AAC Spotlight is a series of interviews. Reading about other people who are interested in AAC (augmentative-alternative communication) can help us connect with each other and share experiences and concerns. NWACS will occasionally interview people to help all of us learn more about each other and AAC.

By Molly Menzie, MS, CCC-SLP; NWACS Board Member

reading time: 8 minutes

The views expressed in this post are that of the author and do not necessarily reflect the views and policies of NWACS. No endorsement by NWACS is implied regarding any device, manufacturer, resource, or strategy mentioned.

I recently had the pleasure of interviewing Rachel Madel, SLP (speech-language pathologist). She owns a private speech therapy practice in Santa Monica, CA. She also has an online business that promotes AAC (augmentative and alternative communication) resources and education. You can find her online platforms here:

Website | YouTube | Instagram | Facebook | Podcast

Establishing AAC as her speech therapy niche:

As a graduate student, Rachel and a cohort of graduate students visited a special needs preschool classroom. They were there to observe some children they would begin providing speech therapy services for. The children were primarily non-speaking and the classroom was quiet. One of her classmates commented that pictures or picture exchange may be helpful for these young students. Rachel thought to herself, “Why would they need pictures, we’re speech therapists, we’re coming in trying to teach them to talk.” Reflecting on this moment, in fact, these students really needed high-tech AAC. She laughs at how she judged her classmate’s assessment and how funny it is that now her passion is AAC!

Rachel expands on how she really found her love of AAC. During her clinical fellowship year, the school staff described one of her first students as being “very difficult”. He didn’t spend much of his time in his classroom because of challenging behaviors. She focused on finding this student’s motivation. Then on teaching him to use pictures to request preferred items. She eventually transitioned into teaching him to use a communication application on an iPad. The school staff was so impressed that this student was communicating! Because of that, he was functioning in his classroom more successfully. Teachers and colleagues then began funneling all the “more challenging” cases to her for speech therapy. And she loved it! She loved (and still loves) figuring out how to help non-speaking children to communicate using AAC.

Starting her private practice:

While working for an early intervention organization, Rachel was hired by a family to work privately with their autistic son. She worked with him for 5-6 days/week in Philadelphia, PA. She was able to unlock the code that worked for this boy and helped his communication skills flourish. After a year of intensive therapy, this child grew from single words to sentences to conversational discourse. The family told Rachel that they were going to move back to LA. They offered to fly her out to LA for the summer to do intensive speech therapy with him. Rachel, of course, agreed! While there, this family lamented that they wouldn’t be able to find a speech therapist as great as Rachel. They suggested that she move to LA and start a private practice. They even had a list of referrals they could give to her.

After the summer, Rachel went home to Philadelphia and thought about the offer. After a month, she sold everything, moved to LA, and started a private practice. But what a pickle that turned out to be! None of the referrals panned out, and Rachel was in LA with only one client! She didn’t have a network of professionals, no friends or family, and she was on her own. She just kept saying to herself “If I do good work, the referrals will come.” She did good work and connected with other professionals, and the referrals came.

Later, she was able to scale her private practice to select the referrals she wanted to focus on, and work primarily with clients who used/needed AAC. When asked, she said it took about two years to build up her private practice. She laughs that she didn’t buy anything those first two years. She rented a car on a month-to-month basis and bought travel-sized hairspray. Once she felt comfortable that she was staying in LA for good, that the practice was stable, the first thing she bought was a plant.

Building her online business:

The entire time that she was building her private practice, she thought about how she always wanted to do something bigger. This led to doing service work, creating a YouTube channel, and wanting to reach more people with her content. At first, she didn’t make any money from her online business. She just “dumped” money into creating digital content and videos. Of course, things have turned around. Now both her private practice and her online business (YouTube, Instagram, Online Continuing Education courses, etc.) are successful and profitable.

Origins of the Talking with Tech Podcast:

During a webinar with Lucas Steuber (a well-known SLP and AAC specialist), they got to talking about a service trip in Cambodia she had recently completed. This must have sparked his interest in Rachel’s outreach. He explored her online content, and said to her, “You’re an AAC specialist.” Rachel laughs and says she thought, “Am I? Am I an AAC specialist?” He invited Rachel to be a guest speaker on the Speech Science podcast. After that Lucas suggested that together they host an AAC-related podcast with Chris Bugaj. Rachel had been sitting on the name “Talking with Tech” as her play on words for speaking using AAC. When they were brainstorming ideas for the name of the podcast, she wasn’t sure if she wanted to offer it up. She worried that if the podcast failed she’d have used up her ”brand name,” her “baby name.” But she did! And Talking with Tech has thrived and been an incredibly useful resource for parents and professionals.

