Power through Partnership: Lessons Learned in AAC Team ... · Lessons Learned in AAC Team...
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Power through Partnership: Lessons Learned in AAC Team Leadership
Dana Nieder, MAT, MA, CF-SLP, AAC-mom
About Us
Partnership
Family
AAC user
SLP Teacher & staff
Everyone’s an Expert: SLP SLP • Typical language
acquisition & development
• Areas/scope of language • Communicative
Functions • Morphology • Syntax • Semantics
• Data collection & analysis
• Therapeutic activity planning & implementation
• Subconscious expertise • Techniques and
activities for eliciting language
Challenges: • Data-driven • Experience
Everyone’s an Expert: Teacher/Staff Teacher/Staff • Classroom routines and
activities (vocab, communicative opportunities)
• Academic knowledge: unit-specific vocabulary, etc.
• Classroom culture (pragmatics, vocab)
• Relationships
• Academic planning, scaffolding, and instruction
• Subconscious expertise: observations, relationships, etc.
Challenges: • Numerous responsibilities • Supporting many learners
simultaneously
source: NeONEBRAND on Unsplash
Everyone’s an Expert: Family Family Knowledge of their child: • Likes/Dislikes • Motivations
/Aversion • Nonverbal
communication • Life/environment
***Most meaningful generalization***
• Subconscious expertise • Sensory • Exposure to
concepts & vocabulary
• Access/positionin g
Challenges:
• The uninvolved/resistant family • The overinvolved/self-directed family
source: School Specialty store
Familial Resistance to AAC Previously
provided with misinformation
Negative impact on
speech
Pre-requisiteskills
AAC hierarchy
Lack of AAC knowledge
Lack of trust in professional
suggesting AAC
So many cooks in the
kitchen
Minimization of family input
Lack of meaningful
outreach/training
Advocacy demands
exceed capabilities
Past AAC attempts/failur
es
Medical management
School/”other” advocacy
Overestimation of their ability to
understand/predict
Natural phase of parenting
Can be seemingly supported by observations
Difficult to disprove (without access to
language)
Presence of “some speech”
Belief that their child is unable to use AAC
No previous recommendations
Lack of exposure to AAC users
Lack of exposure to similar AAC users
Other: family, culture, tech stigma, tech overwhelming, $
“Overinvolved” families
• Consider the source • Access • Disintermediation – Positive outcomes – Negative outcomes
• Role release
Parents Knowledge of their child: • Likes/Dislikes • Motivations
/Aversion • Nonverbal
communication • Life/environment
***Most meaningful generatlization***
• Subconscious expertise • Sensory • Exposure to
concepts & vocabulary
• Access/positioning
SLP • Typical language
acquisition & development
• Areas/scope of language • Communicative
Functions • Morphology • Syntax • Semantics
• Data collection & analysis
• Therapeutic activity planning & implementation
• Subconscious expertise • Techniques and
activities for eliciting language
Teacher/Staff • Classroom routines and
activities (vocab, communicative opportunities)
• Academic knowledge: unit-specific vocabulary, etc.
• Classroom culture (pragmatics, vocab)
• Relationships
• Academic planning, scaffolding, and instruction
Subconscious expertise: observations, relationships, etc.
Partnership: Building a Team
Everyone needs to feel: • Invested
– Perceive – Believe
• Empowered • Valued
– Heard (and responded to) – Recognized
• Supported
Supporting Team Members
source: Clarinta Subrata on Unsplash
Supporting Team Members
Beginners (dependence)
Intermediate (interdependence)
Advanced (independence)
Getting Started Expand/Diversify Build Leaders
Invest, Empower, Value, Support
Supporting Beginners (dependence)
Beginner
Invest
Perceive Necessity of AAC system
Believe Capability • user • family
*Leader
Empower
View successful AAC users & communication partners
Active coaching
Value
Listen to (and then address) hesitations and concerns.
