Appraisal for speech pathologists who support people · PDF fileAppraisal for speech pathologists who support people with disability ... of the appraisal as assessing a level of competence

Augmentative and Alternative Communication

Appraisal for speech pathologists who

support people with disability

Augmentative and Alternative Communication Core Standard Appraisal, January 2016 2

BACKGROUND

This appraisal was developed for speech pathologists in Family and Community Services (FACS) by the Practice Leader Speech Pathology in Clinical Innovation and Governance. External agencies and services working with people with disability may also find it useful.

This appraisal supports FACS speech pathologists to translate their knowledge regarding augmentative and alternative communication into their everyday practice. It forms part of the supporting resource material for the Augmentative and Alternative Communication Core Standard program. Before undertaking the appraisal the program participant may wish to read the aligned resource material:

1. Augmentative and Alternative Communication (AAC) Practice Guide for Speech Pathologists who Support People with Disability, and;

2. Frequently Asked Questions for the Core Standards Program for Practitioners who Support People with Disability.

The Core-Standards Program and associated resource materials can be found at http://www.adhc.nsw.gov.au/sp/delivering_disability_services/core_standards.

It is inevitable that with such a large and skilled workforce some FACS practitioners will already have the required knowledge. To obtain a certificate in a core standard program a participant can choose to omit further learning. They can simply complete the appraisal and demonstrate the professional application.

GUIDELINES

The program participant must identify a suitable work practice support person who is willing to complete this appraisal. This is ideally a speech pathology senior clinician/supervisor with appropriate skills and experience. An alternative support person may be identified if there is no appropriate professional supervisor, or if the current supervisor believes another person may be better suited to appraising the participant’s knowledge.

The participant is required to arrange a time with this work practice support person to plan and administer the appraisal. The appraisal is self paced and participants are simply asked to answer questions in professional supervision when they feel ready to do so.

http://www.adhc.nsw.gov.au/sp/delivering_disability_services/core_standards


This appraisal consists of the following three sections:

1) Theory

• The information under each question is intended to provide the key points each participant should address. The information is directly from the associated practice guide. It provides participants with a summary of expected knowledge, and guides the support person in the appraisal of this knowledge. Participants can provide more than is itemised and should provide supportive literature to back up their answers if needed.

• Questions may be answered verbally or in writing.

• Questions may be answered in the context of a group discussion as long as the support person is present and satisfied with the participant’s response.

• The support person will sign off each question when they are satisfied the required information has been presented.

2) Discussion (regarding application to work practice)

• Case discussion / examples must have been completed within the previous 12 months.

• Case discussion / examples are acceptable if completed in collaboration with another practitioner as long as the support person can identify the participant’s level of contribution and is satisfied that the requirements are met.

3) Direct observation

• With the consent of the person with disability and / or their person responsible, the support person must observe the participant demonstrating the requirements.

• A direct observation of an assessment session and a direct observation on an intervention session are required.

• There is not a scoring system in this appraisal. All questions are to be answered to a satisfactory level, and there must be satisfactory demonstration of application to the practitioner’s work in the areas outlined.


DISCLAIMER

This Augmentative and Alternative Communication Appraisal was developed by the Practice Leader in Speech Pathology within the Department of Family and Community Services, New South Wales, Australia (FACS).

This appraisal has been developed to indicate whether a participant has increased their knowledge through the completion of the Augmentative and Alternative Communication Core Standards program. It has been designed to promote consistent and efficient good practice. It forms part of the supporting resource material for the core standard program developed by FACS.

Access to this document by practitioners working outside of FACS has been provided in the interests of sharing resources. Reproduction of this document is subject to copyright and permission. Please refer to the disclaimer in the Augmentative and Alternative Communication Practice Guide.

Whilst the information contained in this appraisal has been compiled and presented with all due care, FACS gives no assurance or warranty nor makes any representation as to the accuracy or completeness or legitimacy of its content. FACS does not accept any liability to any person for the information (or the use of such information) which is provided in this appraisal or incorporated into it by reference. FACS does not intend nor guarantee the use of the appraisal as assessing a level of competence by practitioners working outside of FACS.


