Augmentative and Alternative Communication Assessment

Disclosures Let’s Get This Started! Augmentative and Alternative Financial Disclosures: YES Communication Assessment Non- Financial Disclosures: YES

Presented by: Heather Miller Schwarz, M.S., CCC-SLP, UCP Seguin- Infinitec

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Sometimes you learn what is “right” by being “wrong”.

Goals for this Training

• Participants will compare and contrast models of AAC assessment and strategy implementation. • Participants will identify potential AAC users using the participation model as a guide. • Participants will list the components of the feature match assessment to support communication.

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1 AAC Assessment AAC Assessment The goals of AAC intervention and assessment • • Which communication methods should be • Enable individuals to efficiently and effectively maintained or developed? engage in communication and participate in • Which communication tools and methods will activities of their choice. be added to the student’s repertoire? • Assist individuals to meet their current and future communication needs. • What strategies will the communication partners use with this individualto increase communicative competence?

http://aac.unl.edu/yaack/c0.html © K. Post 7 H. Miller-Schwarz, 2018 7 8

AAC Assessment Assessment Models family person with CCN • Expert Model A team approach. teachers/staff • Formal referral system • Formal assessment • Decision made with the help of an ‘expert’ caregivers doctors • Formal report • Then, implementation shifts to team working with this individual therapists • This team is responsible for implementation and determining success of a system close friends © K. Post 7 H. Miller-Schwarz, 2018 Bowser and Decoste, 2016 © H. Miller-Schwarz, 2019 9 10

Assessment Models Assessment Models • Capacity Building Model • Problems with the Expert • Looks at the patterns of referrals Model • Identifies topics for training so that all staff member • TIME! begin to implement AAC strategies in their classroom, • Responds to a referral once agency, hospital, etc. the team has recognized that • Make supports available. the individualhas failed in some area. • Builds agency/district wide capacity. • It’s often reactive instead of • Continued use of strategies to build skills. proactive.

2 Capacity Building

•Each partner should know: • Partner augmented input • AAC prompting hierarchy • Choice-making strategies • How to navigate a communication system • How to be a good communication partner

Matt Baud, NTDSE

Megan Brazas, Infinitec Webinar, 2014 Grether & Sickman, 2008

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Current AT/AAC Assessment Feature Match Assessment Models

• SETT process- Joy Zabala, www.joyzabala.com • Also expanded upon at WATI’s site- www.wati.org • Participation model- Beukelman, D. R. & Mirenda, P. (2013). Augmentative and alternative communication: Supporting children and adults with complex communication needs. 4th ed. Baltimore, MD: Brookes Publishing. • Feature Matching

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SETT • STUDENT: Consider individualstrengths and challenges

• ENVIRONMENT: Document the environments the individualparticipates in daily

• TASKS: Comprehensive list of tasks/goals for student

• TOOLS: What tools will help accomplish the Beukelman, D. & Mirenda, P., 2013 tasks/goals Image from ASHA School Conference, 2007 © K. Post 7 H. Miller-Schwarz, 2018 www.JoyZabala.com © K. Post 7 H. Miller-Schwarz, 2018

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3 Feature Match Assessment

“The systematic process by which a person’s strengths, abilities and needs are matched to available tools and strategies.”

Beukelman, D. & Mirenda, P., 2013

Image from ASHA School Conference, 2007 Shane and Costello, 1994 © K. Post 7 H. Miller-Schwarz, 2018

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Feature Match AAC Assessment AAC Assessment 1.Gather information about strengths and needs as they relate to device features. 2.Compare participation patterns and identify barriers. • The process that we will discuss today is a 3.Integrate the person’s strengths, abilities and needs and match them to a list of features. combination of the Participation model 4.Identify goals and conduct trials. and Feature Matching process 5.Determine tool(s) based on data collected. 6.Summarize/Report data to procure a system. 7.Reassess the appropriateness of your AAC system(s) over time.

Miller Schwarz, 2019 Modification of the DATE Assessment, Texas AT Network 21 22

AAC Assessment- AAC Evaluation Data Gathering What do we know? Need to know? Speech Skills Worksheet (Kathleen Post ) Sensory Skills (Vision & hearing) Motor Skills Communication Skills Language and Literacy Skills Cognition Feature Match Participation- Output Environments Access Where does Symbols communication need to happen? AAC Fixed/Dynamic Who are the Portability communication Durability partners? Vocabulary

Set up Trials and Data Collection (Kathleen Post , Midwestern University, 2018)

4 AAC Assessment AAC Evaluation Protocol Gail Van Tatenhove (GPAT)

Vantatenhove.com

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AAC Assessment Checklist (Vanderbilt Feature Match AAC Assessment University) 1.Gather information about strengths and needs as they relate to device features. 2.Compare participation patterns and identify barriers. 3.Integrate the person’s strengths, abilities and needs and match them to a list of features. 4.Identify goals and conduct trials. 5.Determine tool(s) based on data collected. 6.Summarize/Report data to procure a system. 7.Reassess the appropriateness of your AAC system(s) over time.

