AAC- Yikes! You Want Me To Do What?

1. AAC- Yikes! You Want Me To Do What? June Maranville MSP, CCC-SLP Palmetto Language & Speech Center, LLC Email: plsc@plsclex.com Website: www.plsclex.com

2. I don’t even know what I don’t know “The only disability in life is a bad attitude.” - Scott Hamilton

3. ALL Individuals Can and Do Communicate! -National Joint Commission for the Communication Needs of Persons with Severe Disabilities. (1992) “If all my possessions were taken from me with one exception, I would choose to keep the power of communication, for by it I would soon regain all the rest” -Daniel Webster

4. We’ve come a long way, baby. Who remembers… • Cut and paste pictures from notebooks • Hand coloring each picture • Glue with no Velcro! • No Boardmaker • Contact paper instead of lamination • Heavy-bulky systems that took weeks to program

5. Present Day Where are we now? • Boardmaker • Lamination • Velcro • Over 200 Apps for high-tech devices • AAC App Comparison Chart (SCATP) • http://www.sc.edu/scatp/apps.html • Light weight, durable, intuitive systems

6. What has not changed? • As professionals, practice due diligence when choosing AAC for client. • Team Approach • Client and caregiver as active participants • Best fit- low/medium/high tech • Feature matching • a process that involves matching the skills of the AAC user with the features of the given AAC systems.

7. What is Augmentative and Alternative Communication (AAC)? • “AAC involves attempts to study and when necessary compensate for, temporarily or permanently, the impairments, activity limitations, and participation restrictions of individuals with severe disorders of speech-language production and/or comprehension. These may include spoken and written modes of communication.” (ASHA 2005)

8. AAC is the bridge that enables children with severe communication difficulties to learn higher-level language skills and to interact with individuals outside the family. ~ Page and Quattlebaum (2012) Handbook of Children with Special Healthcare Needs

9. The Goal of AAC • Empower AAC user to • express wants and needs • exchange information • develop social closeness with others • engage in social etiquette routines. • MULTIMODAL approach most effective in order to be able to communicate for different purposes in a variety of contexts. (ASHA, 1991)

10. Objects Signs Gestures Facial Expressions Pictures Speech Nurture residual speech Written Word Symbols Voice output devices Multimodal Communication

11. Feature Matching • Which system is the best match to fit user’s abilities, needs and skills? • Dx does not determine need for specific device • Consider: • Current Skill Level • ADLs and associated wants/needs • Current Communication system/strategies • Future Communication needs • System growth with development and skills • Degenerative/Deteriorating skills

12. Feature Matching Cont. • Objective / Feature / Selection Criteria • Shared symbol system • Development of language system • Construction of messages to interact with others • Meaningful Vocabulary • http://aac.unl.edu/vocabulary.html • Access to communication symbols • Access to communication device ~Page and Quattlebaum (2012) Handbook of Children with Special Health Care Needs

13. Is it a good fit? • Would you ever get the gift box before you purchased the gift? ~ Dr. Carol Page • No! ~ Let’s not do it with AAC either. • Evade “flavor of the month” devices based on marketing, promotion and popularity. • AbleData: AAC products and features http://www.abledata.com/abledata.cfm?pageid=19327&ksectionid=19327

14. Why Assess? • Will use of AAC… • Maximize client’s abilities and decrease challenges of disabilities • Help improve condition or prevent from getting worse. • Help person function in their environment • Help improve independence • How will team find the best fit? • Is a formal assessment needed and required by funding source? • Is use of AAC a medical necessity?