The “Expert” Label:

Rachel comments that the “expert” label does a disservice to SLPs. All SLPs are responsible for doing AAC, and not relying on one specific person as the “expert” to teach AAC. She highlights that each person on a child’s team is equal and needs to collaborate to support the AAC learner.

Challenges in AAC:

When asked about what challenges she comes across when finding the best AAC solution for a learner, Rachel comments

One of the biggest roadblocks is getting everyone on board with what we, SLPs, know will help the AAC learner to learn their AAC system.
Also often challenging is collaborating with and supporting a child’s ABA team to use evidence-based strategies when using an AAC system with a student.
When starting to work with a child whose team struggles to support them in communicating, and does not see the potential, she thinks, “How can I make a small change to show that change is possible? If we can figure out how to tackle the limiting beliefs, we can open up the student to showing that change is possible.”

How to help other professionals get on board with evidence-based strategies:

Interface with individual professionals one-on-one.
Ask questions to figure out others’ ideas, thoughts, and beliefs that are limiting the AAC learner’s progress.
Use a coaching approach to help the professional
- see the roadblocks,
- see the potential, and
- get on board with more functional, supportive, and progressive strategies.
Avoid trying to convince other professionals to adopt your ideas and recommendations by presenting them with research. This can often have the opposite effect, as it could be construed as demeaning or manipulative.

Tools to Support Feature Matching/Device Selection:

The SETT Framework by Dr. Joy Zabala is a tool that Rachel often uses for AAC assessments because it is a team-based approach. This framework helps to get buy-in from the team members during the assessment process. Which in turn helps with follow-through during the implementation process.
The AAC Assessment Bundle resource sold on Rachel’s website. It is a Google form that SLPs can send to members of the child’s team to fill out. It can sync together to create a spreadsheet of the information.
Critical factors to consider:
- Determining if the majority of the child’s team is familiar with the same robust AAC system.
- Engaging the parent in the assessment process to see if they have preferences.
- Asking the child what they like while going through the AAC trialing process.

When is motor planning not the most crucial feature to support?

Rachel is a strong advocate for keeping motor planning in mind when doing feature matching and AAC trialing. She tries to support it whenever possible. But when would motor planning not be on the top of her list? Rachel suggests that we think about the long-term goal for the student’s communication and work backwards. This process can be helpful when working with a student who may need alternative access (e.g., switch use, eye gaze) in the future, or with an early intervention student. With these types of learners, she says, “I’m less concerned about motor planning and I’m more concerned with initiation of communication using AAC.” Even so, it is a smart idea to optimize and implement principles of motor planning whenever possible.

Advice to new SLPs or Budding AAC Specialists:

Rachel’s “one gem of wisdom is to start before you’re ready!” She comments that most SLPs are Type A and feel that they need to know everything about AAC before they can get started. She assures SLPs that, “everything you don’t know you can find the answer to.” She even states that she doesn’t know everything about all the different AAC apps and devices. She feels it’s important to recognize that “it’s less about the technical stuff and more about

language,
how to teach language with AAC, and
coaching communication partners with AAC.”

Recommended Resources for Budding AAC Specialists:

LAMP training: This training helped her understand the importance of motor planning and modeling.
PrAACtical AAC Blog: Rachel feels that at one time she had read every blog on the PrAACtical AAC website. It was so helpful for understanding the foundations of AAC. She also gained knowledge and insight from all the leaders in the AAC field who have posted or been referenced.

Surprising facts about Rachel:

She didn’t feel like an AAC Expert when Talking with Tech started!
Her private practice is not 100% AAC clients!
She has a lot of training in Childhood Apraxia of Speech!
There is a team of SLPs behind the scenes helping produce her social media content!

Goal & Super Talent:

After giving presentations, Rachel states, “I want people to feel empowered that they can do AAC.” She says that her secret weapon is to be able to teach people about AAC in ways that are digestible and implementable.

Thank you Rachel for participating in our AAC Spotlight series! We look forward to spending the day with you at NWACS2022.

Please join us on October 15, 2022, for the 2022 NWACS Virtual Fall Conference featuring Rachel Madel and Chris Bugaj! They are presenting “Designing and Delivering Empowering Experiences to Teach Language Using AAC”! For more information, or to register, visit the conference webpage.