Emphasize importance of their role
Support
Tailored vocabulary
Specific (simple!) activities & materials
Coaching
• Perceive the need for AAC – Mind readers
– Robust system: needed to disprove – Out of sight/Safety – Highlight something possible with AAC
that isn’t possible without it – Vocabulary shouldn’t be situation-specific
• Believe that AAC use is possible – Dispel false beliefs – Acknowledge the challenges
Special note for professional leaders: • Lead gently, but enthusiastically • Understand that families hear a lot of
recommendations • Plant seeds • Focus on the child, not the system
Special notes for parent leaders: • Perceive:
• developmental norms: vocabulary size, communicative functions
• Believe: • videos of home use (or photos or stories),
shared enthusiastically
*Hook one professional
• I see a bus! • I like that bus! • That bus is yellow! • That bus is big! • That looks like my school bus! • That is not my school bus! • I want to go on that bus! • I have a toy bus that looks just like that! • I want to play with my toy bus! • Look at the wheels on that bus! • That looks like the bus from (movie/book/show)! • I had fun riding the bus to school today! • Did you see that bus? • Is that my school bus? • Can I ride on that bus? • Is there a driver on that bus? • Can we sing the Wheels on the Bus? • Something happened to me on the bus.
Are you pointing to those leaves because of their colors? Or the way that they swirl when they fall, like water in a toilet bowl?
Or did you do an art project at school today with leaves, one that I won’t find out about until it comes home three weeks from now, faded and with holes from being stapled to a bulletin board . . . when I’m helpless to connect the two?
Or, wait, is it not the leaves at all . . . is it that car? Or the lady in the pink coat crossing the street?
Or maybe you’re pointing because we parked next to that tree the other day and I stepped in gum over there and you laughed and laughed?
I’m not your voice.
I clearly cannot be it.
-Dana Nieder, “I’ll be her microphone”, Facebook
Supporting Beginners (dependence)
Beginner
Invest
Perceive
Necessity of AAC system
Believe
Capability • user • family
Leader
Empower
View successful AAC users & communication partners
Active coaching
Value
Listen to (and then address) hesitations and concerns.
Emphasize importance of their role
Support
Tailored vocabulary
Specific (simple!) activities & materials
Coaching
• Empower: – Exposure to models of
success • AAC users • Modeling/Aided
Language Stimulation
– Coaching • Valued: Validated and address
doubts/fears/concerns – First, acknowledge. Than,
reframe. – troubleshooting
• Parent/Teacher/SLP
AAC Users: • Maya Finds Her Voice • Felix Finds A Voice • We Speak PODD YouTube
Channel (search YouTube!)
Modeling/Aided Language Input: • AAC: Video Examples of Implementation/Aided Language Input,
Pinterest board by Lauren Enders, MA CCC-SLP • Take-A-Look-Tuesday: Aided Language Input/Modeling
(Uncommon Sense) • And this video of modeling even when it’s mostly to yourself
(search YouTube!)
Supporting Beginners (dependence)
Beginner
Invest
Perceive
Necessity of AAC system
Believe
Capability • user • family
Leader
Empower
View successful AAC users & communication partners
Active coaching
Value
Listen to (and then address) hesitations and concerns.
Emphasize importance of their role
Support
Tailored vocabulary
Specific (simple!)activities & materials
Coaching
Concrete tools • Meaningful
vocabulary – (core & highly
motivating fringe) • Concrete activity
ideas • Sample Activities:
– Meal/snack time – Book reading – Cooking – Art – Any discrete activity:
map it out! • Coaching
Tailored Vocabulary: • Core Word Classroom by AssistiveWare • A Year of Core Words by PrAACtical AAC • AAC Implementation: Where Do I Start? by Heidi LoStracco, Speak for
Yourself blog *includes “Building Language: Where Do I Start” brainstorming chart
Professional Leaders & Parent Leaders: • Identify opportunities that already
exist. • Make it easy. • Make it errorless. • Check-in and celebrate!
Pool Noodle Robot & book
Supporting Beginners (dependence)
Beginner
Invest Perceive
Necessity of AAC system
Believe
Capability • user • family
Leader
Empower
View successful AAC users & communication partners
Active coaching
Value
Listen to (and then address) hesitations and concerns.