AUGMENTATIVE AND ALTERNATIVE COMMUNICATION APPRAISAL

PARTICIPANT NAME: __________________________________

SUPPORT PERSON NAME: _____________________________

SUPPORT PERSON POSITION: __________________________

DATE APPRAISAL COMMENCED: _______________________

THEORY QUESTION

Support Person Comments

Meets requirements (Y/N, date, initial)

1. What is augmentative communication?

What is alternative communication? Augmentative communication strategies are designed to support a person’s speech abilities. Alternative communication strategies are designed to replace speech when, for varying reasons, such as physical disability, speech development is not possible.

Augmentative and Alternative Communication (AAC) is “an area of clinical and educational practice that provides communication interventions for people who have little or no functional speech or who have complex communication needs” (SPA 2012 p. 13).


THEORY QUESTION



2. Who might be involved in an AAC team?

Why is team work important?

The following people might be involved in an AAC team:

• the person • immediate or extended family • paid or voluntary carers • teachers and teachers aids • speech pathologist • physician • occupational therapist • physiotherapist • social worker • education specialist • psychologist • rehabilitation engineer • vision specialist.

Working in a team provides different perspectives and skills. It allows collaborative decisions to be made about AAC systems based on a broad range of information. Involving the person with disability and their family/ carers is vital for identifying and respecting their preferences.


THEORY QUESTION



3. What is unaided AAC? Give three examples.

(Participant should be able to provide a description of unaided AAC and name at least three examples). Unaided AAC refers to communication strategies which do not require the use of an external aid. For example:

• gestures • pointing • vocalizations • body language • behaviours e.g. taking a person’s hand and

leading them to the door • eye contact / eye gaze (within an environment) • facial expression • touch cues • tactile signing.


THEORY QUESTION



4. What are Janice Light’s four AAC competencies? Describe the meaning of each of these competencies.

(Participant should be able to name and describe the four competencies below).

• Linguistic- this includes learning the linguistic code of the AAC device as well as learning the language of the home and community e.g. learning to combine words to form sentences.

• Operational- refers to the technical skills

required to operate and maintain the system e.g. keep the vocabulary in the device up to date, arrange necessary repairs. Often family/ carers as well as the AAC user are responsible for operational competence.

• Pragmatic/Social- includes all the skills

required for social interactions e.g. giving and taking turns, initiate, maintain and terminate conversations.

• Strategic- means having the flexibility to adapt

communicative style to suit the communication partner. It involves having a range of strategies to use when communication breakdown occurs e.g. the AAC user learns to send the message “I don’t understand”, “please slow down”.

(Light & McNaughton 2014; Light 1989).


THEORY QUESTION



5. List four critical aspects you need to

consider when doing an assessment for AAC.

For example:

• Person centredness. • Goal setting. • Participation needs. • AAC communication competencies. • Environments. • Communication situations and partners. • Self advocacy/choice/adaptability. • Intellectual abilities. • Physical abilities. • Sensory abilities. • Social, personal, emotional preferences. • Literacy skills. • Symbolic abilities.

(Beukelman & Mirenda 2013; Light & McNaughton 2014; Light 1989).


THEORY QUESTION



6. How do you work as an evidence based

speech pathologist with AAC? The process of evidence based practice in AAC includes:

• asking a well-built question • conducting a search of the literature • examining and appraising the evidence for

internal, external and social validity • determining if the evidence is valid • discussing the findings with relevant people • identifying and exploring the views,

preferences, concerns and expectations that people may have.

Speech pathologists need to be able to measure and evaluate AAC interventions. The choice of intervention needs justification and may be a requirement when seeking funding for a device. In the field of AAC, an increase in the availability of systematic and narrative reviews and a growing interest in evidence-based practice have resulted in a wider appreciation of the benefits of AAC across many populations… (Speech Pathology Australia, 2012 p.15)


THEORY QUESTION



7. Define low tech AAC and high tech AAC.

Give two examples of each.

