Explain digitized speech is recorded speech

It Takes Two to Communicate How I Can Help Enhance Communication Carrie Leonhart, M.S., CCC-SLP Augmentative Communication Services Coordinator May 18, 2012 2:15 – 3:30 Philadelphia Regional Conference on Developmental Disabilities

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 Survey Your role and Current Knowledge Housekeeping Presentation posted at www.CommunicatePA.wikispaces.com (“Communication & Inclusion” Page) Questions Time at end Phone or e-mail

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

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? Effective communication allows the person to: Provide an 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

Communication Bill of Rights

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

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

Who uses AAC? There are no standard or “typical” users Complex communication needs (CCN) Any discrepancy between ability and need Temporary vs. Long Term Receptive vs. Expressive No one should be denied a chance

What if we don’t try AAC? Risk being misunderstood or not listened to: “Behaviors” Often communication attempts Functional vs. Non-functional (appropriateness) Throwing food on floor to indicate done vs. pressing a switch that says “all done” Shift perspective & raise expectations

Examples of AAC No Technology Strategies No extra equipment involved Uses 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 Inventory Helpful for new or fill-in staff A record across settings Keep a copy separate from formal plan (in home-work notebook) that can easily be updated Include ?s or guesses to help problem-solve

Examples of AAC Low Technology Simple and readily available external equipment Materials are inexpensive, easily made and replaceable

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

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

Examples of AAC Mid Technology Equipment that requires source of power (typically battery) Easy to program Printed overlay can use pictures, symbols, and words Can record (digitized) speech Recording can be matched with abilities Static display with no computer features $80-$3000

Examples of AAC High Technology Equipment with rechargeable power source Require most training, support and maintenance Speech-generating device Can produce synthesized speech Some also allow recorded (digitized) speech Dynamic display with computer features Environmental controls, computer access $1500- $16,000

iTechnology CommunicatePA.wikispaces.com “iTechnology”page

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” Adjust your behavior as communication partner Be creative problem solvers People with disabilities can have trouble understanding others and being understood by others

Everyone CAN communicate Everyone DOES communicate!

So What Can I do? Ask team to start the process Team (IFSP, IEP, ISP) should discuss functional communication every year (is the current system working?) 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.”

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 47

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

Action Steps Spread the Word Learn More Test Yourself CommunicatePA.wikispaces.com Communication & Inclusion page

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

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

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

Resources CommunicatePA.wikispaces.com Website, E-mail listserv Provides information about AAC in PA Office of Developmental Programs Communication Bulletin Communication Champions (Philadelphia) iTechnology Information App presentation List of PIAT’s loaded apps Links to Resources Calendar Local, Statewide, and Web-based Training Events Resources Information Product-Devices Providers Lists SLPs working in AAC

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

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!

Wrap-Up Questions? Comments? Thank You!