Gather Information-Speech and Speech Intelligibility Intelligibility As it relates to an AAC system (Feature Match): • Feature Match Goal is to determine size and type of • Consider the needs and goal for your student. system, symbolic representation, vocabulary & output • If the system will only be used to clarify a options. communication breakdown, then the features will • Intelligibility is how well the individualis able to make often differ from a individualwho is using it for all himself understood? expressive output. • These measurements are often given as ratings by • Vocabulary familiar vs. unfamiliar listeners. • Output • This information is often used to determine “eligibility” or to provide “proof of need” for funding agencies. • Symbols • Fixed vs. Dynamic file:///C:/Users/heath/Downloads/2320-Flipsen-Peter-2.pdf © K. Post 7 H. Miller-Schwarz, 2018

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5 Speech Intelligibility Speech Intelligibility As it relates to an AAC system As it relates to an AAC system (Feature Match): (Feature Match): • Vocabulary features Output features • Vocabulary may be different for a • supplemental/augmentative users vs. a user • Voice/no voice that needs a system as an alternative method of Message communication. • window/no • E.g., topic setting, photo access, calendars, message window? letter displays, news, scripts

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Speech Intelligibility Speech Intelligibility As it relates to an AAC system As it relates to an AAC system (Feature Match): (Feature Match): SIZE

• Symbolic representation • Use of symbols for every word or one symbol for a phrase? • Use of a keyboard alone.

Nordness, Beukelman & Ullman (2010), Hustad & Garcia (2005). © K. Post 7 H. Miller-Schwarz, 2018 https://tactustherapy.com/aac-slurred-speech-dysarthria/

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Sensory/Perceptual- vision Gather Information-Sensory Skills As it relates to an AAC system Vision Feature Match Goal is to determine size, (Feature Match): type, placement of symbols & identify language input & output options. • Symbols: Size, number, type, complexity, enhancements • Visual Acuity • Visual Field • Symbol Fields and arrangements • Oculomotor Functioning (will discuss the symbols more in depth again later) • Cortical visual impairment Output features • Light Sensitivity Access features • Color Perception

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6 Sensory/Perceptual- vision Sensory/Perceptual- vision As it relates to an AAC system As it relates to an AAC system (Feature Match): (Feature Match): • Symbols: Size and number of symbols, space • Type of symbols (e.g., object, tactile, line drawing, between symbols. etc.)

Tactile connections, APH

Sensory/Perceptual- vision Sensory/Perceptual- vision Tactile Symbols Symbol Enhancements Example- PCS TM High Contrast If vision is compromised, but motor skills are not, consider tactile symbols. http://www.tsbvi.edu/tactile-symbols or True Object Based Icons (TOBIs)

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Sensory/Perceptual- vision As it relates to an AAC system Complexity of Symbols (Feature Match): • Symbol Fields and arrangements • Grid style • Word webs-aacorn • Visual scene display (will discuss the symbols more in depth again later)

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7 Sensory/Perceptual- vision Sensory/Perceptual- vision As it relates to an AAC system As it relates to an AAC system (Feature Match): (Feature Match):

• Output features: backlit screen • Access features: auditory preview through fishing or scanning

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Sensory/Perceptual- vision Sensory/Perceptual- hearing As it relates to an AAC system As it relates to an AAC system (Feature Match): (Feature Match):

• Fixed vs. Dynamic: Will the individualbe using • Hearing Feature Match motor planning or pragmatic branching Goal is to determine approaches? sound tolerance, voice output type and volume needs, simultaneous ‘activation’ signaling.

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Sensory/Perceptual- hearing As it relates to an AAC system Gather Information-Motor Skills (Feature Match): Motor Feature Match Goal is to identify optimal seating, positioning, and motor technique for using AAC system. Work with other members of the interdisciplinary team as • Output features: necessary. • Voice output • Identify appropriate positioning (seating, walking, etc.) • Type of voice output • Identify selection method and technique (direct, • Volume options scanning, encoding) • What part of the body will be active (hands, head/voice, • Simultaneous ‘activation’ signals feet, arms/elbow, legs/knees, eye gaze)?

