Transcript Help Me Help You: Effective Training for Communication Partners of

Help Me Help You:
Effective Training for Communication
Partners of Adults with a Disability
who use AAC.
AAC EBP Group 2012
The Alternative and
Augmentative Communication
(AAC) EBP Group
Began about 4 years ago with 5 people
 Has now grown to 25 Speech Pathologists
 Members are from various organisations
supporting adults and children with disability.
 This year Dr Andy Smidt was invited as our
academic consultant and attended several
meetings.
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Evolution of the Clinical
Question
Voted to explore AAC with adults
 A group member had been asked by her
manager
How much time do you need to
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train support staff to use an AAC
system with a person with complex
communication needs?
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The clinical question evolved from this.
The Clinical Question
In Adults with Disability, What Forms of
Communication Partner Training are
effective in facilitating communication using
an AAC System?
Selection Criteria for
Papers
Papers were excluded if:
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Focused on training strategies for communication
partners of children
Training was for the client rather than for the
communication partner
Outcome of the training had not been measured
Subjects of the study with communication needs
were at a non symbolic level of communication
Paper was older than 1990
Background Question
What Forms of Training are there for People
who Support Adults with Disability?
Approx 20 papers were read, summarised
and discussed in the group…
Main Points from Background Reading…
Positive outcomes to training are more
likely when:
 Training is delivered in a naturalistic setting
 Trainees learning is supported with coaching
and feedback from supervisor /trainer,
 Managers are trained too
(Jahr,E 1998)
Background Reading:
Training strategies which resulted in changes
in trainee behaviour and client –trainee
interaction included:
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Interdisciplinary training (Dobson et al 2001)
Direct SP in put as well as workshop (Chatterton
1999)
Train the trainer (peer to peer/ pyramidal training)
(Haberlin et al 2012)
Video training (Macurik 2008)
Focus on individual clients (Bloomberg and West
2003)
Modules delivered over 6 months (Chatterton 1999,
Bloomberg and West 2003)
CAPs for the Clinical Question
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14 articles were
appraised by the
group
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5 included in CAT
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Kirkpatrick’s Ratings
were used to
evaluate the training
The Kirkpatrick Model
Donald Kirkpatrick 1996
Four Level Model Evaluating the
Impact of Training
1- Trainees Reaction
2- Trainees Learning
3- Changes in Trainees Behaviour
4- Results (Impact of Training)
Papers included in CAT
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Chadwick D & Joliffe J (2009), ‘A pilot investigation into the efficacy of a signing training
strategy for staff working with adults with intellectual disabilities’ British Journal of Learning
Disabilities 37:1 pp. 34-42
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Smidt, S. Baladin, V.Reed and J. Sigafoos (2007) “ A Communication Training Programme
for Residential Staff working with adults with challenging behaviour: Pilot Data on
Intervention Effects”, Journal of Applied Research in Intellectual Disabilities 2007, Vol 20,
pp 16-29
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Light, Janice, Dattilio, John English, Jane Guiterrez, Lisa; et al; (1992) “Instructing
facilitators’ to support the communication of people who use AAC”, Journal of Speech and
Hearing Research, vol 35(4), Aug, 1992
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C.Torrison, E.Jung, K. Baker, C.Beliveau and A.Cook, (2007)“The impact of staff training in
Alternative/Augmentative Communication (AAC) on the communication abilities of adults
with developmental disabilities”, Developmental Disabilities Bulletin ,2007, Vol 35,No 1 & 2,
pp 103-130-
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Wood, Luiselli & Harchik (2007), Training instructional skills with paraprofessional service
providers at a community-based habilitation setting, Behavior Modification 31(6), 847-855
D.Chadwick and J.Joliffe (2009)
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Formal sign training to staff can improve the recall
and use of sign in communicative exchanges with
adults with intellectual disability.
Level of Evidence (NH&MRC): III-2- control group
used
Kirkpatrick Rating: level 2-knowledge tests
level 3-changes in trainees
behaviour
A.Smidt, S.Baladin, V.Reed and
J.Sigafoos (2007)
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MOSAIC training to residential support workers
resulted in increase in staff use of AAC over a 3
month period.
This was not sustained in the long term (apart from
in 1 out of 3 groups trained)
Level of Evidence (NH&MRC): IV –Single Case
Design
Kirkpatrick Rating: Level 4 –Client outcomes
measured
J.Light, J.Dattilio, J.English, and L.
Guiterrez et al; (1992)
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Client focused training delivered 1:1 to support staff
in a naturalistic setting can increase conversation
participation and control for people who use AAC.
Level of Evidence (NH&MRC): III 2 - evidence
obtained with a case control study
Kirkpatrick Rating: Level 4
C.Torrison, E.Jung, K. Baker,
C.Beliveau and A.Cook (2007)
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Client focused training in communication and AAC,
combined with 1:1 support from trainer to staff can
result in small changes in client AAC use
A range of success among the 4 clients, but impact
was seen in both clients and trainees.
Level of Evidence (NH&MRC): IV
Kirkpatrick Rating: Level 4 -outcomes for
clients measured
Wood, Luiselli and Harchik (2007)
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A combination of instructions, demonstrations,
behavioural rehearsal and performance feedback
can be combined to produce rapid and significant
training outcomes.
Level of Evidence (NH&MRC): IV
Kirkpatrick Rating: Level 4
The Clinical Question
In Adults with Disability, What Forms of
Communication Partner Training are
effective in facilitating communication using
an AAC System?
Clinical Bottom Line: Strategies that show
evidence of training communication partners to facilitate
communication in AAC Users include
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A series of half day direct training sessions
Use of video illustrating using AAC
Use of video feedback to communication partners
Analysis of videoed interaction by trainees
Visual aids (e.g. cards showing KWS)
Person Centred training
Action Planning/ Goal Setting
Training on making AAC resources
Instruction within the Natural Environment
Coaching methods-e.g.. demonstration and feedback
Individual and small group training
The outcomes evaluated included:
Observations and video recording of
interactions in the natural environment
 Knowledge/ Skills tests of trainees pre and
post training.
 Self ratings on behaviour changes of
trainees.
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What Next?....E3BP
Integrate the external evidence we appraised this year
and
Look at the best available evidence internal to our
clinical practise.
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What training are we delivering?
How are the outcomes for our clients evaluated?
How can this be improved?
How can we integrate the external evidence?
2013
Venue for our meetings to be confirmed!
Contact Clinical Group Leader:
Bettina Bacall Arenstein
E: [email protected]
PH: 8424 2536