Transcript Creating Communication Environments

Creating Communication
Environments
An Overview
Developed by
Judi Cumley and Mary Wirkus
Wisconsin Assistive Technology Initiative
Learner Outcomes
Understand the foundations of functional and
interactive communication
Identify target activities and strategies for
eliciting active participation by student(s)
Select communication opportunities that are
natural and appropriate
Arrange the environment to promote
communication
Identify the steps in a “least to most” prompt
hierarchy
Agenda
• Background of “Creating Communication
Environments” (CCE)
• Purposes of Communication
• The Three Main Ingredients of Creating a
Communication Environment
•
•
•
Activity
Environment
Partner
• The Prompt Hierarchy
• How Can This Be Useful for YOU?
Background Information
CCE is based on ECT (Environmental
Communication Teaching) - developed by Dr.
George Karlan at Purdue University
Developed for a classroom TEAM
Emphasis on eliciting communication within
natural environments
Originally developed as a 5-day training
program for school-age children who use or
need AAC
Replicated throughout the country for children
and students of all ages & disabilities (CCE in
Wisconsin since 1999)
Everyone Communicates…
Crying
Eye contact
Sounds
Words
Pointing
Falling asleep
Screaming
Silence
Communication
boards
Picture exchange
system
Voice output systems
Gestures/signing
Hair-pulling
Communication Purposes
Expressing Wants and Needs
*Once desired action or object is achieved,
communication ends
Social Interactions including Social
Etiquette
*Social vocabulary is difficult to provide, but vital
for social acceptance
* Greetings, Conclusions, “manners”, etc
.
Exchanging Information
* Starts as “joint attention” then develops into more
complex interchanges with content or topic
specific
vocabulary
Changing Purposes of Communication
Sharing
Information
WANTS
Sharing
Information
&
NEEDS
WANTS
&
NEEDS
Sharing
Information
WANTS
&
NEEDS
The importance of different communication purposes changes over
our lifetime
J. Cumley, 2001
Based on J. Light, 1988, 1997, 2005
If we only have to think about
encouraging our students to
communicate for three different
purposes, why is it so
HARD…..
what can make it easier?
AAC
Augmentative/Alternative Communication
*refers to the ways (other than speech) that are used
to send a message from one person to another (ASHA,
2005)
Examples
• Communication boards/books/picture symbols
• Speech Generating Devices (SGDs)
• Picture Exchange Communication System (PECS)
• Morse Code
• Eye Gaze
• Picture Schedules
AAC can be a vehicle for developing:
expressive language
receptive language
literacy
control over the environment
communication initiation
AAC is not….
A last resort
“Giving up” on speech
Only for those of a certain IQ or Age
Only the job of the speech-language pathologist
Myths and Misconceptions:
Young Children with CCN
(Complex Communication Needs)
Myth and Misconceptions
AAC hinders or stops
further speech
development
The Evidence
AAC approaches (signs, picture
symbols, VOCAs*) do NOT
hinder speech development. In
fact, speech often increases
during AAC treatment
approaches
*VOCA= Voice Output Communication Aid
From: Augmentative Communication News, Volume 18, Number 2, June, 2006
Myths and Misconceptions:
Young Children with CCN
(Complex Communication Needs)
Myth and Misconceptions
The Evidence
There is a representational
hierarchy of symbols from
objects to written words
Children can learn to understand
and use a variety of symbols at a
very young age (e.g., sign
language) through repeated
exposure to the symbol and its
referent in natural contexts
From: Augmentative Communication News, Volume 18, Number 2, June, 2006
Myths and Misconceptions:
Young Children with CCN
(Complex Communication Needs)
Myth and Misconceptions
The Evidence
Children must have certain
skills to benefit from
AAC (e.g., be at a certain
age, have a particular
cognitive or linguistic
level, etc.)
There are NO prerequisites for
communication. AAC focuses
on all aspects of communication
and communication begins at
birth. AAC is an appropriate
intervention approach for anyone
with CCN.
From: Augmentative Communication News, Volume 18, Number 2, June, 2006
Myths and Misconceptions:
Young Children with CCN
(Complex Communication Needs)
Myth and Misconceptions
The Evidence
AAC is a last resort and means
professionals are “giving up”
on speech
The “Wait and See approach” is
not an effective way for teams
(e.g., speech-language
pathologists, teachers,
paraprofessionals, parents to
develop communicative
competence)
From: Augmentative Communication News, Volume 18, Number 2, June, 2006
Using AAC effectively
 Communication partners must model AAC use
•
•
•
•
Use of a penlight or finger on paper displays (aided language stimulation)
Sit next to individual with device to facilitate modeling
Use it as both a receptive and expressive tool
Be natural-focus on communication, not the device/board
 AAC must be engineered into the environment
• Displays mounted around the room/school/home
• ACCESS to communication wherever student “is”
– Pool
– Playground
– Home
– Out shopping
– Bathtub
– School or instructional settings
When designing AAC overlays,
be sure to include...
Vocabulary that reflects all 4 categories




