CMJ Vol 26 No 2 - Communication Matters

AUGUST 2012 Volume 26 Number 2

THE JOURNAL OF COMMUNICATION MATTERS / ISAAC (UK)

IN THIS ISSUE

AAC in Northamptonshire: Involving parents

GOAL! Creating a Resource to Facilitate ClientInput to Goal Setting

Group Work to Promote Communication andLiteracy

How Was School Today...? In the Wild

Making the Transition from Paper Based SymbolResources to Interactive Teaching Resources

My Communication Story From 1981 to 2012

Narrative Use in the Care Environment

PECS with Older Students and Adults?

Possible New Ways of Scanning for Switch Users

Starting from Scratch: Setting up an AACassessment service for children in Cornwall

Telling Stories: Communicative roles duringnarrative interaction

Work Experience with MPs

Your Thoughts, Your Ideas, Your Life: A Serviceuser conference

REGULAR COLUMNS

Trustees’ News & BHTA eCAT NewsHot News & Diary Dates

COMMUNICATIONMATTERS

1COMMUNICATION MATTERS VOL 26 NO 2 AUGUST 2012

2 Work experience with Sharon Hodgson MP andSarah Teather MPNadia Clarke

5 My Communication Story From 1981 to 2012Barry Smith

8 Making the Transition from Paper Based SymbolResources to Interactive Teaching ResourcesLaila Emms

11 Group Work to Promote Communication and LiteracyAnne Emerson & Sarah Riley

13 Telling Stories: The communicative roles played by anatural speaker and an aided speaker during narrativeinteractionPippa Bailey & Karen Bunning

17 AAC in Northamptonshire: Involving parentsClare Pearce & Deborah Pugh

20 PECS with Older Students and Adults?Nikky Steiner & Sarah Upton

29 Your Thoughts, Your Ideas, Your Life: A Service userconferenceOliver Lee & Christine Griffiths

35 GOAL! Creating a Resource to Facilitate Client Input toGoal SettingJulie Atkinson, Claire Hayward, Julie Sheridan & Ruth Williams

38 How Was School Today...? In the Wild: Using a mobilephone to support data collection for automatic narrativegenerationRolf Black, Annalu Waller, Ehud Reiter & Nava Tintarev

41 Narrative Use in the Care EnvironmentSuzanne Prior, Annalu Waller, Rolf Black & Thilo Kroll

43 Starting from Scratch: Setting up an AAC assessmentservice for children in CornwallAlison Webb

46 Possible New Ways of Scanning for Switch UsersJoris Verrips

REGULAR COLUMNS

23 Trustees’ News

24 BHTA eCAT News

25 Hot News

26 Diary Dates

27 AAC Evidence Base Research Project

CONTENTS

Cover: Sophie McMullen bearing theOlympic Torch (page 25)(Photo credit Mike Bickerton; courtesy of Humber NHS FT)

COMMUNICATION MATTERS JOURNALISSN 0969-9554ISSN 0969-9554ISSN 0969-9554ISSN 0969-9554ISSN 0969-9554

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Copy SubmissionPreferred text format: Microsoft WordPreferred graphics/photo formats: JPEG, TIFFCopy deadline: 12 October 2012 (Vol 26 No 3)

The Communication Matters Journal is the officialpublication of Communication Matters / ISAAC (UK),and is an ISAAC affiliated publication.This Journal provides a forum for discussion, and views expressedin any section of this publication are the views of the writer(s)exclusively: publication in this journal does not constituteendorsement by Communication Matters / ISAAC (UK) or ISAAC ofthose views expressed. This is in no way affected by the right of theEditors to edit all copy published. Publication of advertisements inthis journal is not an endorsement of the advertiser nor of theproducts and services advertised. Communication Matters reservesthe right to reject or cancel without notice any advertisement.Copyright for all published material is held by CommunicationMatters / ISAAC (UK) unless otherwise stated.

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COMMUNICATION MATTERS JOURNAL

VOLUME 26 NUMBER 2AUGUST 2012

2 COMMUNICATION MATTERSVOL 26 NO 2 AUGUST 2012

Work Experience with Sharon Hodgson MPand Sarah Teather MP

NADIA CLARKE

My name is Nadia Clarke, I am 20 yearsold, and I am disabled and I am also pro-foundly Deaf. Because of my disabilitiesI communicate using both a computercalled a DynaVox, and British Sign Lan-guage. I have a very strong view aboutthe rights of disabled people like my-self and have done a lot of campaigningabout our entitlement to equal rightsover the years. I believe that disabledpeople have the right to have a voice asmuch as non-disabled people and I wantto eliminate all the barriers that disabledpeople face each and every day of theirlives. I am hoping to go to University inthe next few years, as I want to studyDisability or Special Educational Needand Inclusion because my ambition isto advise the Government on Disabilityissues as a young Disabled woman inthe future.

Because of my ambition I decided tocontact the Government to see if I couldorganise some work experience formyself in this field. After months ofplanning I finally had a two day visitplanned for the end of May this year.This is my experience:

On Tuesday 22nd May 2012 I set offexcitedly to London, where I wouldspend the next two days with SharonHodgson, MP Shadow Minister of Chil-dren and Families as part of my workexperience. I arrived in London andstraight away was escorted to the Houseof Commons, a big traditional buildingin the heart of London. I was taken towatch a meeting taking place betweenSharon Hodgson and Jean Gross. Theywere discussing Augmentative and Al-ternative Communication (AAC), whichI found extremely interesting and in-formative.

When the meeting came to an end, I wasgreeted by Sharon Hodgson in person,and we went for lunch inside the House

of Commons. I had a chicken sandwich,which was delicious, and comple-mented the great day I was alreadyhaving. After lunch, Sharon took me tothe Houses of Parliament, which wastruly awesome! The old building wasbeautiful, and I felt privileged to see it.Sharon then took me outside where wesat near a river in the sun, ready for meto interview her. I couldn’t have askedfor a better place to be holding the in-terview.

The questions and answers were as fol-lows:

Nadia: Hi, how are you?

Sharon: Hi Nadia, I am very well, it’s abeautiful day and we are sat on the Ter-race at the House of Commons. Perfect!

Nadia: How long have you worked asShadow Minister of Children andFamilies?

Sharon: It’s coming up to two years.

Nadia: What do you like about yourjob?

Sharon: Oh gosh, I think for me it’s thebest job in the whole of Parliament andwithin the Government portfolios thatyou can have. My job covers Early Years,Children with Special EducationalNeeds, Sure Start, Child poverty, Youngcarers, school food and children'srights. So for me it’s one of the mostinteresting and most important areas ofGovernment policy.

Nadia: Interesting! Why do you chooseto work in the Labour Party?

Sharon: I couldn’t imagine being a poli-tician for any other party. Labour is theparty I feel the most affinity with; La-bour values are my values – the valuesof fairness, equality, social justice andthe fact that everybody should be ableto achieve their full potential and besupported. The fact that where and

which family you were born into shouldnot determine your life, outcomes andthe chances that everyone should have– and have an equal chance – and to goon and achieve and to live full and ful-filling lives. For me, the best party forthis is the Labour party.

Nadia: This is really fantastic.

Sharon: Thank you.

Nadia: I would like to be an advisor onbehalf of the Labour party on Disabil-ity and Communication issues.

Sharon: Fantastic, that would be great,you would be a great Advisor.

Nadia: Do you think in the future youcan see me as an Advisor, if so whencan I start?

[Sharon, Joel (Sharon’s PA) and Cheryl(Nadia’s PA): laugh at Nadia’s sense ofhumour!]

Sharon: Yes I certainly can see you as anAdvisor, you’re so good at doing that roleanyway. When you gave evidence to theSEN hearing on Labour party policy, youcame along and gave your advice, that’swhat an Advisor does. You’re going tobecome more knowledgeable in thefuture, especially after you have beento America and you have found outmore about AAC devices.

Politicians, such as myself, are alwayslooking to experts in that field, such asyourself. I mean you can really talk

Nadia with Sharon Hodgson MP


knowledgeably from your experiencearound the issues that affect, childrenand adults with disabilities.

And, I think the second part of the ques-tion asked, how can you get a job? Wellyou’ve got to apply for one, but with yourskills everybody will be keen to haveyou on board.

Nadia: I want to help create new poli-cies for disabled people and those withcommunication impairments.

Sharon: Definitely. The work that you’redoing already, to bring this to the atten-tion of the Politicians such as myself andyou’re seeing Sarah Teather tomorrow, isa key part of becoming a campaigner.

I can’t imagine the barriers you have toface in your day to day life; you need tocampaign to let people like us know,and that’s what you’re doing. You’rehere and you’re doing it very well.

Nadia: What are your views about with-drawal of support staff for Deafstudents in the exam room?

Sharon: I just think that it can’t be al-lowed to become the case because, ifwe really believe that all children canachieve their full potential, how can youwithdraw the support that acts to levelthe ‘playing field’ and to give childrenwith disabilities – in this case deaf chil-dren – a chance to compete and achieveon the same level as non-disabled chil-dren? No, I think that’s definitely an areaof policy that we need to look at strongly.

Nadia: Would you like to come and takepart in 1Voice this September? It is acharity supporting children and youngpeople who use communication aids.

Sharon: I think we looked at dates forthat and I don’t think I am available. Iwould have done if I could. So if youcan ask again for a future date, I woulddefinitely try and get the date in my di-ary early and protect it, absolutely, yes.But I think we have looked at the datefor this year.

Nadia: Don’t worry.

Sharon: [smiles]

Nadia: I have been going for 13 yearsbecause my Mum set it up. It has madea big difference to my life.

Sharon: Oh, wow, so your Mum set it up!Very good, you must be very proud ofyour Mum.

Nadia: [agrees] She is! I will tell myMum.

Nadia: I will be famous one day andyou will have wished that I was partof your team.

[Sharon, Joel and Cheryl: laugh at Nadia’shumour]

Sharon: I think you are a part of my teamalready, and I’m sure you will be famousone day, I think you’re already famousnow, I do hope that you will advise menow even in a voluntary capacity andhopefully one day in the future youmight make it your job.

Nadia: Do you like working with Joel,and is he any good?

[Sharon and Joel: laugh out loud]

Sharon: Joel is fantastic, he is an intelli-gent, capable young man who is anabsolute joy to have around, he’s verylike you Nadia, he’s happy to be aroundand full of joy and lifts your spirits, verysimilar to you Nadia. But, trouble (Sharonsigns ‘trouble’ to Nadia) – I have to keepan eye on him!

Nadia: Is there anything you would likenow to ask me?

Sharon: Oh gosh! So what would yourdream job be?

Nadia: My dream is to work, I want tobe a Government Advisor and changepolicy around Disability Rights andEducation.

Sharon: Fantastic! I think that’s a reallyamazing aspiration for a 20 year old tohave. I strongly believe that young peo-ple should have dreams and set outeach day to do something to take youcloser to fulfilling that dream and toreach that goal. Some of the young peo-ple today do not have that; they think“what chances am I going to have?” andthey don’t even have the aspiration.

I think what is amazing about whatyou’re doing is that you not only havegot the aspiration and the dream, youare doing something about chasing it,and here you are today: your secondtime in Parliament, you even gave evi-dence to the SEN review, you’re hereshadowing me, tomorrow you will bewith Sarah Teather, so already you aredoing so much to try and make thatdream a reality and I know you will do it.

Nadia: First, I want to go to University,but I don’t know what’s happeningbecause it was a really hard exam,English and barrier.

(I find English really difficult because Iam deaf. I found it hard to read andunderstand my English Level 1 exams soI failed. Now I can’t go to University be-cause I kept failing my English. This is abarrier for deaf people. Universities don’tunderstand about deaf issues. I am nowwaiting until next year when I hope totry to get into University again as I willbe 21 and won’t need English as I will beclassed as a mature student. I also wantto find a University that has an inclusiveattitude.)

Sharon: So you took an exam in English,and it was really quite difficult, I think Iwas talking to Cheryl about that before,but I think it is only a small hurdle.

Nadia: Thank you.

Sharon: No, thank YOU!

After I had finished interviewing SharonHodgson, I went to look inside theHouses of Parliament. I kept stoppingand driving my wheelchair really slowlybecause it was so awesome inside andI just kept thinking “Wow!!” We thenmoved on to watch the Deputy PrimeMinister’s questions – I thought it wasbrilliant. I left early and shadowed SharonHodgson to a meeting about learningdisability. I loved meeting those involvedas I enjoy meeting new people.

Later in the day I had an escorted touraround the Speaker’s house. This wasamazing because I got to see the bed-room and living room in the Houses ofParliament where Kings and Queens ofour history would have stayed. Unfortu-nately I was unable to meet Mr Speakerin person due to him having urgent busi-ness to attend to. Instead I meet MrSpeaker’s Personal Assistant, who organ-ises Mr Speaker’s day and co-ordinateshis business in the Houses of Parliament.

I went on to the House of Commonsbecause it was break time there, so Iwas able to go in and meet up withSharon Hodgson and her boss StephenTwigg MP, who is the Shadow EducationSecretary. We discussed the day andtalked about AAC and the possible with-drawal of support for AAC users inexaminations. I especially spoke aboutMainstream Schools, and SpecialSchools, and children with disabilitiesand the barriers they can face in educa-tion. I could see that Stephen Twigg wasimpressed with my knowledge and ex-pertise.

The day concluded on the terraces ofParliament. As the sun set over theThames, a small group of us sat andreflected over the day’s events. SharonHodgson bought drinks and asked if Iwould like to participate in future policyreviews. I didn’t need to be asked twice,I was ecstatic! Sharon’s genuine warmthwas heart-felt and I could see she reallywanted to learn about all my concernsand ideas around AAC. I know that myfuture in politics is going to happen, andprobably sooner rather than later, as Inow know that I don’t need a degree asI have the life experience to become aleader in disabilities that no degree cangive me.

On Wednesday 23 May I was so elatedover the previous day’s events that itsomehow overshadowed what was go-


ing to happen that day. Nevertheless, Iwas ready and waiting for a car fromSarah Teather MP’s office to collect meand take me to Alfred Salter PrimarySchool. It was today that I was to shadowthe MP for Children and Families arounda SEN primary school, to observe visitsand discussions with regard to theschool and its future works.

Sarah Teather was unavoidably detainedin another meeting which presented mewith a chance to meet with the SchoolGovernors, staff and the children. I hadan hour of talking and exchanging viewswith regards to disabilities, social welfareand most importantly the great news thata Year 3 student was about to discoverthe world of AAC. Never before had theschool experienced a student with anAAC before, and they showed so muchinterest in how I used my device that Iwas really pleased to have been a posi-tive role model for this pupil and theschool. The Headteacher went on to in-vite me to continue to be a role model forthe Y3 student in the new term, which Iaccepted without hesitation.

Sarah Teather then arrived, there was ashort introduction to everyone present,and she was then whisked away to lookaround the school as her time is so pre-cious. She did acknowledge me as herwork experience, but due to the size ofthe classrooms and accessibility of thecorridors, it was hard to share the sameroom and listen to her conversations.Nevertheless, my own personal experi-ence was unforgettable. I will takememories of it away with me and cher-ish them forever.

After a brief meeting, Sarah Teather’sPersonal Assistant asked if I could havethe interview, which I had already pre-pared, in the back of a taxi as she hadother meetings to attend. Cheryl, myown personal assistant, advised thatthis would not be possible due to ac-cessibility and the need for my interpreterto be present. Basically there was a lackof room in a London black cab.

Back at the Department of Education Iwas rapidly sped along to the next meet-ing, not knowing what to expect. Thismeeting was arranged by David Chater,Sarah’s co-ordinator. During the meet-ing I sat at the side of a boardroom table,as the panel discussed the issuesaround Child Poverty, which was due fordebate in the House of Commons in thenext coming weeks. I was in awe of theconversation. It was highly excitingwatching an assistant advise Sarah onan issue, then another objecting, andstating other issues that should beraised. Even though I did feel that mostof the conversation went over my head

a bit, the sheer excitement of being in-volved was overwhelming.

When the meeting came to a close Iasked Sarah if I could interview her,which she obliged as she had some flex-ibility that day. The interview questionsand answers were as follows:

Nadia: Hi

Sarah: Hello

Nadia: How are you?

Sarah: I am good thank you. It’s been abusy morning hasn’t it?

Nadia: How long have you worked asthe Minister of Children and Families?

Sarah: For just over two years. We hadthe General Election in May 2010, andthe Coalition Government was formeda week later, and I was appointed onthe Friday, so just over two years now.

Nadia: What do you like about yourjob?

Sarah: I like lots of things about my job,but most of all I get an opportunity tomake a difference. I’ve been an MP forquite a long time since September2003, so nearly nine years. You can doa lot as a ‘back bench’ MP and lots inopposition but if you’re in Governmentyou can actually get to make decisionsand I particularly like the work aroundSEN and disability and we’re trying to re-ally change the system at the moment.

Nadia: Why did you choose to work inthe Conservative Government?