Emphasize importance of their role
Support
Tailored vocabulary
Specific (simple!) activities & materials
Coaching
• Technology and Language Center, Inc. (TALC) webinars: SMoRRES and Partner-Augmented Input; Communication Partner Instruction in AAC by Jill Senner, PhD, CCC-SLP and Matthew Baud, MS, CCC-SLP – training & poster available under “Links
and Downloads” section of website
source: Autumn Mott Rodeheaver on Unsplash)
• PRC’s Implementation Classes (live webinars-CEUs) • Angelman Syndrome Foundation’s Communication Training Series (on
demand webinars) • ReAACtion Therapy and Proof of Competence by Heidi LoStracco, MS
CCC-SLP
Prompt Hierarchy Rachael Langley, MA, CCC-SLP
source: online
Parent Leaders: • Keep it specific to your child • “An SLP recommended” . . . • Sponsoring training • Don’t dump, trickle • Check in (and give advanced warning)
Professionals: • “One thing that I’ve seen other
families do” • Connect families
Social M edia
Facebook Pages • PrAACtical AAC • USSAAC • CALL Scotland • Lauren Enders,MA, CCC-SLP • Rachael Langley, AAC
Specialist
• Hold My Words • We Speak PODD • Fine Motor Boot Camp • Uncommon Sense
Facebook Groups • User groups for each
app/company • AAC for the SLP • AAC (Alternative Awesome
Communicators) • AAC through Motivate,
Model, Move Out of the Way
• TalkingAAC Professional Learning Page
• Angelman, Literacy and Education (Including Alphabet Therapy)
Instagram • AACiswhereitsAT • PrAACticalAAC • TalkAACtome • FirstcoffeethenSLP • Lotsacomptons • WeSpeakPODD • AACchicks • AACtivists • UncommonSenseBlog
Other • AAC in the Cloud 2017 • Chapel Hill Snippets: activities, printables • POWER AAC Modules, developed by PaTTAN with Gail Van Tatenhove, CCC-SLP • USSAAC • CALL Scotland • CDAC (Canada) • Jane Farrall • Special Crafts for Special Kids
Supporting Intermediates (interdependence)
Intermediate
Invest
Perceive
Areas of potential growth
Believe
Growth/fl uency are attainable
Empower
Review and build upon past successes of AAC user/communication partner team
Value
Emphasize success
Listen for new challenges
Support
Share the long term plan!
Gently push (complacency)
Trackers/challenges
• Ongoing monitoring and assessment ofcommunicative needs across contexts
• Widening the focus:– Expanding language – Communicative functions– Communication breakdown & repair– Self-advocacy training
• As focus widens, acknowledge & celebrate your current location on the road
• New challenges: slow/inconsistent progress,plateaus, lack of urgency, overwhelmed by thebreadth of communication, (sometimes) speechdevelopment (augmentative/alternative). Seek to establish goals as a team.
Communicative Functions
Areas of Language
Supporting Intermediates (interdependence)
Intermediate
Invest
Perceive
Areas of potential growth
Believe
Growth/flu ency are attainable
Empower
Review and build upon past successes of AAC user/communication partner team
Value
Emphasize success
Listen for new challenges
Support
Share the long term plan!
Gently push (complacency)
Trackers/challenges
• Increasing goals/expectations: – Vocab/Syntax/Morphology
• Increasing sophistication of modeling
• Vocabulary challenges – Communicative functions
(previous slide) – Using additional features of the
system• Search function,
keyboarding, etc.
• Re-investing check-ins – Modeling challenges/trackers
• Progress Monitoring and nudges
• Introduction to programming (for the user)
• Exposure to higher level AAC users (for the user and the communication partners)
• Linguisystem’s Communication Milestones Guide
• Brown’s Stages of Syntactic and Morphological Development
• Handbook of Language and Literacy Development, Canadian Language & Literacy Research Network
• Communicative Competencies (Dr. Janice Light & Dr. David McNaughton) article • presentation (with strategies!): (last presentation linked
on Monday, 7/21/14)
SLP leaders: Share your goals (with an open mind)
Parent leaders: Ask, suggest, delegate.