Wants & Needs
Exchanging Information
Social Closeness
Social Etiquette
Use a communication board to talk to each other.
Does it contain the 4 purposes of communication?
AAC:
Establishes a means of communication
Provides opportunity for social interaction
Promotes receptive communication
Encourages expressive communication
Decreases frustration
Provides opportunity for initiation
Think about YOUR students
who are struggling to
communicate effectively…
What are some
characteristics of their
communication?
Common Characteristics of
Students Using AAC
Rarely initiate interactions
Usual form of communication is NOT
using a communication device
Gestural responses (head nods) to
yes/no questions main form of
communicating
May use “challenging” behaviors to
communicate
Common Characteristics of
Students Using AAC
Most vocalizations are unintelligible
Rarely interact with peers
Communication system may not be
available when needed
Necessary vocabulary is not
programmed or correct symbol is not
available
Supporting AAC users….
Create a Communication Environment
Expect all students to communicate
Recognize and respond to the student’s
communication initiations
Arrange the environment to increase the
likelihood for communication
Identify communication opportunities within
natural routines and activities
Addressing Communication
Challenges AND Creating a
Communication Environment…
Requires changes in the…
 Activities


Environment
Partner
Communication
“Incidental teaching episodes are brief,
positive, and oriented toward
communication rather than
language teaching.”
Dr. George Karlan
Selecting a Target Activity to Elicit
Communication
Should be brief in nature, but occur 3-4 times per
week
Requires communication (initiations) by the
student
Activity should be process - not product oriented
Activity represents a class of activities


Art activities, cooking, reading books, snack
Variation in content from episode to episode,
but same “core” vocabulary
Choices are offered during the activity

COMMUNICATION
Selecting Target Activities
Start by identifying a “target” activity






Student must have a reason to perform the
activity
Activity must provide opportunities for success
Must be motivating
Must be functional and interactive
Must be age-appropriate
Must reflect family wishes/team consensus
Describe your Target Activity on the
The Target Activity Form- Sample
Target Activity Description
Students come to table at snack time. Snack materials are on counter. Materials: food, placemats, napkins, straws,
milk (white & chocolate), communication overlays for requesting snack items & standard vocabulary-more, all done, uh oh, help, etc.
Communication Turns
What does student have to
say to begin the activity ?
Communication Considerations
Prompt Hierarchy
How is vocabulary represented:
Activity Vocabulary:
Wants/Needs:
Environm ental Cue…
Open Questions…
Social Interactions & Etiquette:
What does student have to
say to continu e the activity ?
Sharing Information:
Prompt or Request Communi cation…
Environmental Modifications
Full Model
What does student have to
say to end the activity ?
Descriptive Feedback
Cumley, J & Pallaske, M. 2002
Does your Target Activity have at least
THREE
opportunities for the student to initiate?
What does the student have to say to BEGIN the
activity?
What does the student to have to say to CONTINUE
the activity?
What does the student have to say to END the
activity?
If you can’t think of 3 statements the student
needs to say to be engaged in the activity….
pick a different activity!
Communication Turns-example
Snack
Beginning: Student asks for snack items.(e.g., milk, cracker, napkin,
straw, placemat)
“I want….” “Can I have ….” “milk”, etc.
Middle: Student asks for “more”, “help”, makes social, informational
or etiquette comments to peers and adults
“I want more ….”, “more ….”, “good …..” “I like …” “You want…”
End: Student indicates when finished
(asks to be excused, says “all done”, asks for clean-up materials, asks to
go to transitional activity)
“all done”, “clean up”, “no more”, “bye-bye”
The Target Activity Form- Sample
Target Activity Description
Students come to table at snack time. Snack materials are on counter. Materials: food, placemats, napkins, straws, milk (white & chocolate),
communication overlays for requesting snack items & standard vocabulary-more, all done, uh oh, help, etc.
Communication Turns
What does student have to
say to begin the activity?
Student asks for snack items (e.g.,
Milk, cracker, napkin, straw, placemat)
“I want …”
“Can I have….”
“milk”
What does student have to
say to continue the activity?
Student asks for “help”
Student asks for “more…”
Makes comments to peers and adults
“I want more…”
“I like ….”
“good …”
“You want …..?”
Communication Considerations
Prompt Hierarchy
How is vocabulary represented:
Activity Vocabulary:
Wants/Needs:
Environmental Cue…
Open Questions…
Social Interactions & Etiquette:
Sharing Information:
Prompt or Request Communication…
Environmental Modifications
Full Model
What does student have to
say to end the activity?
Student says “all done” when finished
“clean-up”
“go play”
“bye-bye”
Cumley, J & Pallaske, M. 2002
Descriptive Feedback
Communication Considerations
How will the vocabulary be represented (e.g.,
objects, tangible symbols, photos, symbols,
etc.)
List the vocabulary that must be available. Try
to have vocabulary that represents
• Wants/Needs
• Social Interactions & Social Etiquette
• Sharing Information
The Target Activity Form - Sample
Target Activity Description
Students come to table at snack time. Snack materials are on counter. Materials: food, placemats, napkins, straws, milk (white & chocolate),
communication overlays for requesting snack items & standard vocabulary-more, all done, uh oh, help, etc.
Communication Turns
What does student have to
say to begin the activity?
Student asks for snack items (e.g.,
Milk, cracker, napkin, straw, placemat)
“I want …”
“Can I have….”
“milk”
What does student have to
say to continue the activity?
Student asks for “help”
Student asks for “more…”
Makes comments to peers and adults
“I want more…”
“I like ….”
“good …”
“You want …..?”
Communication Considerations
Prompt Hierarchy
How is vocabulary represented?
Communication board with PCS
symbols. Vocabulary for expansion &
Environmental Cue…
labeling. Student points w/some
vocalizations. Teacher models & expands
Activity Vocabulary: milk, straw, napkin,
cracker, placemat…
Open Questions…
Wants/Needs:I, want, more, help, specific
snack items
Social Interaction & Etiquette:sit here,
want some?, please, thank you
Sharing Information:good, yucky, uh oh,
all done
Prompt or Request Communication…
Environmental Modifications
Full Model
What does student have to
say to end the activity?
Student says “all done” when finished
“clean-up”
“go play”
“bye-bye”
Cumley, J & Pallaske, M. 2002
Descriptive Feedback
Video…..
Addressing Communication
Challenges AND Creating a
Communication Environment…
Requires changes in the…