Sarah: Well, it’s not a Conservative Gov-ernment, it’s a Coalition Government,and just after the election day at thestart of May 2010, no party won the over-all majority, so the Conservatives couldnot have governed on their own, Labourcould not have governed on their own,and we talked to both Labour and theConservatives and the only way actu-ally to form a government was with theConservatives, there weren’t enoughMPs if we joined with Labour to make aGovernment, but the Conservatives andLiberal Democrats negotiated to have aCoalition agreement that included thebest of our manifesto and the best oftheir manifesto, so that was the bestway in which we were able to get thethings we wanted to do and when wewere on opposition in active Govern-ment.

Nadia: In the future, what do you planto do to support Disability Rights forChildren and Young People?

Sarah: Well, we are rolling out a big re-form at the moment for SpecialEducational Needs and Disabilities, andwhat we are trying to do is to make theeducation system work much better

and make sure children get the supportthey need early enough to make surethey can progress and develop. We knowthat lots of children don’t get access toSpeech and Language Therapy, for ex-ample, when they need it. They struggleto get the right wheelchair as they strug-gle to get access to the schools theywant to go to and so we are trying toimprove the system so that all childrenget much better care at an early stageand so that they get a better chance tofulfil their potential, really, and be thebest they can be.

Nadia: Do you think that creating poli-cies for Disabled young people youshould have a Disabled advisor likeme, helping to inform you?

Sarah: Well, we involve lots of Disabledyoung people who help in developingour policies, I don’t have a disabled ad-visor as such, but the Council forDisabled People [Office for DisabilityIssues] have an Ambassador’s scheme,and they’ve consulted heavily on theproposals that we are making and I’vegot to meet the young Ambassadors ondifferent occasions to check throughwhat they think and make sure we aredoing everything in the right way, and Ithink the important thing is that we in-volve a range of children with Disabilitiesand SEN with different needs and we con-sult as many different people as possible.Just having one advisor, I am not sure it’squite enough, which isn’t to say that Iwouldn’t recommend your help.

Nadia: How can you support familiesto feel more positive about their lives?

Sarah: Well, some of it is making surethey get the help they need, you know,if you’ve been fighting the system toget your child into the right high schoolor a wheelchair, or to get a bit of extrahelp for your child in school or for abreak, then it’s no wonder you feel verynegative. I think for a lot of families,they’ve basically fought a war with Coun-cils and the Health Service for a reallylong time to get what they want, and ittakes its toll on families.

Nadia: Thank you.

Sarah: Thank you.

The morning concluded with a latelunch, after which I was exhausted, sowe said our goodbyes and went our sepa-rate ways.

I gained so much knowledge and gaineda wealth of experience over those twodays. It was a work experience that I willnever forget and that I will take with meon my way as I build a career aroundLeadership and AAC.

Nadia Clarke


My Communication StoryFrom 1981 to 2012

BARRY SMITHEmail: [email protected]

WHO I AM

I am Barry Smith and I have been livingwith Cerebral Palsy since I were born 33years ago. Since I were three years old Ihave been using different communica-tion aids to help me to get my voiceacross so everybody knows what amsaying.

When I were three years old my speechtherapist at that time, started teachingme how to sign by using my hands. Af-ter a few weeks of this the speechtherapists found this wasn't working forme. This were down to the jumping move-ments that are a part of me havingCerebral Palsy. So the speech therapistwent back to her drawing board. Thenshe tried me with a Bliss Board whichwas like a bit of card with lot of wordson it. Under each word there was a sym-bol so I can understand what the word is.

A FEW WEEKS

After a few weeks of trying this thespeech therapist told my parents shewas so happy I was picking it up so well.Then the speech therapist told them shewere trying to teach a girl about the sameage as me. She asked them “Would youmind if I take Barry to meet her, becauseshe has not seen anybody using a Blissboard. My plan is if she sees Barry withhis board, well she might start doing this

as well.” My parents were happy for meto do this.

The day I met the girl both of us wentdown beside a river sitting at a table,with both our Bliss boards on it. Whenwe were both sitting at the table I pointto my board, then I take her, hand to lether see she were able do the same asme. By the time I leave her she werehappy using her Bliss Board.

CAN'T WRITE WITH A PEN

When I went to school I couldn’t writewith a pen and because of this I use aLightwriter®. I remember what my firstone looked like – it was bigger and hada printer – the paper was rolled up like atill roll. I used this on and off for a fewyears but was still using the Bliss boardat the same time, when people can’tunderstand my speech.

MY LAST YEAR OF SCHOOL

When I were in my last year at school Iwent for a test at a college that I wantedgo to, after I leave school. The staff toldme if I wanted to do a course at thecollege, I better get a high tech Com-munication Aid. So I spoke to myschool’s speech therapist, and after-wards she sent a letter to Technologyfor the Communication Impaired(SCTCI), to ask for their help.

A few weeks later they came to meetus at my school, bringing with themthree different types of communicationaids for me to try and see which one Iliked. I preferred the Lightwriter® as Ifelt it was a nice size for me. I was askedif I wanted it mounted onto my chair – Isaid No thank you. I then got thatLightwriter® for a trial loan which gaveme time to get used to it.

AFTER I LEAVE SCHOOL IN 1997

I got a new speech therapist in NorthAyrshire who sorted me out with aLightwriter and a bag also. Then she alsoasked me would you like me to lookinto getting you a mount to put it ontoyour chair. NO THANKS, I said. At col-lege I was a part of two courses that weregreat. After I had been at college for afew months my speech therapist cameup to see me, and to give me a new SL35.The SL35 had a deep Keyguard. Thespeech therapist checked with me thatI was happy not having a mount? A cou-ple of months went by then, I got talkedinto getting a mount by my college.

2001 TO 2005

After I leave college I went and stayedwith my Dad for a few years. Then mydad take ill. After one year I move intoRed Cross House. In 2002 I was told

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about a new project just started calledGateways, for people aged between 16and 25 years old. I ask, “Could I be apart of this?” Yes, I was told.

From doing this I got supported to acourse called Partners and Poll making.From doing this I found out about myrights as a disability person. After I didthis course I tried to set up a networksupport group, this was to help me tomake dream come true. I say I want toget my own house. I started looking intohow to get a house.

One day at college I remember one ofthe staff were reading CommunicationMatters journal to us. Then they saw anad looking for Lightwriter users to go toCommunication Matters ’98 confer-ence. So me being me, I write to wintwo free places for myself and a sup-port worker to go to it? When I got wordback about this, it were great news – Iwas to go! So me and a support workerwent down for the conference. I re-member I hear a lady speak who werejust back from ISAAC. I thought intomyself, one day I would like do thatmyself.

2006

In April 2006 I got a two bedroom house– one thing I needed. It needed door ac-cess because I couldn’t open my door.My mum came and lived with me in tillmy door was fixed.

Then about June 2007 I was botheredby some young boys who were trying toact big, so I told the police about it, withmy SL35.

2008

In 2008 I found out that Communica-tion Matters were looking for AAC usersto tell their story at their conferencelater that same year. So I send in a paper“About my life story being a AAC user”.When I got word back about it, I remem-ber all I could think about was, wherecould I get the funding to pay for this?

So after I speak to my speech therapistabout this. We came up with ideas and Iasked Toby Churchill could they sup-port me? I got word back to tell me theywere happy to do this for me. Over thefew months was time to programme mytalk into the SL35 with the support ofmy speech therapist.

In September of ’08, with a supportworker, I went down to Leicester wherethe Communication Matters confer-ence were on. I remember meeting alot of people who were like me. I metthe people who work for Toby Church-ill, as well. On their stand they wereshowing the new make of Lightwriter,

which was the SL40. Their people gaveme a try; you could text with it. I sentmy mum a text – my mum couldn’t be-lieve it were me because she knew Icouldn’t send texts because of myhands.

After I came home I told my speechtherapist about this. She asked me, “Doyou think it would be any good for you?”I told her what I was told about it, thatyou could save up to five books, and itwon’t break. Then she told me shewould look into getting some fundingto get me one.

2009

One day in February 2009 I got a tel-ephone call from my speech therapistto ask me, could we met up sometime?I said Yes but I had no idea what thiswas about. When we met up, before shecould tell me why wanted to see me,for I asked her what was happeningabout me getting an SL40? She startedto laugh and went into her bag and tookout a SL40.

Then I put a paper into speak at Com-munication Matters ’09 called “How fastthe world has moved on”.

When I went to the conference, I hearda lady talking. She told everybody to gofor their Dream no matter how small orbig. My dream was to speak at the ISAACconference in Barcelona the next year.So after I came home I started to thinkabout writing a paper to speak at theISAAC conference.

2010

At the start of 2010, all I could thinkabout was how I could find the fundingfor myself and two supports workersto go with me, to do this. Just before Igave up hope, and when I was about togive up, Linda my speech therapist toldme about Augmentative Communica-tion in Practice: Scotland who mightfund a person who uses AAC. I got wordback, it was good. After getting thingsplanned for us to go, July came and meand two support workers went over andstayed for a week.

The first workshop I take part in wasover two days. A band was set up, whereI was playing the Keyboards. It was goodbecause it were different AAC users,from all around the world. This work-shop were over two days before themain conference opened. At the open-ing of the main conference I and theband had a bit to play. The Queen ofSpain was there. After the opening therewere workshops on. Many people usingaugmentative communication like mewere there. We AAC users tried to goto each others’ sessions.

2011

In March of 2011 I went to a Communi-cation Forum Scotland meeting thatgave me a different way of looking atcommunication. It was about people notAAC but with all different kinds of com-munication, and what they were finding,all around Scotland. It was a good thingto be made aware of, but I knew it werenot my type of meeting. I told them in anice way and wishing them well in whatthey were trying to do.

In April of that year I was asked for feed-back about what I think of using the newSL40+. One thing is different about this;it is a mobile telephone as well. At firstwhen I got it felt so good. Just beforethis, I put in my paper to Communica-tion Matters, about my time at ISAAC in2010. Then Linda my speech therapistasked me, would I like to do a talk atCommunication Matters with her? I toldher I would love to. When we went downto Communication Matters I did myISAAC talk, I felt liked crying when I weretelling my story, because when I lookedaround the room when I was speaking,some people who were at ISAAC 2010were here at CM2011 too. I felt this wasso nice. The next day Linda and I did ourtalk, which was great too.

About a few weeks later a lady came tosee me at my house, to tell me about aproject called “Inclusive Communica-tion in Scotland,” and to ask for me tohelp out with the project. The projectoutline was: To make sure everybodycan understand all information given tothem about health and other things, likefrom the council. And to make sure eve-rywhere in the community is accessiblefor people with communication supportneeds, like ramps for people in wheel-chairs. Remembering some people can'tsee well, or hear well, or understand andspeak well, so they might need a littlebit of more time to understand and beunderstood.

I was asked to talk about Inclusive Com-munication at some meetings aroundScotland. At the end we went to theScotland Government in Holyrood tohand into what we had found out, to-gether. I tried to get to ISAAC 2012, butthere was no funding.

2022

In ten years time, by the year 2022, Ithink communication aids wouldstopped moved on as fast because peo-ple would not have the money, It mightbe in the year 2013 that the UK govern-ment stop giving money.

Thank you all for reading this. Bye.

Barry Smith


PAPER PRESENTED AT THE CM2011 NATIONAL SYMPOSIUM, UNIVERSITY OF LEICESTER, SEPTEMBER 2011

Making the Transition from PaperBased Symbol Resources toInteractive Teaching Resources

A school’s experience

LAILA EMMSSelworthy School, Taunton, TA2 8HD, UKEmail: [email protected]

This article is about the implementa-tion of a new symbol software program(Boardmaker Studio) into the schoolenvironment. It follows the school’sjourney from trial to implementationand discusses the reality of interactivesoftware in a busy classroom setting,for children with special educationalneeds.

BACKGROUND

In December 2010, newly employed ata Special School in Somerset, I set aboutevaluating the school’s existing symbolsoftware and looking at alternative soft-ware with the aim of improvinginteraction, engagement and commu-nication in the classroom setting.

Selworthy School is a co-educationalspecial school for children and youngpeople with learning difficulties aged 2-19. It is a specialist school for cogni-tion and learning and is the holder oftwo ICT excellence awards.

There are currently 84 students on theregister, 19 teachers and 60 teachingassistants. Approximately 40% of thestudents have severe learning difficul-ties (SLD), 30% autistic spectrumdisorders (ASD) and 30% profound and

multiple learning difficulties (PMLD). Inaddition to this, there are a smallnumber of children with moderatelearning difficulties (MLD).

RATIONALE

The symbol software in use at Selworthyschool at the time was solely used formaking paper based resources and theschool had produced a variety of goodquality paper resources to meet theneeds of its very complex students.Visual timetables, communicationbooks, social stories, symbol supportfor reviews and student council meet-ings and a very extensive range ofinformation booklets (E-safety, Aboutmy Body, My Feelings) were just a fewof the resources already in place. In-deed, Selworthy had developed someexcellent resources for providing infor-mation but we began to ask ourselveswhether it really was accessible andwhether we were doing enough to helpour young people express their ideasand opinions? Was there a better, moreinclusive way of doing this?

It was reported that the symbol soft-ware in place was unreliable andalthough interactive add-ons were avail-able, it was apparent that they were not

in use. The school recognised that theremay be benefits to interactive symbolteaching resources that had yet to beexplored and more importantly, thereremained a number of students whocontinued to find paper based re-sources difficult to access and engagewith. The school was keen to engagewith these ‘difficult to reach’ students.

We were very aware that introducing newsoftware into a busy school was not go-ing to be easy and that there would beteachers who felt they simply did nothave the time to take it on board. In thiscurrent financial climate, there is notime for software that it is not userfriendly and reliable. We were determinedthat this would not be a piece of softwarethat sits on the shelf. Our aim was that thesoftware would be integral to cognition andlearning and also to the development of awhole range of associated skills.

TRIALS

Following extensive trials with two of themajor symbol software packages avail-able at the time, a list of keyrequirements was generated:

1. Reliability and ease of use.

2. Interactive elements.



3. Ability to produce paper based re-sources.

4. Versatile enough to the meet abili-ties ranging from PMLD to MLD.

Following this trial, the decision wastaken to implement Boardmaker Studioand in March 2011, twenty licenceswere purchased. The very impressiveinteractive elements of Studio werecentral to this decision. We concludedthat this was the most versatile symbolsoftware package on the market and theschool’s senior management team andgovernors were all positive about the fi-nancial commitment we were makingin purchasing this product.

IMPLEMENTATION

Having made the decision that Studiowas the right product for us, the mostdifficult part was still ahead of us – im-plementation. Enabling the staff groupto use the new software quickly and ef-ficiently was the first challenge. Thestrategy for the implementation of Stu-dio was based on the premise that thesoftware was primarily intended for in-creasing interaction, engagement andlearning in the classroom setting. Thismeant teaching the teachers to use thesoftware first.

In my experience, the majority of sym-bol resources are made by a speech andlanguage therapist or an assistant andare used as paper based resources tosupport a child’s learning. The majorityof these resources are used for chil-dren who are not literate. The makingof such resources for classrooms isoften a time intensive activity and I can-not be the only person who spendshours making individual resources, goesinto a classroom following the lessonand picks up the symbol resource won-dering exactly how much it was usedand to what effect?

The major difference in the new soft-ware was that it was intended as ateaching resource, made by teachers,for teachers, to support and increasewhole class learning. Therefore, the

training I first needed to do was withthe teaching staff – not the supportstaff.

This was a radical change in approachfor Selworthy School, but I felt it wascritical to the success of the use of sym-bols in the classroom setting. Theschool is after all, a special school andevery child in every classroom needsadditional support with their learning,not just those struggling with literacy.

So, our focus changed. It is no longerabout making paper based resourcesfor individuals who are not literate. It isabout supporting a whole school envi-ronment with 21st Century interactivetechnology to meet the very individualneeds of every student.

The implementation strategy was there-fore to load Studio onto teachers’laptops and initial training for the teach-ing staff took place. The training variedfrom twenty minutes to one hour andthe majority of the staff found the soft-ware reasonably intuitive. The majorfocus of the training was the interac-tive content of the software, enablingteachers to confidently use the softwarein their classroom setting.

The extensive range of pre-made tem-plates and activities meets the needsof our very diverse school populationand is enabling our teachers to deliverlessons using interactive symbol basedtechnology. Subsequent training forteaching assistants has concentrated onthe production of paper based resourceswhich continue to be used to supportlessons in the more traditional way.

Mayer-Johnson helped us produce atemplate for registration and every childnow has the opportunity to use the in-teractive white board independently toregister themselves in on a daily basis.They are able to tell us whether theyare having sandwiches or a school din-ner and to comment on the weather,what date it is and how they feel today.

We continue to be supported byDynaVox Mayer-Johnson and have athree hour advanced training session

planned for our teaching staff at the endof January. This extended training pe-riod is only possible because of thecontinuing commitment and supportfrom the senior management team asthe level of timetable adjustments re-quired for this is not insignificant.

OUTCOMES

Taking a fresh look at the software inuse at school was a good start at lookingat how we might enhance interaction,engagement and learning in our class-rooms and has given us the opportunityto re-think how we use symbols to sup-port our learners and whether we couldimprove our practice in this area.

