Unlocking AAC: Navigating Assessment Challenges
For many speech-language pathologists (SLPs), the prospect of conducting augmentative and alternative communication (AAC) assessments can be daunting, especially for graduate students entering the field. As someone often invited to share insights into the AAC assessment process, I understand the anxiety and trepidation accompanying this crucial aspect of our profession.
AAC assessments diverge significantly from other evaluation activities in which SLPs typically engage. It's not a one- or two-session task; it requires a more comprehensive approach, spanning 4 to 6 sessions. Beyond the traditional ASHA Big 9 areas, an AAC assessment delves into a person's visual and motor capabilities, seating and positioning, technological skills and comfort levels, to name a few.
One key element that sets AAC assessments apart is the imperative for device trialing. Given the high rate of device abandonment and rejection, this step is pivotal—studies show that 33% to 39% of individuals cease using their AAC devices for communication, typically within one year of getting their device (1, 2).
I advocate using the Participation Model (3), an evidence-based framework that provides a structure to your AAC assessment. One often overlooked aspect of this framework is the examination of opportunity barriers. These obstacles to communication and AAC device use exist outside of your client's control and are embedded in their environment, involving the professionals and individuals they interact with regularly.
So, what are these opportunity barriers?
Policy Barriers: These encompass legislative or regulatory rules and decisions that impact communication and device use. Examples include federal or state laws, school district regulations, and requirements imposed by health insurance companies. To collect data on policy barriers, a thorough document review is essential. Dive into insurance regulations, school district policies, and federal regulations to examine what policies could hinder AAC device implementation.
Practice Barriers: These are commonplace procedures or standards in an employment setting that can hinder AAC device use. While not always explicitly written in policy, these practices can be changed. To gather data, conduct interviews or administer questionnaires to relevant stakeholders such as the committee on special education chair, special educators, and rehab directors.
Attitude Barriers: The beliefs and attitudes of relevant stakeholders play a crucial role. Use rating scales to assess their opinions and knowledge levels regarding AAC and its use for interaction.
Knowledge Barriers: Stakeholders' understanding of AAC is paramount. Utilize rating scales to gauge their knowledge levels, opinions, and attitudes toward AAC.
Skill Barriers: Assess stakeholders' ability to interact with individuals who use AAC and have complex communication needs through observation. Observe naturalistic conversations to evaluate the effectiveness of current communication strategies.
Incorporating these elements into your assessment process is pivotal to understanding and addressing the opportunity barriers your clients may face. Collecting data on policy, practice, attitude, knowledge, and skill barriers can create more targeted and effective AAC interventions.
In the realm of AAC assessments, knowledge is power. Let's work together to break down these opportunity barriers and ensure everyone has the communication support they deserve.
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Remember, effective communication is not a one-size-fits-all solution—let's tailor it to fit the unique needs of every individual.
References:
Johnson, J. M., Inglebret, E., Jones, C., & Ray, J. (2006). Perspectives of speech-language pathologists regarding success versus abandonment of AAC. Augmentative and Alternative Communication, 22(2), 85-99.
Moorcroft, A., Scarinci, N., & Meyer, C. (2021). “I've had a love-hate, I mean mostly hate relationship with these PODD books”: parent perceptions of how they and their child contributed to AAC rejection and abandonment. Disability and rehabilitation: assistive technology, 16(1), 72-82.
Beukelman, D. R., & Light, J.C. (2020). Augmentative and alternative communication. Baltimore: Paul H. Brookes.