146 Maple Street V Lexington, Massachusetts 02420

Lexington Public School 146 Maple Street  Lexington, Massachusetts 02420 SETT AT FORM: Communication Functions Interview - AAC

General Information: Person completing the form: Interview participants: Date of interview: Student initials: Reason for referral/AT Domain:

Overview: This form is designed to help teams explore different aspects of a student’s symbolic communication. Symbolic communication includes the use of aided methods (e.g., communication book, communication device, etc.) and the use of some unaided methods such as ASL (American Sign Language), SEE (Signed Exact English), and/or conventional gestures that are easily understood by others (e.g., shaking head, “no”, waving for hello/goodbye, etc.). For students who use some speech, their spoken communication should also be recorded on this form. A note should be made to differentiate communication using speech and using AAC methods.

For each area answer the questions and/or complete the table, indicating: 1. The level of independence with the skill (Listed across the top of the columns: Solid, Stronger Emerging, Weaker Emerging, Not Yet in Repertoire, or Don’t Know). 2. The type of communication (Write the appropriate letter code for the student’s current communication in the correlated level of independence column: SW=single words, P=phrases, SW/P=single words and phrases)

NOTE: Be sure to review the example and description sheets before filling out this form. Notes/anecdotes about the student’s communication with a given communication function are encouraged and should be typed directly into the corresponding box on the form.

SW = using single words P = using phrases SW/P = uses single words and phrases

Requesting/Regulating: SOLID: uses skill STRONGER WEAKER NOT YET IN DON’T KNOW: independently* EMERGING: EMERGING: REPERTOIRE: person filling out 80% of the time or uses skill uses skill uses skill only form is not sure more, across independently* independently in at when prompted or about the student’s multiple activities, 50% to 80% of the least 25% of not at all. use of this skill. communication time, across more opportunities partners and than 1 activity, within a highly settings. communication structured activity partner or setting. or activities.

Adapted by Amy Golding M.A., CCC-SLP from materials created by Gail Van Tatenhove: http://tinyurl.com/kfdxe6c, the Functional Communication Profile – Revised (L. Kleiman, LinguiSystems), and the Augmentative and Alternative Communication Profile (T. Kovach, Ph.D., LinguiSystems) Lexington Public School 146 Maple Street  Lexington, Massachusetts 02420 SETT AT FORM: Communication Functions Interview - AAC

Requests items Requests actions Requests recurrence and/or “more” Requests assistance Requests information Requests clarification Expresses protest or resistance Disagrees Negotiates Advocates for self Directs others

Labeling/Commenting: SOLID: uses skill STRONGER WEAKER NOT YET IN DON’T KNOW: independently* EMERGING: EMERGING: REPERTOIRE: person filling out 80% of the time or uses skill uses skill uses skill only form is not sure more, across independently* independently in at when prompted or about the student’s multiple activities, 50% to 80% of the least 25% of not at all. use of this skill. communication time, across more opportunities partners and than 1 activity, within a highly settings. communication structured activity partner or setting. or activities. Labels/comments with nouns Labels/comments with verbs Labels/comments with descriptors Comments spontaneously Informs about self (personal information, preferences) Informs about others (personal information, preferences) Expresses feelings/internal states

Maintaining and Initiating Interactions SOLID: uses skill STRONGER WEAKER NOT YET IN DON’T KNOW: independently* EMERGING: EMERGING: REPERTOIRE: person filling out 80% of the time or uses skill uses skill uses skill only form is not sure more, across independently* independently in at when prompted or about the student’s Adapted by Amy Golding M.A., CCC-SLP from materials created by Gail Van Tatenhove: http://tinyurl.com/kfdxe6c, the Functional Communication Profile – Revised (L. Kleiman, LinguiSystems), and the Augmentative and Alternative Communication Profile (T. Kovach, Ph.D., LinguiSystems) Lexington Public School 146 Maple Street  Lexington, Massachusetts 02420 SETT AT FORM: Communication Functions Interview - AAC

multiple activities, 50% to 80% of the least 25% of not at all. use of this skill. communication time, across more opportunities partners and than 1 activity, within a highly settings. communication structured activity partner or setting. or activities. Reciprocates greeting and/or farewell Initiates greeting and/or farewell Gains attention of others Initiates conversation Maintains social interactions by answering direct questions Maintains social interactions by making related comments and/or asking related questions Seeks approval or affirmation Gives compliments Expresses gratitude or politeness Expresses agreement Tells jokes Politely interrupts Repairs communication breakdowns

Questions SOLID: uses skill STRONGER WEAKER NOT YET IN DON’T KNOW: independently* EMERGING: EMERGING: REPERTOIRE: person filling out 80% of the time or uses skill uses skill uses skill only form is not sure more, across independently* independently in at when prompted or about the student’s multiple activities, 50% to 80% of the least 25% of not at all. use of this skill. communication time, across more opportunities partners and than 1 activity, within a highly settings. communication structured activity partner or setting. or activities. Answers Y/N questions about preference Answers Y/N questions about information/accuracy Answers concrete Who, What, and/or Where questions

Adapted by Amy Golding M.A., CCC-SLP from materials created by Gail Van Tatenhove: http://tinyurl.com/kfdxe6c, the Functional Communication Profile – Revised (L. Kleiman, LinguiSystems), and the Augmentative and Alternative Communication Profile (T. Kovach, Ph.D., LinguiSystems) Lexington Public School 146 Maple Street  Lexington, Massachusetts 02420 SETT AT FORM: Communication Functions Interview - AAC

Answers abstract Who, What, and/or Where questions Answers concrete When, Why, and/or How questions Answers abstract When, Why, and/or How questions Asks Y/N questions Asks concrete Who, What, and/or Where questions Asks abstract Who, What, and/or Where questions Asks concrete When, Why and/or How questions Asks abstract When, Why, and/or How questions

Additional Observations/Questions: 1. What output method does the student prefer? 2. Does the student prefer different methods of communication for different tasks/communication partners/environments? 3. Who does the student communicate with frequently? 4. Estimate the percentage of time familiar listeners understand the student, if the student uses multiple modes of communication, include percentages for each mode (e.g., speech- 60%, communication book-75%) 5. Estimate the percentage of time less familiar or unfamiliar listeners understand the student, if the student uses multiple modes of communication, include percentages for each mode (e.g., speech-60%, communication book-75%) 6. Any additional observations:

Recommendations:

Adapted by Amy Golding M.A., CCC-SLP from materials created by Gail Van Tatenhove: http://tinyurl.com/kfdxe6c, the Functional Communication Profile – Revised (L. Kleiman, LinguiSystems), and the Augmentative and Alternative Communication Profile (T. Kovach, Ph.D., LinguiSystems)