The school was keen to get the best forthe students and equally important, forteachers to have reliable 21st Centurysoftware. At Selworthy School, as withmany specialist schools, concentrationand learning is often fleeting thereforeopportunities cannot be missed be-cause the technology lets you down.Classrooms can be volatile places andthe learning opportunities need to bemaximised before interest is lost

In changing symbol software packages,Selworthy School has put the needs ofits pupils first. It has resisted the temp-tation to stick with what it knows andtried to take on board the changinglearning styles and needs of its 21stCentury pupil population. We are sur-rounded by touch screen andinteractive technology in our daily lives,surely our teaching methods should re-flect this?

This one software program producesboth paper based and interactive activi-ties to meet the varying needs of thepupils. Technology has opened up aworld of possibilities. Interactivewhiteboards are being used creativelyby some teachers but there is still muchmore to be achieved and the benefitsof interactive symbols teaching meth-ods have yet to be fully explored.

MOVING ON

We have come a long way from cuttingand sticking, to the use of paper basedsymbol resources that are now reason-ably common practice in the classroomsetting. But this is only one way of facili-tating learning and its roots are basedin the 20th century.

We now have opportunities to extendcognition and learning through 21st Cen-tury technologies that are moreaccessible and better encourage crea-tivity and choice making.

Laila EmmsCommunication Specialist

Boardmaker Studio in use at Selworthy School

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Group Work to Promote Communicationand Literacy

ANNE EMERSON 1 & SARAH RILEY 21 Division of Psychology, Nottingham Trent University, Burton Street, Nottingham NG1 4BU, UK Email: [email protected] Oak Field School & Sports College, Wigman Road, Nottingham NG8 3HW, UK

Our presentation at the 2011 Commu-nication Matters National Conferencefocused on an unusual group run in OakField special school which provides all-years education to 150 children rangingfrom those with severe learning disabili-ties to those with PMLD.

One of the authors is a full-time staffmember in the school, with her ownclass and additional responsibility forcommunication and information tech-nology across the school. The secondauthor is a university lecturer and re-searcher who had been paying regularvisits to the school for several years.

THE GROUP

The group of five students was set upas an ‘experiment’ with multiple aims.We needed to find a way to see a largernumber of students on a regular basis.Some of the students had begun to re-spond to adults in individual sessionsand we wanted to encourage morecommunication between peers. We alsowondered whether the children whowere more responsive would encour-age the participation of others.

Additionally, it was important to find ameans of training staff to use success-ful techniques and since many of thesechildren could be very challenging towork with, we aimed to provide supportto staff. The group objectives were topromote student engagement in a rangeof social activities, to promote inde-pendent pointing as a means ofexpression and to make communica-tion and literacy activities fun, for bothstudents and staff.

There was an underpinning philosophyfor the group, developed through yearsof research and practice. Since one ofour objectives was to promote and sup-port engagement we rewarded all

participation, even in instances whereit was unclear whether the student in-tended to participate or had actedrandomly.

This was further encouraged by using‘no fail’ activities, such as giving a pupila range of resources to make a selec-tion from, any of which wouldconstitute an appropriate answer. Ad-ditionally, although we were particularlypromoting the use of pointing, we en-couraged students to participatethrough any means and so took facialexpression, body movement, gestureand eye-gaze as responses. Anotheraspect that later appeared to be impor-tant was the extent to which wepersisted in including students whomay have only been responding ran-domly, while treating as many of theirresponses as deliberate as we could.

A further aspect of the philosophy wasto provide a range of materials for thestudents to respond to, such as theusual symbols and pictures, and alsoletters, words and numbers. Whateverthe material being used, the memberof staff working with the student wouldtell them several times what it was.

STRUCTURE OF THE SESSION

Sessions lasted one hour and followeda consistent format. Each student wasaccompanied by a member of stafffrom their class. Since this was a socialgroup, and none of the children typi-cally appeared to be aware of theirpeers, each group started with a greet-ing. Three button voice recorders wereprogrammed with different styles ofgreetings. Each child was encouragedor supported to press each button tohear the greetings and then to choosethe one they wanted to use.

The buttons were labelled with num-bers on Post-it notes so students could

either directly press the button theywanted, or if access to this was diffi-cult they could select a number on aPost-it removed from the buttons andplaced wide apart. Obviously in this ac-tivity there was no ‘correct’ responseand any indication of choice by the stu-dent was accepted as the way theywanted to greet the group.

Initially, the second activity of each ses-sion involved projecting a news clipfrom the CBBC website onto a wall, fol-lowed by asking some questions aboutwhat the students had viewed. Somepupils could be seen to look at the clipswhile others appeared unaware. Stu-dents were given a small number ofwords or symbols with which to respondand even the pupils who did not appearto watch would sometimes consistentlyanswer correctly.

After a term of this approach a newrange of games were introduced, mod-elled around the television programmesCountdown and Play Your Cards Right.Students were required to identify thecorrect letter or playing card within thetime limit provided by the soundtrack.

Another set of activities revolvedaround sentence completion activitiesto create stories and poems. These weredesigned to make sense no matter whatselection the student made and so thatthe same materials could produce dif-ferent outcomes. Such tasks includedwriting a poem using nouns and adjec-tives and compiling an original versionof The Twelve Days of Christmas. As theyear progressed, other more complextasks were included such as questionand answer sessions between students,party planning and ‘My ideal job’ ques-tionnaires.

Students were awarded a large colouredstar for each time they participated andat the end of the session stars were



counted and a winner congratulated.This was discontinued half way throughthe first term as it became apparent thatstudents were self-motivated to partici-pate.

INDIVIDUAL OUTCOMES

Nyron was 14 when the group startedand had previously been seen individu-ally. Some years before, he had usedFacilitated Communication and hadpointed to spell words and conveymeaning. However, following a seriousillness he had been unwilling to point atall and in the group showed a prefer-ence for using a pencil.

Although he did not appear to write any-thing meaningful, he could mark thepaper and in this way select an option.At first most of his responses appearedto be random but he gradually came todiscriminate more clearly and over timebegan to participate by independentlyselecting words and pictures. For Nyronthe outcome was more independentpointing and a more constructive atti-tude to participation.

Lenny has a diagnosis of autism and wasaged 13 when the group started. He hadno clear method of communication andwe had not worked with him before. Itwas reported, by his teaching assistant,that he was able to follow basic familiarinstructions if she sat alongside him,gave a simple instruction and waited fora response. However he did not haveany reliable system of communication.In group sessions Lenny was one of thefirst students to start to respond appro-priately by independently selectingfrom a small range of options, despiteappearing not to look directly atchoices.

Commencing in the group, and throughcontinued work in class between ses-sions, Lenny further developed hisindependent communication andstarted to use Facilitated Communica-tion to express himself more fully, oftengiving verifiable information, such aswhat he had done at the weekend, tostaff. Once Lenny had started to pointand communicate consistently, informa-tion on supporting his communicationwas relayed to his family.

Anita was the most obviously expres-sive member of the group. She was 14at the start, with a diagnosis of cerebralpalsy, but despite her willingness to at-tempt to communicate, no clear methodhad been established with her. Her re-sponses tended to be inconsistent andit was not clear how much she couldunderstand. The routine of the groupappeared to help her, and she seemed

very motivated to try to compete withthe others.

We had not worked with her before andfocused on establishing a consistentmotor pattern that she could practice.Her hand was placed in the same posi-tion at the start of each point and shewas helped to wait before moving togive herself time to look and select. Shestarted to be able to order words tocreate a sentence and provide informa-tion about herself. The speech andlanguage therapist was asked to seeAnita and provided a DynaVox whichshe now uses independently to selectwords and express herself. Althoughsome of the work on learning to usethe technology has occurred outsidegroup sessions, it was her motivationto participate and her success with par-ticular activities that raised staffexpectations of her ability to commu-nicate.

Natalie was well known to the authorswho had been supporting her with heruse of Facilitated Communication forfive years. Although at times able tocommunicate effectively, she was gen-erally slow to respond and had atendency to giggle and be unable to pro-ceed when she was the focus of adultattention. Work had focused on the de-velopment of independent pointingwithout much success prior to thegroup. In group activities she continuedto frequently be slow to respond butthe element of peer competition, andnot being the sole focus of attentionappeared to help her to concentratebetter and she has been able to makeindependent selections more thanpreviously, now regularly selecting inde-pendently from a choice of two or three.

Christina was aged 12 and presentedwith autistic features and challengingbehaviour. We had not worked with herpreviously and this was the student whostood out in the group as the personwho appeared to be least aware of whatwas happening around her and who visi-tors commented was not gettinganything from her attendance. Shewould reach for anything put in front ofher and put it in her mouth.

Over time it was discovered that sheresponded very well to structure andcould point when taken through a seri-ous of steps reminding her to hold herhand still while she looked, and thenpoint. Towards the end of the first term,Christina appeared to be more awareof the routine and respond to expecta-tions. She started to press the buttonson the recorders to say “hello” and par-ticipated increasingly in all theactivities. After many months she

started to spell words by putting Post-itnotes into the right order and independ-ently spelled ‘A d e’ when asked tochoose a role model in one of the ses-sions (Ade Adepitan).

GROUP OUTCOMES

Evidence from video records, observa-tion and record keeping showed that allthe students made changes over thefirst year of attending the group whichappeared to be linked to their attend-ance. The achievement of the studentsin the group, and the extent to whichthe group has been perceived by staffas beneficial and effective, surpassedour expectations.

Despite the students having no obviousobservable awareness of each other,they all seem to have impacted on eachother. All the students improved theirspeed and rates of response over timewhich, we hypothesise, may be due tothe element of competition and also be-cause if they did not respond, theactivity moved on and the opportunitywas lost. This was in contrast with indi-vidual sessions where we would tend tocontinue to wait and prompt studentsto respond for longer periods of time.

We feel that they benefit from not be-ing the sole focus of attention, and thatstaff benefit from continuing to be mo-tivated to keep trying as at some pointthere would be at least one pupil re-sponding, even if others were not doinganything. Each time a student partici-pated, or achieved something new, theatmosphere of the group as a whole in-creased in positivity which seemed toset up a cycle of achievement. It alsoappears that, by being in groups ofpeers, the students served as role mod-els for each other and that this led to anincrease in skills.

Our ‘no fail’ approach, particularly in theearly sessions, allowed the students totake risks in responding and thereby todevelop their self-confidence, increas-ing the cycle of being willing to attemptan answer.

The agenda of staff training was defi-nitely met, staff were very positiveabout coming to the group and wouldprioritise attendance. They consistentlycommented on how much they en-joyed the session and how delightedthey were at the achievements of thepupils. This appeared to lead to raisingexpectations in class and more con-certed efforts at supporting students todemonstrate their abilities in all situa-tions.

Anne Emerson, LecturerSarah Riley, Teacher



Telling Stories

The communicative roles played by a natural speaker andan aided speaker during narrative interaction

PIPPA BAILEY & KAREN BUNNINGSchool of Allied Health Professionals, University of East Anglia, Norwich NR4 7TJ, UKEmail: [email protected]

BACKGROUND

This paper presents findings from a sin-gle case as part of a current PhDresearch project focusing on the use ofaugmentative and alternative communi-cation (AAC) during narrative interactionbetween aided speaking pupils and theirteaching staff. Within education, themost important conversation partnersfor an AAC user is their teaching staff(Popich & Alant, 1999) and therefore,staff-pupil interactions are highly signifi-cant for an AAC user’s languagedevelopment (Millar, 2001).

Narrative has been identified as beingimportant to a child’s language devel-opment and in normal developmentnarrative begins to emerge from as earlyas 3 years old (Owens, 2008). The useof narrative with AAC users has there-

fore been suggested as key to devel-opment (Liboiron & Soto, 2006).Narrative focuses on the sharing of ex-perience, and this is why it is viewed ascentral to the English curriculum (Grove,2005). Despite this, the narrative inter-action between AAC users and theirteaching staff remains under-re-searched.

METHODOLOGY

The aim of the study was to examinethe key features and communicativeroles employed in narrative interactionsbetween pupil (aided speaker) andteaching staff (natural speaker). Ethicalapproval for the study was granted bythe University of East Anglia School ofEducation and Lifelong Learning EthicsCommittee.

Due to the small population of high-tech AAC users, participants wererecruited using a convenience samplingmethod using an inclusion/exclusioncriteria. Participant demographics ofaided speaker (AS) and natural speaker(NS) participants are shown in Tables 1and 2.

Four data collection sessions were heldwith each participant over a period ofthree months. All data collection ses-sions were completed in a familiar roomwithin the participant’s school to mini-mise reactivity to the environment. Onceboth participants were comfortable inthe research environment the NS heldan informal conversation with the AS andexplained the narrative tasks to be com-pleted. This ensured that bothparticipants became familiar with the en-vironment, limiting reactivity to the videocameras used.

Two video cameras were used for datacollection: one to capture both partici-pants from the front and a secondcamera to capture the AS’s devicescreen and a more accurate picture ofthe NS face. A digital voice recorder wasalso used to ensure a high quality ofaudio recording.

Fictional stimuli used were all selectedfrom well known speech and languagetherapy assessments: Renfrew Bus Story

tnapicitraPSA)SNtnaveler(

egA sisongaiDelpicnirP desueciveD emitfohtgneLecivedgnisu

)1SN(hsoJ 11:7 DSA sulleTiboM shtnom4

)2SN(yllaS 80:21 yslaPlarbereC ezagilletnIaelA shtnom4

)3SN(revilO 60:9 lamosomorhC,aixarpsyDytilamronbA

artlU1Q-PNgnusmaSerawtfosklat-Qhtiw

shtnom21

)4SN(neB 11:01 yslaPlarbereC 4TMIIIxovanyD sraey3

Table 1 AS participant demographics



(Renfrew), Peter and the Cat (Black SheepPress Ltd) and The Squirrel Story (BlackSheep Press Ltd). For this task the NSpresented the AS with a picture bookpositioning it so both participants couldsee it. Both participants then lookedthrough the book before the NS askedthe AS to tell the story shown by thepictures. Once the AS appeared to havefinished their narrative, the NS asked “Isthat everything?” before assuming theAS had finished to ensure they werehappy with the narrative produced.

The stimuli selected for the personalnarrative task had been used success-fully in past research to elicit personalnarratives (Allen et al, 1994). This pastresearch was completed in America andtherefore the topics were selected asmost relevant for the current partici-pants. The subjects chosen were abirthday, Christmas, pets and Your firstday at school.

This task was introduced by the NS us-ing the phrase “I’m going to tell you astory about (given subject) then I’d likeyou to try and tell me one”, or equiva-lent. At this point the NS then told ashort personal narrative on the topic,provided by the researcher. Once theyhad completed their story the NS askedthe AS if they would tell a similar story.This was captured as the personal nar-rative sample. The same procedure asabove was used to check the narrativehad been completed.

ANALYSIS

The informal conversation and introduc-tion of tasks were deleted from finalanalysis to limit the effect of camerareactivity on the findings. All verbal andnon verbal acts recorded were tran-scribed into standard orthography inaccordance with the conventions fromJohnson (1995). Transcripts were used

alongside video capture to improve ac-curacy of coding each interaction.Three outcome measures were used inorder to identify the roles occupied byeach of the communication partners.These were communication modality,linguistic move type and type-token ra-tio.

Communication modality was codedusing a momentary time sampling (MTS)methodology. MTS is a systematic ob-servation method in which it is recordedwhether a target behaviour is happen-ing at the end of a specified interval.This was done by superimposing bleepsonto each recording at ten second in-tervals using the video editing softwareAdobe Premiere Elements 4.0. The re-searcher then coded the communicationmodality in use at each bleep (Brulle &Repp, 1984).

Once coded, this data was used to yieldthe proportions for modalities used andprovide comparisons between NS andAS. Modality of communication wascoded using the following categories:‘speech’, ‘vocal gesture’, ‘co-action’,‘AAC-encoding’, ‘AAC-output’, ‘eye gazedevice’, ‘eye gaze person’, ‘eye gazeother’, ‘facial and body gesture’, ‘sign’,‘environmental reference’, ‘neutral’ and‘not possible to code’.

The second coding structure used wasbased on the Human CommunicationResearch Centre Move Category Codes(Based on Carletta et al, 1997). Thisstructure codes the linguistic purposeof the communicative moves made bythe participants. This highlights the rolesplayed by the NS and AS by providing

tnapicitraP dlehnoitisoP sraeylatoTNEShtiwgnikrow

gnikrowemitlatoTtnapicitraphtiw

htiwtnepsemiTkeewreptnapicitrap

1SN rehcaetssalC sraey61 shtnom4.xorppA ,yadloohcslluFkeew/syad5

2SN noitacinummoCgnihcaettsilaiceps

tnatsissa

sraey9 sraey3 dnakeew/gninrom1sasruohartxe

ybdetseuqerrehcaet

3SN rehcaetssalC sraey02 sraey2 ,yadloohcslluFkeew/syad5

4SN rehcaetssalC sraey71 shtnom6.xorppA ,yadloohcslluFkeew/syad5

Table 2 NS participant demographics

Figure 1 Distribution of Communication Modalities across four data collection sessions



detailed analysis of how each commu-nicative move is employed to constructthe narrative. This structure was origi-nally developed for the analysis of aninstructional task interaction, and wastherefore adapted following a pilotstudy to test the relevance of the exist-ing codes to narrative interaction. Thecodes developed for use in the fullstudy are shown in Appendix 1.

