Transcript AAC EBP Group The many environments of AAC

AAC EBP Group
The many
environments of
AAC - Which are
most effective?
Presented by:
Trisha Khatri (ADHC Hurstville)
Clare Thomson (ADHC Parramatta)
How we decided what to CAT
● 2013: Investigated the barriers and facilitators to AAC
use, but did not do a CAT.
● 2014:
o Group members all conduct AAC intervention in
different environments.
o Decided upon an extension of 2013’s topic as it
covered a large area of research that is of interest to
all members of the group.
o Investigated environmental factors in more detail
● We also investigated some of the benefits of AAC, but
did not do a CAT for this topic.
Clinical Question
In children learning to use
Augmentative and Alternative
Communication, which environment is
most conducive to successful
implementation?
http://www.marion.k12.fl.us/
dept/ssp/trn/
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yID=9751&subid=9751
Literature Search
● Databases used: Medline, Proquest, ERIC, Psychinfo,
OVID, EBSCO, Google Scholar, Scopus, Cinahl and
Pubmed.
● Search terms used: clinic, school, home, respite,
community access, preschool, child care, early
intervention, AAC, augmentative and alternative
communication, low technology AAC, high technology
AAC, multimodal, functional approach, clinical
approach, successful implementation.
● 36 papers were summarised.
Main points from literature
search and clinical experience
● Light (1989) proposed that “communicative competence
is the ability to functionally communicate within the
natural environment and to adequately meet daily
communication needs”
● The World Health Organizations’ (WHO) International
Classification of Functioning, Disability and Health
● Many barriers and facilitators to AAC implementation
are environmental factors.
Main points from background
reading and clinical experience
● “Lots” of low level evidence in a number of
environments.
● Very little evidence comparing environments.
● Is there a particular environment that appears to be
most conducive to AAC implementation based on
barriers and facilitators within it?
● Do different environments encourage the development
of particular skills?
Results
6 papers were CAPped to answer the clinical question.
Reference
Environment
AAC method
Level of Evidence
Van Der Schuit,
Segers, Van Balkhom,
Stoep & Verhoeven
(2010).
Home and day care
Manual sign systems, combination of speech and
manual signs, graphic symbols, and VOCAs.
Level IV
Cosbey & Johnston
(2006).
Inclusive Classroom
Single switch voice output communication aid
(VOCA).
Level III-3: (Multiple baseline
probe design across 3
subjects)
Stoner, Angell &
Bailey, (2010).
Inclusive school
Dynawrite (VOCA)
Single case study
Dodd & Hagge.
(2014).
Intensive 2 week AAC
camp.
Nonelectronic communicator displays,
communication books, static display speech
generating devices, manual signs, and picture
symbols.
Level III-3
Clarke, McConachie,
Price & Wood. (2001).
Participants only
interviewed in school
setting.
VOCAs, low-tech AAC including at least 20
symbols, pictures or written words.
Level IV: qualitative interviews
Brady, ThiemannBourque, Fleming &
Matthews, (2013).
School and home
Speech, Sign, PECS and Speech Generating
Devices (SGD)
Level IV
Strengths & Limitations of
Research
Strengths:
● A broad range of disabilities were presented
● A broad range of AAC was discussed
● Stage of schooling of participants across the board
Limitations:
● Low level evidence
● Small sample sizes
● Limited statistical analysis
● No cross comparative studies
(ie: comparison of environments)
http://sample.campusmag.in/2014/03/20/invest-in-your-strengths-anddelegate-your-weakness/
Clinical Bottom Line
● There has been no research that compares the most
suitable environment for AAC intervention in children,
however there has been low level research conducted
in but not across a variety of environments with
successful outcomes.
● It was noted that there were a range of other factors that
appeared to impact successful implementation including
a collaborative team approach, adequate
communication partner training and input from AAC
user.
Recommendations
● There is no concrete evidence from articles appraised
that would warrant using one environment over another
for AAC intervention in children.
●
More research evidence and evidence on clinical
practice is required before further recommendations can
be made.
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Questions?
Next Year
In 2015 we will be trialling use of video conferencing in place
of face to face meetings
For more information contact:
● Ashleigh Colombini: [email protected]
● Mitchel Hurdis: [email protected]
References
Included in the CAT:
Brady, Nancy C; Thiemann-Bourque, Kathy; Fleming, Kandace & Matthews, Kris (2013) ‘Predicting
Language Outcome for Children Learning Augmentative & Alternative Communication: Child and
Environmental Factors’ Journal of Speech, Language & Hearing Research 56 (5) pp. 1595-612
Clarke, M., McConachie, H., Price, K., & Wood, P. (2001). Views of young people using
augmentative and alternative communication systems. International Journal of Language and
Communication Disorders, 36, 107-115.
Cosbey, J.E., Johnston, S., (2006). Using a single switch voice output communication aid to increase
social acces for children with severe disabilities. Research and Practice for Persons with Severe
Disabilities, 31(2), 144-156.
Dodd, Janet. L & Hagge, Darla. K (2014) ‘AAC camp as an alternative school-based service delivery
model: A retrospective survey’ Communication Disorders Quarterly 35 (3) pp. 123-132.
Stoner, JB, Angell, ME & Bailey, RL (2010) ‘Implementing augmentative and alternative
communication in inclusive educational settings: a case study’ AAC: Augmentative and Alternative
Communication 26 (2) pp. 122-35
Van der Schuit, M., Segers, E., van Balkom, H., Stoep, J., and Verhoeven, L. (2010). Immersive
communication intervention for speaking and non-speaking children with intellectual disabilities.
Augmentative and Alternative Communication, 26, 203-220.
References for background question available on request.