Transcript - SlideBoom

Communication Takes Two
How I Can Help My Partner’s Communication
IDS Tier 1 Training
Carrie Leonhart, M.S., CCC-SLP
Lynette DiLuzio, M.S., CCC-SLP
Augmentative Communication Services Coordinators
Institute on Disabilities @ Temple University
Pennsylvania’s University Center for Excellence
in Developmental Disabilities
Education, Research and Service
"For people
without
disabilities,
technology
makes
things
easier.
A program of the Institute on Disabilities at Temple University
For people
with
disabilities,
technology
makes
things
possible.”
Introductions and Welcome
• Location
– Emergency Exits
– Bathrooms
– Cell Phones?
• Survey
– Your role
– Your current knowledge
• Participation is rewarded!
– Ask questions
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Why Group Trainings?
• Intellectual disAbility Services (IDS)
– AAC Evaluations for registered Philadelphia adults
• Individual Sessions vs Group Trainings
– YOU know most about consumer
• Consumers don’t want to talk to ME!
– YOU can best improve communication
In daily routines In familiar settingsWith familiar people
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Why Group Trainings?
• What WE offer?
– Training & Materials
• Licensed, certified Speech-Language Pathologists
• Content & Brainstorming for Team to use
– Observation Visits
• Individualized sessions to explore supports/strategies
– Referrals
• More in-depth services available via Medicaid
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Your Role
You learn to:
• Encourage your consumer to communicate
• Use tips to make communication more effective
• Educate others about communication
You’ll leave with customized information:
• Communication Profile
• Allow Me! Strategies for Supporting
Communication
• Resources for learning more
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Communication Benefits
Effective communication allows the person to:
• Interact with and control environment
– Needs and wants, Preferences, Choices
– Self-determination, advocacy, and empowerment
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Communication Benefits
Effective communication allows the person to:
• Provide a MORE effective way to express self
– Reduce frustration, fear and anxiety
– Behavior IS communication
• Including challenging, inappropriate, or self-injurious
actions
• Providing a different mode of self-expression can
reduce these undesired behaviors
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Communication Bill of Rights
(Handout)
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Behavior or Communication?
• “I can remember the frustration of not being
able to talk. I knew what I wanted to say, but I
could not get the words out, so I would just
scream.”
-Temple Grandin
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Individual Differences
• We each receive the SAME message in
DIFFERENT ways
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Sensory System
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Sensory System
• Each person’s sensory system is different
• Scheduled sensory times/activities may help
person stabilize
–
–
–
–
Needs to be individualized
Avoid OVERstimulation
Use Alerting activity, then Calming activity
Otherwise, person will seek out sensory stimulation
on own
• Plugging ears, hitting head, spinning objects
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QUIZ!
To communicate, does a person need… (Yes/No?)
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To have clear speech.
To have an IQ of __.
Good hearing.
To have mastered cause and effect.
To have language.
To be able to understand and use picture-symbols 90%
of the time.
• At least a 500 word vocabulary.
• To be able to read and write at a 3rd grade level or
higher
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What IS Needed…
• Something to talk about
– AND a desire to communicate about it
• Somebody to communicate with
– Help use strategies, repair unclear messages
• Some way to convey information
– Speech, gestures, body language, drawing
pictures, AAC device, etc…
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How We Communicate
• Conventional / Symbolic
– Easily recognized &
understood by others
– Speech
• Tone of voice?
• Facial expressions?
• Body Language?
– Written text
– Gestures
• Signs?
– Pictures / symbols
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• UNconventional /Non-symbolic
– “Idiosyncratic” = specific or
unique to that person
– Vocalizations (Sounds)
– Gestures / Signs, SelfInjurious Behavior?
– Facial Expressions, Body
Positioning
– Symbols, Communication
Boards/Books, Recordable or
Talking Devices
Using Tools and Things
Augmentative & Alternative Communication (AAC)
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Allow Me!
A Guide to Promoting Communication Skills
in Adults with Developmental Delays
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Allow Me!
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•
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Slow Down & Capture Moment
Allow Partner to Lead
Adapt Activities to Share
Conversation
Add info & Experience
Encourage AAC Systems
Create Activities with a Purpose
Allow Me!