Type-token ratios (TTR) were also cal-culated in order to provide a measureof linguistic complexity (Watkins & Kelly,1995). TTR is a ratio of the number ofdifferent words (‘types’) in a languagesample to the total number of wordsused within that sample (‘tokens’). Thisratio provided an indication of the lin-guistic diversity used by participants.The total number of content words andfunction words were also calculated.This enabled a more detailed depictionof the vocabulary used by AAC usersduring narrative interaction.

FINDINGS

The findings presented are from a sin-gle participant dyad: Josh and histeacher (NS1). They provide a detailedobservation of the narrative construc-tion process between the NS and AS.The findings also enable the identifica-tion of the roles occupied by the twointerlocutors within the interaction.

Communication Modality

A wide range of communicationmodalities were used by both AS andNS during all narrative interactions. TheAS employed a total of nine modalitiesand the NS made use of eleven. Eyegaze-device was the most common oc-curring modality for both interlocutors(AS n=176, NS n=142). Speech was thesecond most used modality by the NS(n=113). In contrast, the AS tended touse a wide spread of the modalitiesmore equally. Figure 1 also shows thatthe AAC device was employed not onlyby the AS but also by the NS. The NSwas coded AAC-encoding on five oc-casions and AAC-output once.

Linguistic Moves

Figure 2 shows clear disparity betweenthe interlocutors in terms of the typeof linguistic moves made during narra-tive interaction. The NS made 438initiation moves across all narrativesrecorded whereas the AS only pro-duced a total of 81. In relation to this,the majority of the AS moves were re-sponses, totalling 228 moves incomparison to the NS who made 184responses.

Figure 2 Distribution of Linguistic move types across four data collection sessions

lanosreP lanoitciF

sdroWtnetnoClatoT 231 582

sdroWnoitcnuFlatoT 4 01

nekoT 631 592

epyT 76 89

RTT 94.0 33.0

Table 3 Summary table of vocabulary type & TTR

The difference between the interlocu-tors was also shown in the mean numberof linguistic moves made. The NS wasidentified as making a greater meannumber of linguistic moves across bothnarrative conditions.

A large number of question types wereemployed by the NS in order to elicitnarrative during all recorded interac-tions. Other directive moves such asinstructions were also shown to makeup a large proportion of the NS initiationmoves. Alongside the high number ofinitiations, the NS role also included theprovision of acknowledgement of theAS moves. The NS produced a total of87 ‘acknowledge’ and 24 ‘praise’moves. This highlights the considerableposition that feedback held within theprocess of narrative construction.

TTR

There is a considerable difference be-tween the number of content andfunction words used across both narra-tive conditions. These findings show ahigh frequency of content words dur-ing narrative construction with littlegrammatical or syntactic structureadded through function word usage. Thesum of the total words shows a dispar-ity between conditions, with over twiceas many words produced under the fic-tional narrative condition.

However, despite a larger number ofwords in use during the fictional narra-tive condition there is not as large a ratiobetween different words and total wordsused. This leads to the TTR being lower



for fictional narrative construction(TTR=0.33) than across personal narra-tives (TTR=0.49).

CONCLUSIONS

This paper presents the findings from 8narratives produced by a single caseduring the ‘Telling Stories’ PhD study.Due to the small amount of data andsingle case presented generalisation isnot possible. However, some patternsof interaction showed similarities tothose observed in existing research ofconversational interaction betweenAAC users and both parents and peers(Pennington & McConaghie, 1999; Clarke& Kirton, 2003).

In corroboration with the existing stud-ies, the findings showed distinct rolesbetween the AS and NS with an initia-tion, response, feedback type patternobserved. The AS produced responsesto a predominance of questions fromthe NS leading to a question-answerstructure to the narratives recorded.This provided evidence of narrative co-construction as opposed to theindependent construction modelled bythe NS.

The paper has presented a single casefrom the full findings of the ‘Telling Sto-ries’ project and therefore provides onlya brief overview of the patterns of in-teraction observed. However, due to thecorroboration between the NS initiationand AS respondent roles identified inthis study and existing AAC user inter-action studies, it is suggested that thefindings may provide important infor-mation for the future development of

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APPENDIX 1 - LINGUISTIC MOVES CODED

narrative language use for aidedspeakers.

Pippa Bailey, Research Student

Dr Karen Bunning, Reader

REFERENCESAllen, M.S., Kertoy, M.K., Sherblom, J.C.

& Pettit, J.M. (1994) Children’s narrativeproductions: A comparison of personalevent and fictional stories. AppliedPsycholinguistics, 15, 149-176.

Brulle, A. & Repp, A. (1984) An investiga-tion of the accuracy of momentary timesampling procedures with time series data.British Journal of Psychology, 75, 481-485.

Carletta, J., Isard, S., Isard, A., Kowtko,J., Doherty-Sneddon, G. & Anderson, A.(1997) The reliability of a dialogue struc-ture coding scheme. ComputationalLinguistics, 23 (1), 13-31.

Clarke, M. & Kirton, A. (2003) Patterns ofinteraction between children with physi-cal disabilities using augmentative andalternative communication systems andtheir peers. Child Language Teachingand Therapy, 19 (2), 135-151.

Grove, N. (2005) Ways into Literature: sto-ries, plays and poems for pupils with SEN.London: David Fulton Publishers Ltd.

Johnson, K. (1995) Understanding Com-munication in Second LanguageClassrooms. Cambridge University Press.

Liboiron, N. & Soto, G. (2006) Shared sto-rybook reading with a student who usesalternative and augmentative commu-nication: A description of scaffoldingpractices. Child Language Teaching andTherapy, 22 (1), 69-95.

Millar, S. (2001) Supporting Children UsingAugmentative and Alternative Commu-nication in School. Communicatingwithout Speech: Practical Augmentativeand Alternative Communication, ed.Cockerill, H. & Carroll-Few, L. London,MacKeith Press.

Owens, R. (2008) Language Development:An Introduction. Boston, Pearson Edu-cation.

Pennington, L. & McConaghie, H. (1999)Mother-Child Interaction Revisited: com-munication with non-speaking physically

disabled children. International Journal of Lan-guage and Communication Disorders, 34 (4),391 - 416.

Popich, E. & Alant, E. (1999) The Impact of a Dig-ital Speaker on a Teacher’s Interaction with aChild with Limited Functional Speech. South Af-rican Journal of Communication Disorders, 46,73-82.

Watkins & Kelly (1995) Measuring children’s lexicaldiversity: Differentiating typical and impairedlanguage learners. Journal of Speech and Hear-ing Research, 38 (6), 1349.



AAC in Northamptonshire

Involving parents

CLARE PEARCE & DEBORAH PUGHNorthamptonshire Adult and Children's Services, Springfield, Cliftonville, Northampton NN1 5BE, UKEmail: [email protected]: [email protected]

INTRODUCTION

The fundamental aim of AAC interven-tions is to aid the development ofparticipation in all types of situationsand yet research suggests that AAC ismuch more likely to be used in educa-tional contexts rather than in naturalcontexts. For almost all children, themost natural context for communicationis the home: AAC interventions affectnot only the child but also the parentsand siblings.

This paper describes how the Northamp-tonshire AAC team is working withparents of children using AAC to de-velop their confidence and knowledgeof the AAC process. It will also considera small scale evaluation of the CountyAAC service and parents’ views on theirchild’s communication and implemen-tation of AAC within the home.

MODEL OF SERVICE DELIVERYIN NORTHAMPTONSHIRE

Within Northamptonshire there is amulti-agency commitment to improv-ing the identification and provision ofAAC for children from pre-school tonineteen years of age. The service wasdeveloped in 2002 through collabora-tion between Northamptonshire CountyCouncil and the NHS Trust which re-sulted in the establishment of two AACassessment teams, in the North andSouth of the County. The teams consistof the Additional Needs Team of spe-

cialist teachers, aCounty AAC Officer,special school staff,specialist speech andlanguage therapists,physiotherapists andoccupational thera-pists.

The Northampton-shire AAC Policy andPractice documentidentifies the ‘AACpathway’ and a case-work meeting is heldsix times a year to dis-cuss referrals with theidentification of a lead person for eachassessment who will liaise with thechild, family and other professionals in-volved.

Within the County there are two loanlibraries for low and high tech equip-ment and, following assessment,children may be offered a trial of a de-vice to establish whether it is the mostappropriate for their needs. Through ad-ditional funding, four Special schoolswithin the County have also developedtheir knowledge and expertise in AACand children are using augmentativecommunication extensively withinthese schools.

SMALL SCALE EVALUATION

In 2010 a small scale evaluation of theservice was conducted: to explore the

parents’ perceptions of the current AACservice; identify possible improvementsto service delivery; and consider thebarriers to the successful use of AACwithin the home as identified by par-ents.

The teams were aware that targets setfollowing an assessment – in agreementwith schools, the child and their family,– were not being fully achieved and thechildren were failing to use their devicesin all environments. The study was basedon the premise that for AAC outcomesto be successful, parental involvementwas vital in supporting the child’s useof AAC and developing communicationin everyday life.

The parents of eight children/youngadults aged between 9-22 years agreed

Northamptonshire AAC Conference/Parent Forum held in 2011



to be interviewed as part of the study.All the children/young adults were pre-viously assessed or supported by theCounty AAC Service and were using ahigh tech device as one of their com-munication modalities.

The semi-structured interviews withparents were recorded and subse-quently transcribed. A thematic analysisof the interview transcripts identifiedparents’ views on the county serviceand the barriers they perceived to ef-fective AAC use within the home.

PARENTS’ VIEWS AND EXPERIENCES OFAAC PROCESS

The study outcomes were favourableabout the process of referral, assess-ment and funding of AAC services inNorthamptonshire. The process of ap-plying and receiving high tech AACdevices was considered effective, withthe assessment seen as child-focusedand informative:

“It was quite straightforward and wesailed through it.”

Families were positive about the AACintervention methods to which theywere introduced, but reported: (1) theywanted to be more involved in decision-making concerning their child’s overallcommunication needs and (2) they re-quired further support in implementingAAC within the home. This was particu-larly mentioned in terms ofcommunication books, as parents wereunaware as to how to implement themeffectively at home.

These results compared with other stud-ies which found professionals need tobe more open in their communicationwith parents (Goldbart and Marshall,2008, Parette et al, 2000, Allaire et al,1991) and need to develop more col-laborative problem solving (Granlund etal 1998).

The importance of early interventionwas stressed by parents and the identi-fication of need for AAC at the earliestopportunity:

“If we could have the expertise right fromthe beginning we would have got towhere we are much quicker.”

PARENTS’ VIEWS ON HIGH TECH DEVICES

Parents reported initial unrealistic aspi-rations and goals concerning theintroduction of a device:

“We thought it would be some sort ofbreakthrough and enable him to talk toanyone.”

One parent considered the devicewould be of some help but did not real-

ise how important it was to become forher child’s communication:

“I didn’t realise how important self-gen-erated conversation is.”

Parents acknowledged the considerabletime needed for training, personalisingthe device and for its initial implemen-tation. The degree of parentalinvolvement in programming the devicewas wide ranging but for some parents,programming was a major challenge.These parents felt a more individual-ised training geared to their ownknowledge, capabilities and understand-ing of technology would be beneficial,with a rolling programme of training tobuild on their previous learning.

Professionals need to acknowledge theadditional time required to implementAAC strategies and also be aware thatthis may lead to stress for the family(Jones, Angelo and Kokoska, 1998).

Parents suggested their children ben-efited from ‘add-ons’ (keyboard,predictive text, mobile phone) at dif-ferent developmental stages and thatthey were reliant on professionals whoknew their child well to suggest addi-tional technological support whenavailable or appropriate for their child.

Parents felt they would like a review oftheir child’s communication at leastonce a year at which new strategies ortechnological advances/equipmentcould be discussed.

PARENTS’ VIEWS ON THEIR CHILD’SCOMMUNICATION AT HOME

Parents in the study were able to givefull and extensive reports of their chil-dren’s communication and thedifferent modes they used. All the AACusers used more than one mode ofcommunication and this is supported

by other studies (Allaire et al 1991,Romski and Sevcik 2005) with gestures/signing and speech the most frequentlyused modes (Fig. 1).

The parents considered the communi-cation modes currently used at homewere effective but they were also ableto identify barriers which limited theirchild’s communication:

“Everything is so slow for him – he has tobe accurate on hitting the switch.”

“It’s really how he is feeling – when he isphysically low you get much less out ofhim.”

Parents reported their children usedtheir devices less with unfamiliar adultsand relied on others to communicatefor them:

“When he’s with people he knows, he’sstraight in but when he doesn’t know peo-ple he will only address questions to theperson he is with, the carer.”

The importance of skilled communica-tion partners was highlighted, particularlyfor expanding their child’s involvementin different situations, illustrating theneed for training of communication part-ners (Lund and Light, 2007) across thechild’s social networks.

They reported feelings of isolation andloneliness as a result of their child us-ing an alternative form ofcommunication, and peer mentoringand meeting other AAC users were con-sidered a good way forward to improvetheir child’s communication and theirown support networks.

This small scale study illustrated boththe challenges and support available forimplementing AAC strategies within thehome. The study led to a more in depthunderstanding of different perspectiveson AAC which were used to develop

Figure 1 Modes of Communication used at home by child/young adult (N=8)


and improve service provision and de-livery within the County. A number ofactivities were organised in 2011 withthe aim of promoting further liaison withfamilies on using AAC within the homeand addressing some of the concernshighlighted within the evaluation.

PROJECTS IN NORTHAMPTONSHIRE IN 2011

Northamptonshire AAC Conference/Parent Forum

A Parent Forum and an AAC Conferencewere held in 2011, focusing on the in-volvement of parents in AAC. One ofthe highlights of the conference wasthe launch of Yakety-Yak, a web-basedforum for parents in Northamptonshire(www.yaketyyak.org.uk), which also hasthe support of the NorthamptonshireParent Partnership Service.

At the annual AAC conference, a par-ent of a child using AAC gave her ‘TopParent Tips’ (Fig. 2) and a well receivedpresentation on her experiences ofAAC and her daughter’s journey. Theconference also included a concertfrom pupils in five NorthamptonshireSpecial schools, using their communi-cation aids to contribute in storytellingand songs, further illustrating the impor-tance of participation and involvementfor children using alternative commu-nication systems.

Individualised Training

Parents in the study reported consider-able problems with programmingdevices and making resources for usewithin the home. Acting on these find-ings, the AAC Officer, Specialist Speechand Language Therapist and AAC Co-ordinator at Greenfields School inNorthampton held a series of coffeemornings once a month to support par-ents by helping them programmedevices and collaboratively considersuitable vocabulary.

The emphasis was on family decisionmaking and developing the family’sstrengths (Crais, 1994) and problemsolving the use of the device within thehome. One aim was to encourage theparents to provide a further network ofsupport for each other to overcomesome of the challenges of using AACwithin the home.

Early Intervention

In 2011 the Northamptonshire AACteam was asked to pilot a training courseYou Matter developed by the ACE Cen-tre and NHS Milton Keynes to deliver toparents of children with significantspeech difficulties and their support-ing professionals.

The course was two and a half days andincorporated an opportunity for parentsto be videoed at home or in school withtheir child with the aim of helping par-ticipants to review their own style ofinteraction and to discuss any concernsthey might have about their child usingaided communication.

The feedback received from parentsattending the initial You Matter coursewas excellent and showed the team theimportance of providing practical sup-port for parents in implementing AACwithin the home. Since the trial, the AACteam has held a further You Mattercourse and plans to implement thistraining for parents twice a year.

CONCLUSION

Positive communication outcomes arelinked to parents who are actively in-volved in planning and organising theirchildren’s learning experiences(Launonen 2003).

The County AAC team acknowledgesthe vital role of parents in supportingand enhancing AAC and continues todevelop the involvement of parents byseeking their views, and the views ofthe children, during every part of theAAC process. The establishment of theNorthamptonshire County AAC servicehas enabled children with complexcommunication needs to receive ap-propriate devices and support.

However, the service needs to main-tain its collaboration with parents andeducation staff to enable the child to


Figure 2 A parent’s view on using AAC within the home

use their communication systemsfunctionally in all settings.

Clare PearceNorthamptonshire County Lead for AAC

Deborah PughSpeech & Language Therapist

REFERENCESAllaire, J., Gressard, R., Blackman, J. & Hostler, S.

(1991) Children with severe speech impairments:caregiver survey of AAC use. Augmentative andAlternative Communication, 7, 248-255.

Crais, E.R. (1994) Moving from "parent involve-ment" to family-centered services. Hearsay, 9(2), 12-15.

Goldbart, J. & Marshall, J. (2004) "Pushes and Pulls"on the Parents of Children who use AAC. Aug-mentative & Alternative Communication, 20,194-208.

Granlund, M., Bjorck-Akesson, E., Wilder, J. &Ylven, R. (2008) AAC Interventions for childrenin a family environment: Implementing evidencein practice. Augmentative and Alternative Com-munication, 24, 207-219.

Jones,S., Angelo, D., & Kokoska, S. (1998)Stressors and family supports: families with chil-dren using AAC technology. Journal of Children’scommunication Development, 20, 37-44.

