think about students,
parents, special ed. teachers, speech language pathologists and then of course we can include
those other participants as is appropriate for the student. So the top of this page we
can see that it’s blue. We have color coded these documents for ease of use and so we
can see that it’s blue and just some basic information about the student. So let’s go
on down to part one, which are the present communication modalities.
The first thing you’re going to do is you’re going to answer some basic questions about
how the student presently communicates, and the word effectively is there. You see a variety
of different ways ranging from gestures to sign language to typing, voice output devices,
so you’ll want to make sure you think about that. It’s nice to have the array of team
members because perhaps there’s things used in the home that’s not used at school and
vice versa so you can think about effective communication and the different modalities
currently used. And then if you drop on down, we’re going
to talk about those that are emerging. Again our focus here is how do we help that student
communicate effectively today and if we can really hone in on how is he or she communicating
now and what are those emerging ways, those are the place we want to start. This will
really help us to identify the most appropriate system or systems for the students by focusing
on these particular areas. So spend a few minutes among the team discussing both current
communication as well as those emerging skills. Next we have the communication history as
noted a few minutes ago. You’ll want to make sure if a record review is needed that you
have the records available or that you’ve done that before this meeting. Again this
is where multiple team members are helpful because very often the parents having been
there through the child’s entire educational career can provide a lot of information about
different systems or modalities that were attempted and the results of those, and so
you’re going to document that here. And one of the columns that you see on the far right,
is this system recommended for consideration. And so you’ll want to think about this. So
you’ll want to fill this table in and document the system and the description that was attempted
at some point with the student, the date attempted, the results obviously. Think about this question
though because very often what we find is that sometimes we attempt using a system with
a child when either the student wasn’t quite ready. So for example, perhaps we tried to
use a picture based exchange system using icons when the student doesn’t yet have picture
discrimination and so we didn’t meet a lot of success in the beginning. Or perhaps we
have a situation where it wasn’t implemented to the fidelity and integrity that it needed
to be. And so some of these things can be accounted
for because very often what we can do is find that perhaps something that we tried a little
earlier may be successful a little bit later on down the road. So this table is not to
say what has been tried and things that are out of question that this table is to say
what has been tried, what were the results and do we want to consider those again. Do
we want to put those in the mix? Was there some promise there? Was there may be a potential
now because of some skills that the student has developed and those sorts of things.
All right next we go on to part three, the student considerations and the AAC system
feature analysis. Now this is going to take you to a whole separate document and it’s
going to take you to a pretty, what seems like a complex document but we have tried
to really make this as simple as possible. Let me explain for a second what the feature
analysis is. What we have done is we have looked at student characteristics and we have
really worked to prioritize those based on what are the characteristics that are most
important to think about and to consider when choosing an AAC system. So we’ve gone from
those that impact the most students or the most important that may impact fewer students.
And so what you will see on this page, this is still part of the inventory, is that you
will see a list. You see symbol considerations, the student’s learning abilities and needs,
issues related to typing, usability, gross motor difficulties, fine motor difficulties,
hearing difficulties and vision difficulties. Again, if we think about this in a hierarchy,
symbol consideration, learning abilities and needs will impact every student as far as
our considerations. If we scroll on down, typing is not going
to impact every student. It’s going to impact fewer students. If we keep going down, and
let’s drop all the way down to the bottom to hearing difficulties and vision difficulties,
it’s going to impact fewer students and so we put this in a hierarchy so if you are doing
the inventory you can say for every students we need to consider the symbol and the learning
abilities and needs, and then we can determine whether we consider these other areas based
on the specific characteristics of that student. So let’s take a look at our document. So this
is what it looks like, very colorful. The color has meaning. We have color coded this
as well. I am going to jump out of here and go pull up the documents so bear with me just
one second. Okay, so here we are looking at the document itself and we can look up at
the top, see the directions. Across the top heading we see the different types of system
options. I’ll go ahead and read those. First of all we have object exchange, icon exchange
for example, picture or symbol. Single page device, we talked about that earlier. A touch
screen device using communication apps, so again a table or smart phone, something like
that. A multiple page device with voice output and
access to unlimited icons for novel messages. So multiple pages means that I have an electronic
system that will allow me toggle between different pages, so perhaps I have a page that represents
basic words like I, want, and maybe some different verbs and stuff like that, and then I have
a page that represents food and then I have a page that represents toys, and then I have
a page that represents video games or whatever that student needs to communicate we can have
different pages to represent that and so they can move between those pages and have lots
of options to communicate and to build sentences and to ask questions and to do those sorts
of things. And then finally we have a multiple page device
with voice output access to unlimited icons and semantically compact intuitive language,
for example, what is called unity language. Now I’m sure a lot of you are going huh, what,
what does that mean? So this in my opinion is really the most confusing or perhaps the
only confusing category we have to think about. An object exchange, icon exchange, single
