Perspectives from individuals who use augmentative and alternative communication on communication access in restaurant settings.

Communication accessibility has been defined by many scholars and organizations, but it is generally described as clear communication that everyone can access and understand. The objective of this manuscript was to assess communication accessibility for people who use augmentative and alternative communication (AAC) within a variety of restaurant settings through interviewing five adults who utilize AAC as their primary form of communication. Interviews were qualitatively coded and revealed common communication accessibility themes restaurants and restaurant staff were not implementing, such as direct communication and increasing AAC awareness. The implications of the interview data include its potential usage in training restaurant staff and management to utilize communication accessibility tips and features to increase the communication accessibility of the restaurant patrons they serve, especially for individuals who use AAC. This could then lead researchers in creating a formal training schema for restaurants to implement into their businesses reliably and effectively.

Assessment With Children Who Need Augmentative and Alternative Communication (AAC): Clinical Decisions of AAC Specialists.

Purpose: The purpose of this study was to explore how speech-language pathologists (SLPs) who are augmentative and alternative communication (AAC) specialists approach the assessment process for 2 case studies, 1 child with cerebral palsy and 1 with autism spectrum disorder. The aim of the study was to answer the following questions: (a) How do clinicians with expertise approach the AAC assessment process for children with developmental disabilities? (b) Can any initial hypothesis be drawn about how SLPs approach the assessment of children with motor versus social interactive deficits? Method: This study used a phenomenological qualitative design. The researchers conducted 2 in-depth, semistructured interviews with 8 SLPs who specialized in AAC and self-identified as primarily working with children. Results: Four major themes emerged from the data: area of assessment, method of assessment, evaluation preparation, and parent education. Each major theme contained multiple subthemes and categories within those subthemes. Conclusions: Participants discussed similar areas of assessment for both cases, indicating that some aspects of AAC assessment are universal. However, the specific aspects of what they were assessing and how they went about assessing them differed between the 2 cases. The results of the current study provide an outline of an assessment protocol for children with complex communication needs.

Personnel roles in the AAC assessment process.

Completing an augmentative and alternative communication (AAC) assessment is a complex process that involves many stakeholders and professionals. To help clarify professional roles and provide assessment guidelines, an AAC Assessment Personnel Framework was developed. This framework was adapted from the work of Beukelman, Ball, and Fager in 2008, which focused on general AAC needs (not just assessment) and concentrated specifically on adults. In contrast, the present model examines the assessment process for all individuals who require AAC. The following AAC assessment personnel are discussed: AAC finders, general practice SLPs, AAC clinical specialists, facilitators and communication partners, collaborating professionals, AAC research and policy specialists, manufacturers and vendors, funding agencies and personnel, and AAC/assistive technology agencies and personnel. Current barriers for successful assessment outcomes are discussed, and suggestions for addressing personnel-related barriers are explored.

AAC assessment and clinical-decision making: the impact of experience.

People with complex communication needs often require a comprehensive augmentative and alternative communication (AAC) assessment to maximize participation in daily interactions. Assessment of AAC is a complex process and limited practice guidelines exist. The purpose of this qualitative study was to explore how 25 speech-language pathologists with varying levels of experience approach the AAC assessment process. Participants were classified as either (a) General Practice Speech-Language Pathologists (GPSLPs), (b) AAC Clinical Specialists (AAC-CS), or (c) AAC Research/Policy Specialists (AAC-RS). In-depth, semi-structured interviews were conducted to explore the participants' approach to AAC assessment. The results revealed that GPSLPs approach AAC assessment differently than the AAC-CS and AAC-RS; however, the Specialists reported a similar approach that may help guide the development of practice guidelines for AAC assessment.

The pipeline training program in maternal and child health: interdisciplinary preparation of undergraduate students from underrepresented groups.

The Preparing Academically Successful Students in Maternal and Child Health (MCH PASS) training program provided financial support and specialized training to occupational therapy (OT) and speech-language pathology (SLP) undergraduate students from underrepresented groups in maternal and child health. The project assisted undergraduate trainees to matriculate into graduate programs in their respective fields and facilitated application into long-term maternal and child health training programs. Sixteen trainees (8 OT and 8 SLP) participated in an undergraduate training program with an emphasis on interdisciplinary teaming, family mentoring, leadership development, public health and population-based research. Instruction occurred in community and classroom settings through didactic instruction and small group discussions. Fifteen of the trainees applied to and were accepted in graduate programs in their respective fields. Two trainees applied to a long-term MCH training program. Students reported increased knowledge about programs that serve women and children, the effects of poverty on health, interdisciplinary teaming and the daily routines of families who have a child with a special health care need. The MCH PASS program provided a unique opportunity for undergraduate students in OT and SLP to learn about public health with an emphasis on maternal and child health. The specialized preparation enabled students to understand better the health concerns of underserved families whose children have special health care needs.