Launonen, K. (2003) Manual sign as a tool of com-municative interaction and language: thedevelopment of children with Down Syndromeand their parents. In von Tetzchner, S. andGrove, N. (Eds.) Developmental Issues in AAC(p.83-122) London, Whurr Pub.

Lund, S. & Light, J. (2007) Long-term outcomesfor individuals who use augmentative and alter-native communication: Part II, Communicativeinteraction. Augmentative and Alternative Com-munication 23, 1-15.

Parette, H, Brotherson, M. & Huer, M. (2000) Giv-ing families a voice in AAC decision makingEducation and Training. Mental Retardation andDevelopmental Disabilities, 23, 177-190.

Romski, M. & Sevcik, R.A. (2005) AugmentativeCommunication and Early Intervention: Mythsand Realities. Infants and Young Children, 18,174-185.


PECS with Older Students and Adults?

NIKKY STEINER 1 & SARAH UPTON2

1 Orchard Hill College, Old Town Hall, Woodcote Road, Wallington, Surrey SM6 0NB, UK Email: [email protected] Lewisham Community ALD Team

INTRODUCTION

The Picture Exchange CommunicationSystem (PECS) is an AAC system whichwas developed over 20 years ago, ini-tially for children with autism, althoughit is now more widely used across arange of different disabilities.

PECS is a picture-symbol-based ap-proach which emphasises thetransactional nature of communication(Bondy and Frost, 1994). It focuses onthe initiation component of communi-cation and goes on to teachdiscrimination of symbols and con-struction of simple symbol sentencesand encourages the user to progressthrough a number of phases. Other prag-matic skills such as commenting oranswering questions are taught at laterstages.

Many schools use PECS as a communi-cation system; however, there is muchless evidence of its use in adult serv-ices. Similarly, in the writers’ clinicalexperience anecdotal parent/carer re-ports suggest that PECS is used muchless frequently in the child/adult’shome. One reason for this may be lackof training and support for its imple-mentation.

PECS is different from other communi-cation systems in that it uses

behavioural principles such as shapingand differential reinforcement. There-fore its successful implementation isreliant on an understanding of the pro-cedures and/or teaching techniquessuch as error correction and prompt-ing.

Anecdotally, speech and languagetherapists have reported that someolder students using PECS can become‘stuck’ at a certain phase. The focusand outcome of the PECS use was of-ten on the user’s needs, wants and theirbehavioural management. PECS wastypically only used in structured activi-ties e.g. snack time or structuredliteracy sessions. Again, anecdotallythere are concerns that some PECS us-ers had not developed strategiccompetence of the system, so whenthey transitioned, e.g. to another classor adult setting, they did not use theirPECS spontaneously. This was a particu-lar concern for older students whowould be transitioning to adult services.

For PECS users who had developed stra-tegic competence and ownership oftheir PECS folder, there appears to behigher use of PECS across settings, e.g.making requests for drinks/snacks/motivators. However, requesting alonedoes not make an individual a function-ally effective communicator.

There is a concern that there is no com-monly agreed definition of functionalcommunication. Functional communi-cation can mean different things todifferent professionals, parents/carersor stakeholders. It is influenced bymany factors including professionalbackground, training, experience, per-sonality and culture.

Functional communication as definedby Light (1988), involves needs andwants, information transfer, socialcloseness and social etiquette. Socialcloseness and etiquette are areaswhere there is far less research evi-dence. Joan Murphy (CommunicationMatters National Conference 2010)raised this issue and presented a Func-tional Communication Frameworkwhich could be used to include and ratethese features.

THE PURPOSE OF THIS STUDY

PECS with Older Students and Adults?aimed to explore whether a codingframework could be used to analysePECS users and their communicationpartners’ interaction. Of particular fo-cus was rating areas relating to socialcloseness. This information could thenbe used to identify strategies to helpdevelop the PECS users’ functional com-municative competence.



STUDY DESIGN

The Effectiveness Coding Frameworkfor Functional Communication (Murphy,2010 and Cameron, 2010) was adaptedand some features added for PECS us-ers (Table 1).

PARTICIPANTS IN THE STUDY

• Seven students across two specialschools.

• Aged 17-19 years.

• Six had a diagnosis of autism and oneof Cornelia de Lange syndrome.

• All had used PECS for 5+ years.

• PECS use ranged between phases2-6.

Consent from the PECS users to partici-pate in the study was gained. Each PECSuser was assessed using a functionalassessment of capacity and if it showedthe PECS user was unable to consent, abest interest discussion was held.

Video footage was taken of each stu-dent interacting with familiarcommunication partners in their class-room at snack time. The videos of thePECS users were rated using the adaptedversion of the Effectiveness CodingFramework for Functional Communica-tion (EFFC).

Five additional Speech and LanguageTherapists viewed the videos using the

EFFC to establish consensus aroundease of use of the EFFC.

Feedback sessions with school staffwere arranged to discuss how to supportthe PECS user’s communication needs.

OUTCOMES

The EFFC was a quick and easy tool touse; however, on occasion there was aneed for further discussion about whateach feature being rated related to.

It was felt that prompt questions wereuseful to help clarify each feature andthese were added to the EFFC, for ex-ample:

Timing/Pacing: Was the pacing of theinteraction appropriate? Were there longpauses/delays? Did these disrupt theflow? How could this be improved?

Naturalness: Were any features of PECS– e.g. design, number of symbols – abarrier to the interaction? Were any strat-egies used by the CommunicativePartner a barrier to naturalness of inter-action? How could this be improved?

Other prompt questions included:

• Did the communicative partnerknow what the PECS user wanted orwhat they were trying to communi-cate? What modes of communicationwere most easily understood? Howcould this be improved?

• How were the PECS user and com-municative partner positioned, e.g.side by side, standing, sitting? Wasthere shared eye contact, smiling?Was there shared enjoyment? Howcould this be improved?

• Was the communicative partner’s be-haviour predictable? Was the languagelevel appropriate? Did any othermodes help? How could this be im-proved?

DISCUSSION

The EFFC was a useful tool to promptreflection and consider how to developthe students’ Total Communication.

It highlighted the need for the commu-nication partner to attend tospontaneous, naturalistic non-verbalcommunication. It also illustrated thatsometimes a formal system (e.g. PECS)may be being given greater value thaninformal or idiosyncratic behaviours.

It was observed that some training strat-egies used in PECS may not encourageengagement and social closeness e.g.removal of eye contact, physical prox-imity, communicative partner turningaway or using a ‘blank’ facial expression.It is important that these behaviours arereviewed and phased out.

All the students in this study were es-tablished PECS users (over 5 years). In

Table 1 Showing part of adapted version of Framework extended to include qualitative indicators, e.g. naturalness



some cases the EFFC highlighted thatthere had been a focus and emphasison continual PECS teaching, i.e.progressions through PECS phases. Onecould suggest that it is important to con-sider mastery of skills and have adiscussion and agreement on when tofocus on teaching and using Total Com-munication across environments ratherthan teaching the next PECS phases.

Qualitative analysis of the interactionwould suggest that the PECS user’s com-municative competence was not linkedto the phase of PECS use. For examplea student at an early phase of exchang-ing a single symbol could do this in amanner where there was social eye con-tact, shared attention and equality ofcontrol. The communicative partner’scommunication style was a major influ-ence on the effectiveness of the PECSuser’s functional communication. “Thepartner is no doubt a major factor inthe success or failure of many commu-nicative interactions.” (Light, 1988)

The EFFC can provide a structure forrating qualitative aspects of communi-cation. It could be used as an outcomemeasure pre and post intervention andcan encourage a collaborative approach,

identifying which modes of communi-cation are most effective and what for.

As students move out of school intoadult services they need to have sys-tems and approaches which areeffective, natural, person-centred andwhich go beyond needs and wants. Thefinding from this pilot study would sug-gest that the EFFC is a tool that can guidetherapists in clinical decision makingaround the use of PECS with older stu-dents and adults.

There is a general consensus that theabandonment of AAC systems includ-ing PECS is an issue and is of particularconcern during the transition from pae-diatric to adult services. By exploringand considering broader aspects of in-teraction linked to social closenessperhaps we can have better under-standing of how to develop appropriateAAC systems that are easy to use, re-warding, and effective to both thecommunicative partner and user. Fur-ther research in this area is needed.

Nikky SteinerSpeech & Language Therapist

Sarah UptonTransition Speech & Language Therapist

THANKS

We would like to thank the staff and stu-dents at Greenvale and Tuke schools fortheir time and involvement in the study.Special thanks to Cher Tully for her insightand suggestions. Additionally, we thank LoisCameron and Joan Murphy for their supportand feedback in the use of the EFFC.

REFERENCESBondy, A. & Frost, L. (1994) The Picture Exchange

Communication system training manual. CherryHill, NJ: Pyramid Education.

Cameron, L. (2010) The Validation and reliability ifthe Effectiveness Framework of FunctionalCommunication (EFFC) for Speech and LanguageTherapists. ISAAC presentation Barcelona 2010.

Murphy, J. (2010) Can AAC ever be effective?Plenary Talk, Communication Matters Confer-ence, Leicester 2010.

Murphy, J., Gray, C.M., Cox, S., van Achterberg,T. & Wyke, S. (2010) The effectiveness of TheTalking Mat Framework with People with De-mentia. Dementia: International Journal ofSocial research and Practice, 9 (4), 454-472.

Murphy, J. & Cameron, L. (2008) The Effective-ness of Talking Mats for People with IntellectualDisability. British Journal of Learning Disabil-ity, 36, 232-241.

Sulzer-Azaroff, B., Hoffman, A.O, Horton, C.B.,Bondy, A. & Frost, L. (2009) The Picture Ex-change Communication System (PECS): Whatdo the data say? Focus On Autism and OtherDevelopmental Disabilities, 24, 89-103; origi-nally published online 23 March 2009.


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COLLATED BY JANICE MURRAY, CHAIR

TRUSTEES’

NEWS

ISAAC CONFERENCE

Writing this in July, it is just two days before I setoff for the ISAAC conference in Pittsburgh, USA. Atthis event there will be many opportunities to up-date on the latest research, practice and userperspectives.

Those Communication Matters members fortunateenough to be attending hope to be able to sharesome of this information when we next meet at ourown CM2012 National Conference in Leicester on23-25 September.

Whilst at ISAAC, I will be attending an all-day meet-ing for all Chapter representatives (the ISAACCouncil meeting). This will allow us to discuss is-sues that are uppermost in our minds and find outwhat is happening across the world in terms of AAC.

I will be re-visiting some discussion points raisedat the previous meeting of its kind held in Barce-lona in 2010. For example:

• What do Chapters get from their ISAAC mem-bership?

• Waiving of ISAAC capitation fees for subsidisedmembership categories within CommunicationMatters.

• Issues that are important to present the UK per-spective on, e.g. technology developments andintervention approaches.

• AAC topics.

ISAAC remains an important organisation for manypeople; it is my role to ensure that the UK gets themost from its membership of ISAAC.

PUBLICATIONS

Communication Matters continues to be very busy.

We are in the process of producing a publicationon outcome measurement which will be launched atthe CM2012 conference in September, along with theremaining Quality Standards documents. We antici-pate a similar document on competencies to follow.

LOBBYING & MARKETING

We continue to work with The Whitehouse Consul-tancy, a company that is making a difference toour lobbying activities. Part of this collaboration hasresulted in another parliamentary event anticipatedfor 12th September. Watch this space and the Com-munication Matter E-News for more information.

Partly on the back of this activity, we have just ap-pointed a part-time consultant in Marketing (SandraHartley) to review and develop a marketing strat-egy that will ensure that we grow in membership,raise awareness across a wider group of people and

employees involved in complex communication dif-ficulties; and secure the evolution of ourorganisation in terms of activity and impact. Thiswill commence in September and we will review thisexciting development in 12 months’ time.

ONLINE TRAINING COURSE

Our online training course is about to be launched.This was developed with considerable input fromthe membership in terms of video material. Again,watch out for a CM E-News announcement.

RESEARCH

You will see from the AAC Evidence Base Researchupdate on page 29 that the project continues tomake headway with exciting updates due for launchat the conference in September.

AND FINALLY...

This will be the last Trustees’ News that I will haveresponsibility for writing, as I am coming to theend of my three-year term of office as Chair ofCommunication Matters.

Over that time, I have had the privilege of workingwith a large number of people who are both aninspiration to me and a challenge for me to domore, and to do it better.

I believe that Communication Matters remains astrong organisation that is moving forward. Itsstrength comes from its focus on AAC but its ca-pacity to view AAC from many perspectives. Theseperspectives keep us open minded and forwardreaching.

Whilst I would like to express my thanks for theopportunity to serve as your Chair over the last fewyears, I can assure you that my commitment toCommunication Matters will remain strong and Ido not plan to disappear entirely.

Janice MurrayChair of Communication Matters


BHTA eCAT

NEWSNEWSBHTA eCAT

LOBBYING

Following the House of Lords event in March 2012to raise awareness of the need to support chil-dren and adults who require AAC services andcommunication aids, Lord Rennard attended thelast eCAT meeting to discuss how the event hadbeen received very positively and to confirm thatsupport from him alongside the lobbying fromCommunication Matters was continuing. He alsogave an insight into how questions might be askedin the House of Lords in order to obtain moresupport and funding for AAC users and their carers.

POSITION PAPER

In relation to this there was a discussion regard-ing a possible ‘position paper’ that might be givento Government officials and members of the Houseof Lords, setting out the current position of AACin an effort to increase awareness of the lack ofprocesses and procedures, the ‘postcode lottery’and the general lack of funding. It was felt thatthis was important to ensure that decision mak-ers were fully aware of the situation before anydiscussion took place in parliament. It was alsofelt important that this document should supportboth the work being done by Communication Mat-ters in lobbying and the proposals put forward inJean Gross’s final report. We are going to try andproduce a document to be available in time forthe CM2012 National Conference in September.

IPADS AND OFF-THE-SHELF PRODUCTS

Another issue reported by members was the in-creasing number of incidents where fund-holderswere purchasing iPads and other off-the-shelfproducts rather than specific communication aidsagainst the advice of the relevant speech and Lan-guage therapist or other professional. This is aworrying trend that should be included in the po-sition paper. eCAT members welcome the increasein opportunities for people with speech difficultiesto gain access to an AAC device, which low pricedoff-the-shelf products have given, especially whereit gives communication to someone who eithercannot obtain funding for a more traditional AACdevice or who does not need such a comprehensivedevice. However, the worrying trend is where, due tolack of funding, they are given inappropriately andagainst the advice of qualified professionals.

CM ROAD SHOWS

Another concern discussed by members relatedto Communication Matters Road Shows. As costsincrease (due to higher refreshments and venuecharges), these events need to be cost effectivefor suppliers, who share the overall costs betweenthem as well as the costs incurred by Communi-cation Matters in the administration andorganisation. However, the concern is to see del-egates remaining for the morning session and

the free lunch and then not reappearing in theafternoon. Whereas members understand thatsometimes circumstances dictate whether an in-dividual can stay all day or not, it is disconcertingwhen delegates admit that they are using theopportunity either to get home early or even to“go shopping” – yes, we really have been told that!

We have made CM’s administrator, Patrick Poon,aware of this concern but it is difficult to see whatwe can do to address the problem other than toask delegates to be fair to suppliers and to stayuntil the end. Those who don’t are effectively en-dangering the future of these Road Shows, whichwe believe are of benefit to the AAC community.

David Morgan, Chair of eCAT section, BHTA

Note: BHTA is the British Healthcare Trades Associa-tion; eCAT is one sector of the BHTA, dealing withelectronic Communication and Assistive Technology

HOT

NEWS

MARTIN PISTORIUS RECEIVES ISAAC AWARD

Congratulations to Martin Pistorius for receivingthe ISAAC President's Award which acknowledgesextraordinary support of ISAAC by an individual.

Martin was born in South Africa. Following an ill-ness which left him with a significant disability,wheelchair bound and physically unable to speak,he spent 14 years in institutions for the profoundlymentally and physically disabled. In 2001 he wasassessed at Pretoria’s Centre for Augmentativeand Alternative Communication, following which helearnt to communicate via computer and communi-cation boards, and rebuilt a life worth living.

Martin has served on many national and interna-tional AAC committees, has given presentationsin South Africa, Israel, Canada and the UK, andrecently published a book on his life, Ghost Boy.

In 2008 he met the love of his life, Joanna andimmigrated to the UK. Martin is currently studyingComputer Science at the University of Hertford-shire, and is also running a freelance web designer/developer business in Essex.


HOT

NEWS

SOPHIE SHINES IN OLYMPIC TORCH RELAY

In June, Sophie McMullen, 18, proudly carried theOlympic torch through the streets of Bridlington.

Sophie, a student at Frederick Holmes post-16 col-lege unit, uses a wheelchair and the torch wascarried in a special holder attached to her chair.

Sophie's progress with the torch was watched byhundreds of people lining the streets of Bridlingtonand cheering her name; she was also featured onBBC Look North.

