Transcript on Best Practices in Facilitated Communication

Facilitated Communication
Standards and Best Practice
Christi Kasa-Hendrickson
Darlene Hanson
Don Cardinal
Structure
Attitude
Best Practice Elements of
Facilitated Communication fall into
three categories
Practice
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Elements of FC
Structure
Attitude
Practice
FC
USER
Practice
Attitude
Structure
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Attitude Elements
Citizenship
Presumption of Competence
The Right to Communicate
Empowering the Facilitated Communication
User
Total Communication
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Principles &
Best Practice: Attitude
Citizenship and Presuming Competence
• Citizenship is membership in a community
• Citizenship carries with it a presumption that
a person's interests and those of her or his
community are somehow intimately linked
with each other.
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Principles &
Best Practice: Attitude
Right to communicate
• That all people have a means of communication which
allows their fullest participation in the wider world
• That people can communicate using their chosen method
and that their communication is heeded by others.
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Principles &
Best Practice: Attitude
Empowering FC user -- Questions to ask:
• "Am I determining the pace or am I allowing the facilitated
communication user to determine the pace?",
• "Am I getting a third person's attention or am I teaching the
facilitated communication user how to do that?”
• "Am I determining who reads or hears what the facilitated
communication user has typed, or am I letting the facilitated
communication user determine who receives his or her
communication?"
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Principles &
Best Practice: Attitude
Total communication approach
• Not meant to replace current successful communication
methods
• Meant to enhance and expand current communication
opportunities
• Many people who type also use some speech, sign,
prepared communication boards
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Practice Elements
Pointing
Ergonomic Setup
Communication Partner
Establish a regular schedule
Physical Support
Use challenging material
Prompts and Cues
Activities to Maximize Success
Encouragement and Emotional
Support
Varied and open ended activities
Monitoring
Treat the person as a competent
Saying each letter as it is indicated
Avoid interrupting verbal and typed
echoes
Device correction strategies
Control difficult behavior
Reliability Check
Patient, positive, and persistent
attitude
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Elements of Facilitated Communication Training
Created by Cardinal 2006
Monitoring (look
at keyboard)
Emotional
Support
Control Difficult
Behavior
Physical
Support
Ergonomics
Comm.
Partner
Structured
Activities
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Device
Correction
Strategy
Pointing
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Principles &
Best Practice: Practice
Elements of FC Training: Physical Support
• Physical support may include the following:
– Assistance in isolating the index finger;
– Stabilizing the arm to overcome tremor;
– Backward resistance on the arm to slow the pace of pointing or
to overcome impulsiveness;
– A touch of the forearm, elbow, or shoulder to help the person
initiate typing; or pulling back on the arm or wrist to help the
person not strike a target repetitively.
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Principles &
Best Practice: Practice
Elements of FC Training: Emotional Support
• Emotional support involves providing encouragement,
but not direction, as the person points to communicate.
Elements of FC Training: Communicative Support
• Various forms of prompts and cues to assist the FC user
to stay focused in the communication interaction, to
provide feedback to the FC user on the content of their
message, and to assist the FC user in clarifying unclear
messages.
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Principles &
Best Practice: Practice
Introducing the Technique
• Follow the recommendations of the assessment regarding
choice of hand, type of support, and seating.
• Plan in advance the choice and position of device(s), and
appropriate activities for getting started.
• Establish a regular schedule by which the practice of
pointing through facilitation can develop.
• Clearly explain to the communicator what is being done
and why, and have the use of the technique demonstrated
either by an experienced facilitated communication user,
or through use of a video.
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Principles &
Best Practice: Practice
Introducing the Technique
• Use challenging material that is meaningful to the communicator.
• Structure activities to maximize the success of the communicator.･
Provide varied and open ended activities, allowing for the opportunity
for complex communication.
• Treat the person as a competent communicator, one who has ideas and
feelings to share.
