The Assistive Technology Industry Association (ATIA) has just released the results of a 2011 survey of speech-language pathologists (SLPs) that was conducted to explore attitudes and use of assistive technology (AT) and augmentative and alternative communication (AAC).  549 SLPs participated in the survey, all of whom were part of either the Schools special interest group or AAC special interest group divisions of ASHA.

Some of the results of the survey are of particular interest to those of us in the school setting.

  • Most respondents felt that their undergraduate and graduate education did not prepare them to competently provide AAC services within their practice.
  • 86% of respondents would like to know more about AT and AAC services and equipment.
  • Only a tenth of respondents believe that there are “sufficient ranks of SLPs with AT and AAC knowledge to meet the needs of consumers.”
  • Many respondents reported that AAC services were inconsistently delivered in their setting due at least in part to lack of expertise.

Oh, dear!  But I think these problems come as no surprise.  While we all know gifted professionals in our field who are providing exemplary AAC services in the schools, the survey reminds us that many SLPs would like more training in AAC to improve their knowledge and skills.   If you are one of them, you are not alone! We all want to provide our students with the best possible services!   ASHA reports that greater than 50% of school-based speech-language pathologists serve students who are in need of AAC,  (ASHA, 2010), yet we know that school-based SLPs often rate themselves as having low levels of AAC expertise.  (Fallon, 2008)

ATIA makes the following recommendations:

  • Pre-service educationat both the undergraduate and graduate level should provide more coursework in AAC and AT.
    • That will be helpful in the long term, but doesn’t help those of us in the field today!
    • Maybe this is something that we can all be working towards in our state organizations for the SLPs of the future.
  • Continuing educationand conference opportunities must be more robust, including on-line offerings.
    • This is the key, in my opinion.  And I think we can recognize that continuing education may take a variety of forms for those of us working in the schools, including:
      • Local in-service opportunities, both intra and inter-school district.  Let’s share the knowledge and expertise as much as possible in our geographical areas.  Could you or someone you know offer in-service training?   Consider interdisciplinary training, and training that includes parents and families.
      • Greater focus on AAC tracts in state and national conferences.  We may have to do a better job of informing conference organizers that we need more AAC!
      • Maybe everyone can’t go to everything, but sending an ambassador from your district to worthy training opportunities and conferences to “train-the-trainer” can be very cost-effective.
      • We have to do a better job of educating our school administrators about our need for continuing education in the area of AAC!  Advocate for your students and yourself by demanding (politely, of course) the time needed to attend worthwhile training events.

Coinciding with diminishing school district funds for conference attendance is a dramatic increase in on-line training opportunities in the field of AAC.  Many current on-line offerings in AAC are of very high quality, and generally allow you to invest your time in small “bites.”  One hour courses or serialized courses offered one hour at a time over a number of weeks are common.  While some are “live,” most are archived and so are available at any time.  There is a list of on-line classes on our website at http://www.tobiidynavox.com.

  • Mentoring as a path to proficiency.  In many school districts or educational co-ops you find one or two SLPs who are more knowledgeable and comfortable with particular areas of practice, like AAC.  Often these SLPs informally advise and assist their colleagues as needed.  I have found a more formal mentor-mentee arrangement to be effective, with clear guidelines established to address the goals, timelines, and expected outcomes of the collaboration.    One objective of the mentorship may be that the current mentee becomes a mentor to others in the future!

ATIA’s survey says that we need greater knowledge and skills in AAC, and we want greater knowledge and skills in AAC.  Maybe we should all make an action plan for how we personally are going to get it in the coming school year. What is your plan?

References

American Speech-Language-Hearing Association (2010). 2010 Schools Survey report: SLP caseload characteristics. Accessed from:  www.asha.org/research/memberdata/SchoolsSurvey.htm on October 12, 2011.

Assistive Technology Industry Association (2012).  The critical need for knowledge and usage of AT and AAC among speech-language pathologists, Survey white paper. Accessed from: http://www.atia.org/i4a/pages/index.cfm?pageID=4327 on June 18, 2012

Fallon, K.A. (2008). AAC in the schools: Current issues and future directions.  Perspectives on Augmentative and Alternative Communication, 17, 6-12.

 

I broke my ankle this week.  Just a slip on the ice and gravity did the rest.  I am using crutches to get around, and am doing pretty well, but what annoys me is this:  while I am up on my crutches, I can’t use my hands, and so can’t carry anything.  I never noticed before how much carrying of things I typically do.  I carry the newspaper into the house, I carry the coffee to the desk, I carry my book to my couch.  I think maybe I typically carry and walk more often than I just walk.

Coincidentally, while I am obsessed with carrying things and how hard it is to do so right now, I had a call from a PT who said that the child she supports needs a communication device that he can carry independently.  Let me clarify:  The PT wants the child to carry and use the communication device simultaneously and independently.  That is her top priority.  The child is three years old and has a fairly unsteady gait.

Let’s think about young children and carrying.  I can park outside of my neighborhood elementary school and watch as kids walk in every morning.  About a fourth of the young ones have a parent with them, carrying a lunchbox, or a backpack, or an art project.  Another fourth of them are pulling rolling backpacks.  The remaining half have regular backpacks.   Exactly none of them are walking and carrying something.  Are we holding the child who uses a communication device to a higher standard than all of the other children?