Sophie, 18, was nominated by Judith Chapman, aspeech and language therapist who works for Hum-ber NHS Foundation Trust within the school. Sophieuses an electronic ‘talker’, controlled by a headswitch, for much of her communication. Sophie said:

“Judith nominated me because I have come on reallywell with my talker and I am an Augmentative andAlternative Communication (AAC) ambassador for theschool”

Judith is full of praise for Sophie’s achievements:

“When we have children at the school who we are thinkingabout starting with talkers, Sophie talks to them and totheir parents and she runs and co-ordinates activitiesat AAC user days with other Yorkshire schools. She’s afantastic role model and she just seemed like the rightperson to carry the Olympic torch.

“Sophie’s got a B grade double ICT GCSE, for whichshe studied at St Mary’s College and is now doingcourses at Hull College and is hoping to do more. She’sjust a lovely girl, even when she’s being a stroppyteenager! She was one of the first communication aidusers at the school and it hasn’t always been easy, butshe’s brilliant at using it now.

“It’s so important for people to know that even thoughSophie can’t talk very well she still has lots to say.”

(Photo credit Mike Bickerton; courtesy Humber NHS FT)

PROFESSORSHIP FOR ANNALU WALLER

We are delighted to report that Annalu Waller –pioneer of AAC in South Africa and long time mem-ber of ISAAC and Communication Matters – hasrecently been appointed Professor Annalu Waller.Congratulations Annalu!

Annalu was born and educated in Cape Town, SouthAfrica, where she established the first AAC assess-ment and training centre in 1987. She came to theUK in 1992 to do a PhD in Computer Science, atDundee University, Scotland – and stayed. She wasappointed Lecturer and then Senior Lecturer, andnow leads a busy programme of research projects,all concerning aspects of Assistive Technology andAAC for the benefit of disabled people. She is com-mitted to empowering end-users by involving themin the design of technological solutions.

Annalu is such a busy person that it’s impossibleto list all of her activities here. As well as headingup the AAC Research Group at Dundee Universityand supervising doctoral students, she is also onthe boards of academic journals and of a numberof national and international organisations, suchas Blissymbolics Communication (UK and interna-tional), Capability Scotland, International CerebralPalsy Society.

Annalu has a special gift of making complicatedtechnical things easy to understand and simple toimplement. Having cerebral palsy herself, Annalualways has special time and attention to give toyoung people who use AAC, and is much loved bythem, as they see in her an inspiring role modeland mentor.

Annalu is also an ordained priest in the ScottishEpiscopal Church and works as an Honorary Chap-lain at the University and in a local church, as partof a team.

(Photo courtesy of the University of Dundee)


CMROAD SHOW

13 November 2012 LondonCommunication Matters Road Show: LondonFREE Tel: 0845 456 8211 www.communicationmatters.org.uk15 November 2012 EdinburghTechnology for Complex Needs and Switch UsersContact CALL Scotland: 0131 651 6235 www.callscotland.org.uk22 November 2012 EdinburghiPads, iPods - Easy to Use Picture Apps forCommunicationContact CALL Scotland: 0131 651 6235 www.callscotland.org.uk26 November 2012 WarwickRAatE 2012 ConferenceContac hdti: 024 7615 8000 www.raate.org.uk6 December 2012 BristolVoice for Life (Bristol)Contac Afasic: 0845 355 5577 www.afasicengland.org.uk6 December 2012 EdinburghBoardmaker StudioContact CALL Scotland: 0131 651 6235 www.callscotland.org.uk7 February 2013 MerseysideVoice for Life (Merseyside)Contact Afasic: 0845 355 5577 www.afasicengland.org.uk

11 September 2012 WebinarSwitch Access and iPadsContact CALL Scotland: 0131 651 6235 www.callscotland.org.uk12 September 2012 LondonCommunication Matters Parliamentary Briefing Eventfor MPs on AAC Commissioning in EnglandContact: 0845 456 8211 www.communicationmatters.org.uk13 September 2012 OldhamiPod and iPad Apps for AACContact ACE Centre North: 0161 358 0151 www.ace-north.org.uk14 September 2012 EdinburghEye Gaze - What is it, Who is it for, What is Available?Contact CALL Scotland: 0131 651 6235 www.callscotland.org.uk21-23 September 2012 Swanwick, Derbyshire1Voice 'Media Madness' WeekendContact 1Voice: 07932 858 363 www.1voice.info23-25 September 2012 LeicesterCM2012 National ConferenceContact: 0845 456 8211 www.communicationmatters.org.uk2 October 2012 WebinarCo:WriterContact CALL Scotland: 0131 651 6235 www.callscotland.org.uk

DIARY

DATESDIARY

DATES


23-25 SEPTEMBER 2012 UNIVERSITY OF LEICESTER

CM20 1 2

NATIONAL CONFERENCE

The Communication Matters / ISAAC (UK)National Conference is an annual eventembracing a wide range of issues relating toaugmentative and alternative communication.The two and a half day event provides a forumto meet and to exchange information withrepresentatives from all disciplines associatedwith AAC, including people who use AAC andtheir family members.

SYMPOSIUM PROGRAMME

Platform PresentationsPractical WorkshopsCase Studies & Research PapersSeminarsTrade ExhibitionGuest SpeakersSocial Events

REGISTRATION

All registrations allow full access to all thepresentations and trade exhibition. The registrationfee also includes refreshments, lunch and eveningmeals. Residential registration additionally coversaccommodation in student halls (with breakfast).There is a substantial discount if you register andpay before 31 July. Prices from £385 for fullresidential registration.

There are a number of subsidised places for peoplewho use AAC, and their family members. Bookearly to avoid disappointment.

BOOKING FORM & INFORMATION

For further information and a booking form, pleasevisit www.communicationmatters.org.uk, or ringCommunication Matters on 0845 456 8211 oremail: [email protected]

COM

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We have just completed the secondyear of the AAC Evidence Base projectand this report reflects on the work todate and also looks forward to the ex-citing final year of the project whichends in June 2013.

GATHERING DATA

The University of Sheffield researchers(in collaboration with Barnsley Hospital)have been engaged in a wide-rangingexercise to collect data about AAC serv-ice provision and the prevalence ofneed for AAC in the UK, by travellingacross the UK and talking to specialistAAC services, Speech & LanguageTherapy services, local authorities, NHSservices, schools, colleges, charitiesand companies, as well as interviewingpeople who use AAC and their familymembers and carers.

The researchers have been able to drawon the AAC reports recently completedfor governments of Scotland and Walesand to link in with the work that Com-munication Matters has been leading onstandards, outcomes and competen-cies.

From Autumn 2012 they will start to fo-cus on analysing the data so thatconclusions can be drawn and the find-ings published.

INVOLVING THE AAC COMMUNITY INRESEARCH

The research team at Manchester Met-ropolitan University includes aco-researcher who uses AAC who hasprovided his perspective on the re-search processes. The researchers helda series of nine focus groups withstakeholders, including people who useAAC, their families, professionals whowork with them, researchers and man-agers. The focus groups were a keyinput to the design of the AAC EvidenceBase website which will make informa-tion about AAC available to a wideraudience. This participatory approachis continuing as the website is devel-oped. The development cycle includesreviews of the website prototype bystakeholders.

Manchester Metropolitan University hasdeveloped the single case study proto-col, based on a methodology proposedin the work of Pennington, Goldbart &Marshall (2007). This will provide amechanism for capturing evidencefrom best practice in the field of AACthat might otherwise not be published.The protocol has been developed insuch a way that it can be used by pro-fessionals and people who use AAC aswell as by researchers. People who use

AAC have reviewed the content of pro-tocol and its usability.

We are looking forward to launching theAAC Evidence Base website and thecase study protocol later this year.

THE INDEPENDENT RESEARCH PANEL

The Independent Research Panel hasmet twice in the past year. The Panel is

Research Project – End of Second Year

Communication Matters – Research Matters:An AAC Evidence Base

DAVID MORGAN & KATIE HOLMESCommunication Matters, Catchpell House, Carpet Lane, Edinburgh EH6 6SP, UKEmail: [email protected]: [email protected]

Research Involvement Network member,Simon Stevens (L) with David Morgan


made up of eight people who representdifferent interests, including a personwho uses AAC, a family member, acommissioner and professionals work-ing in the field. They provide advice tothe project and also to CommunicationMatters about its research activities.

THE RESEARCH INVOLVEMENT NETWORK

We have launched the Research In-volvement Network which will supportfurther research into AAC by helping tofind participants and co-workers for re-search projects. The procedures arenow in place for reviewing and accept-ing research proposals and researcherswho are interested in using the Networkcan apply through the CommunicationMatters website. In the next year welook forward to helping our first re-search project to find participants. Wewill also seek to encourage more peo-ple who use AAC and more familymembers and carers of people who useAAC to join the Network.

FINANCE & REPORTING

We have worked within budget duringyear two and through efficient financialmanagement we have been able to in-crease the amount of staff timeavailable to the project. We expect tocontinue to work within the agreed fi-nancial plan in year three. There areregular reports to the Trustees and Katieattends two trustees meetings eachyear. The end of year report has beensubmitted to the Big Lottery Fund. Atour suggestion the trustees have estab-lished a Handover Group to ensure asmooth close down of the project andthe continuation of the research initia-tives created by the project after June2013.

COMMUNICATION & DISSEMINATION

Two articles about the systematic lit-erature review carried out by theUniversity of Sheffield have been pub-lished in academic journals1 andCommunication Matters has written andpublished online a short lay summaryof the first article which has beenviewed by over 100 people. The firstarticle was referenced in a key report forcommissioners published by the Officeof the Communication Champion2.

There were two presentations at Com-munication Matters Conference 2011and in addition presentations weregiven at a research conference at Man-chester Metropolitan University, at aspecialist AAC assessment servicesmeeting and at two Voice for Life eventsfor parents hosted by Afasic in Leices-ter and Stockton-on-Tees.

There have been a number of links be-tween the project and initiatives in thefield of AAC policy which have con-tributed to raising awareness of theneed for AAC in the UK and increasingunderstanding of service provision.

We are looking forward to publishing thefinal report next year and publicising thefindings as widely as possible.

We hope the research will provide evi-dence that can be used to make thecase for better service provision as wellas enabling people to find the informa-tion they need via the AAC EvidenceBase website.

The whole project will both leave alegacy for the future for Communica-tion Matters and also become aspringboard for new and future re-search projects.

David Morgan, CM Research Lead

Katie Holmes, CM Research Manager

REFERENCES1 Baxter, S. et al. (2011) Barriers andfacilitators to use of high technologyaugmentative and alternative commu-nication devices: a systematic reviewand qualitative synthesis. InternationalJournal of Language & CommunicationDisorders. Volume 47, Issue 2.

Baxter, S. et al. (2012) Interventions Us-ing High-Technology CommunicationDevices: A State of the Art Review. Fo-lia Phoniatrica et Logopaedica, in press.2 Specialised AAC Provision – Commis-sioning National Services (2011) Officeof the Communication Champion &Council, November 2011.

Many children and adults haveplenty to say, but are unable tocontrol their mouth muscles tospeak clearly. They can use aidssuch as pictures, written wordsand technology to communicate.

1Voice takes a family and socialperspective on communication andrecognises the great need foradult role models to inspirechildren and families alike.1Voice promotes familiessupporting each other toovercome the isolation that beingunable to speak can bring.

For more information, visitwww.1voice.info or contact byemail: [email protected] or phoneon 0845 330 7862.

1 Voice is run by a team offamilies, role models andprofessionals in consultationwith children to provide anetwork of information andsupport for children and familiesusing communication aids.

For more informationplease contact:

1 VoicePO Box 559, Halifax HX1 2XL

Tel: 0845 3307862Email: [email protected]

www.1voice.info

Communicatingtogether

ABOUT THE PROJECT

In October 2009 CommunicationMatters was awarded a £467,751grant by the Big Lottery Fund underits research programme for aproject entitled CommunicationMatters - Research Matters: an AACEvidence Base.

Communication Matters is leadingthe project and working with threeresearch partners. The University ofSheffield and Barnsley Hospital NHSFoundation Trust are researchingprevalence of need and mappingservice provision. Manchester Met-ropolitan University is developingthe AAC Evidence Base and a casestudy template.

For more information, contact KatieHolmes, CM Research Manager, [email protected]


Your Thoughts, Your Ideas, Your Life

OLIVER LEE & CHRISTINE GRIFFITHSSpeech and Language Therapy Dept for the Directorate of Learning Disability Services, Abertawe Bro Morgannwg University Health BoardEmail: [email protected]

INTRODUCTION

Service user involvement should be keyto all we do (in the health service) andthere are many events and conferencesaround to encourage this and learn howto work more closely together. Asspeech and language therapists, how-ever, we felt that there wasn’t a greatdeal going on specifically to help involveadults with a learning disability who havesignificant communication difficulties.

The Speech and Language Therapy de-partment for the Directorate of LearningDisability Services, Abertawe BroMorgannwg University Health Board(ABMUHB) consists of seventeen quali-fied SLTs and seven assistants for whomwe use the title Communication Devel-opment Officers. The Directorateprovides specialist services to adultswith learning disabilities across a largepart of South Wales, from Cardiff toSwansea. All of the SLTs work inmultidisciplinary teams within jointhealth and social care bases. A key fo-cus of our service is service userinvolvement and there are a number ofprojects being undertaken within theteams to develop better engagement.

As a profession, communication is keyto our work and we are committed toengaging appropriately with service us-ers, and to supporting others to create

appropriate environments tosupport and aid communica-tion. We have spent a numberof years developing a trainingand support package for healthstaff and other support organi-sations to facilitate InclusiveCommunication environmentsin the community.

When our SLT departmentcame to look at related re-sources and tools to supportservice user engagement andhow people are directly in-volved in their care, we noticed thatdifferent tools and working practiceshad been developed in our own SLT de-partment, as well as by otherprofessionals. This led to us wanting todevelop a service user conference toshowcase these resources and ap-proaches to support communicationfor adults with a learning disability, thusenabling the service users to becomemore involved in with the services theyreceive. A proposal was put togetherand sent to Communication Matters,and we were successful in obtainingfunding to run the conference.

When looking at the content of the day,we wanted to look at what we and otherdepartments/services were doing toencourage service user engagement at

different levels. As information and re-sources were gathered, it was decidedthat the main body of the day wouldconsist of four workshops aimed at shar-ing ideas for strategies to improve activeservice user engagement at differentlevels – direct patient carer, primaryhealth, general choices and person cen-tred planning and service engagement.

The conference aimed to demonstratethrough active engagement in the work-shops some of the things that had beendeveloped either by our own SLT serv-ice or by others. We also hoped to learnfrom service users and their carersabout any experiences or advice thatmade it easier for them to get their viewsacross, and what actually mattered tothem.

Service user conference


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WHO WE INVITED

We wanted the conference tobe top heavy with service us-ers and deliberately didn’tinvite lots of organisationmanagement, although we didhave some representation.The majority of those who at-tended were service usersand carers being either paidstaff or family members. Weinvited professional heads ofservices and some Directoratemanagement so that theycould then take the messageand information of the daysconference back and to putinto practice.

Other organisations were invited, and wehad representation from Mencap andPeople First. We also had a member fromLearning Disabilities Wales who is lead-ing a Welsh government project todevelop a website providing accessibleinformation for people with LearningDisabilities. Representatives from Lib-erator and Logan Technologies alsoattended to showcase a range of tech-nology and communication aids.

THE CONFERENCE

When developing the conference, it high-lighted the amount of planning andorganisation required to hold the event.This included booking the venue, decid-ing who to invite, making the venueaccessible, and food requirements be-cause of the eating and drinkingdifficulties of some of the participants.This was all achieved on a limitedbudget, and involved the whole SLTTeam in either planning or helping torun the day.

A lot of help was needed in the actualrunning of the day, from carrying outthe workshops, to directing peoplewhere to go, handing out resources, or-ganising lifts. Our aim was to make thewhole day as accessible as possible,and to not just focus on the work shops.

All of the rooms and workshops hadsigns and were colour coded, and peo-ple were on hand to help where needed.Prior to the event we sent out accessi-ble application forms for individuals tochoose which workshop they wantedto attend. On arrival at the event partici-pants were given a pack withinformation and the agenda for the day.Service users were provided with theirown individualised timetables and otheraccessible information, and supportstaff and carers were encouraged toenable them to use the packs through-out the whole day. Ticks, crosses andhappy/sad picture symbols were used

throughout the day to help service us-ers engage during workshops anddiscussions. Service users could reallyengage and participate in the day. Weencouraged staff and carers to makethe resources functional, so some pro-moting was needed, some times by SLT,and sometimes by service users them-selves.

Our SLT department also had a stand toshow some of the information that wehave developed in our de-partment to support serviceuser involvement. This in-cluded accessible therapygoal planning, accessibleguidelines for making infor-mation easier tounderstand and adviceabout holding meetings,etc.

If we hadn’t got the littlethings right the whole daywouldn’t have flowed. Byspending enough time onthe development of re-sources, it meant thatpeople were able to be involved on theday. This was worth the time taken andit made the day.

People with learning disabilities were in-tegral to the organisation andpresentation of the day. We wanted theservice user theme right through theday and, where we could, service userswere involved, i.e. the food was pro-vided by Vision 21 (a cateringorganisation employing people with alearning disability); actors from Hi JinxProductions were involved in the plan-ning and participated in workshoppresentations; and a co-presenter witha learning disability working for PeopleFirst was involved in one of the work-shops. Service users were also involvedin judging a competition and present-ing a prize at the end of the day.