• Support the communicator in avoiding or interrupting verbal and typed
echoes when they interfere with communication which accurately
expresses the communicator's intent.
• Support the communicator in controlling difficult behavior.
• Work with a patient, positive, and persistent attitude.
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Structure Elements
Assessment
Independence
Competency-based Facilitator Training
Multiple Facilitators
Technical Assistance
Documentation
Portfolio Approach
Validation, Authorship and Authenticity
Sensitive Information
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Principles &
Best Practice: Structure
Assessment
• An individual needs to be identified as a
candidate
• Those who support that individual need to
show commitment to the training process.
Both of these elements begin with the
assessment.
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Principles &
Best Practice: Structure
Questions that drive the Assessment
• What are the current communication strategies?
(candidacy)
• How have people developed the communication to
this point? (environment)
• How does this person interact with the printed
word? (starting point for the exploration)
• Does support make a difference? (benefit)
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Principles &
Best Practice: Structure
Determining Candidacy?
• Facilitated communication is a type of
Augmentative/Alternative Communication
(AAC) for people who do not speak or whose
speech is highly limited and disordered, and
who cannot point reliably
• The method has been used by people with
autism, Down syndrome, cerebral palsy,
pervasive developmental disorders, and other
developmental disabilities
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Principles &
Best Practice: Structure
Collaborative Team Approach
Support and commitment from an aid user's
team (program planning team, circle of support,
etc.) is critical to long term success with
augmentative/alternative communication (AAC)
and facilitated communication training.
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Principles &
Best Practice: Structure
Independence
• A primary, long-term goal of facilitated communication
training is independent communication.
• This goal involves･being able to access
communication aids without physical support;
• being able to initiate the process of communication
with others; and･exercising control over the content of
one's communication.The fading of physical support
should begin at the outset of the training process, with
both facilitators and facilitated communication users
aware of the importance of this goal.
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Facilitated Communication
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Principles &
Best Practice: Structure
Competency Based Facilitator Training
• All facilitators should participate in on-going training and
support
Multiple Facilitators--Each FC user should have
several facilitators
• to reduce dependence on a particular facilitator,
• to increase independent communication, and
• for there to be sufficient examples of valid and authentic
communication to document in a portfolio.
Technical Assistance
• Team problem solving with experienced facilitators
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Principles &
Best Practice: Structure
Documentation
• Portfolio Approach
• The portfolio documents over time instances of novel
communication. It is important to note that validation
represents a set of skills to be learned in the process of
becoming a competent, responsible communicator; it is
not a test of the user's abilities.
• In addition to the facilitated communication user's portfolio,
a portfolio of the facilitators' training, skills, and abilities
should be kept, documenting each facilitator's progress
through competency training. This documentation should
be used to determine the facilitator's level, and which
supports he or she is prepared to provide for the facilitated
communication user.
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Facilitated Communication
Training Standards 2000
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Principles &
Best Practice: Structure
Validation, Authorship
• If the use of more formal validity testing is pursued,
careful consideration needs to be given to such
factors as the types of tasks used, the familiarity and
naturalness of the test environment, the experience
level of the facilitator, and both the facilitator and
facilitated communication user's feelings about doing
the test.
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Facilitated Communication
Training Standards 2000
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Principles &
Best Practice: Structure
Sensitive Information
• Any sensitive information should be verified
through clarification across multiple facilitators.
• Sensitive information should be discussed
carefully with a team of skilled facilitators.
• It is important that the FC user develop an
independent strategy for yes/no as quickly in the
training process as possible.
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Facilitated Communication
Training Standards 2000
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Best Practice: Concluding Thoughts
Learning to type and to use all of the best practice
elements is complex. Remember the following:
• Set goals
• Work and problem solve with a team
• Stay focused and positive
• Create games and strategies that can be successful
each time your practice
• Set aside time to practice as well as remembering to
use typing in the thousand opportunities that come up
throughout the day.
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