Activities

Environment

Partner
Communication
Arrange the Environment to
Increase the Likelihood of
Communication
 Common Strategies….







Use motivating materials and activities
Materials should be in view but not accessible
Student should need assistance with some
materials
Provide small or inadequate amounts of
materials
Sabotage
Provide something the student doesn’t like/want
Use communication boards/devices & visual
Your Environment
Are there any environmental changes
you could make to increase
communication?

Activity-based environmental changes
• Material location, amount, type

Communication-based environmental
changes
• Picture symbols, communication boards,
device placement
Video-
Note Environmental Arrangements
The Target Activity Form - Sample
Target Activity Description
Students come to table at snack time. Snack materials are on counter. Materials: food, placemats, napkins, straws, milk (white & chocolate),
communication overlays for requesting snack items & standard vocabulary-more, all done, uh oh, help, etc.
Communication Turns
What does student have to
say to begin the activity?
Student asks for snack items (e.g.,
Milk, cracker, napkin, straw, placemat)
“I want …”
“Can I have….”
“milk”
What does student have to
say to continue the activity?
Student asks for “help”
Student asks for “more…”
Makes comments to peers and adults
“I want more…”
“I like ….”
“good …”
“You want …..?”
What does student have to
say to end the activity?
Student says “all done” when finished
“clean-up”
“go play”
“bye-bye”
Cumley, J & Pallaske, M. 2002
Communication Considerations
Prompt Hierarchy
How is vocabulary represented?
Communication board with PCS symbols.
Environmental Cue…
Vocabulary for expansion & labeling.
Student points w/some vocalizations.
Teacher models & expands
Activity Vocabulary: milk, straw,
Open Questions…
napkin, cracker, placemat…
, Wants/Needs: I want, more, help,
specific snack items
Social Interaction & Etiquette: sit here,
want some?, please, thank you
Sharing Information: good, yucky, uh
oh, all done
Prompt or Request Communication…
Environmental Modifications
All students have snack placemat with
specific snack vocabulary velcroed on
top & core vocab. permanently on sides.
Single small pieces of snack
Straw on table, but out of reach
Milk carton not open
Wrong flavor of milk (sabotage)
Full Model
Descriptive Feedback
Addressing Communication
Challenges AND Creating a
Communication Environment…
Requires changes in the…