(Participant should be able to describe low and high tech AAC and provide at least two examples of each). Low tech AAC strategies involve the use of aids that do not require a power source to be operated. Some examples are:

• schedules • timetables • choice-making supports • community request cards • communication boards • Talking Mats • Picture Exchange Communication Systems

(PECS) • Pragmatic Organisation Dynamic Display

(PODD) • alphabet display • pictures, letters or word boards • calendars • shopping lists • daily planners • diary • labels and signs • continuum lines • timers • small objects • cue cards • memory books • memo boards • memory wallets • reminiscence (generic) photos • photo albums & individual photos • communication books • communication boards • generic greeting cards (i.e. holidays) • phone lists.


THEORY QUESTION



High tech generally refers to a computer-like device to generate speech output to convey a message. For example:

• dedicated speech generating devices • computers • mobile devices such as tablets or smart

phones.


THEORY QUESTION



8. List three AAC assessment tools.

For example:

• Augmentative & Alternative Communication Profile: A continuum of learning (AAC Profile) (Kovach 2009).

• Communication Matrix-Communication Assessment for Parents & Professionals (Rowland 2012; Rowland & Fried-Oken 2010).

• Functional Communication Profile – Revised (Kleiman, 2003).

• Interaction Checklist For Augmentative Communication (Oakander Bolton & Dashiell 1991).

• (MOSAIC) A Model of Observational Screening for the Analysis of Interaction and Communication (Smidt 2010).

• Positive AACtion: Information Kit for AAC Teams (Rocky Bay 2010).

• Triple C Checklist of Communication Competencies (Bloomberg et al. 2009).

• Test of Aided Communication Symbol Performance (TASP; Bruno, 2010).

• Social Networks Inventory (Blackstone & Hunt Berg 2003, updated 2012).


THEORY QUESTION



9. What relevance does the International

Classification of Functioning (ICF) have to AAC?

Using the ICF framework defines a person’s level of functioning in different environments and takes into account health, activity, social, cultural and personal factors, within the context of any interaction. All the components of an AAC system assessment still happen (i.e. access, devices, choice of modality, vocabulary, training, etc.) but the assessment framework focuses on everyday functioning rather than disability or systems changes (Simeonsson, Bjork-Akesson, & Lollar, 2012). Application of the ICF framework changes and widens the overall focus of evaluation of AAC interventions. By using the ICF framework the outcome of using AAC can directly measure people’s functioning in their daily lives. For example, the efficacy of an AAC intervention can be measured by being able to do an activity or participate in a social engagement (Lund & Light, 2006), (Lund & Light, 2007). The ICF is a tool for “moving the goal of health services away from body function and towards involvement in life situations” (Pless & Granlund, 2012 P.11)


THEORY QUESTION



10. Why is literacy an important consideration

with AAC systems? What are two effective strategies for teaching literacy with AAC users?

Development of literacy skills for those using AAC has traditionally lagged behind peer literacy development. “Approximately 70% of individuals with severe communication impairments are significantly behind their peers in literacy learning” (Koppenhaver & Yoder, 1992 p. 1). Literacy learning can be more challenging for people with disabilities who use AAC for a range of reasons including vision impairment, motor impairment, cognitive impairment etc. However, these are not reasons to neglect or avoid literacy learning opportunities. Literacy skills can increase the range of devices and communication options. Michalicek et al. (2010) found that systematic instruction strategies were best for teaching literacy skills such as phonemic awareness, phonics, vocabulary, text comprehension children who use AAC. These strategies include:

• scaffolding • direct instruction • least-to-most prompting with time delay.


THEORY QUESTION



11. List three factors which should be considered to enable a successful AAC intervention.

For example:

• Selection and trial of appropriate. aids/tools/devices/systems/vocabulary

• Ensuring there is a back up system. • Ease of access and determining how the

person will manipulate and use their system. • Determining if scanning is required to access

the device. • Training in systems for the person and

communication partners. • Identifying communication opportunities. • Participation needs and changes in

communication requirements. • Consideration of communication partners. • The environment and impact it has on

communication and use of AAC systems. • Mentoring for the user and clinician.

