Today's guest post in the Stepping Outside Your SLP Comfort Zone is my friend Jessica Solari from Consonantly Speaking!
When I was in graduate school, my two favorite areas of study were fluency disorders and augmentative and alternative communication (AAC). I definitely was more interested in the technology side of AAC, as I am a very techy person. We had a device lending library at college, where I spent a lot of time. I actually took the AAC course twice, once at my undergrad college as an undergrad credit (I could have chosen to get undergrad/grad credits) and once at my graduate college as a graduate credit. This was the smartest thing I could have done because the two courses were taught slightly differently. With one professor, I felt like I got a lot more time with devices, device types, how to program the devices, and even wrote an entire comparison-type manual about the devices. With the other professor, I felt like I learned and created and used a lot more low-tech AAC and really felt comfortable about evaluating someone for AAC. The second professor even would come in each class period pretending to be a different client for us to evaluate and we sat in on a couple occupational therapy classes to learn about positioning.
Fast forward four years later, and I had not used an AAC device or much low-tech AAC in the schools. For four years, all of my clients were verbal and a few needed visuals from time to time for vocabulary and word-finding skills. I would not feel comfortable assessing someone for a device today. After leaving my first long-term school position, I decided to cover another speech-language pathologist’s (SLP) maternity leave. When I read the goals of some of my students and met them, I was nervous. I had not used an entire AAC system of communication since graduate school and there were multiple non-verbal/2-3 MLU children in the ECSE classroom I was working in. However, I am always up for a challenge and to learn new things/refresh previous skills.
The best thing that an SLP with a new caseload can do is read through goals, IEPs, and recent evaluations/medical history as well as meet the students/observe the previous SLP prior to working with the students. I went in two-weeks prior to starting to do exactly this and I am positive that it helped immensely. The ECSE classroom used a communication book called the Pragmatic Organisation Dynamic Display (PODD). The special education staff went to a training on how to use the PODD the previous year. They had just started using the PODD 100% of the time just before I started working there, but the special education teacher of the ECSE classroom used the PODD so much throughout the day, as well as her parapros, that they seemed like masters! I was definitely intimidated.
The second best thing that I did was taking home one of their extra PODD communication books to practice using it, because I didn’t have training. I practiced using the PODD on my husband. I practiced two different lesson plans, written out word for word, action for action, multiple times with the PODD. I desperately looked for professional development, especially webinars, on the PODD online and could not find much of anything.
By the third day of using the PODD, to my surprise, I had many compliments of how fast I learned how to use it. Within the first month, the occupational therapist and speech-language pathologist team who were evaluating one of my students for a more technical AAC device thought I was a pro at it. The best two things about the PODD, that helped me learn how to use it without training, were the P and the O. P – Pragmatic means that you use the communication book throughout the day in socially appropriate situations. In addition, there are a lot of pragmatically appropriate phrases within the book as well as in the way you move through the pages during conversations. O – Organised means that everything is organized in categories with tabs. Everything you need to talk about bubbles (one of the most used pages for us) is on the bubbles page. To get to the bubbles page, it is in the toys or play category and its image shows which numbered tab (also labeled “Bubbles”) to flip to in the corner. The first two pages contain phrases to start conversation as well as the most commonly used pages. What I also love about the organization of the pages is that you can copy a page for an activity to be used at home or post it in pragmatically appropriate locations in the classroom. For example, the sandbox page was photocopied and placed above the sandbox in the classroom. So, although we all carried a PODD at our hip, the child or adult could point to the words/pictures immediately related to the activity he or she was participating in without us having to flip through pages.
Other than learning to use the PODD, I had to think about communication using activities not included in the communication book. Since the ECSE did not have a high tech device for any of the students at the time, I used the PODD in conjunction with communication boards that I made myself a lot of the time. Luckily, since I did not have a copy of Boardmaker (the special education teacher did, but didn’t have a computer to use it at home), I used a website called Lesson Pix to create communication boards. For example, I would use the PODD to tell the students that we would be looking at a book and leave the book page open so that they could say phrases like “turn the page”, but have a communication board that I created with specific characters in the book to the side in the same style as the PODD pages. Another way that I used a communication board was in preparing one child for using a high-tech communication device. The occupational therapist and speech-language pathologist evaluation team for AAC were there multiple times, so I got to observe some of their evaluations. This really helped refresh my memory on AAC evaluation. They decided to start this child using the Dynavox application for the iPad/Android with a key overlay. They weren’t going to start with too many buttons, but start using semantic compaction so that the student would be able to use core words that would always stay in the same spot on the device as the students’ vocabulary grew. There was a device at home that the student used, but it did not travel to school as placement for this child was being determined as well within a month. However, the speech-language pathologist laminated a board of what the screen would look like so that we could use it along with the PODD. I wasn’t there long enough to see much progress for this particular student, but what I did get to do was collaborate with other team members, review appropriate communication goals for the child’s upcoming IEP, view an AAC evaluation, and use multiple forms of AAC at a time to meet students’ communication needs. For many of the other students I heard first words, saw them carry around their own PODD to communicate, become more intelligible, and expand their utterances. Who knew so much could be learned in the course of 3-4 months; but it was all thanks to the consistency of the staff!
This post is not to tell you to learn to use any form of AAC without researching it or attending a training course on it. As you can see above, I researched as much as I could. I even asked to go to a course, but since I was only there for 3-4 months and no spots were available, I couldn’t go. However, when a form of AAC has already been set in place for a child, you must adapt and learn as much as you can immediately to communicate with the child and grow their communication. If you get training before, that’s the best case scenario, but do your best to help them communicate until you can get the training. I know there are some programs, such as PECS, where it is not recommended to do communication therapy with that child without the training However, there are ways to use the system, such as the PECS symbols or a form of AAC on the side, that will not undo the program/do any harm. Do not begin using AAC without first consulting a licensed speech-language pathologist.
With AAC and with new research and techniques coming out all of the time, it is important to keep yourself up to date. You can do so by reading journal articles, the ASHA Leader, ASHAsphere, SLP blogs, keeping your CCC’s active through professional development, and by collaborating with other professionals. New territory can be frightening at first, but the way I see it is that it is a new adventure in which I get to be a lifetime student!
Jessica Solari, M.A. CCC-SLP is a speech-language pathologist who writes articles on the blog Consonantly Speaking. She blogs about mobile applications, materials, techniques, therapy ideas, and topics related to speech-language pathology. Jessica also created and manages SpeechieFreebies, an award-winning blog where speech-language pathologists can find free materials to use in their therapy sessions. Be sure to follow her on social media!