I wish that I could use my crutches and carry something at the same time, but I can’t, so I am using the supports available to me.  I have learned to sling a bag over my shoulder with the newspaper or the granola bar.  I can ask someone to bring me the coffee, or the newspaper, or the whatever.  I currently have special needs, and am using accommodations.  It is okay.

Back to the child that the PT called me about.  I personally think that greater harm can come from not providing appropriate communication supports than can come from this child’s lack of independence in walking and carrying and talking all at once.  These options all make sense to me:

  • A person (parent, educational assistant, teacher, peer) can provide support by carrying the device and putting it where it can be used.  For a child on the floor, the device can be on the floor.  For a child at a desk, let’s put it on the desk.
  • A rolling backpack can provide independence if it is manageable.  And the child can have a signal or symbol to use to ask for assistance in removing the device from the backpack if needed.
  • In the long term, we can set a goal for greater independence if that is important to the stakeholders.  In the short term, let’s provide a communication device of the highest caliber for communication right now.

By Patti Murphy

It is disheartening when a child is crying and cannot tell you why. Ask a school nurse, who is likely to witness this sort of thing on a regular basis. It can be especially tough with children who are nonverbal or whose speech is hard to understand.

School nurses see a different mix of kids every day. In 2010, the Health Resources and Services Administration reported that 73,697 registered nurses in the United States worked as school nurses, far outnumbered by their students. Nurses may not always know in advance when a student is identified as having CCN, or complex communication needs, or may not recognize it just by looking. Collaboration with the speech-language pathologist and other staff who see the child more is good practice. The mix of augmentative and alternative communication (AAC) solutions (high-tech devices, low-/light-tech tools such as static devices or picture books, or unaided techniques such as gestures) that work best for the child can vary depending on the circumstances, the level of support needed to implement the solution and how well they know their communication partners. Keeping everyone in the loop can only make solutions better.

While their experience with kids who use an AAC device ranges from daily to rare or none, nurses I’ve talked or emailed with easily named situations where the reason for a child’s tears could be clarified, in a timely way, through AAC device use. Parents, too, appreciate that the technology, combined with other AAC methods, lets their child be specific and independent when telling the nurse (or other adult) what’s wrong. Here are some examples:

Situation: The child may be getting sick but it is hard to know whether to keep them home.

Resolution: A mother saw that her preschooler seemed extra tired one morning. So on the way to school, she asked the child to practice saying “I feel sick and need to go home” –a phrase the child automatically shared with her school aide later that day, avoiding guessing games and maybe an unnecessary visit to the nurse.

Situation: The child feels overwhelmed and simply needs a break.

Resolution:   When children can’t say what’s bothering them, it often magnifies the problem. A change in routine, for instance, can trigger negative behavior in children with autism. Having age-appropriately phrased messages on their AAC device like “I need some space,” “Too much is happening at once,” “I don’t like surprises,” or “Can I have a time out, please?” is important. It is empowering for the young person to have a voice in the matter. And it helps others to help them.

Situation: The child has physical pain they cannot describe.

Resolution: Give them words that go beyond “It hurts” or “I have a headache” to make sure others get it. AAC devices offer descriptive vocabularies for health-related issues, allowing the child to say where it hurts and whether the pain feels sharp, dull, or like pins and needles. They can tell you whether bumping into an object may have caused the discomfort or how to reposition them in their wheelchair so they feel comfortable again.

Situation: The child fears that he/she may be getting a shot during a routine height, weight, vision and hearing screening.

Resolution: One mom says her son, who has autism, likes to know when he’s about to get a shot and uses his device to ask. He is more at ease on family doctor and dentist visits, too, because he can be specific about his concerns. In addition to choosing from the many pre-programmed messages on his device, he types novel ones on its onscreen keyboard, which has helped him taper his habit of simply repeating what he thinks others want him to say when asked how he feels.

Such situations usually involve multi-modal communication occurring with or without the aid of a device. The child, realizing that an adult understands his/her concerns or starting to feel better, may smile or give a fist bump. They may stay close, or even tap the adult on the shoulder, if they have more to say. To stay on topic, the child may point to pictures or printouts of content from their AAC devices, or blend device use with verbalization of familiar words. Some children have a system of blinking their eyes once for YES, twice for NO, fast when they have exciting news or slowly to show that they’re listening. Others hold up their right or left and to give a specific message, or do finger spelling. Team members can be creative. One nurse shared that some children respond best during hearing exams by tossing clothespins in a bucket when they hear sounds.

Nurses like when a child to conveys information instead of relying on an aide to do so. True, aides often spend more time with the child than anyone else at school. They may be the best interpreters of a child’s non-verbal expression and the main device programmers. But the aide may be a substitute or busy with another child. There is less continuity in districts where aides change from year to year.

It is important to let children do their own talking, no matter how they do it. Conversations with the school nurse or similarly infrequent—but vital—communication partners teach self-care. That’s a truly valuable skill for all kids to learn while growing up.

March is Music in Our School Month!

Did you know that music has many positive effects on students? Here are just a few–

  • Music boosts brain power – It stimulates parts of the brain that are related to reading, math, and emotional development.
  • It improves memory – Music stimulates different patterns of brain development that can improve students’ learning ability and memory.
  • Music teaches patience – When playing an instrument in a group, you have to work together and that sometimes means waiting your turn.
  • It helps children socially – Picking up an instrument and participating in a group can help a student break out of their shell.
  • Music teaches discipline – When playing an instrument, students not only have to practice in class, but also at home in their free time.