Communication is for EVERYone How to Help Support Communication Carrie Leonhart, M.S., CCC-SLP Augmentative Communication Services Coordinator March 2013 9:00-11:00 Present; 11:00-11:30 Q&A Westmoreland County BH/DS

Pennsylvania’s University Center for Excellence in Developmental Disabilities Education, Research and Service

VISION A society where all people are valued and respected, and where all people have the knowledge, opportunity and power to improve their lives and the lives of others. MISSION The Institute on Disabilities leads by example, creating connections and promoting networks within and among communities so that people with disabilities are recognized as integral to the fabric of community life.

"For people without disabilities, technology makes things easier. For people with disabilities, technology makes things possible.” A program of the Institute on Disabilities at Temple University

Introductions and Welcome Location Emergency Exits Bathrooms Cell Phones? Survey Your role Your current knowledge Participation is encouraged! Questions throughout + Q&A at end

Think Green! To request an electronic or alternate format copy of this presentation Email ATinfo@temple.edu To view a web-based copy of this presentation See the “Communication & Inclusion” page of CommunicatePA.wikispaces.com We strive to be environmentally friendly.

Learning Objectives Identify 2 strategies for supporting someone’s communication efforts Describe your role in supporting effective communication Identify resources in PA for communication supports

Why Communication? Effective communication allows the person to: Interact with and control environment Express needs and wants, Make choices, Share preferences, Socialize Express self-determination, advocacy, and self-empowerment Access and participate in: home, education, community, and employment activities

Why Communication? No standard or “typical” people who benefit from communication supports (AAC) Anyone with Complex Communication Needs (CCN) No one should be denied a chance Risk being misunderstood or ignored

Why Communication? 20-30% of people served by ODP (MH/MR) in PA don’t have effective communication using speech (IM4Q data) Only 1/3 of this population have “formal communication system” in place They need people (like you!) to advocate for and support their communication

Communication Bill of Rights

Why Communication? Effective communication allows the person to: Provide an effective way to express self Functional vs. Non-functional (appropriateness) Throwing food on floor to indicate done vs. pressing a recorded button that says “all done” Shift perspective & raise expectations

Why Communication? Behavior IS communication Including challenging, inappropriate, or self-injurious actions Providing a different mode of self-expression can reduce these undesired behaviors Reduce frustration, fear, and anxiety

Why Communication? “Careful attention to communication reveals that behaviors that on the surface appear to be random, maladaptive, or challenging, are purposeful…” Olney, M. F. (2001). Communication strategies of adults with severe disabilities: Supporting self-determination. Rehabilitation Counseling Bulletin, 44, 87-95.

Not being able to speak is not the same as not having anything to say clearly

CommunicatePA.wikispaces.com Communication & Inclusion http://communicatepa.wikispaces.com/Communication+%26+Inclusion Communication Bill of Rights Presentation Action Steps

Communication Overview and Strategies WH’s of Communication Why do we communicate? What do we communicate? How do we communicate? When/Where do we communicate? All the time, Everywhere Who do we communicate with? Everyone we interact with

Why We Communicate To “give information to, or receive information from, another person” Expression AND Understanding To share an understanding of information and perspectives Adapted from: National Joint Committee for the Communicative Needs of Persons with Severe Disabilities, 1992

Why We Communicate Types of Communicative Interactions Express Needs and Wants Ask for directions, order food, request an item Information Transfer Wide variety of topics, problem solving, personal stories, details

Why We Communicate Types of Communicative Interactions Social Closeness Content not as important as interaction Develop and maintain relationships Jokes, Cheering, I love you Social Etiquette Politeness (Thank you, please, etc)

Supporting “Why” Provide opportunities for interaction Offer choices (to express needs/wants) Include gestures, objects, or pictures to show options Be an active listener Allow time for social relationships “Take Time, Take Turns” With family, friends, roommates, and staff Encourage social etiquette Makes person seems more polite AND competent

Vocabulary Labels Items, People’s names, Places Feelings, Emotions Actions (Verbs) Ideas Perceptions, Opinions Knowledge / Facts Jokes, Stories Grammar What We Communicate

Supporting “What” Provide vocabulary to discuss variety of content (ALL your topics, activities) Consider type of symbol (objects, photos, pictures) Example: excited!

Supporting “What” Visual Scene Displays Whole views, in-context New research – may be more effective for young children, aphasia

Supporting “What” Materials Resources FREE! Low-Tech AAC or “Aug Comm” Materials www.speakingofspeech.com/AugCom_Materials.html Topic and routine-specific communication boards Social stories Materials saved in PDF format (even if made in Boardmaker) Emergency Preparedness Boards disabilities.temple.edu/aacvocabulary

How We Communicate Conventional Signals Understood by everyone (within a culture) Speech Tone of voice? Facial expressions? Body Language? Written text Gestures Signs? Pictures / symbols Unconventional Signals “Idiosyncratic” = specific or unique to that person Vocalizations (Sounds) Gestures / Signs, Self-Injurious Behavior? Facial Expressions, Body Positioning Pictures / Symbols, Objects, Textures / Tactile, Communication Boards / Devices