Teaching young people who are blind and have autism to make requests using a variation on the picture exchange communication system with tactile symbols: a preliminary investigation.

This study used a single-subject multiple baseline across participants design to evaluate the effectiveness of a modified picture exchange communication system (PECS) teaching protocol with tactile symbols. Three students (two male, one female) aged 12-17 years who had autism and were blind participated in the study. The instructional program involved three phases. First, each participant learned to exchange a tactile symbol with his/her communication partner to request a preferred item/activity. Second, the distance between the communication partner and the participant was increased. Third, the participants were required to discriminate between two dissimilar tactile symbols. One out of three participants completed all phases of the instructional program. Although the other two participants did not complete the program, they demonstrated improvement from baseline responding rates. This study provided preliminary results that using tactile symbols with strategies from PECS may be an effective method to teach requesting to youth who are blind and have autism.

Long-term outcomes for individuals who use augmentative and alternative communication: Part III--contributing factors.

In order to improve outcomes for individuals who use augmentative and alternative communication (AAC), it is important to understand what factors contribute to or detract from positive outcomes. Seven young men who had used AAC systems for at least 15 years, their family members, and professionals who had worked with them, participated in the study. Qualitative interviews were used to identify contextual factors that may have contributed (both positively and negatively) to the young men's outcomes. Factors that impeded positive outcomes included: attitude barriers, cultural differences, technological barriers, and service delivery limitations. Contributions to positive outcomes included: community support, parent and family support, personal characteristics, and appropriate and high-quality AAC services. The results are discussed with implications for clinical practice and directions for future research.

Long-term outcomes for individuals who use augmentative and alternative communication: part II--communicative interaction.

This study evaluated the communicative interaction skills of seven young men (ages 19-23 years) who had used AAC systems for at least 15 years. Turn-taking patterns, use of communicative functions, and linguistic complexity were analyzed. Current performance was compared to the participants' skills when they were preschoolers and participated in another study of interaction skills (Light, 1985; Light, Collier, & Parnes, 1985a,b,c). Results indicated that the turn distribution between partners was more equitable than it had been when the participants were preschoolers; five of the participants approached reciprocity in turn taking during at least two of the interactions observed. During interactions with their caregivers, the participants fulfilled most of their obligatory turns and more than half of their non-obligatory turns. The communicative functions used most frequently by the participants were confirmations/denials and provisions of information. Three of the participants demonstrated the ability to use complete and complex syntax and committed few errors in grammar, while the other four participants demonstrated many syntactic errors. The results are discussed with implications for clinical practice and directions for future research.

Long-term outcomes for individuals who use augmentative and alternative communication: part I--what is a "good" outcome?

Over the past 20 years, there have been many advances in the field of augmentative and alternative communication (AAC). Despite these advances, there are no data on the long-term outcomes of AAC interventions. This study evaluated the long-term outcomes for a group of seven young men (ages 19-23 years) who had used AAC systems for at least 15 years and were part of the first generation to have received AAC services since they were in preschool. Outcomes were measured in the following domains: (a) receptive language; (b) reading comprehension; (c) communicative interaction; (d) linguistic complexity; (e) functional communication; (f) educational and vocational achievement; (g) self-determination; and (h) quality of life. The outcomes for the group were diverse, with individual variations across all measures. Evaluation of the data raised many issues surrounding the challenges of outcomes measurement; these are discussed with suggestions for future research.

The effectiveness of grammar instruction for individuals who use augmentative and alternative communication systems: a preliminary study.

This study examined the effectiveness of an instructional program designed to teach grammar skills to individuals who communicated via augmentative and alternative communication (AAC). A single-subject, multiple probe across behaviors design was used to measure the effect of the instructional program on the acquisition and maintenance of the skills learned. Two adults with cerebral palsy participated in the study. The instructional program was used to teach 2 grammatical forms to each participant. Word order in adjective phrases and inversion of the auxiliary do in wh- questions was targeted for 1 participant; use of possessive pronouns and inclusion of to when using infinitives as modal verbs was targeted for the second participant. The instructional program was shown to be effective. Both participants learned to produce the grammatical forms taught. One participant maintained these skills for at least 2 months after the completion of instruction; the other participant required additional instruction in order to maintain the skills learned. Although based on a small sample, the results suggest that intervention can help individuals who use AAC improve their grammar skills. Limitations of the study are discussed, along with directions for future research.