by John Kim, MS CCC-SLP, ATACP (he/him) (speech/language pathologist and assistive technologist), NWACS guest blogger and Eunsey (Sarah) Lee, MS, CCC-SLP, NWACS Board Member (she/her)

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The views expressed in this post are that of the authors 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. It is important to keep in mind HIPPA and FERPA compliance when utilizing various tools and when communicating protected healthcare information or student information.

The people and systems supporting AAC users are critical to their success. This is well-studied for AAC intervention. Including families during the evaluation process and in therapy is important. Especially when addressing cultural-linguistic diversity. Failure to include families and AAC users in decisions can lead to AAC abandonment.

Who are the team members?

The most important team member is the AAC user. We must always center AAC users in decisions. And also include them in choosing and customizing their AAC device. The perspectives of AAC users should lead the assessment process and team planning. Other team members are anyone supporting the AAC user.

• Family/caregivers - close family friends, aunts, cousins, and siblings, etc.

• School team - classroom teachers, special educators, paraprofessionals, OT, PT, SLP, etc.

• Communication partners

• Paid staff, healthcare professionals
  
  

What are current evidence-based collaboration models?

Currently, there are many types of evidence-based models for team collaboration. They follow similar components: 

• Clear roles and tasks within the team

• Clear team goals

• Effective interpersonal and communication skills

• Respect and support all team members' voices and ideas

• Make time and resources for the team

• Use different communication methods for teamwork

• Collaborate in the educational process

• Consistent attention to team development and evaluation

• Provide knowledge/skills about family needs and supporting family partnerships

What are the barriers and limitations in schools?

• Leadership support. School systems don't always allow time and resources for on-going training.

• A shortage of staff from teachers to therapists. 

• Accessibility of AAC devices and AT tools through IDEA (Individuals with Disabilities Education Act) mandates or state funds.

• Lack of family-centered approaches and empathy. Particularly in multilingual homes and when addressing culturally-responsive practices.

• Lack of bilingual/multilingual SLPs.

• SLP workload is overwhelming and AAC service requires much time.

• AAC coursework/training in SLP departments and universities. 

How can we bridge the gap?

Although we cannot address all the limitations, we have found strategies and tools to help. The following may be useful in creating healthy collaborative partnerships:

Being accessible. Healthy boundaries are important to stress. Working around family schedules is also very important. Not all our families have the privilege of accommodating schedules. If there is anything we’ve learned during the pandemic it is the option of virtual video platforms. Use alternative tools to show AAC through:

• Personal videos of you working with the student/client

• YouTube channel videos 

• Text/WhatsApp. We should ask families what system they most often use and is easy to get a hold of. 

• Google Meet or Zoom video

• Phone video conference. Apps like FaceTime or WhatsApp video, can be useful for a session instead of meeting in-person.

A comprehensive intake form. Questionnaires and surveys that depict family vocabulary and language history. It is useful to understand bilingual/multilingual families' language learning sequence or preference. We can use this information when addressing language and vocabulary needs in AAC systems. 

Be respectful. Do not assume your educational background and work experience make you an expert. Parents/caregivers are the experts of their children.

Inclusive practices. Learn about what holidays and special occasions families celebrate. Don't assume because of their cultural background they must celebrate specific cultural celebrations. Also don't assume they celebrate all American holidays. When professionals include these ideas in their lessons, families/caregivers can feel seen. Additionally, it provides the opportunity for multicultural families to celebrate one another. Some examples might be:

• Mexican Mother’s day

• Día De Los Muertos

• Lunar New Year

For more information, refer to Mirrors, Windows, and Sliding Glass Doors.

Use Interpreters and Translators. If the home language is not a language you are proficient in, use a translator/interpreter. A phone call or conversation with an interpreter is best. Written paperwork is not always successful. Even with both English and a home language translation. Do not assume all families have the literacy level to read academic jargon. 

Cultural humility.

“A lifelong process and commitment to self-evaluation and critique, to redressing the power imbalances in the caretaker-patient dynamic, and to developing mutually beneficial and non-paternalistic relationships and partnerships with communities on behalf of individuals and underrepresented populations.”

- Tervalon & Murray-Garcia, 1998

The above quote points out the importance of continual self-reflection. Evaluating our ways of thinking helps develop equity. It makes room for underrepresented families, caregivers, and communities to be equal and valued partners.

Power dynamics can be difficult to recognize. Clinicians should be intentional in considering their position of power at every interaction. We recommend cyclical, on-going reflection when interacting with families. This might look like asking questions such as:

• Am I doing more harm than good?

• What are the social structures in place that helped shape the client’s experiences?

• How does the family view AAC and special education?

Co-teaching or alternating instructions with the classroom teacher. SLPs can try to push-in to the classroom during a designated subject where they can either:

• Teach the whole class together or

• Lead whole-class instruction in alternating weeks or months.

This is helpful for the classroom teacher to see how SLPs are providing AAC support. It also provides demonstration for supporting AAC users in the classroom. This promotes a collaborative relationship with the teacher. It requires planning and communication.

AAC vendors are often able to provide device loans to trial with students. They may also provide free communication app access for SLPs. State-funded AT lending libraries (e.g., NATADS, WATAP, SETC, OR TDAP) can assist with loans, too. For example, iPads for those interested in trialing before purchasing. 

We hope this was helpful to you as you consider AAC intervention strategies and service delivery models. Team collaboration should be at the front of our minds when recommending or providing AAC support. We may be unable to control many of the system-level barriers (e.g., school administration decisions, funding). There are still ways we can attempt to navigate those issues and center AAC users.

What tips do you have for successful AAC collaboration?

References

Bailey, R.L., Parette, H.P., Stoner, J.B., Angell, M.E., & Carroll, K (2006). Family members’ perceptions of augmentative and alternative communication device use. Language, Speech, and Hearing Services in Schools, 37, 50-60.

Beukelman, D.R., & Mirenda, P. (2005). Augmentative and Alternative Communication: Supporting children and adults with complex communication needs. (3rd ed.). Baltimore: Paul H. Brookes Publishing Co.

Beukelman, D.R., Burke, R., Ball, L., & Horn, C.A. (2002). Augmentative and alternative communication technology learning part 2: Preprofessional students. Augmentative and Alternative Communication,18, 250-254. 

Binger, C., Ball, L., Dietz, A., Kent-Walsh, J., Lasker, J., Lund, S., McKelvey, M., & Quach, W. (2012). Personnel roles in the AAC assessment process. Augmentative and Alternative Communication, 28(4), 278–288.

Bishop, R. S. (2015, January 3). Mirrors, windows, and sliding glass doors - scenicregional. Mirrors, Windows, and Sliding Glass Doors. https://scenicregional.org/wp-content/uploads/2017/08/Mirrors-Windows-and-Sliding-Glass-Doors.pdf

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