Activities
Environment

Partner

(And that means YOU!)
Communication
What are some common
characteristics of communication
partners?
As a Communication Partner…
What Can DISCOURAGE a
student from
communicating…
--test, bombard, or demand responses (e.g., “what is
this called” “what do we use a knife for?” “what do we
call this?”)
--use rhetorical questions (e.g., “you don’t want milk,
do you?”)
--use YES/NO questions
--anticipate their needs so they don’t have to ask
As a Communication Partner…
What else Can DISCOURAGE a
student from
communicating…
--don’t give them regular access to their communication system(s)
--when they make a choice, ask them again
--use only teacher-directed activities so the student doesn’t HAVE to
communicate
--”GOOD TALKING!” as a reinforcer
--use figurative language (“take your seat” vs. “sit”)
--”rush” the student’s communication
Strategies to Promote
Communication
Adapted from Original ECT, Hodgdon, 1999
Engage (get at their level, eye contact)
Establish attention
Proximity to child
Be in their line of vision
Watch for student to orient to you (attention shift)
Use visuals (present visual first)
Use meaningful gestures
Exaggerate movements to attract attention
Hold gestures (point long enough to mutual referent)
Less may be better!
Match student’s verbal output?
Expand by one
Strategies to Promote
Communication
Adapted from Original ECT, Hodgdon, 1999
Wait for responses
Count to 5, 10 after a command/question
Stay engaged
Increase opportunities for initiation
Be consistent with labels (why?)
Modify the environment to create active
participation, communication
Make sure the student has access to
communication at ALL TIMES!
The most language learning will
occur when your response is
related to the student’s focus of
interest or to what he has
communicated.
YOU are part of the
environment …
When you use a prompt hierarchy you
can:
Provide consistency across partners
because of framework
Give students processing time
Be individualized
Provide only as much prompting as is
needed
Prompt Hierarchy
Environmental Cue

PAUSE
Open Question

PAUSE
Prompt OR Request for Communication

PAUSE
Full Model

PAUSE
Incorporate descriptive feedback into each
step
Descriptive Feedback
Use after the student has produced a
communicative response (at any point within
the hierarchy)
Descriptive feedback is specific to the student’s
communication
“Oh, you asked for more juice, here’s your juice.”
“You want paint. Here’s some blue paint.”
“You asked to be all done. We need to do just one
more, then we’re all done.”
“You looked at the cheese, here’s some cheese for your
sandwich”.
Descriptive Feedback
Serves Three Functions

Acknowledges
• Immediately acknowledges that the partner
“heard” the student’s communication attempt

Confirms
• Confirms that the message sent by the student is
the same as the message understood by the
partner.

Models
• Can be used to model an expanded version of the
communication message.
Prompt Hierarchy Step #1
Environmental Cue
Set up the environment to signal to the student
that an activity is about to begin.





Lining up at the door
Getting everything ready for an activity & then
waiting……..
Art materials prepared but out of reach
Desired items visible but inaccessible
Cutting the pizza up and waiting
If student responds, provide...
Descriptive Feedback
Prompt Hierarchy--Pausing
Pause after every step to give the
student time to respond to the cue.
Focus your attention on the student
(expect communication!)
A
N
PAUSE
D
If the student responds, provide...
Descriptive Feedback
Prompt Hierarchy Step #2
Open Question
If the student does not respond to the pause by
making a response:

Ask a WHAT, WHY, WHO, WHEN, WHERE, OR
HOW Question ONE time
• “What do you want?”
• “Whose turn is it?”
• “Where does that go?”
AND then…...PAUSE
If student responds now, provide...
Descriptive Feedback
Prompt Hierarchy Step #3
Prompt or Request Communication
If the student does not respond to the open
question & pause……

Provide a prompt to students (ONE time)
• Choices, carrier phrase, initial sound, visual cue
OR

Request Communication (ONE time)
• “Tell me what you need.”
• “Tell me what goes next.”
AND then……PAUSE
If student responds now, provide...
Descriptive Feedback
Prompt Hierarchy Step # 4
Full Model
If the student does not respond to the
partial prompt and pause…..