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8 Motor skills- fine motor abilities Motor skills- Overall positioning As it relates to an AAC As it relates to an AAC system (Feature Match): system (Feature Match):

Seating and positioning • Ambulation • is critical for use of assistive technology (AT) and • Wheelchairs participation in a variety of environments. (AAC- Standers RERC) • Other positioning devices- issues • effects access, fatigue, comfort, alertness, • motivation and so much more. • Impacts how a person will access their AAC system when walking vs. in adaptive equipment such as wheelchair, stander, or while resting out of equipment. Image from: slpzone.blogspot.com Image from: www.childrenscolorado.org Image from: www.medicaleshop.com © K. Post 7 H. Miller-Schwarz, 2018 Image from: rjcooper.com

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Motor skills- fine motor abilities As it relates to an AAC Scanning system (Feature Match): • Scanning- A method of accessing in which a highlighted area Access Options: moves repeatedly from one character (or group of characters) to the next. The individual activates a switch to make a • Direct Selection- selection. • Directly touching the item or target desired • Partner Assisted Scanning- (PAS) or Partner Assisted Auditory Scanning (PAAS) as a training option or low tech • Scanning- system to support other communication system use. • Moving a highlight to a specific target • Linear, circular, row column, column row, group row column, etc. • Single switch automatic scanning, two switch step scanning, inverse scanning, etc.

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Motor skills- fine motor abilities As it relates to an AAC system: Direct Selection Selection Methods cont’d • Size of Targets Considerations • Method of Direct Selection • Type, range, accuracy, consistency, strength, speed, etc. Image from: www.sc.edu • Activation site: the minimum size of the targets, Image from: www.orin.com possible number of targets, spacing of targets, etc., will be determined by accuracy • Sensitivity: the amount of pressure or force needed to activate the target.

• Motor planning system vs. navigation Image from: speechlanguageinfo.myefolio.co m Image from: cerebralpalsy.org © K. Post 7 H. Miller-Schwarz, 2018 © K. Post 7 H. Miller-Schwarz, 2018 Image from: www.rjcooper.com

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9 Gather Information-Motor Skills Image from Ablenet Inc

• Direct Selection • Handheld pointers • Head pointers • Mouth sticks • Light pointers/Laser pointers

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Gather Information-Motor Skills Gather Information-Motor Skills

• Conductive Pointers for iDevices •Direct Selection • Required to access capacitive screen technology- • Mouse, trackball, joystick regular ‘pointers’ won’t work! • Have to complete a ‘circuit’ • Head Mouse options • May need to adapt pointers! • Eye Gaze Technology

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Fine motor skills- access options Fine motor skills- access options Direct Selection options Additional Considerations • Device Access Settings • Questions to ask yourselves: • Hold/release times • Can the method of access be used • Touch enter/touch exit repeatedly without undue fatigue, • Activation pressure discomfort or embarrassment? • Ignore repeated selections • What does the individual like/tolerate? • Cut out Gloves • Can this method be used across all environments or will there need to be other • Keyguards or Touch Guides options for other situations/positions?

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10 Gather Information- Communication Skills Communication Skills As it relates to an AAC • Feature Match Goal is to identify communication skills used to interact and engage with others. system: • When assessing current communication skills, make sure that you document the following in activities or environments that you believe would benefit from augmentative and alternative communication supports: • Baselines in • Communicative intent • What should you supplement? • Functions expressed • What should you add? • Frequency within a timeframe • Complexity of messages • What should you replace? • Why? So that trials later on can provide you with information on whether communication increased or not! © K. Post 7 H. Miller-Schwarz, 2018 © K. Post 7 H. Miller-Schwarz, 2018

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Communication Skills Gather Information- As it relates to an AAC Language and Literacy Skills system: Language skills • Ease of retrieval of messages Feature Match Goal is to identify language skills • Prediction/no prediction for communication and comprehension. Influences symbol selection. • Navigation to get to important vocabulary • Vocabulary • Grammar • Discourse/Pragmatics • Literacy