Slow down and capture the moment
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SLOW
Share, Listen, Observe, and Wait
Routines support interaction
Community Excursions
Creative Outlets
Recreational Activities
Allow Me!
Levels of Communicators
1. Communication is reflexive
2. You read their body language
3. Use sound, gestures, eye gaze to send messages
intentionally
4. Intentional, uses symbols, words, signs, and/or
pictures
5. Uses sentence fragments
6. Simple sentences
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Document Communication
When this is happening Person Does
We think it means We should
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Communication Profile / Inventory / Dictionary
Documents the unique ways the person “says” things
Helps new or fill-in staff
A record across settings
Has a working copy (separate from formal plan) that
can easily be updated
• Includes ?s or guesses to help problem-solve
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When this is
happening
It’s near mealtimes
Anytime
Anytime
PERSON does
 Walks to kitchen
 Sits at table
 Runs hands through hair
 Waves hands to herself (flaps
hands)
 Cries tears
 Spits/makes raspberry noise
PERSON’s been in same Tosses items to the ground
place/activity for a long
time
We think it means
PERSON is hungry
She is happy
She is upset
Provide her food (according to
her safe-swallowing diet)
 Continue the activity
 Join PERSON in the activity to
enjoy it together
 Offer a hug
 Offer choices of other
activities/items
 She is done using them
 Tell PERSON: “I can tell you’re
 She wants to stop the activity done with this. Please pick it
up and we’ll take it to your
room”
 Remind PERSON to place
things down safely
 Offer choices of other
activities/items
She wants attention / to engage  Engage with PERSON verbally
with someone
(discuss music, family, etc.)
 Offer choices of
activities/items for PERSON to
do
Anytime
 Stands up
 Walks toward or follows staff
Anytime
 Screams loudly
She is sick
 Coughs
 Shows a significant decrease in
activity
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We should
 Check vitals (temperature,
heart rate, ears)
 Notify health services
Your Turn
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Understanding __’s Communication
Describe what you see. How do you know…?
__ is having fun / Likes what’s happening
__ is bored / Doesn’t like what’s happening
__ is angry / upset
__ is hungry
__ is tired
Other?
Allow Me!
Allow your partner to lead
• ROLES:
– Helper
– Mover
– Director
– Responsive Communication Partner
Wait.
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Observe.
Listen.
REMEMBER … it takes two to talk, and what you do with
your half of the conversation makes all the difference.
There will always be times when you have to play the
Helper, Mover or Director roles,
BUT
be aware that these roles make it hard for your partner to
become a better communicator.
When you spend most of your time in the "Responsive
Conversation Partner" role, you create many more
opportunities for your partner to learn to communicate.
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Following Their Lead
3 tried-and-true techniques
• Respond immediately
• Interpret
– Say it as your partner would if she could
• Imitate
– Repeat what your partner says and does
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What is Cause-Effect
• Understanding how actions impact the
objects/people in environment
• Important skill for learning & development
– Knowing she can control her environment helps
her understand power of communication
– She can make things happen through
communication
• Actions, facial expressions, gestures, sounds, or words
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Learning Cause-Effect
• Learn by repetition
– Experience same action over and over
• For example: flicking a light switch to watch it go on/off
– again and again
• Gain exposure to objects with clear causeeffect relationships
– Demonstrate impact he can have on his
environment
– e.g., Music only plays if I press this button
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Learning Cause-Effect
• Choose fun & motivating items
– She should be reinforced and rewarded for using
the item
– Let her know that she is the one making item work
• Use a variety of items
– Helps person discriminate between reactions of
different buttons, symbols, & objects.
– Recognize different actions produce different
results
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AT for Cause-Effect
Assistive technology (AT)
• Specialized or Modified items
– Easier to use (buttons are larger, more sensitive, or brighter-colored)
• Switch adapted
– Add a cord allowing use of switch (external button)
– When press switch (plugged into item’s cord), it turns on
item!
– Press button again & again to watch item activate
• Battery interrupters add switch cords to existing items
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Allow Me!