15. Medical Necessity • Medicare defines as • “Service or supplies that are needed for the diagnosis or treatment of medical condition and must meet best practice standards.” • Buzz words • Correct deficits • Ameliorate deficits - to make better or tolerable • Palliate- to make less severe or unpleasant without removing the cause. • Letter of medical necessity and physician order with high-tech AAC purchases

16. Who can assess formally? • Licensed and credentialed in related field • PT, OT, SLP, Rehab Engineer • AT specialization certification • Other Team members—as warranted • Vision specialist • Nurse • Psychologist • Educators • Hearing specialist

17. Who pays for AAC?Funding sources consider AAC dedicated communication devices • Private Pay • Babynet (0-3) • IFSP Team, parents and professionals • Schools (3-21) FAPE • Private insurance- appeal if denied • CRS • Medicaid • Medicare • VA • Vocational Rehab • Community • Service organizations • Church and local charities

18. Who really pays for AAC? We all do!

19. Components of Successful Assessment • Team Assimilation • Medical Information • History • Functional Goals • Technology that has been tried in the past and results • Clear communication among team members • Trials with AAC • Time is your best friend!

20. Assessment Help • There are no standardized AT assessments. • Ecological Inventory ~ Nalty and Quattlebaum (1998) • Joy Zabala SETT Framework • It’s not about technology or device • It’s about matching • The Student • The Environment • The Task • The best Tool • Communication Matrix • Every Move Counts, Clicks and Chats

21. Trials with AAC • Low-tech • Examples: Communication boards, booklets. • Can start immediately • Boardmaker is your friend! • Backup system-as needed if high-tech device malfunctions

22. Trials with AAC • Mid-tech • Examples: BigMack, iTalk 2, Go talk series. • Typically requires a battery to operate. • Human voices recorded on device

23. Trials with AAC • High-tech • Examples: Dynavox, Prentke Romich, Tobii- SGDs • Increase vocabulary opportunities • Digitized, synthesized speech • iPads and Tablets

24. Purpose of Trials • What works. • What does not work. • Show evidence of optimal fit for individual communication need. • System not to be used or recommended just because only one tried, most popular, or most promoted.

25. AAC Intervention • If we’re using pictures do we call it AAC? • AAC vs. other types of learning activities

26. Picture Identification vs. Functional Communication • Picture ID- END • Receptive Skills and Knowledge • Touch the “____” • Teaching Format-Get response • Match, sort, reinforce • Academic Achievement

27. Picture Identification vs. Functional Communication • Functional AAC Communication- MEANS to END • Demonstrates desire to engage with communication partner to share wants, needs and ideas. • Nurtures social interactions • Empowers • Beyond Requesting Powerpoint

28. Message Sets • Vocabulary linked to social/emotional development • Feelings • Decrease behavioral problems with appropriate vocabulary selection • Vocabulary Selection • Provides means to interact • Motivating vocabulary imperative • Consider user’s interest first • Variety of word types

29. Core Vocabularyhttp://aac.unl.edu/vocabulary.html • Typical Peer 5-minute Conversation Sample • More than Nouns • Rich language experiences • Increase message set expansion • Generalizes across communication settings • Teaches rules of Syntax • Language to Literacy Expansion • juice, want juice, no juice, more juice, write or type juice –Page and Quattlebaum 2012 • Quick Hits/Urgent messages • One Icon to represent message • Example: “I need help” “I feel sick”

30. Prognostic Indicators • Extrinsic Factors • Skin in the game • Buy into use • Switch gears from basic needs to anticipating needs • Co-treating • Chain of cues • Model, model, model! • Enable vs. Empower • 15x per day • Intrinsic Factors • Knowledge is power • User grasps that power is in communication • Motivation • Example: Music variety • Active participant • Engage 15x per day using AAC device • Present and Possible Changes • Medical condition status • Plan implement ahead of time • Monitor and adjust to assess wants/needs • Dynamic and ever-changing process • ~ Page and Quattlebaum (2012)

31. Parent/Caregiver Roles • Active participants • Ongoing programming • Vocabulary selection • Facilitate carryover of device to all settings • Model use of device with motivating activity for user • Troubleshoot problems • Recognize when message sets changes needed • Attend training

32. Carryover • Functional • Motivating • Means-End • Efficient • Effective • Interactive • All Environments • At least 15 opportunities per day • Update AAC system when change occurs • Transition Strategies for Adolescents and Young Adults Who Use AAC

33. Resources • SC Assistive Technology Program • Apps that make life easier • Apps comparison chart. • SC Equipment Distribution Program • SC Vocational Rehabilitation