(Bech, Bain, & Vass 2008; Caulfield & Carillo 2010; Michalicek et al. 2010).


THEORY QUESTION



12. Describe three areas you could measure to

evaluate an AAC implementation. For example:

• Outcomes on the goals made by the person using AAC, their family and people with whom they interact with.

• Changes to any of the five ICF domains- body

functions and structure; participation; activity; environmental factors and personal factors using ICF codes and tools (World Health Organisation, 2001).

• Participation in relation to increased opportunities for communication. This could be measured using the Participation Model of AAC (Beukelman & Mirenda 2013) or the Children's Assessment of Participation and Enjoyment (CAPE) and the Preferences for Activities of Children (PAC) (King et al., 2004).

• Changes to communicative competency using

Light’s Communicative Competence for Individuals who use AAC (Light, Beukelman, & Reichle, 2003).

• Changes in other areas of communication skills

and abilities (like speech, language, literacy, fluency, voice, and pragmatics) which are targeted goals within the AAC intervention.

(Speech Pathology Australia, 2012).


THEORY QUESTION



13. What are two tools might you use to

measure outcomes in AAC intervention? For example:

• ICF codes.

• COPM.

• GAS.

• AAC Profile.


DISCUSSION

Application to work practice. Sample required, must have been generated within the previous 12 months.



Discuss two case studies where the following was incorporated when working with a person who uses augmentative and alternative communication:

• Person with disability and their family/ carers actively participated in planning and decision making.

• Identification of person centred goals.

• Assessment/ intervention was person centred and evidence based.

• A combination of direct and indirect assessment methods as well as feature matching was used to determine the best AAC system or strategy for the person.

• Assessment included a trial of potential AAC systems.

• Light’s (1989) communication competencies were considered during assessment/ intervention e.g. linguistic, social, strategic, operational.

• Analysis and interpretation of assessment findings took place.

• Assessment findings/ device trial were discussed with the person with disability and their family/ carers to assist in selecting the most appropriate AAC system or strategy.


DISCUSSION

Application to work practice. Sample required, must have been generated within the previous 12 months.



• There was consideration of physical abilities,

vision, hearing, intellectual abilities, literacy, mental and physical health, social networks, activities of daily living, personal preferences and environments when choosing and implementing the AAC system.

• Intervention involved training communication partners.

• The environment was set up in a way that supported use of the person’s AAC system/ strategy.

• The speech pathologist consulted other team members or specialist services as needed e.g. OT regarding mounting AAC system to wheelchair.

Describe and produce the outcome measures used to monitor and review progress.

Show hard or digital copy examples of AAC systems used within the two case studies.

(Review progress notes, reports and other written evidence).


DIRECT OBSERVATION

Observations must have been conducted within the previous 12 months and with the consent of the person with disability and / or their person responsible. Observations are ideally in real time, but may also be done via filming.



Observation of the speech pathologist interacting with a person using augmentative and alternative communication during an assessment or intervention session. Is there evidence of the following practices being administered where possible/ relevant?

• Person with disability and their family/ carers actively participate in assessment/ intervention.

• Person centred, functional, meaningful goals are selected.

• Assessment/ intervention is holistic, functional and evidence based.

• A combination of direct and indirect assessment methods as well as feature matching is used to select the best AAC system/ strategy for the person.

• The AAC system/ strategy is appropriate for

the person and enhances their ability to communicate.

• The vocabulary for the AAC system/ strategy was selected in collaboration with the person with disability and their family/ carers. There was consideration of core vocabulary as well as fringe vocabulary that reflects the individual needs and preferences of the person.

• The type of symbols used in the AAC system are selected in collaboration with the person with disability and their family/ carers.


DIRECT OBSERVATION

Observations must have been conducted within the previous 12 months and with the consent of the person with disability and / or their person responsible. Observations are ideally in real time, but may also be done via filming.



How the person with disability will access and use their AAC system is considered and supported.

