Transcript Dia 1

Increasing the communicative opportunities
and skills of young people with multiple
physical and sensory disabilities
Hannahs at Ivybridge and Plymouth University
Tamzin Gribble (SLT)
Dr Ruth Firth (SLT)
Dr Allegra Cattini
Lauren Carroll
September 2013
COMMUNICATION MATTERS…
Overview
• The aim of the project
• How the project came about
• What we did
• Findings
• What next?
How the project came about
• Trickier to access parents  piecemeal
training & plenty of room for improvement!
•
AAC introduced late
•
A need to improve training for our care
staff
Plymouth University Research Awards
prompted action!
•
• It is the parent/carer who can hold the key to
developing effective communication for a
VOCA user, if they are provided with the
appropriate support (You Matter Project;
Bousaki, Lloyd-Cocks, Latham, and Moore,
2011).
Aims of the Project
1. To increase the amount of AAC use,
particularly beyond the school/college day.
2. To investigate whether increased AAC use
(particularly use of Voice Output
Communication Aids) leads to improved
cognitive abilities.
•
Hypotheses
Providing You Matter training for the parents and care staff
of young AAC users will result in increased VOCA use.
As a result of increased communication and interaction
using their VOCA the young people will show an increase in
their cognitive abilities.
What did we do?
Baseline
Questionnaire for parents/carers
IQ testing
Data logging
Intervention
2 day training for parents/carers
Post measures
Questionnaire for parents/carers
IQ testing
Data logging
Who was involved?
• 15 young people aged 13-25
• 23 parents/carers completed Q’aire 1
•
3 parents + 9 carers attended training
•
4 parents + 8 carers completed Q’aire 2
(7 of whom received the training)
Questionnaire
•
•
•
•
•
•
•
How often the VOCAs are used
What VOCAs are used for
Situations when VOCAs used most/least
Who tends to initiate interactions
Technical barriers to using VOCAs
Other barriers to using VOCAs
Suggestions as how to motivate VOCA users to
use them more
• General comments
Cognitive Testing
Teaching alternative communication has been
shown to lead to cognitive advancement in
other areas (Capirci, Cattani, Rossini and
Volterra, 1998).
Leiter R Non-Verbal IQ Test
(Age 2;0-20;11)
Figure Ground
(The ‘Find It’ game)
Identification of embedded figures or
designs within a complex stimulus.
Testing in progress!
Data Logging
The Training
• You Matter (Bousaki, Lloyd-Cocks, Latham,
and Moore, 2011) ... with a few adaptations
• 2 full day sessions
• Brings together carers/parents and professionals on
an equal footing in order to provide practical and
positive ways forward for the children’s AAC needs.
• Gives parents/carers the tools and the support
needed to evaluate their child’s communication
levels, set their own goals, solve their own difficulties
and become active decision-makers in supporting
their own child’s communication
What We Found
• Key findings from Questionnaire 1
• Key findings from Questionnaire 2
- evaluation of training
- comparison between training vs. no
training
• Data logging to date
• Findings from cognitive testing
Questionnaire 1
What VOCA Is Used For and How Often
Not used
Used
Carers
………….Talk about likes and dislikes
Parents
….....Indicate choices
What VOCA used for
……………Talk about feelings/emotions
…………Ask a question
………………Give information
………………..General chat
…..Ask for something
…….Say hello
………Get someone’s attention
-3
-2
-1
0
How often
-3 (Never) to +3 (All the time)
1
2
3
Technical Barriers to VOCA Use
(Strongly disagree (-3) to strongly agree (+3))
Barriers to Use
Mean Scores
Parents
Care Staff
-1
-2.45
Too heavy
- 0.6
-2.45
Charging
-0.88
-1.5
Too slow
- 0.29
-2.2
Content
-0.57
-1.45
Reliability
-1.43
-1.91
Set up time
-1
-2.44
Safety reasons
0.6
-0.9
Programming knowledge
0.78
-1.8
Set up knowledge
-0.11
-2.10
Too big
Technical Barriers to VOCA Use
Barrier
Potential technical barrier to VOCA use
Non Barrier
-3
…………….....Too big
Carers
…..................Too heavy
Parents
…………….....Charging
…...................Too slow
….....Content
…...................Reliability
…...................Set up time
….....Safety reasons
…..Programming knowledge
…...................Set up knowledge
-2
-1
0
1
Level of agreement
-3 (Completely disagree) to +3 (Completely agree)
2
3
Other Barriers to VOCA Use
(Strongly disagree (-3) to strongly agree (+3))
Parents
Care Staff
Other forms of communication
preferred
1.55
-0.3
Lack of time
-0.88
-2.15
Only relevant for school/college
-2.25
-2.92
Not sure of all the VOCA can do
1.88
-1.64
Limited opportunities
-0.43
-2.55
It’s frustrating
-0.25
-1.55
Knows what AAC user wants without
VOCA use
2.09
-0.42
It’s for use with unfamiliar people
0.11
-2.33
1
-0.67
Practical reasons
Other Barriers to VOCA Use
Non Barrier
Barrier
…………..Other forms of
communication preferred
Carers
Parents
Other potential barriers to VOCA use
…....................................................Lack of time
…........................Only relevant for school/college
.................Not sure of all
VOCA can do
…..........................................Limited opportunities
…………………………………………...Frustration
….Know what AAC
user wants without it
…………….......For use with unfamiliar people
……………………..Practical reasons
-3
-2
-1
0
1
Level of agreement
-3 (Completely disagree) to +3 (Completely agree)
2
3
Participants’ Comments
•
•
•
•
•
More training wanted
More quality time with AAC user
Larger staff group with knowledge of AAC user
Easier without access issues
Frustrations re. hardware issues
One parent’s thoughts
“ I feel guilty I do not use the communication aid
with [name]. I recognise and appreciate it is
important for him to express himself. I just
about get through the day , feeding him, doing
medicines etc...The aid is one more thing that
stresses me...”