page devices are fairly common, more used. Touch screen device, multiple page device,
we see those being used a lot with students too. But then we think about what does unity
language mean? What does semantically compact intuitive language
mean? This is a special kind of system. And let me jump back here for one second and I’ll
give you some examples of those. As we look at different types of systems that use language,
a springboard, vantage, accent, okay these are types of systems that use this. What this
means is that number one, the icons are always in the same place on that device and the language
is more compact. It doesn’t work in the same way we think about language as far as how
we structure a sentence. So if I want to say on a different device I want a cookie, I might
hit the icon, the want icon and the cookie icon, put that together in a sentence. With
something like the springboard, vantage and accent you might have one icon that represents
something like that or one icon that represent I want, and then you can go out and find other
ways. So there’s different ways this language works
that makes it more compact. It’s just a different way of thinking about it. One of the reasons
why we would choose this system for a student is for a student who has difficulties with
motor planning, actually let me word that a different way. We would choose this for
a student who can use motor planning to help them communicate more effectively. The icons
remain in the same place always. So for a student using one of the other devices
as he or she learns more language, those icons might move around on the pages and you might
get more pages and it might be more complex and so they really have to go and find those
icons. With this type of system, instead they always remain in the same place so I can always
use the same motor movements to make the same or similar types of messages, so just something
for us to think about as we’re choosing this kind of system and one of those considerations.
All right so I’m going to go back to the document here. So those are the devices or the system
I should say that we’re going to be considering. And as we scroll on down, it scrolls slowly
and hopefully you have this and you’re looking at it. We are going to ask ourselves this
question. My student needs a system that. This is always going to be running through
our heads as we’re answering these questions, and then we’re going to go down the list and
ask ourselves these different questions. And again, we’re going to ask for every student,
what symbols do they currently recognize. You see this is color coded green and its
color coded green, green light for everyone. We’re going to ask these two sections for
everyone to kind of make this as you’re in a meeting working with teams you say I always
need to do the green. It’s an easy way to remember what you need to cover.
So let’s think about this for a second. My student needs a system that has the following
symbols currently recognized. Using objects rather than icons or pictures, uses actual
pictures rather than picture representations, uses picture representation, uses text, has
a keyboard to type words and sentence and so on. So you can look at these and determine
the characteristics of the student, of the person, and then determine what types of symbols
are required in the system that you’re going to be selecting.
Now if you scroll on over, you will see some of those squares are grayed and some of those
squares are white. If they are grayed, it means that is not a good match, okay. So if
you have a student that has a need for pictures, you are going to see the object exchange is
blocked out. That’s not a good match but you can see there are other options there that
would be really good matches. And so again if it’s white it means it’s a good match.
If it’s grayed out it means this is not a good match for that particular need for that
student. All right let’s go on down. My student needs
a system that, let’s look at features to facilitate learning abilities and needs and so here are
some of those. Shows unlimited number of icons per page for those who currently communicate
a few messages or may gain new messages at a slow pace. So this is for a particular type
of learning, maybe someone who is just beginning to communicate or really as they learn new
nouns or verbs or ways to communicate different messages, that pace might be rather slow so
we don’t want to overwhelm him or her by having 18 icons on a page for example, or four pages
of icons that they have to scroll through. That might be overwhelming for that particular
learner and so again you’ll look at systems that have a good match for that particular
characteristic. Conversely is able to provide students with
more than 32 icons that can be added instantly to allow students to quickly learn to deliver
more messages. So this is for a learner that you see is just really picking up on the communication
quickly and we really want to stay ahead of him or her on the number of icons that we’re
able to add so that he or she can communicate effectively.
I’m not going to read all of these but you can pick out some of these as you have that
document in front of you. It has a camera so new pictures can be added quickly. That
might be a team consideration that we want to think about. Easily create a variety of
familiar routine messages for the student that there are certain things that student
finds him or herself wanting to say or wanting to communicate over and over again so you’ll
want a system that’s able to do that. We have everything on here that might be a good consideration
including motor planning that we talked about earlier. It has voice output and so these
different considerations that you’ll want to think about regarding the learning needs
of the student. Scrolling on down to the reddish area, now
these are considerations that might be less applicable to your student but you’ll want
to consider each one so you’ll want to consider features to accommodate typing. Is that something
relevant? If so, explore this area. Features to accommodate usability. So in other words,
it might be a student who is not yet using the system and you might have to help him
or her be motivated by it a little bit so things like has stylish cool embellishments
to increase acceptance of the system, changing the voice quality so it sounds more like him
or her. Those might be some considerations. But here’s
another one, is the device or the system able to do functions such as access the internet
and email, text? That might be important for the usability for that student. Conversely
for some students that might be extremely distracting and so we want a device that’s
able to block that so you’ll want to think about that in your considerations.