Supporting “How” Notice ALL the ways the person communicates When 1 mode breaks down, try another way Explore assistive technology and/or Augmentative and Alternative Communication (AAC) Strategies and supports (low-tech to high-tech devices) to minimize or compensate for communication difficulties Provide opportunities to practice communication and build on skills

CommunicatePA.wikispaces.com AAC 101 http://communicatepa.wikispaces.com/AAC+101 What is AAC? (and where to get it) No Tech • Low Tech Mid Tech • High Tech

Examples of AAC No Technology Strategies No extra equipment involved Use natural communication abilities May be difficult to interpret Specific to the individual Ask the person about preferred communication style Example Strategies Ask yes/no questions to clarify Partner-Assisted Scanning (offer choices out loud, person answers with “that one”)

Using Sounds and Speech

Using Body

Communication Profile Document the unique ways the person “says” things Helps new or fill-in staff A record across settings Keep working copy (separate from formal plan) that can easily be updated Include ?s or guesses to help problem-solve

Range of AAC (AAC = AT for Communication) Low Technology Simple, usually home-made “equipment” Printed pictures, communication books, ABC boards Mid Technology Recordable device Paper “overlays” (static display) show 1-128+ buttons/msg Can hold multiple pages (levels) of recordings & pictures High Technology Speech-generating device (no need to pre-record) Computer screen (dynamic display) Other advanced features (ECU, calendar, etc.)

Your Turn Challenge - use AAC “ways” to find out about me

Visual Supports Schedules and Lists Support understanding (& reduces anxiety) Increase predictability Warn of schedule changes When activity is “all done Provide information about expectations If… Then… Support independence and participation Plan together (out loud, pictures, written)

Behavior Supports

CommunicatePA.wikispaces.com Behavior & Communication http://communicatepa.wikispaces.com/Behavior+%26+Communication Visual Supports Problem-Solving Visual Social Story First-Then / Token board Visual Schedule Rules Timers

AAC Overview Keep it simple 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) Goal is to be engaged in the communication (conversation) process Build on person’s existing communication skills Use creative problem-solving! DON’T give up

When/Where We Communicate WHEN Playing Eating Working Watching tv Riding in the car Anytime we’re awake! WHERE Home Day program, Work Community Activities Grocery Store Church Gym, Park Everywhere we go!

Who Do We Communicate With Familiar Parents, Family Friends, Roommates Staff? Boss, Co-workers, Job Coach Less-Familiar New, Temporary, or Substitute Staff Clerks at stores Teammates Emergency personnel (security, police, fire) Strangers

Supporting “When/Where” & “Who” Provide supports across settings Help ensure boards/devices go everywhere Allow person to practice skills with others (given support) Allow opportunities to practice communication and build on skills

Communication Overview WH’s of Communication Why do we communicate? What do we communicate? How do we communicate? When/Where do we communicate? All the time, Everywhere Who do we communicate with? Everyone we interact with

Your Turn To communicate, a person needs… (true or false?) To be able to understand and use picture-symbols 90% of the time. To have clear speech. To have language. Good hearing. To have an IQ of __. To have mastered cause and effect. To be able to read and write at a 3rd grade level or higher At least a 500 word vocabulary.

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…

Communication Overview Expressing and understanding Shared information between a “sender” and “receiver” People with disabilities can have trouble understanding others and being understood by others

Everyone CAN communicate Everyone DOES communicate!

Mobile Technology Portable, generic, easily‐available devices, including: Music/game players (Apple iPod Touch, Nintendo DS) Smart phones (Droid, iPhone, Samsung Galaxy S) Tablet computers (Kindle Fire, iPad, Galaxy Tab) May run "apps" (applications or programs) Are becoming increasingly popular for use as assistive technology iPods, Androids, Smart Phones, Oh My!

Mobile Technology Why are they being used? An “all-in-one” solution Apps for most AT functions What’s the problem? Choose Tools before Task Poorly-informed assessments Not magic Sensory needs, vision, durability, etc.

Uses of Mobile Technology Learning/Therapy Tool (Professional use) Use as teaching material Vocabulary, grammar, reading, writing Social stories, video modeling Promote home practice or carry-over Use for Professional Data collection E-mail, documentation Assistive Technology (Family/student use) Use for communication AAC apps from low-tech (pic boards), to mid-tech (recordable buttons w/ pics), to high-tech (adv. language layouts w/ synthesized speech) Use for hearing, vision, fine motor, behavior, and MORE

Uses of Mobile Technologies For consumers, families, and/or professionals

Mobile Technology Communication Starter to Full-Featured Apps Text-to-Speech (TTS)

Mobile Technology Social (Pragmatics) Video modeling, Prompts, Teaching new skills Language Vocabulary, Grammar Including Foreign & Sign Language Reference: Dictionary, Thesaurus, Spell Check, Word Webs

Mobile Technology Fine Motor Tracing, Swiping, Games Literacy Writing, Spelling, Reading Organization / Behavior Timers, Schedules, Prompt Systems Daily Living New Skill Learning, Safety, Task Lists Hearing & Vision Magnification, Sound Checks, Amplification, Telecommunication