Adapt activities to share
"Where opportunity doesn't knock, build a door.“ -Milton Berle
• Base activities on Partner’s
– Preferred interest patterns
– Daily living activities
– Ensure built-in opportunities for both of you to participate and
communicate
• Know Partner’s level of communication
– Be realistic about type of communication you expect
• Allow partner to lead
– Respond immediately to messages
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Show and Tell
(Visual Supports)
• Support understanding (& reduce anxiety)
– Increases predictability
• Warns of schedule changes
• When activity is “all done
– Provides information about expectations
• If… Then…
– Supports independence and participation
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Visual Supports
• Visual rules
– Images represent expected behavior
• “First-Then” or token board
– Pictures represent:
• Current activity (and how much of it is completed)
• Consequence of completing it
• “First green beans”  “Then dessert”
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Visual Supports
• Visual schedule
– Symbols (spoken words, pictures, written) represent
each activity in the timeframe
– Can be removed and placed in an “All Done”
pocket as schedule proceeds
• Visual timer
– Designated time shown in a colored segment that
gets smaller as time runs out
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CommunicatePA.wikispaces.com
• Behavior & Communication
– http://communicatepa.wikispaces.com/Behavior+
%26+Communication
– Visual Supports
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Problem-Solving Visual
Social Story
First-Then / Token board
Visual Schedule
Rules
Timers
Allow Me!
Get the conversation going and keep it going
• Get conversation going
– be face-to-face
– wait, observe and listen
• Keep it going
– show your pleasure and interest
– use questions that continue the conversation
• Limit questions that don't
– use signals to encourage your partner to take another
turn
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Functional Communication
Go BEYOND
eat…
drink…
toilet…
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Choice-Making
Offer preferred & non-preferred items
• Hold up 2 objects
– Favorite cookie vs. non-favorite carrot stick
• Person receives whichever one she selects
– Even if non-preferred
– Reinforces her ability to choose
• What If…
– If she selects an item she does not truly want
– Give it to her for a brief (20-30 second) period
– Remove it and offer her 2 options again
• This is NOT a punishment
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Choice-Making
Expand Vocabulary
• Start with 1-3 familiar symbols or messages
• Wait until person understands & reliably
makes choices from these options
• Slowly add more vocabulary/options
– Still only offer 2-3 at a time
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Allow Me!
Add information and experience
• Promote partner's understanding of language
& ability to express self
• Use language appropriate to partner's level of
communication development
• At a time when partner can best absorb it
– when your partner wants something
– during daily routines
– when things go wrong
– when your partner's initiations are undesirable
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Add Information and Experience
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Use gestures
Emphasize key words
Talk about what is happening
Repeat - use consistent labels
Expand on your partner's message
– Add one more word, idea or action
• Extend the topic
– Build your partner's understanding of the world
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Symbols
• Symbol Type
– Depend on person’s vision, motor skills, &
learning/understanding
– Depend on environment (partners, setting, culture)
Cartoon
elephant
cup
[actual object]
Different pictures of the same thing.
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Real
elephant
Symbols
• Visual Scene Displays
– Whole views, in-context
– New research – may be more effective for certain people
vs
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Symbols
• Symbols “stands for” something else
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Objects
TV remote = activity of watching show
Parts of objects
keys = go for ride
Textures/Fabrics soft fabric of blanket = sleep
Gestures/Signs
pantomime throwing = play ball
Pictures
photo of Grandma = Grandma
Sounds
“kiss sound” = Grandma
Spoken names
“Grandma” = Grandma
Symbols
• Use type/form most appropriate for person
– Person uses mostly gestures  You (partner) use
a lot of gestures
– “Too many supporters stick to verbal
communication because that is what they do best,
when the person might better understand nonverbal cues.”
- KNI Training
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Teaching Symbol Use
• “Sabotage” the environment
– Requires the person to communicate more
– Gives him more practice with successful interactions
• Example:
– Set a timer to turn off TV after a few minutes
• Knowing that person will want to watch more
– Wait (and watch) for person to use a symbol to
continue the activity
• Reach toward remote, Look at picture of remote, OR Press
button to play recorded “more” message
– Repeat!
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Teaching Symbol Use
Study shows that learning to use symbols:
• Requires environment rich with models &
opportunities
– Infant is exposed to approx. 4,380 hours of oral language
(verbal speech) before speaking (about 18 months)
– If people only experience alternate symbols in
“class/therapy” (20-30 minutes, 2 times a week)…
– Will require 84 years to receive same amount of exposure
- Reference: Brinker, 1982
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Teaching Symbol Use
Study shows that being a proficient symbol user:
• Person needs to see and use symbols to learn
– Child has approx. 36,500 hours of practice with oral
language before being a “competent” speaker (9-12
yrs)
– If people only practice alternate symbols in
“class/therapy” (20-30 minutes, 2 times a week)…
– Will require 701 years to receive the same amount of
exposure
- Reference: Brinker, 1982
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Allow Me!