Provide a full model for student
• Use student’s AAC device
• Use developmentally appropriate model
AND then…...PAUSE
If student responds now, provide...
Descriptive Feedback
PAUSE
Pause Pause Pause Pause Pause
Pause Pause Pause Pause Pause Pause
Pause Pause Pause Pause Pause
Pause Pause Pause Pause Pause
Pause Pause Pause Pause Pause Pause
Pause Pause Pause Pause
Pause Pause Pause!
Pause
In other
words…PAUsE!
Prompt Hierarchy
Gives student the necessary time to
process information and to formulate a
message to communicate
Provides a structure for adults that
encourages communication
Can be customized for individual
students
Organized as least to most
Prompt Hierarchy
The Target Activity Form - Sample
Target Activity Description
Students come to table at snack time. Snack materials are on counter. Materials: food, placemats, napkins, straws, milk (white & chocolate),
communication overlays for requesting snack items & standard vocabulary-more, all done, uh oh, help, etc.
Communication Turns
What does student have to
say to begin the activity?
Student asks for snack items (e.g.,
Milk, cracker, napkin, straw, placemat)
“I want …”
“Can I have….”
“milk”
What does student have to
say to continue the activity?
Student asks for “help”
Student asks for “more…”
Makes comments to peers and adults
“I want more…”
“I like ….”
“good …”
“You want …..?”
What does student have to
say to end the activity?
Student says “all done” when finished
“clean-up”
“go play”
“bye-bye”
Cumley, J & Pallaske, M. 2002
Communication Considerations
Prompt Hierarchy
How is vocabulary represented?
Communication board with PCS symbols.
Environmental Cue…
Vocabulary for expansion & labeling.
Student points w/some vocalizations.
Snack materials set out, but out of reach of students.
Teacher models & expands
Adult waits expectantly.
Activity Vocabulary: milk, straw,
Open Questions…
napkin, cracker, placemat…
, Wants/Needs: I want, more, help,
What do you want?
specific snack items
What do you need now?
Social Interaction & Etiquette: sit here, Who do you want to pass that to?
want some?, please, thank you
Sharing Information: good, yucky, uh
oh, all done
Environmental Modifications
All students have snack placemat
with specific snack vocabulary
velcroed on top & core vocab.
permanently on sides.
Prompt or Request Communication…
Do you want apple or crackers?
I want ……..
Mmmmmmm (for milk)
Full Model
I want milk.
Apples please
I want more crackers please
Single small pieces of snack
Straw on table, but out of reach
Milk carton not open
Wrong flavor of milk (sabotage)
Descriptive Feedback
You asked for milk…here’s more milk.
Crackers…..here’s 3 more crackers.
Milk is good! Are crackers good too?
CCE is a paradigm shift…
• From sole focus on the student’s AAC device to
communication
• From focusing on the student’s communication
limitations to creating a communication environment
• From a single player to team ownership
for communication opportunities
• From product-oriented activities to consciously designed
communication-based activities
Where do I go from here?
Some Possibilities…
 Identify one specific student (do not select
your most “challenging” student!)
 Encourage other teams in the district to join you &
form a “study group” where you….
 Use videotaping to help you analyze your activities,
partner behaviors & environment
 Critically analyze the activities for student
communication opportunities (minimum of 3)
 Set up your environment to maximize
communication (one activity a day)
 Post prompt hierarchy & start to use
 Provide feedback to team members & ask for same
 Others?
References
American Speech-Language-Hearing Association website: www.asha.org
Burkhart, L. 1993, Total Augmentative Communication in the Early Childhood
Classroom, p.38
Binger, C. & Kent-Walsh, J. (2005). Evidence-Based Language Supports for
Children Using AAC: Increasing Expressive Communication. Closing the Gap
conference, Oct. 2005, Minneapolis, MN.
Blackstone, S. (2006). Young children. False beliefs, widely held.
ACN:Augmentative Communication News, June 2006, 18 (2).
Casey, K. & Kornfeld S. (2004). Developing language-rich light tech AAC systems
for young children. Closing the Gap, October/November 2004, 23 (4).
Hodgdon, L.A. (1999). Solving behavior problems in Autism: improving
communication with visual strategies. Troy, Michigan: QuirkRoberts Publishing.
Karlan, George. Environmental Communication Teaching Training. Field-Initiated
Research Grant Award No. H023C9005 from the Office of Special Education,
U.S. Department of Education. Lafayette, Indiana: Purdue University.
Light, J. (1996) Communication is the essence of human life: Reflections on
communicative competence. AAC Augmentative and Alternative
Communication, June 1997 (13), 61-70. Light, J.C. (2005, May). AAC
interventions to maximize language development for young children. State
College, PA: AAC-RERC. Retrieved June 10, 2008 from http://aacrerc.psu.edu/index-16147.php.html
Skotko, B., Koppenhaver, D., & Erickson, K. (2004). Parent Reading Behaviors and
Communication Outcomes in Girls with Rett Syndrome. Exceptional Children, 70
(2), 145-166.
Quill, K. (2000) Do-Watch-Listen-Say: Social and communication intervention for
children with autism. Baltimore: Brookes Publishing.
WATI (2009). Assessing student’s Needs for assistive technology. www.wati.org
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