Next we have features to accommodate gross motor difficulties, like do we want something
that fits in a pocket or on a belt holster or something like that, has a strap, mounting
options on a wheelchair or anything of that nature.
And then finally we get down to the orange section. Again, likely if you’re students
we’ll need to think about this but we do have some with more challenging needs and more
intense considerations so thinking about accommodating fine motor difficulties. Switch activation,
I gaze, things of that nature. Features to accommodate hearing difficulties and then
of course vision difficulties. All right so I’ve already gone over this part
but again to emphasize there’s three layers. All students you will discuss symbols currently
recognized, learning abilities and needs. For some students typing, usability and gross
motor, and then for fewer student fine motor, vision and hearing.
So how do you use this feature analysis? We really looked hard at this entire process
and again our goal was to empower teams but we wanted to empower teams without creating
more barriers, and we wanted to empower teams without creating more barriers and further
delaying the communication system selected and implemented for the student. So as we
piloted this tool and as we looked at how to use this tool, this is a recommendation
we are making. The entire inventory you are going to do together as a team, so you’re
going to talk about the current modalities for the student. You’re going to talk about
the emerging modalities for the student. You’re going to talk about the past communication
history of the student. You’re going to do all of these as a team.
When it’s time to do a feature analysis, every team member around that table are part of
this meeting, part of this process will have this document in front of him or her, will
fill it out independently and they will do this by identifying to themselves what are
the top student priorities? What are the top characteristics at home, at school, wherever
that student might be participating, what are my thoughts regarding the biggest priorities?
And then based on that, they’re going to look at those features on that feature analysis
and then they’re going to identify the appropriate systems that might be a good match for that
student. So again, this is all done independently. I’ll tell you the reasoning why is because
we thought if that entire document is done as a team process and you went line by line
by line, this is going to be a pretty lengthy process and so we thought this is a way that
everyone is able to consider it, is able to think about it, is able to look at each of
those items and really consider those individually but then we bring it back to the team.
So once everyone has had a chance to look at that document, identify the priorities
and then identify the appropriate systems, then we’re going to bring this together and
discuss it as a team. We’re going to put it on chart paper. We’re going to identify. List
the priorities, list the AAC systems that were identified as potential and that’s where
we’re going to start. That’s really how we’re going to narrow this down and make a really
good match for this student. One other part of this feature analysis I
said earlier, we have to be realistic about system maintenance and resource considerations.
We have to think about can we maintain this system. If that thing is sitting on a shelf
waiting to be repaired, that’s not doing any good for that student so we have to think
about the maintenance and resource considerations so you will find on the back page of that
feature analysis that there is a page for system maintenance and then there are a few
items under resource considerations. And so things to be thinking about, has a camera
so new pictures can easily be added, requires team members to program information into the
system to keep it updated, has a specific operating system. Looking at the warranty,
what happens if it’s broken? What about the memory and storage, the battery life?
All of these things are things that you’ll want to think about regarding how that system
will be used. For example, if that student is using that system across the entire school
day and then taking it home, the battery is a very real concern and so you’ll want to
think about that because again if it has a dead battery, that’s not doing a lot of good
for the student. Some of these are things that you do want
to think about as far as what is the true usability for that student but some of these
are things that might get you thinking as a team if we pick that system, if that’s the
right fit for the student then how are we going to address some of these issues. How
are we going to insure that if it’s broken it’s repaired very quickly or that we have
someone who can update it and those sorts of things?
And then finally the topic no one likes to talk about, the resource considerations. Is
this system available in a reasonable timeframe? This is something you have to think about.
Again, we want that student communicating today, not six months from today and so if
it takes literally three months of trying to find that system or get it ordered, we
might want to think about another option in the short-term as we move into that one, or
we might want to think about a different system all together. These are things you’ll want
to think about. The last one is looking at is this the best
option for the cost? This is a question you will want to think about. It may not be the
thing that ultimately makes the decision. Obviously we cannot make decisions based on
resources and based on the cost of items but certainly there’s been a lot of research on
these different systems that we’re advocating throughout this presentation to say these
are viable systems. These are effective systems and sometimes we can use a less costly system
for the same results and so we’ll want to think about that but we just want to evaluate
is this the best option for the cost. And we’ll want to make all of these decisions
in the context of truly what is the best fit for that student. That’s what it all comes
down to. Okay, moving on. We have now looked at the
communication history. We have now looked at current modalities and emerging modalities.