Encourage AAC Systems
Augmentative & Alternative Communication
(AAC)
• AUGMENTS &/or ALTERNATIVE
– Enhances or replaces spoken communication
• Assistive Technology for Communication
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Encourage FAIR AAC Systems
• Flexible
– Contains common vocabulary to be used in any situation
• Active
– Can be used purposefully & functionally during interactions
• Individualized
– Contains vocabulary for partner's unique communicative needs
• Respected
– Viewed & treated as valuable part of interaction between you &
partner
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Voice-Output devices
• Devices store & play-back recorded messages
– Person can repeatedly hear (and learn to “pair”)
spoken word with actions/items
• Allow person to understand how speech
impacts his environment
– Use in addition to other strategies & supports
– Will enhance both his understanding and his use
of speech for communication
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Voice-Output devices
• Record short, repeated messages
– Help assign meaning to specific spoken words
– Help understand how same message can be used in
different contexts (across times of day, people, settings)
• Messages can Ask for:
– Objects (cup, TV)
– Actions (more, all done, come here)
– Activities (go for walk, sing, drive)
• Messages can be Social:
– Hi, My name is ___, Want to watch with me?
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Voice-Output devices
• Record sequenced messages
– Help understand how things stop or continue in-a-row
• Sequences can be:
– Ordered
– Songs/ Books
– Games
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(steps to getting dressed, counting)
(each line recorded separately)
(ready-set-go, Simon Says instructions)
Voice-Output devices
• Change the device when you change words
– E.g., switch picture, add texture
– Helps person realize it’s a different message
• Use it as her “voice”
– Record someone who sounds like her
– Choose same gender, similar voice / accent
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CommunicatePA.wikispaces.com
• AAC 101
– http://communicatepa.wikispaces.com/AAC+101
– What is AAC? (and where to get it)
• No Tech
• Mid Tech
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• Low Tech
• High Tech
CommunicatePA.wikispaces.com
• iTechnology
– Communicatepa.wikispaces.com/iTechnology
– Presentation
– List of Apps
– Resources
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Allow Me!
Create Activities with a Purpose
• Appropriate communication goals are
– Specific, useful & attainable
• Activities that
– Promote communication across environments
– Are interesting & interactive
• Require partner to initiate
– Provide information at partner’s level
• And help achieve goals at NEXT stage of communication
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Review
• Plan specific to person’s
individual strengths,
interests, & needs
• Communication is a lifelong process
– Remember this is a
marathon, not a sprint.
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Review
• Adjust your behavior as the communication
partner
– Be creative problem solvers
– Provide opportunities to
• practice communication
• build on existing skills
– Focus on
• taking turns
• Shared experiences
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What did you say?!?!
If you don’t understand…
DON’T
• Pretend you did (fake it)
• Assume you can “fix” it or
speak for him/her
• Pick poor environments
(tired, loud, distracting) for
important talks
• Give up
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DO
• Repeat what you DID
understand (topic, emotion,
key words)
• Ask what to do (guess, ask
?s, try again later)
• Concentrate on what is said
• Offer or encourage “other
ways” to say it
Review
“We already tried that…” BUT
• Communication constantly changes & evolves
– Person’s needs, environment, vocabulary,
motivation, experiences
– Technology, understanding of what works
• AAC doesn’t have to be either / or
– Use whatever tool you need at that time
– Use as many tools as you need
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Review
• Keep it simple
– Goal is to be engaged in the communication
(conversation) process
– Become knowledgeable about what is available to
person & team
– Not all devices have to be a computer
• Low-tech can be very effective
• “Don’t use a hammer when you need a screwdriver”
—Sarah Blackstone (PSHA, 2009)
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Next Steps…
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Services & Supports
• Team-Based
– Learning
– Brainstorming
• Resources
– Materials
– Learning
• Refer
– Contact [email protected]
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Services & Supports
• Learning
– Check out an “Allow Me!” book
– Attend future trainings (other staff)
• http://CommunicatePA.wikispaces.com/ids
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CommunicatePA.wikispaces.com
• Beginning Communicators
– Communicatepa.wikispaces.com/Beginning+Communicators
– Communication Profile
– Tips & Techniques
– Symbolic Communication
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Services & Supports
• Brainstorming
– Borrow a communication device from PIAT
• IDS has: ExpressOne
• Other: Talk Block, Talk Point
– Try Communication Boards / Books
• See Resources for FREE printable ones
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Services & Supports
• Tier 2 Options
– Check out “Symbol Kit“
• Try Objects, Cards, and Picture Boards
• Familiar, Functional Items
• See which “Symbol” works best
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Services & Supports
– Check out “Pixon Project” kit
• 10 pre-designed Communication boards
• Language & Learning Activity Notebook
(Curriculum and Plan for Teaching Communication)
• Sample Educational and Environmental Materials
• Picture Set CD for PC and Mac
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Services & Supports
Experiment and explore potential devices!