Sample vocab/core word challenge
Source: Rachael Langley, MA, CCC-SLP via PrAACtical AAC
• Core Word Classroom: Planning for Core Words by AssistiveWare
• Learning to Speak AACtion Plan by Heidi LoStracco, MS, CCC-SLP of Speak for Yourself
• “Core Word of the Week” Words and Activities by Center for AAC and Autism
Monthly Modeling Tracker (source: Dana Nieder, Uncommon Sense)
21 Days of Modeling Challenge (source: Dana Nieder, Uncommon Sense)
Supporting Experts (fostering independence)
Expert
Invest
Perceive Self-assessment
Gaps in mastery/auto nomy
Believe Communication autonomy is obtainable
Empower
Pass the reins: programming, maintenance, social media, messaging, etc.
Value
The AAC user (with support, as needed) is now the team leader.
Support
Troubleshooting in community
Facilitate AAC community/leadership.
• Total communication in all contexts – Identify gaps – Check on communication partners – Communication modality self-selection
Supporting Experts (fostering independence) Invest
Perceive Believe
Empower Value Support
Self-assessment Communication Pass the reins: The AAC user Troubleshooting in Expert autonomy is programming, (with support, community
Gaps in obtainable maintenance, social as needed) mastery/autono media, messaging, is now the team Facilitate AAC my etc. leader. community/leadership.
• “What can I help with?” “What would you like me to focus on?”
• Pragmatics (across all contexts) • Programming & Use of additional features
– Text/email/social media
• Relationships with AAC mentors & community
• Opportunities to provide outreach and mentorship to less experienced users, professionals, and families
Invest Empower Value Support Perceive Believe
Beginner Necessity of AAC
system
User capability
View successful AAC users &
communication partners
Active coaching
Listen to (and then address)
hesitations and concerns.
Emphasize importance of
their role
Tailored vocabulary
Specific (simple!) activities &
materials
Coaching
Intermediate Areas of potential
growth
Growth/fl uency are
attainable
Review and build upon past
successes of AAC user/communicati
on partner team
Emphasize success
Listen for new challenges
Share the long term plan!
Gently push (complacency)
Trackers/challeng es
Expert Self-assessment
Gaps in mastery/au tonomy
Comm. autonomy
is obtainable
Pass the reins: programming,
maintenance, social media, messaging, etc.
The AAC user (with support)
is now the team leader.
Troubleshooting in community
Facilitate AAC community/leade rship.
When Things Break Down
• (Universal) Stressors/Fears/Frustrations: – Having
knowledge/experience/ opinions devalued, doubted, or discounted
– Not being (really) heard
– Being asked/required to do things that we don’t think we can do
– Families: Wasting time
ASHA’s Position Statement (2005): Roles and Responsibilities of SLPs With Respect to Augmentative and Alternative Communication: “Integrate perspectives, knowledge and skills of team members, especially those individuals who have AAC needs, their families, and significant others in developing functional and meaningful goals and objectives.”
• Presume sincere good intentions. Really. • Listen (without response). • Acknowledge. • Ask about what they need. • Speak about priorities in your domain. Ask
about their priorities. See if there are ways to work together.
Navigating roadblocks: – Give them an “out” – Create a “trial” – “We have nothing to lose” – Refocus on the AAC user – Gather evidence of success/ease of
implementation first – Families: speak specifically about your child – Which approach has the potential to cause
more damage, and which approach has the potential to yield more success?
Responding to a pro’s “no”s: Common Sense Approach
If you hear:
You can respond . . .
“too young”
We start speaking to babies at birth. He’s not too young to start having language modeled in an accessible way.
If we start “too late” we are losing communication learning time-if we start “too early” nothing is lost.
“too old” There’s not an age when people stop learning.
If we don’t try, we are denying her the fundamental human right to communicate.