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Language Language As it relates to an AAC system (Feature As it relates to an AAC system (Feature Match): Match): • Message storage: levels vs. message • Size of vocabulary set needed encoding • Types of vocabulary • Encoding: • Core language, whole messages, clarification • Numeric codes: 1: hi, 2: my name is Joe, 3: bye strategies • Letter codes: (e.g., abbreviation expansion/instant • Symbol type and use (single, stringing, messages). sequenced) • hhy: hello how are you?/cuz: because • Semantic encoding (e.g., Unity) • Use of morphological markers (past tense, plurals, etc.) © K. Post 7 H. Miller-Schwarz, 2018 http://www.augcominc.com/whatsnew/ncs5.html

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11 Gather Information- Language Skills Symbol Sets Symbol Selection • Photos • Determine how an individual can • Drawings communicate with symbols & possible symbol • Symbol Sets types Pixon Symbols • Objects, Texture cues or symbols, True Object Based Icons (TOBI),Cut Out Photographs, Pictures, and Symbols, Photographs, Line Drawings (Color), Line Drawings (Black & White), Realistic (Color), Realistic (Black & White), Visual Scenes, Alphabet/Spelling PCS or BoardMaker Symbols SymbolStix Unity Symbols Widgets

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Language- symbol selection As it relates to an AAC system (Feature Gather Information-Literacy Match): Considerations when choosing symbols: • Vision • When assessing literacy skills, note ability to • Situation use spontaneous spelling, first letter of word • Individual or family preference recognition, word recognition (sight word and • Age appropriateness word prediction/completion). • Cultural or ethnic influences • Why? These skills can assist in language retrieval in AAC systems. • Motor abilities • Skill levels- literacy, processing, cognition • Exposure

Language- symbol selection Gather Information- As it relates to an AAC System Cognitive Skills (Feature Match)

• Site words representation vs symbols • Awareness • Initial letter retrieval to symbols • Communicative intent • Alphabetical ordered vocabulary • World knowledge • Keyboard on main page vs navigate to keyboard • Memory • Symbolic representation • Metacognition

Rowland and Schweigert, 2003

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12 Cognition As it relates to an AAC system Gather Information - Vocabulary (Feature Match): Features • These strengths or needs can impact which Skills to assess: vocabulary system a individual might use. • Ability to categorize • Various commercially produced vocabulary • Ability to use semantic associations for sets are available for different systems. recall of language (e.g., Unity) • Using the information you have collected and analyzed in the Feature Match process, would • Ability to use memory to recall a vocabulary set be an option to explore in a words/motor patterns trial?

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Additional Device Features to Gather Information - Vocabulary Consider Features • Output (voice output vs. paper- based) • Core Vocabulary • Access (direct access vs smart partner) • Activity Specific Vocabulary • Fixed/Dynamic • Word-based vs. Phrase- based vs. Carrier phrases • Portability and durability • Sentence-based vocabulary • Closed vs open system (able to get out of • Visual Scene display vocabulary to use computer or iOS features Funding options • Scrolling lists • • Product support & warranty

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Feature Match AAC Assessment AAC Assessment- What do we know? Need to know? 1.Gather information about strengths and needs as Speech Skills they relate to device features. Sensory Skills (Vision & hearing) 2.Compare participation patterns and identify Motor Skills barriers. Communication Skills Language and Literacy Skills 3.Integrate the person’s strengths, abilities and Cognition Feature Match needs and match them to a list of features. Participation- Output Environments Access 4.Identify goals and conduct trials. Where does Symbols communication 5.Determine tool(s) based on data collected. need to happen? AAC Fixed/Dynamic Who are the Portability 6.Summarize/Report data to procure a system. communication Durability partners? Vocabulary 7.Reassess the appropriateness of your AAC system(s) over time. Set up Trials and Data Collection

13 What do we know, need to know? Gather information: Participation Participation/Environment/Partners • Look at the circles of communication and • The customary environments in which determine which the person is (or can be) expected to methods work with live, learn and grow. (Joy Zabala) which partner. • Frequently occurring activities • Identify • Communication partners communication supports for different circles.

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Communication Barriers Gather Information About Barriers

Partner Characteristics • • Partner habits and beliefs: •Vocabulary issues • Systems not available •Device issues • Lack of training • ‘Donʼt need it’ attitude • Wonʼt use their own voice if they have other supports

Dr. George R Peterson-Karlan, Illinoise State University, Environmental Communication Teaching

Post, 2009 81 82

Partner’s Interaction Style Partner’s Instructional Style •Use rhetorical speech •Adults often dominate interactions Use fills or tags which obscure •Don’t give students time to formulate • messages: “We need to get messages something, right?” •Fail to respond to a student’s initiation •Sometimes we state a message •Anticipate student’s needs, making over and over again “what do you communication unnecessary need? Tell me what you need?”