WORKSHOPS

The main body of the day con-sisted of four workshopsentitled ‘Our Health’, ‘MakingChoices about Your Life’, ‘Mak-ing Everyday Choices’ and‘Having your Say’.

Our Health

In our experience we find thatservice users can have diffi-culty engaging in GPappointments; communica-tion is a barrier for both thedoctor and service user, result-ing in a negative experience.The ‘Our Health’ workshop ex-plored people’s experiences

of visiting the doctor.

Bad and good scenarios were acted outdepicting a service user visiting the GP.The bad scenario showed the GP talkingto support worker and the service usernot being listened to with their commu-nicative attempts, making it difficult forthem to indicate how they were feelingor what was wrong. The audience wasthen asked for feedback using ticks andcrosses sheets, facial expressions andvocalisations to give their views.

We included a recorded interview with aGP, to give the doctor’s view of what it islike if they do not have access to appro-priate information about a person’scommunication, and the difficulty thatensues when trying to involve the indi-vidual in the appointment. We thenshowed the DVD of the Welsh PersonalHealth Profile and how it might help. Thisis an accessible booklet which containsinformation about a person’s health andhow they can be supported.

A good scenario was then acted out, withthe same service user going to the GP,but giving them his Personal Health Pro-file. The GP then had a better idea ofhow to effectively communicate di-rectly with the service user rather thanjust talking to the support worker. Thisincluded the doctor’s explanation of




what the problem was and howit was going to be treated. Itmade a considerable differ-ence to the way the serviceuser was feeling and their sub-sequent involvement indecision-making about treat-ment. The audience were againasked their views.

A general discussion about go-ing to the GP and hospitalappointments happened after-wards, and SLTs shared ouraccessible resources that havebeen developed in the Direc-torate teams for hospital visits.

Making Choices about your Life

The ‘Making Choices about your Life’workshop aimed to demonstrate thelink between person centred planningand developing a new visual timetablethat truly reflected the interests of theservice user.

By using Talking Mats beforehand thisidentified what the service users liked,didn’t like or wanted to try out, and alsohighlighted some health problems theyhad been experiencing.

We showed two scenarios. The first hadno pre-planning, resources used weren’tmade accessible, and the member ofstaff led what activities were to go in thetimetable. The service user wasn’t happyand was frustrated by the outcome.

The second meeting was different. Thisinvolved the service user preparing forthe meeting, using more accessibletools, such as a Talking Mat to reviewand talk about activities she did in theweek (Fig 1), and changes she wantedto make. They were more involved withthinking about what she was doing dur-ing the week, and showed the carersworking in a more person centred way,taking into account the person’s cur-rent health needs.

A Flip camera was used to make acces-sible minutes of the meeting. However,in a real situation the camera could beused to show a service user examplesof new experiences, or the service usercould show others things that they hadtried.

After each scenario, the audience wasencouraged to feedback on how eachsession used the accessible resourceswith the tick and cross cards and happyand sad expressions.

At the end, we spent some time look-ing at some sections from the actor’sown Person Centred Plan document.There was some audience participationto identity who else had a Person Cen-tred Plan, and discussed how they can

be useful for the service user to iden-tify what was important to/for them, andhow they can let carers and others know.

Making Everyday Choices

The ‘Making Everyday Choices’ work-shop was very interactive and was setup to enable service users and carersto try out different ways of makingchoices through use of signing,switches, pictures and symbols, videocameras and communication aids.

The next part of the workshop demon-strated how the service users can getwhat they want if their environment is

set up to help them. A modelof a kitchen had been made andservice users were asked to finditems when the environmentwasn’t made accessible.

The service users were thenasked again to find items, butthis time picture symbols andphotographs were used. Thisreally helped to demonstratehow much easier and less con-fusing it is if an InclusiveCommunication environmentis used, with rooms and cup-boards being labelled. Peoplewere then more empoweredto find things more easily

themselves.

Having your Say

Finally, the ‘Having your Say’ workshopbegan with an excellent presentationfrom a service user working for theSouth Wales People First organisation.This raised awareness of how it feels tobe excluded and not given a voice. Thiswas then followed by examples of hold-ing a meeting.

The first scenario was at too fast a pacewith an abundance of jargon so that itwas difficult to follow. The second ex-ample took the service user’s adviceand kept the language simpler, showingways of involving people more.

This was a very powerful presentationand was well received by participants.There was a lot of engagement from thegroup and it was obvious that this was asubject people felt strongly about.

OUTCOMES FROM THE DAY

We were very fortunate in that our localmedia students from the University of

Figure 1 Talking Mat showing one service user’s activities during the week



Glamorgan videoed the day’sevents. During the lunch breakthe film crew captured evalu-ations of the conferenceparticipants. Participants werealso filmed engaging in a‘Speech Bubble’ activity, whichwas part of the Royal Collegeof Speech and LanguageTherapists Giving Voice cam-paign. Service users weresupported by carers and SLTsto complete speech bubblesof what communicationmeant to them. Photographswere taken of these which willbe part of the overall collec-tion of material developednationally. We also decided to hold acompetition for the best Speech Bub-ble, which was judged by one of theactors and professional head of SLT.

Listed below are some of the main out-comes that have come from theconference:

• There was a request made by a serv-ice user for a Welsh personal healthprofile to use at GP appointments andto help with their annual health checks.

• During the ‘Making every day choices’workshop there was an activityaround choosing a menu. It becameclear that one person had not tried arange of desserts and that the carerhad assumed that he didn’t likethem. The plan was for the serviceuser to go home and try these des-serts out. We have now learnt that heloves lemon meringue pie!

• During the day there was an interestby participants and SLTs in TalkingPhoto Books. Since then, a self-re-ferral has been made to acquire oneof these, and have also been usedmore within our department.

• Loans have been requested for thecommunication aids that wereviewed on the day. Use of the com-munication aids are still ongoing andhave been helping promote the range

of aids that can be used to supportcommunication.

• The conference has also had an im-pact on professionals within thedirectorate, helping networking withother professionals within the di-rectorate who showed lots ofenthusiasm following the conference,as well a building links with other agen-cies outside the directorate, with arepresentative from a service user or-ganisation requesting access toresources for use in her own training.

CONCLUSION

All of the workshops demonstrated thatcommunication needs to be inclusive;it is about finding out what would helpeach person, and being prepared. Theworkshops showed what is achievableif the time if taken to do this. A précisof the day has been put onto DVD andsent to participants and others in thedirectorate to help raise the awarenessof the benefits of improved engage-ment to a wider audience.

From the information we have receivedsince running the service user confer-ence, we feel that we have achievedwhat we set out to do. As the confer-ence was run in the East side of thedirectorate, we are hoping to run a simi-lar event in the West.

Oliver Lee & Christine GriffithsSpeech & Language Therapists

REFERENCESBarnes, L. et al (1998) Life Plan-ning: Guidelines for increasingservice user involvement in the plan-ning process. Oxleas Trust/TizardCentre, University of Kent at Can-terbury.Beamer, S. (2001) Making Deci-sions: Best practice and new ideasfor supporting people with highsupport needs to make decisions,Values into Action, London.Beamer, S. (2001) It’s Your Choice:Values into Action, London.

Bradshaw, J. (2000) A total communi-cation approach: towards meeting thecommunication needs of people withlearning disabilities, Tizard LearningDisability Review, 5 (1), 27-30.Chapman, J. & Forshaw, N. (2002) Mak-ing services more accessible, RCSLTBulletin, May 2002, 7-8.Coldham, S. & Marler, R. (2002) Involv-ing service users in the process ofrevising a policy on personal relation-ships, Tizard Learning DisabilityReview, 7 (1), 39-44.Department of Health (2001a) ValuingPeople: A new strategy for Learningdisability for the 21st Century, Lon-don: Department of HealthDepartment of Health (2001b) PersonCentred Planning Guidance, London:Department of Health.Dobson, S. & Worrall, N. (2001) Theway we were…, Bulletin of the Royal

College of Speech and Language Therapists, May589, 7-9.

Evans, C. (1999) Gaining our Voice: the developingpattern of good practice in use involvement,Managing Community Care, 7 (2).

Foundation for People with Learning Disabilities(2000) Everyday Lives, Everyday Choices. ForPeople with learning disabilities and high supportneeds, Edited by A Wertheimer, The MentalHealth Foundation, London.

IAHSP (2001) Deciding together - Working withpeople with learning disabilities to plan servicesand support, London, Community Care Devel-opment Centre, Institute for Applied Health andSocial Policy.

Jones, J. (2000) The total communication ap-proach: towards meeting the communicationneeds of people with learning disabilities, TizardLearning Disability Review, 5 (1) 20-26

National Assembly of Wales (2001) Fulfilling thepromises: Proposals for a framework for serv-ices for people with learning disabilities, LearningDisability Advisory Group.

Michael, J. (2008) Healthcare for All: Independentinquiry into access to healthcare for people withlearning disabilities.

PROJECTS/PRESENTATIONS

British Institute of Learning Disabilities, Hearingfrom the Seldom Heard; Project funded by theDepartment of Health.

Connect - Health Talk Project (2011) Ongoing twoyear trial to test a resource pack designed tosupport efficient and effective management ofconsultations with health professionals wherepatients have communication difficulties. BeckyMoss is the contact person.

Connect - Working Together Project - supportedby the King’s Fund - explored what it takes toinvolve people with aphasia in decision makingand the day to day business of an organisation.Contact person: Alan Hewitt.

Connect - Communication Access Toolkit - whatmakes health and social services accessible orinaccessible - 2 day training and toolkit - mak-ing communication access a reality.

Connect - Taking Control - Self managementproject to enable more access for people withaphasia to the expert patient programme.

Connect - Bristol Feedback Project - Traininghealthcare workers about aphasia - people withaphasia give the healthcare workers construc-tive feedback about their communication skills.

LDIAG - Participation Roadshow - presentation re-garding being involved at a service level (buttargeted at the more verbally able people withlearning disabilities).

Previous Communication Matters Conference Pres-entation: Sharon Hambley, Susan Williamson,Francis Sturman 2009 - Inclusive Meetings forPeople with Learning disabilities (see short ab-stract on the Communication Matters website).


INTERESTED IN HOSTING A COMMUNICATION MATTERS ROAD SHOW IN YOUR AREA?

The Communication Matters Road Shows are great oppor-tunities to learn all about the latest communication aids andsoftware from some of the UK’s leading AAC suppliers. About10-15 Communication Matters Road Shows are held every yearat various locations in the UK - and they are free!

At each Road Show, there are usually 12 to 14 companies pre-senting. The presentations are given in parallel and repeated fivetimes during the day - participants choose which of the fivecompanies they wish to hear during the day. The current formatis: Registration is 9.00-9.25am; the day begins at 9.25am with ashort introduction from each company, followed by three ses-sions in the morning and two in the afternoon, and a short‘exhibition’ session after lunch. The day finishes at 3.30pm.

WHAT’S INVOLVED IN HOSTING A ROAD SHOW?

We are always looking for new venues to hold Road Shows, soif you would like to host one in your area, here are a few thingsto consider. Don’t be put off by the long list of requirements – wewill offer you a lot of help and advice along the way!

The Venue: We will work with you to find a suitable, wheelchairaccessible venue in your area. The cost of venue hire will be metby the suppliers attending.

Catering: The cost of lunch and refreshments will be met by thesuppliers attending.

Advertising: To get a broad cross-section of delegates, youwill need to advertise the event to speech and language thera-pists, teachers, social work staff, people who use AAC and theirfamilies, voluntary organisations and other professionals involvedwith communication aids. Communication Matters does not nor-mally pay for the cost of advertising or mailshots.

Bookings: Communication Matters will provide you with a mas-ter copy of a flier/booking form to duplicate and send to your localcontacts, the local press, professional magazines, local newslet-ters, etc. Anyone interested in attending has to complete and sendthe booking form (by post or online) to Communication Matters.

All bookings will be handled entirely by Communication Matters:delegates will be sent a booking confirmation immediately, andjoining instructions (map, directions, timetable) two weeks priorto the event.

On the day: You will be responsible for the smooth running ofthe day, including: setting up workshop spaces, signage, regis-tering delegates (Communication Matters will provide you withliterature, a delegates list, name labels and other information).

STILL INTERESTED?

Patrick Poon would be delighted to hear from you - please con-tact 0845 456 8211 or [email protected]

Augmentative and Alternative Communication

Thiis the official journal of the International Society for Augmentative

and Alternative Communication (ISAAC), published quarterly by

Informa healthcare. AAC publishes original articles with direct application

to the communication needs of persons with severe speech and/or

communication impairments for whom augmentative and alternative

communication techniques and systems may be of assistance.

Unterstutzte Kommunikation

This ISAAC affiliated publication is published four times a year in

German by ISAAC-GSC.

AGOSCI in Focus

AGOSCI in Focus (formerly AGOSCI News) is the

newsletter of the Australian Group on Severe

Communication Impairment. It is an ISAAC affiliated

publication and is published twice a year.

ISAAC Israel NewsletterISAAC Israel Newsletter is an ISAAC affiliated

publication. Published annually in the spring of each

year, in Hebrew with a few English abstracts.

Members of Communication Matters (ISAAC UK) can order these publications by contacting:Communication Matters, Catchpell House, Carpet Lane, Edinburgh EH6 6SP

CM Tel & Fax: 0845 456 8211 Email: [email protected] www.communicationmatters.org.uk

If you are not a member of Communication Matters, you can order in local currency from your local Chapter of ISAAC, or in dollars directly fromISAAC, 49 The Donway West, Suite 308, Toronto, ON M3C 3M9, Canada Tel: +1 416 385 0351 Email: [email protected] Website: www.isaac-online.org



GOAL! Creating a Resource to FacilitateClient Input to Goal Setting

JULIE ATKINSON, CLAIRE HAYWARD, JULIE SHERIDAN & RUTH WILLIAMSAccess to Communication & Technology, 91 Oak Tree Lane, Selly Oak, Birmingham B29 6JA, UKEmail: [email protected]

INTRODUCTION

Access to Communication & Technol-ogy (ACT) is the West Midlands regionalelectronic assistive technology assess-ment and provision service. Our MissionStatement is “To work with clients andtheir local teams to assess for and pro-vide techniques and technologies whichoptimise the potential for communica-tion and control.”

As a tertiary service, the way in whichwe work in partnership with clients andtheir local teams is constantly being re-fined to increase flexibility; this is

reflected in the different models ofservice delivered to clients and theirlocal teams.

We strive towards establishing a clearway of enabling clients to input to theformulation of goals. However, given ourclients’ communication difficulties, thiscan be challenging to implement. Toelicit clients’ opinions more robustly, inorder to inform our goal setting, ACThave created a goal development re-source which can be implemented bythe local Speech & Language Therapistprior to referral to ACT.

Goal setting is an incredibly subjectivearea with a great number of variablesimpacting upon the process. Brewster(2004 p169) cautions “there is always adanger of ‘putting words into theirmouths’ when it comes to interviewingpeople with learning disabilities” and sug-gests that “a more fundamental shift is… required, towards accessing views asan ongoing process, rather than regard-ing an interview as a one-off event”.

EVALUATING CURRENT PRACTICE

The West Midlands AAC Care Pathwayassessment and implementation docu-mentation is currently used as the basisto make referrals to ACT. This docu-mentation has a section to recordclients’ goals and the expectations ofthe local team with regard to how a VoiceOutput Communication Aid may helpsupport a client’s communication –alongside, in addition to, or as an alter-native to a low tech system. However,clients’ goals are often expressed by theteam, with limited specific discussionwith the client prior to the appointment.

Working as a tertiary specialist service,ACT clinicians are unlikely to have metthe client before the initial assessmentappointment. This lack of familiaritybrings into question whether it is in theclient’s best interest to communicate,for any significant exchange, with theACT clinician. In practice, this some-times means that the local speech &language therapist or a family member

Means(How we communicate)

Speech & writingNon-verbal ParalinguisticSigns volumesymbols intonationgestures ratebody language tonefacial expression fluencypointingobjects & pictures‘behaviour’

Reasons(Why we communicate)

attentiongreetings

wants/needsrequest information

give informationask questions

protest/denyfeelingschoices

preferences

Opportunities(Where, when and withwhom we communicate)

speech & writingpartner

time & placeshared language

shared communication systemshared interests

Figure 1 Means, Reasons and Opportunities: The original model



assumes the apparent role of interpreteror advocate. Therapists working as partof ACT or the local team may perceivethat advocating for the client is part oftheir role. However, any person who hasa relationship other than voluntary andimpartial advocate is likely to have goalsand agendas which they may try and ex-ert. Tannous (2000) argues that any paidhealthcare professional, or indeed fam-ily member, cannot be a true advocate asthey lack any external motivating factors,and contends that the label of ‘spokes-person’ may be more appropriate.