34. Resources Cont. • CRS- Children's Rehab Services • SCATP- Device Loan Program • SC Independent Living Program • CDR- Centers for Disabilities Resource Library • Loaner programs through vendors. • Key Technologies • Dynavox • Tobii • Prentke Romich

35. Prize Time!Q and A

36. Wrap it Up!When you know better, you do better~ Maya Angelou • Use the resources • Celebrate great resources in your backyard • Don’t be afraid to ask for help • Enjoy the journey and be inspired! • Heart of the Ravens! Superbowl 2013 Champs! • http://espn.go.com/video/clip?id=8815080

37. Bibliography Works Cited AAC and Speech Devices from PRC. N.p., n.d. Web. <http://www.prentrom.com/>. "AAC Messaging and Vocabulary." AAC References. N.p., n.d. Web. <http://aac.unl.edu/vocabulary.html>. "AbleData: Products." AbleData: Products. N.p., n.d. Web. <http://www.abledata.com/abledata.cfm?pageid=19327>. "Apps That Make Life Easier." Apps That Make Life Easier. South Carolina Assistive Technology Program, 7 Jan. 2013. Web. ASHA. "Goal of AAC." (1991): n. pag. Print. "Augmentative and Alternative Communication (AAC)." American Speech-Language-Hearing Association. N.p., 2005. Web. <http://www.asha.org/public/speech/disorders/AAC/>. "Beyond Requesting." Beyond Requesting. N.p., n.d. Web. <http://www.slideshare.net/slpwendy/beyond-requesting-presentation>. CDR Library, School of Medicine Library, University of South Carolina. N.p., n.d. Web. <http://uscm.med.sc.edu/cdr/>. "Communication Assessment for Parents & Professionals." Communication Matrix. N.p., n.d. Web.

38. Bibliography Cont. DynaVox: Communication Devices – Speech Devices. N.p., n.d. Web. <http://www.dynavoxtech.com/>. "EMC, Inc. Home." EMC, Inc. Home. N.p., n.d. Web. <http://www.everymovecounts.net/>. ESPN. ESPN Internet Ventures, n.d. Web. <http://espn.go.com/video/clip?id=8815080>. "Independent Living." South Carolina Department of Social Services. N.p., n.d. Web. <http://www.state.sc.us/dss/independent/index.html>. Key Techonologies. N.p., n.d. Web. <http://www.gokeytech.com/>. Nalty, L., and P. Quattlebaum. "A Practical Guide to Augmentative and Alternative Communication: Assessment and Intervention Strategies." Greenville:Super Duper (1998): n. pag. Abstract. Severe Communication Disorders (2012): 32. Print. National Joint Commission for the Communication Needs of Persons with Severe Disabilities. Guide-lines for Meeting the Communication Needs of Persons with Severe Disabilities (1992): n. pag. Print. Page, C. A., and P. D. Quattlebaum. "Severe Communication Disorders." Ed. D. Hollar. Handbook of Children with Special Health Care Needs (2012): 23-46. Print.

39. Bibliography Cont. SCATP Device Loan Program. N.p., n.d. Web. <http://www.sc.edu/scatp/loan.htm>. "SCATP." South Carolina Assistive Technology Program (SCATP). N.p., n.d. Web. <http://www.sc.edu/scatp/>. "Sharing the SETT Framework." Joy Zabala SETT Framework. N.p., 2005. Web. South Carolina Department of Health and Environmental Control. N.p., n.d. Web. <http://www.scdhec.gov/health/region5/crs.htm>. "South Carolina Equipment Distribution Program." SCEDP. N.p., n.d. Web. <http://www.scedp.org/>. South Carolina Vocational Rehabilitation Department (SCVRD). N.p., n.d. Web. <http://scvrd.net/common/index.php>. Tobii Technology Global. N.p., n.d. Web. <http://www.tobii.com/>. "Transition Strategies for Adolescents and Young Adults Who Use AAC." ASHA Online Store Details. N.p., n.d. Web. <http://www.asha.org/eweb/OLSDynamicPage.aspx?Webcode=olsdetails>.