Dr. George R Peterson-Karlan, Illinoise State University, Environmental Communication Teaching

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14 Gather Information about Barriers Barriers: Message Issues

• Barriers with system •We do not have the vocabulary available to participate in discussion • Limitations of vocabulary • Access •Vocabulary available is not appropriate to the task (e.g., topic specific boards) • Fear of systems • Dependency

Dr. George R Peterson-Karlan, Illinoise State University, © K. Post 7 H. Miller-Schwarz, 2018 Environmental Communication Teaching

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Barriers

• Identify and discuss with your team.

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AAC Assessment- What do we know? Need to know? Speech Skills Sensory Skills (Vision & hearing) Motor Skills Communication Skills Language and Literacy Skills Cognition Feature Match Participation- Environments Output Where does Access communication Symbols need to happen? AAC Fixed/Dynamic Who are the Portability communication partners? Durability

Set up Trials and Data Collection

15 Feature Match AAC Assessment

1.Gather information about strengths and needs as Generate a Feature List they relate to device features. 2.Compare participation patterns and identify barriers. • Next Step: Transfer 3.Integrate the person’s strengths, abilities and needs and match them to a list of features. what you know into a Feature Match 4.Identify goals and conduct trials. Worksheet and begin 5.Determine tool(s) based on data collected. to investigate systems 6.Summarize/Report data to procure a system. to obtain for trials. 7.Reassess the appropriateness of your AAC system(s) over time.

TALC Feature Matching Checklist Oklahoma AT Center

https://bit.ly/2HHcjPz http://www.talcaac.com/SGD%20Features%20Checklist.pdf 93 94

Feature Match Worksheet Prioritize Systems for Trial

• AAC App Comparisons Tools • Infinitec Coalition App Search www.myinfinitec.org • iPhone/iPad Apps for AAC by Jane Farrell http://www.janefarrall.com/aac-apps-lists/ • Sorting Through Apps https://qiat.org/docs/resourcebank/Sorting_AA C_aaps_OCT302011.pdf • SpectronicsApps for AAC https://www.spectronics.com.au/iphoneipad- apps-for-aac

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16 Prioritize Systems for Trial Keep in Mind… • Resources for Systems Comparison: Dedicated Speech Generating systems: What is your end goal? • Closing the Gap Resource Directory http://www.closingthegap.com/ Be sure to select a system for today and • Assistive Technology Industry Association tomorrow. http://www.atia.org/i4a/pages/index.cfm?pageid=1 • Assistive Technology Exhibits (ATIA, CTG, CSUN etc.)

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Examples Develop a Trial Action Plan

A document drawn up by an AAC user’s team that describes: • Names the communication systems • Criteria for a successful trial • How to know when troubleshooting is required? • Strategies that will be employed including • Prompting hierarchies • Descriptions of activities & vocabulary plan

https://douglasesd.k12.or.us/sites/douglasesd.k12.or.us/files/File/at-resources/at- documents/assessment/at-extended-assessment-plan.pdf © H. Miller-Schwarz & K. Post, 2018

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Feature Match AAC Assessment Identify Goals & Conduct Trials 1.Gather information about strengths and needs as they relate to device features. • Make sure that everyone on the team is on the same 2.Compare participation patterns and identify page! barriers. • Frequently discuss goals and data with your team to 3.Integrate the person’s strengths, abilities and make sure that you are all tracking the same behavior. needs and match them to a list of features. • What do you hope to achieve by the end of this 4. Identify goals and conduct trials. assessment and evaluation process? 5. Determine tool(s) based on data collected. 6. Summarize/Report data to procure a system. 7. Reassess the appropriateness of your AAC system(s) over time.

17 Remember Begin with the End in Mind! • It’s not about mastery “… begin each day, task, or project with a clear • All students deserve: vision of your desired direction and destination, • To be given a means to communicate … then continue by flexing your proactive • To communicate in their chosen method muscles to make things happen.” • And to be understood and heeded by others

No person should have this right denied because he or she has Covey, S. R. (2004). The 7 habits of highly effective people: Restoring the been diagnosed as having a particular disability character ethic. New York: Free Press.

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Questions?

Please feel free to contact me via email Heather Miller Schwarz, M.S., CCC-SLP [email protected]

Thank you!

*References provided in a separate handout Original presentation (AAC Assessment- Working Together to Achieve Functional Communication) was created in partnership with Kathleen Post, M.S., CCC-SLP 105