Questionnaire 2
Feedback re. You Matter
Reports of increased understanding of:
• how difficult it is for the AAC user
• the AAC user’s level and next steps
• the importance of core vocab
• the need to wait and listen more
Feedback re. You Matter
71% of attendees stated that they had changed
how they interact with VOCA users
Comments
‘”I model more. I wait longer for responses.”
‘”I encourage her to communicate her answer to me
using her VOCA more now rather than just guessing
what I think she actually wants and am amazed at
how often I guess wrong!!’
“I understand better now how using her VOCA gives her
an independent voice. I am trying to use it more at
home.”
What VOCA is Used For Most T2
Not used
Used
……..……….Talk about likes and dislikes
Did not attend training
….............Indicate choices
Attended training
What VOCA used for
………………..Talk about feelings/emotions
…………….…Ask a question
……………..…Give information
…………..…...General chat
……………….Ask for something
………….….Say hello
………Get someone’s attention
-3
-2
-1
0
How often
-3 (Never) to +3 (All the time)
1
2
3
Barriers to VOCA Use T2
(Strongly disagree (-3) to strongly agree (+3))
Training
No Training
Other forms of communication
preferred
0.43
1.67
Lack of time
-2.25
-1.33
Only relevant for school/college
-2.25
-2.33
Not sure of all the VOCA can do
-0.71
2.0
Limited opportunities
-2.57
-0.33
It’s frustrating
-2.88
0.33
Knows what AAC user wants without
VOCA use
-1.5
1.33
It’s for use with unfamiliar people
-1.38
-1.33
Practical reasons
1.67
-0.5
Barriers to VOCA Use T2
Non Barrier
Barrier
……Other forms of
communication preferred
No training
Training
Other potential barriers to VOCA use
….........................................Lack of time
….......................Only relevant for school/college
….....Not sure of all
VOCA can do
…...................................Limited opportunities
………………………………...Frustration
……………Know what AAC
user wants without it
……………..........For use with unfamiliar people
………..Practical reasons
-3
-2
-1
0
1
Level of agreement
-3 (Completely disagree) to +3 (Completely agree)
2
3
Table of data logging to date
1000
T1 - Before You Matter training
Total minutes VOCA used in a week
900
T2 - After You Matter training
800
700
600
500
400
300
200
100
0
BM
DK
ES
FR
Young person
RN
WC
Cognitive assessment
60
T1 - Before You Matter training
IQ Score
50
T2 - After You Matter training
40
30
20
10
0
Age equivalent
MS
RN
DK
8
7
6
5
4
3
2
1
0
ES
KD
BM
DB
FR
BM
DB
FR
Young Person
MS
RN
DK
ES
KD
Young Person
T1 - Before You Matter training
T2 - After You Matter training
Conclusions
• You Matter training was positively received +
had positive outcome in terms of peoples’
views
• Further evidence is needed to determine
whether this leads to a sustained increase in
VOCA use.
• Those with largest increase in VOCA use have
made most marked progress in cognitive
scores but the link between this and training is
uncertain.
What Now?
• More care staff training
• Reconsider training for parents + consider
increasing focus on low tech
• Regular data logging
• Negotiate the introduction of ‘communication
champions’
• Consult the young people about their views
• Input into College module re communication
E-mail addresses
[email protected]
[email protected]