CommunicatePA.wikispaces.com iTechnology Communicatepa.wikispaces.com/iTechnology Presentation List of Apps Resources

Supporting Communication Communication is a life-long process Communication (and AAC) are constantly evolving Person’s needs (why, how, what, who, when/where) Technology, understanding of what works, experiences AAC doesn’t have to be either / or A variety of strategies and tools can (and ARE) used at one time One device/strategy may not (and doesn’t have to) meet all needs

Supporting Communication Adjust your behavior as the communication partner Be creative problem solvers Provide opportunities to practice communication and build on skills

Supporting Expression Provide extra time (take time, take turns) Let her know you’re ready to listen, no matter how long it takes Choose “easy” talking environments Low stress, distractions Plan ahead What do you want me to do when ___?

What?!?! 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 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

Your Turn What DID you understand? 1:33-2:00 (You at least know what she’s feeling) http://www.youtube.com/watch?v=dTCm8tdHkfI 0-:20 (Maybe she just couldn’t hear him) http://www.youtube.com/watch?v=vHn83lm6UCY 1:53; pause at :40 (watch for other “ways” Shane communicates, what does his dad do to help?) http://www.youtube.com/watch?v=3P19gzkPKcQ

Supporting Understanding Use short, clear sentences Break it down into steps Avoid abstract expressions “Give me a shout when you’ve headed out“ “C U L8R” vs. “See you next Tuesday”

Your Turn Rewrite or Rephrase Instructions Following Directions What ELSE could you do? (Adaptations) Add pictures — Give background info Change requirements — Write it down

So What Can I do? Discuss Communication Annual team meetings (IFSP, IEP, ISP) Is the current system working? Should we explore other options? Do we think he/she could be communicating more/better? Team consensus identifies need for “formal” assessment Helpful info may come from progress notes, evaluations, SIS, PA Plus, SIB-R, FBAs

So What Can I do? Document communication Services: Evaluation &/or Therapy; State how often and who provides Supports: Document existing successful strategies (especially devices – even if low-tech) Goals: Incorporate AT/AAC with existing goals For example, “Jim will participate in the community by ordering from a restaurant using his communication device/strategy 80% of the time with moderate assistance.”

CommunicatePA.wikispaces.com How Can I Help? communicatepa.wikispaces.com/How+I+Can+Help Brainstorming Worksheet Communication Dictionaries Opportunities for Communicating

Services & Supports AAC services (Speech-Language Therapy) Provided (or directed) by licensed SLP CommunicatePA.wikispaces.com Providers Page May include: Initial assessment Making communication boards, Programming devices Training Person &/or Staff, Family to support communication and use recommended AAC Are funded by base MA, school-based Access, waivers, private insurance, vocational rehab

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 68

Services & Supports Experiment and explore potential devices! www.AACTechConnect.com Free trial of “Device Assistant” to learn about available features of AAC equipment Free trial of “AAC Apps Assistant” tool that compares and contrasts available AAC apps to help narrow down options and find the ones with the desired features

Funding Communication Supports Public Funding School System (EI, IUs) Medicaid (including waivers) Office of Vocational Rehabilitation (OVR) Medicare Telecommunication Device Distribution Programs (TDDP) *exceptions process* Skilled Nursing Facility Private Funding Insurance Private foundations, charitable organizations Pilot Club, Lions Club, etc. Cash Loans PA AT Foundation, www.patf.us “Previously owned” or recycled equipment PIAT’s REEP, eBay, Craigslist, and more

Pennsylvania Assistive Technology Foundation www.patf.us

AAC Resources CommunicatePA.wikispaces.com Website, E-mail listserv Provides information about AAC in PA AAC 101 Review of AAC hierarchy Free & Low-Cost Ideas iTechnology Information App presentation List of PIAT’s loaded apps Links to Resources How I Can Help Ideas for Getting Started Brainstorming Worksheets Tips for Partners Providers Lists SLPs working in AAC Communication & Inclusion Presentation & Information Action Steps Calendar Local, Statewide, & Web-based Training Events Resources Information Product-Devices

Training Resources Tips for Communicating… www.dol.gov/odep/pubs/fact/comucate.htm Video Example Provide extra time for decision-making Offer assistance (don’t assume) Be patient, flexible and supportive Treat the individual with dignity, respect and courtesy

Training Resources The FOCUSED program: A communication guide (for Alzheimer’s disease) www.musc.edu/scgec/downloads/FOCUSED%20AD%20communication_Ripich.pdf F = Face-to-face O = Orient C = Continuity U = Unstick S = Structure E = Exchange D = Direct

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: ATinfo@temple.edu Web: www://disabilities.temple.edu/piat Mention area of need (“communication, vision, hearing”) and where you heard about us!

Learning Objectives Identify 2 strategies for supporting someone’s communication efforts Describe your role in supporting effective communication Identify resources in PA for communication supports

Your Turn After today, I will do/think about (topic) differently. I will tell (person) information I learned in today’s presentation I need (resources) to help me follow-through on today’s action plan.

Wrap-Up Questions? Comments? Fill out and return the Evaluation Form Thank You!