• Free Device Loan Programs in PA
– PIAT AT Lending Library
• http://www.disabilities.temple.edu/atlend
• For all Pennsylvanians with disabilities, of all ages
– PennsylvaniA Training and Technical Assistance Network
(PAttan)
• http://www.pattan.net/supportingstudents/shorttermloan.aspx
• Device loans open to “registered” educational and EI personnel,
for Pennsylvanians 0-21
• All PA Intermediate Units (SpED) also have AT specialists
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FOR INFORMATION contact:
PIAT - Pennsylvania’s Initiative
on Assistive Technology
411S Student Center
1755 N 13th Street
Philadelphia, PA 19122
Tel:
800-204-7428 (voice)
866-268-0579 (TTY)
Fax:
215-204-9371
Email: [email protected]
Web: www://disabilities.temple.edu/piat
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Mention area of need (“communication, vision,
hearing”) and where you heard about us!
Resources for Materials
PreMade Boards
• FREE! Low-Tech AAC or “Aug Comm” Materials
– www.speakingofspeech.com/AugCom_Materials.html
– Topic and routine-specific communication boards
– Materials saved in PDF format (even if made in
Boardmaker)
• Emergency Preparedness Boards
– disabilities.temple.edu/aacvocabulary
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Resources for Materials
Make-Your-Own Boards
• Cut & Paste Pictures
– Newspapers or magazines
– Circular advertisements
• Grocery, electronics store
• Works well for foods or objects (clothes, movie)
– Remnants
• Food wrappers, movie ticket stubs, receipts
• Internet search on “Google” then “Images”
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Resources for Materials
Make-Your-Own Boards
Use Visuals Engine online
Install Picto-Selector program
connectability.ca/visuals-engine
www.PictoSelector.eu/index.php
•Requires free log-in
•Design & print
communication boards with
1-16 images per page
• Free software to download
• Design & print
communication boards
– Saves as PDF file (can’t edit)
•Use Connectability pictures
or upload own photos
•Can add text label
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– Saves as file to make changes
later OR PDF file
• Can easily rearrange boards
• Gives access to 1000s of
picture symbols or upload
own photos
Resources for Learning
• National Service Inclusion Project (Search “Video
Tutorial”)
– http://www.serviceandinclusion.org
• American Psychological Association (Handout)
– http://www.apa.org/pi/disability/resources/publicatio
ns/enhancing.aspx#You
• Manual by & for Self-Advocates
– http://www.gmsavt.org/index.php?option=com_cont
ent&view=article&id=33&Itemid=4
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Resources for Learning
CommunicatePA.wikispaces.com
– Website, E-mail listserv
IDS specific
CommunicatePA.wikispaces.com/ids
• Calendar
• iTechnology Information
 App presentation
 List of PIAT’s loaded apps
 Links to Resources
• Behavior & Communication
 PBS presentation
 Example Visual Supports
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 Local, Statewide, & Webbased Training Events
• Resources
 Information
 Product-Devices
• Providers
 Lists SLPs working in AAC
Your Role
You learn to:
• Encourage your consumer to communicate
• Use tips to make communication more effective
• Educate others about communication
You’ll leave with customized information:
• Communication Profile
• Allow Me! Strategies for Supporting
Communication
• Resources for learning more
82
Wrap-Up
• Questions? Comments?
• Thank You!
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