“too behavioral”
If communication is not in place, the only way to communicate is through behavior. His “behaviors” are proof that he needs a better communication system, not a reason not to provide one.
With a communication system, his “behaviors” may decrease---without one, they almost certainly will not.
If you hear
You can respond . . .
“too cognitivelyimpaired”
Nonspeakers are notoriously underestimated during formal testing, even when tests are used that have been designed for nonspeakers. The only way to determine true cognitive level will be to provide a robust language system and listen to what he has to say.
How we will ever know if he’s “smart enough” to use big words if we never provide him with big words?
“too motorically impaired”
• For people with use of their hands, but trouble isolating a finger or pointing, there are keyguards, targeting squares, or even gloves.
• Many children see an increase in fine motor ability and hand control from using an app/device.
• For people without reliable hand use, there are switches that can be activated with other body parts, or systems that work with eye gaze.
Our inability to solve an access issue indicates that we need more help—not that this person isn’t a “candidate” for communication .
If you hear You can respond . . . “let’s start small and work our way up”
• He can’t learn to really use language without having access to real language.
• When we speak to infants and toddlers (who are learning typical speech) we use all of our words---not just 20 selected words.
• He has the right to learn a language system that will last---not to be re-taught every year.
• This approach will make him constantly prove that he is ready for the next step, a model of AAC implementation that was rejected 20 years ago. He shouldn’t have to earn words---he should be immersed in them.
Responding to a pro’s “no”s: Academic Approach
Per Communication Bill of Rights: “Each person has these fundamental
communication rights: • request desired objects, actions,
events and people • refuse undesired objects, actions,
or events • express personal preferences and
feelings • ask for and receive information
about changes in routine and environment”
National Joint Committee for the Communication Needs of Persons with Severe Disabilities (NJC)
• In addition to providing an alternate method of communication, AAC is a viable intervention approach that can stimulate the development of language skills and speech.
• Negatives behaviors decrease as functional communication increases
• AAC should be introduced before the child reaches frustration level.
• AAC Myths Revealed TobiiDynavox: series of handouts dispelling AAC myths, with examples and research citations. Some topics include: – Myth: AAC Will Keep Someone from Talking – Myth: Low Tech AAC is Necessary Before Providing a Speech
Generating Device – Myth: Some Speech Means AAC is Not Needed – Myth: AAC is the Responsibility of the SLP Alone – Myth: Too Cognitively Impaired to Benefit from AAC – (and more)
• AAC Modeling Intervention Research Review *research article* by Sennott, Light, & McNaughton (2016)
• Modeling, AAC Style by Dr. Carole Zangari (PrAACtical AAC) *links to 4 research articles
• Annotated Bibliography of Project Core; Center for Literacy and Disability Studies at UNC Chapel Hill
• Myth of Augmentative and Alternative Communication Pre-requisite Skills by Heidi LoStracco, MS, CCC-SLP, Speak for Yourself
Responding to a pro’s “no”s: Turn the Tables
• How do you think this system will allow for access to the functions of language beyond requesting? (commenting, arguing, joking, asking, etc)
• How will this system address morphology and syntax?
• How will this system grow? Will it require vocabulary reorganization as it grows? Will we need to switch systems when his vocabulary reaches a certain size?
• How will he be able to truly communicate without having access to all of the words, all of the time? (Ex. If he is eating lunch and wants to talk about the art project from this morning, how could he do that?)
When All Else Fails
artist: J. Howard Miller
• Ask what the next step will be if you reject their recommendation.
• Look into obtaining a private AAC/AT evaluation (local hospitals are a good starting point).
• Research your state’s AT/AAC Lending Library.
• Are there local (or not local) organizations that provide grants or devices?
• Can you do this on your own first, and then push it in to the school?
Uncommon Sense: niederfamily.blogspot.com
Facebook: “Uncommon Sense Blog”
Twitter: @UncommonBlogger
Instagram: @uncommonsenseblog
email: [email protected]
Artist: Mohamed Ghonemi