We have looked at our feature analysis to say here are the student characteristics and
here’s a good match based on systems. We might have a laundry list of systems. Maybe we’ve
identified three or four, or maybe we’ve identified two. Whatever the case might be, this is time
for the decision making. So what you’re going to do is you’re going to take those priorities
of the student and you’re going to take those systems and you’re going to identify the advantages
and the disadvantages of each of those. So again this is where the teaming comes in.
This is where the chart paper comes in. Identify the advantages and disadvantages.
This particular system is very big and heavy and he’s in middle school and he’s walking
between six different classrooms and he’s in the hallway and he’s being bumped, that’s
not an effective system for him so let’s go with something lighter and more mobile. You’re
going to have those kinds of real conversations about the functionality and the usability
and again those priorities that were identified for that particular student. You’re going
to list those and through that process you’re going to identify the top two and you’re going
to put them in sequential order. What’s your first choice and then what’s your second choice.
We’re going to identify two, not because we’re going to jump right in and try to implement
two right away but what we want to do is we’re going to implement one of those systems and
we want the second one so that we can have a fallback in case it doesn’t work well but
the real reason is very often we find that students do well with multiple modalities
and so that second one might be another modality option. You know we’ll see. It’s a wait and
see. Let’s implement one and see how it goes and see how much independence and progress
we obtain and then we can go from there. But again, you’re going to take those advantages,
disadvantages and from those identify two systems.
Now our next step, after we’ve identified those systems, very often what happens after
a formal assessment is it ends here. The team process, the assessment process ends here
and so we’ve identified the system and we hand it over to a speech pathologist, a parent,
a teacher and we say this is the right one you could buy and good luck. And so what we
have added to this process is what we call the trial implementation phase. And what we
want to do is identify how we’re going to get that system, who is responsible for getting
that system and the date by which it will be obtained or created.
So for example, if we say an icon or a picture exchange communication system is appropriate,
what is the date by which that system will be created? How many pictures are we creating
in the very beginning and then who is the person responsible for doing that? And by
putting this here and by documenting it, we actually have an action plan to move forward
so this is a really important part of this process. We not only need to determine what
is the appropriate system but we have to say how are we going to get it, how are we going
to get it quickly so that student can be communicating and we can be teaching.
We are going to next go into the trial implementation period, so what we want to do is we want to
think about okay we have a date set by which we will have the system in place. And let’s
say it’s a week from that meeting date or three days from that meeting date. We want
to be aggressive. We want it to be fast. What we want to do is say okay we’re going
to have an implementation period, this is our trial implementation period and we are
going to say three to five weeks from that date we are going to meet again to look at
the data, to look at how the implementation went, and make a decision on what to do. Put
more instructional time in place, train more people on how to use the system, try a different
system. You may not be ready for that step but what we want to do is make sure in three
to five weeks we come back as a team and look at the progress and make some changes if necessary.
Perhaps that plan is to continue on. It’s a good system. We think it’s a good match.
The student is starting to really show some progress, then we will want to continue on
with that course of action of course. So after we set that date, now it’s time to
go and implement, so what we’re advocating and through this document is that you basically
outline the implementation plan. So again we don’t stop here. We don’t say okay we have
a date. We know in three to five weeks we’re going to come back and talk about how things
went, but instead we’re going to have a plan for how we’re going to implement this particular
system in the next three to five weeks and so you’re going to have a lead team member
or members, people or person, who is responsible for making sure these steps happen.
Here you’re going to identify the person or people to be trained, the type of training
required, who is going to do the training and when will that begin. So again, if Jarrod
is in math and social studies and PE class in middle school then you need to identify
people in those settings who may need to be trained. If there is a paraprofessional involved,
maybe that person needs to be trained. There’s a lot to think about here to make sure during
this implementation period that people who are interacting with that student, who will
be teaching that student knows how to use this particular system.
And then finally down at the bottom of this particular document you can see the location
activity for implementation, skills to be demonstrated, who will teach the use of the
AAC, how, in other words what sort of strategies will be used, and then what data will be collected.
So this further will help you to delineate that plan.
As we think about the different settings, Jarrod might use that AAC system a little
differently in PE than he does in math for example, but math and history might look kind
of similar in how it’s used. He might do some requesting, asking for help and those sorts
of things so we’ll really want to outline this so we know how it’s going to be used
across these different settings and how we’re going to teach it in the context of our implementation
period. So those are our tools that we have developed
to help you develop an outline, identify and implement augmentative and alternative communication
systems for students with autism. We have these tools available for you on our website
on the VCU-ACE website. Here on this page you can see our website. If you go to the
tab titled resources and then go down to communication that will lead you to these tools.

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