Stepping Outside Your SLP Comfort Zone – Refreshing AAC Skills

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!

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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!