• The speech pathologist ensures the person who will support the use of the AAC system understands what they have to do and how to do it.

• There is planned time for training communication partners on how to use the AAC system/ strategy.

• Information on the AAC system/ strategy is

provided in an accessible format.

• The speech pathologist provides information about ongoing intervention, progress and review.

• The speech pathologist records and

documents assessment/ intervention. Impressions, clinical reasoning and outcomes are discussed with the support person following the interaction.

I, the SUPPORT PERSON, confirm that all requirements have been met for this core standard appraisal.

SIGNED: ___________________________________

NAME: ____________________________________

POSITION: _________________________________

DATE: ____________


References

Bech, A., Bain, A., & Vass, A (Producer). (2008). Training of the Communication Partner provides positive outcomes in facilitating communication of children with Cerebral Palsy who use Speech Generating Devices. Retrieved from http://www.agosci.org.au/docs/trainingcatsp.pdf

Beukelman, D.R., & Mirenda, P. (2013). Augmentative and Alternative

Communication: Supporting Children and Adults with Complex Communication Needs: Paul H. Brookes Pub.

Blackstone, S., & Hunt Berg, M. (2003, updated 2012). Social Networks: A

communication Inventory for Individuals with Complex Communication Needs and their Communication Partners. Verona, Wisconsin, USA: Attainment Company, Inc.

Bloomberg, K., West, D., Johnson, H., & Iacono, T. (2009). The Triple C:

Checklist of Communication Competencies. Assessment Manual and CD Rom (Revised edition ed.). Victoria: Scope Victoria.

Bruno, J. (2010). Test of Aided-Communication Symbol Performance.

Pittsburgh, PA: Dynavox Mayer Johnson. Caulfield, F, & Carillo, D. (2010). 200 A Day the Easy Way, Putting it in

Practice. http://www.closingthegap.com/ Harris, E.J., Ryder, S., & Totten, L. (2010). Positive AACtion: Information Kit

for AAC Teams. Perth: Rocky Bay. King, G., Law, M., King, S., Hurley, P., Rosenbaum, P., Hanna, S., Kertoy, M. & Young, N. (2004). Children's Assessment of Participation and Enjoyment (CAPE) and Preferences for Activities of Children (PAC). Pearson. Kleiman, L. (2003). Functional Communication Profile: Linguisystems. Kovach, T. M. (2009). Augmentative & Alternative Communication Profile: A Continuum of Learning: Linguisystems. Light, J C., & McNaughton, D. (2014). Communicative Competence for

Individuals who require Augmentative and Alternative Communication: A New Definition for a New Era of Communication? Augmentative and Alternative Communication, 30(1), pp.1-18. doi: 10.3109/07434618.2014.885080.

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Individuals Using Augmentative and Alternative Communication Systems: Williams & Wilkins.

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Light, J. C., Beukelman, D. R., & Reichle, J. . (2003). Communicative Competence For Individuals Who Use AAC: From Research To Effective Practice. Baltimore: Paul H. Brookes.

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Use Augmentative and Alternative Communication: Part I – What is a ‘‘Good’’ Outcome? Augmentative and Alternative Communication, 22(December, 4), pp. 284 - 299.

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Michalicek, W, Sanford, A, Lang, R, Rispoli, M, Molfenter, N, & Mbeseha, M.

(2010). Literacy Interventions for Students with Physical and Developmental Disabilities who use Aided AAC Devices: A Systematic Review. Journal of Developmental and Physical Disabilities, 22, 219-240.

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Simeonsson, R. J., & Granlund, M. . (2012). Developing the ICF-CY for AAC Profile and Code Set for Children Who Rely on AAC. Augmentative and Alternative Communication,, 28, 21-32.

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Communication Clinical Guideline In The Speech Pathology Association of Australia Ltd (Ed.), Clinical Guidelines. http://www.speechpathologyaustralia.org.au/.

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Appraisal for speech pathologists who support people · PDF fileAppraisal for speech pathologists who support people with disability ... of the appraisal as assessing a level of competence