The approach currently taken by ACTcould be described as developing a con-sensus view from a series ofspokespeople; this is a recognised ap-proach in meeting the communicationneeds of people with complex disabili-ties and helps to alleviate bias (Groveet al 2000). This technique also sits wellwith the concept of respect for clients,as described by Falardeau & Durand(2002). They contend that acknowledg-ing that autonomy is a goal for someclients, rather than a reality, and thatrecognising and responding to a per-son’s limitations is just as much a partof respect as recognising their skills.Falardeau & Durand relate this approachdirectly to clients with significant com-munication impairments:

“In rehabilitation, clients often have com-munication problems and difficulties indecision-making. The solution for thetherapist is to adopt a low paternalis-tic attitude, thereby fostering the client’sautonomy over the long term”.(Falardeau & Durand 2002)

Clients will of course, have varying lev-els of cognition. Many clients may wellbe able to understand parts, or all, ofthe concepts discussed in the appoint-ment. The question therefore remains,how best to support the understandingof clients to maximise their potential toplay an active role in appointments?

THEORETICAL FOUNDATIONS

ACT recently hosted two final yearSpeech & Language Therapy studentsfrom Birmingham City University onplacement. Project work is encouraged.This year’s students have undertakenresearch into how ACT may better fa-cilitate clients to input into their owngoals. This project has culminated in thecreation of a resource pack for localspeech & language therapists which canbe used prior to referral to ACT in orderto allow client input to the formulationof their own goals for their AAC sys-tems and use. Lewis (2002 p113)suggests that people with “longer termand personal involvement” (such as a

carer or local SLT)should be involved inobtaining clients’views, rather than atertiary service suchas ACT.

The resource createdhas its base within theprinciples of TalkingMats, “a low techframework to helppeople with severecommunication diffi-culties express theirviews” (Murphy 1997).Recently, Murphy &Cameron (2008) concluded that “Talk-ing Mats can be an effectivecommunication resource for manypeople with intellectual difficulty andcan help them express their views byincreasing both the quantity and qual-ity of information communicated.”Their study found that a Talking Matsapproach was most beneficial to peo-ple with at least 2-3 information carryingword level understanding (i.e. 2-3 keywords in a sentence.)

The ACT goal-setting resource has arange of symbols to allow children andadults to explore their ‘Means’, ‘Rea-sons’ and ‘Opportunities’ (MRO) forcommunication (Bulpitt, 1989; see Fig1). This model is used as a foundationto practice for the SLT students at Bir-mingham City University.

The symbol vocabulary which was de-veloped for the resource was expandedand refined from the MRO model butalso incorporating Social NetworksTheory (Blackstone & Hunt Berg 2003).Therefore when using the resource, thefacilitator has a pre-made, comprehen-sive vocabulary which draws togethertwo prominent theoretical models toensure all aspects of communicationare considered.

Means refers to how the client com-municates (based on the West MidlandsAAC Care Pathway section ‘Modes ofCommunication’). Symbols for this in-clude: speech, signing, gesture, facialexpression, pointing, symbol communi-cation book, voice output communicationaid.

Reasons refers to why the client com-municates (based on the West MidlandsAAC Care Pathway section ‘Use of Com-munication’). Symbols in this sectioninclude (Fig 2): getting attention, mak-ing requests, controlling others, refusing,being sociable, giving information, ask-ing questions, expressing feelings,repairing communication breakdowns,imagining/being creative, learning.

Opportunities refers to where, whenand with whom the client communi-cates (based on the West Midlands AACCare Pathway section ‘AAC Environ-ment’). This section has been dividedinto two categories, People and Settings.Symbols in these categories include:

• People (Fig 3): parents, children,brothers/sisters, grandparents,friends, teacher, carer, keyworker,speech & language therapist, occu-pational therapist, physiotherapist,doctor, nurse, neighbours, strangers.

• Settings (Fig 4): home, school/college,day centre, GP/hospital, shops, res-pite centre, restaurants, bank, pub,hairdressers, place of worship, tel-ephone, groups, meetings, 1:1conversations.

The client is facilitated to rate their‘Means’, ‘Reasons’ or ‘Opportunities’ byplacing the symbols on a Visual Ana-logue Scale (Fig 5), described by Gouldet al (2001) as “a measurement instru-ment that tries to measure acharacteristic or attitude that is be-lieved to range across a continuum ofvalues and cannot easily be directlymeasured.” We have opted for a seven

Figure 3 People

Figure 2 Reasons



point Visual Analogue Scale because“there is evidence that the reliability ofmeasures increase with the number ofcategories offered up to about 7” (Pring,2006).

Clients and their teams can choosewhether to administer the entire re-source (which can take up to two hours)or to select the most appropriate part(s).The resource can be administered in avariety of ways:

• The client physically placing thesymbols on the Visual Analogue Scale

• A partner providing a physical and/or auditory scan (of the numbers) withthe client indicating when their cho-sen position is highlighted

• The client using eye pointing to indi-cate their chosen position.

PILOT FEEDBACK

A pilot study involved the resource be-ing implemented to longstanding usersof AAC for their comments.

Feedback from clients included: “I lovethe idea…because everyone get to knowwhat I am thinking.”

Carer comments included: “It’s been abit of an eye opener … I’ve been with hima long time and it’s shown areas we needto work on.” “Very informative – more sothan I thought it was going to be” and“When you see where he’s putting thosesymbols on the board, you see it from hisperspective, his difficulties and how wemight overcome them.”

One client (see mat Fig 6) identified con-cerns about repairing conversationalbreakdowns therefore vocabulary wasprogrammed into the Voice OutputCommunication Aid to allow the clientto repair breakdowns independently.

Another client (Fig 7) insisted that hisSocial Worker should be off the rating

Figure 4 Settings

Figure 5 Seven point visual analogue scale

Figure 6 Example mat for ‘Reasons’

Figure 7 Example mat for ‘Opportunities - People’

Figure 8 Example mat for ‘Opportunities - Settings’

scale – to emphasise his concerns; thecarer said that this would be raised as aconcern when they next met the SocialWorker.

In the third mat (Fig 8), meetings wererated as more difficult than groups be-cause the focus is on the person usingAAC as (s)he creates a message; vo-cabulary was added to the Voice OutputCommunication Aid to allow the per-son using AAC to express theirpreference for the conversation to carryon whilst (s)he built their message.From this mat, additional messagescould be identified to facilitate tel-ephone use, or role play could be usedto further develop skills. The client alsoidentified that telephone use was moredifficult than Skype; again, strategiesfor use on the telephone could be putinto place.

MOVING FORWARDS

The next step for ACT is to introduce thisresource to local teams for them to evalu-ate its usefulness. A number of teamshave begun to use it, both in the WestMidlands and also further afield as a re-sult of hearing the presentation at theCM2011 conference. We would like to seewhether other AAC services feel that thistype of goal setting approach is usefuland would appreciate feedback/com-ments.

Julie Atkinson,Speech & Language Therapist

Claire HaywardOccupational Therapist

Julie Sheridan & Ruth WilliamsSpeech & Language Therapy Students

REFERENCES

Blackstone, S. & Berg Hunt, M. (2003) Social Net-works: A communication inventory forindividuals with complex communication needsand their communication partners. Augmenta-tive Communication Inc.

Bornman, J. & Murphy, J. (2006) Using the ICF ingoal setting: Clinical application using TalkingMats. Disability & Rehabilitation: Assistive Tech-nology, June 2006, 1 (3), 145-154.

Brewster, S. (2004) Putting words into their mouths?Interviewing people with learning disabilities andlittle/no speech. British Journal of LearningDisabilities, 32, 166-169, BILD Publications.

Bulpitt, D. (1989) Means, reasons and opportuni-ties model: Training material. Leicester HealthAuthority & Central Nottinghamshire HealthAuthority.

Falardeau, M. & Durand, M.J. (2002) Negotiation-centered versus client-centered: Which approachshould be used? Canadian Journal of Occupa-tional Therapy, 69, 135-142.

Gould, D., Kelly, D., Goldstone, L. & Gammon, J.(2001) Examining the validity of pressure ulcerrisk assessment scales: developing and using il-lustrated patient simulations to collect the dataINFORMATION POINT: Visual Analogue Scale.Journal of Clinical Nursing, 10, 697-706.

Grove, N., Bunning, K., Porter, J. & Morgan, M.(2000) See what I mean: guidelines for interpret-ing communication by people with severe andprofound learning disabilities. Kidderminster,BILD/Mencap.

Lewis, A. (2002) Accessing, through research inter-views, the views of children with difficulties inlearning. Support Learn, 17, 111-6.

Murphy, J. (1997) Talking Mats: A Low-tech Frame-work to Help People with Severe CommunicationDifficulties Express their Views. Psychology De-partment, University of Stirling.

Murphy, J. & Cameron, L. (2008) The effectivenessof Talking Mats with people with intellectualdisability. British Journal of Learning Disabili-ties, 36, 232-241.

Pring, T. (2006) Research Methods in Communica-tion Disorders. Whurr.

Tannous, C. (2000) Therapists as advocates fortheir clients with disabilities: A conflict of roles?Australian Occupational Therapy Journal, 47:41-46.

West Midlands AAC Care Pathway Assessment &Implementation document Version 5 (2011).



How Was School Today...?In the Wild

Using a mobile phone to support data collectionfor automatic narrative generation

ROLF BLACK, ANNALU WALLER, EHUD REITER & NAVA TINTAREVSchool of Computing, University of Dundee, Dundee DD1 4HB, UKEmail: [email protected]

Figure 1 Phone, name badges with QR code (top) and RFID tag (bottom, tag on back of badge), tagged object("Post Play Set", round tag visible in top left corner of packaging)

INTRODUCTION

The How was School today...? project hassuccessfully introduced a new personalnarrative tool for children with severespeech and physical impairments.

The system collects sensor data, voicerecordings from school staff and otherinformation. The latest implementationof the prototype system uses a mobilephone to facilitate and expand the datacollection. Data now includes photo-graphs that are automatically linked tomulti-part voice recordings, and the abil-ity to read 2D barcodes for interactionand location tracking. Data collectedwith the phone are transferred automati-cally to a remote server and then to thevoice output communication aid (VOCA)of the user.

The system automatically creates an in-teractive narrative on the user’s VOCAthat they can edit and use to talk abouttheir school day experiences.

AAC AND PERSONAL NARRATIVE

Augmentative and alternative commu-nication (AAC) can provide access tocomputerised speech output for indi-viduals who have little or no speech andvarying difficulty in understanding lan-guage. Computer-based speechgenerating AAC devices which provideaccess to pre-stored words, phrases

and sentences are well suited to com-municate needs and wants (such as Iam thirsty). However, they do not sup-port more complex interactions suchas conversational narrative (guess whathappened to me today) and social dia-logue (e.g. pub chats about football)very well. Not only are these interactionsessential for building vocabulary andgeneral language acquisition, they alsoform an essential part in the processof making and sustaining friendshipsand other social relationships. Indeed,social isolation is a major quality-of-lifeissue amongst people with communica-tion impairment (Bercow 2008).

Personal narrative is a vital type of in-teraction for social communication. By

talking about our personal experienceswe translate our knowledge into a narra-tive (McCabe and Peterson 1991),helping us to shape our experience(Quasthoff and Nikolaus 1982). Addi-tionally, by telling and retelling,structuring and restructuring our per-sonal stories we are able to reflect onour life to help us develop a sense ofself (Polkinghorne 1995). Sharing storiesis a major part of both finding new andmaintaining present relationships andfriendships.

Our goal is to develop AAC tools thatsupport storytelling and social dialogue.As a step towards this vision, we con-structed a proof-of-concept systemwhich helps children with communica-



tion disabilities to construct and tell sto-ries about their day at school (Black,Waller, Reiter and Turner 2009; Reiter,Turner, Alm, Black, Dempster and Waller2009). We deployed sensors to track thechildren’s location, activities and inter-actions, created a natural languagegeneration data-to-text system (Reiter2007) which generated a draft storyfrom this data, and built tools which al-lowed the children to edit andinteractively narrate the stories.

DATA COLLECTION USING A MOBILE PHONE

Feedback from the initial prototypeevaluation (Black, Reddington, Reiter,Tintarev and Waller 2010) has led to amodular system structure to allow foreasier and extended data collection. Alldata for story generation are now col-lected by using a mobile phone. Thephone is equipped with a microphonefor voice recordings, an RFID (Radio-fre-quency identification) sensor forinteraction tracking using RFID tags on

staff cards and objects (e.g. teachingtools and toys) and a camera that canbe used for taking photographs or im-ages of barcodes for interaction andlocation tracking (Fig 1).

During the evaluation of the system twoparticipants carried the phone withthem during the school day to allowstaff to collected data. The phone au-tomatically transferred data collectedto a remote server for story generationvia the 3G mobile phone network. In afirst prototype setting the generatedstory utterances and photos were sentmanually via email to the researcherwho updated the VOCAs used by theparticipants to enable them to tell staffand parents about their day at school(Fig 3). The final prototype was able toautomatically update data on the VOCA.Parents at home were also able to col-lect data (voice recordings andphotographic images) to allow the par-ticipants to share experiences andstories from home.

The following data were collected:

Location tracking of the user. Rooms inthe school that were accessible to theparticipating students, such as class-rooms and lunch hall, displayed a signwith a QR code (and RFID tag for backup,Fig 2). When the participant entered aroom during a time that was not sched-uled in the timetable (e.g. going into thehall for a concert) staff used the cam-era in the mobile phone to scan thebarcode.

Interaction tracking of the student. Staffand peers at the school where givenname badges that either contained anRFID tag or a QR code (Fig 1). The QRcode is scanned in the same way as thelocation barcode. The RFID tags arescanned by the holding the mobilephone to the name badge to allow thebuilt in sensor to detect the tag.

Voice recordings. Staff recorded multi-part voice recordings (similar to using aStep-by-Step), which were linked to aphotograph taken at the same time withthe mobile phone (Fig 3). This supportedeasier access to the recordings on theVOCA as the photograph became thelabel to retrieve the recordings. The par-ticipating students could access therecordings on the phone for immediateuse in the school (e.g. to tell the classwhat had happened during a therapysession) either using the phone keypador a switch that was attached to thephone.

EVALUATION

The evaluation focused on the usabilityof the mobile phone component of thesystem. The VOCA interface was notevaluated during this project due totime constraints. Two boys, aged ten andseventeen, were recruited. Peter hasathetoid cerebral palsy, uses a wheel-chair and switch access to technology.Martin has a chromosomal abnormality

Figure 2 Room signs with QR code (left) and RFID tag on its back (right)

Figure 3 Mobile phone with recording interface (left), photograph taken, and VOCA interface (right)



and is ambulatory. Neither boy has func-tional speech. Both have some degreeof intellectual disability.

OBSERVATIONS

Staff were asked to keep the mobilephone with the participants during theschool day. After school the mobilephone was sent home with both partici-pants. Martin carried his mobile eitheron a lanyard around his neck or thephone was carried by a member of staff.Peter’s phone was usually placed in thecradle on his tray (on standing frame oron lap tray of wheelchair) allowing himto access messages via switch, or amember of staff carried the phone.

The examples in Table 1 show multi-voice messages recorded on bothparticipants’ phones. The first ‘story’ re-lates an experience while the second‘story’ was used by a parent to informstaff and the research team about useof the system.

FEEDBACK

After the evaluation, feedback was gath-ered from participants, their parents andschool staff, using interviews and ques-tionnaires.

Feedback from school staff

14 questionnaires were completed bystaff in both participating classes. Themajority (13) used the phone (record-ings, photographs, swiping, QR). Ofthese, half (7) found the phone easy touse; 3 rated the phone as “not easy” to“very difficult” to use; and 4 gave nofeedback. In general staff liked the

Table 1 Examples of multi-voice messages

egamIcihpargotohP sgnidroceRecioV

1 IgninromsihtgnimmiwsmorfkcabemoctsujevahI":1egasseM".nufdoogdah

dluocIossgelymnotupsthgiewgnittegffodetratsI":2egasseM"loopehtnigniklawecitcarp

fonekaterasthgiewehtdnanotemlehehttegInehT":3egasseM.gniodekilIhcihwnwoymnognimmiwsnacIosstaolfemosdna

fognihttseinnufehtllafotsrifosgnimmiwssawInehW":4egasseMaemevigotdeirtdnarevoemac)reep(_____nehwsawyadeht

".ssikgib

2 ehesuacebfloRenohpotevahotgniogs'ehsyasdaD":1egasseMtons'rekaepsehtsknihteH.loohcsmorfsegassemymraeht'nac

".gnikrow

phone but usability was an importantissue which was exaggerated by the factthat the prototype still had some soft-ware bugs.

Staff in general noted greatly improvedcommunication with home. The impacton participants’ enthusiasm to sharestories was mentioned. Staff reportedthat participants wanted to use thephone immediately on arriving in classto share stories from home. They ac-tively sought contact with staff outsidethe class to tell them their story.

Feedback from participants and theirparents

Both participants enjoyed using themobile phone for sharing personal nar-ratives. However, in a post evaluationsemi-structured interview, Peter (whohad just been equipped with an eyegaze communication device) indicatedhe did not like the mobile phone be-cause it contained the wrong stories –things he didn’t want to talk about. Hestated a preference for the eye gazesystem and hoped eventually to be ableto choose his own words.

Parents stated they didn’t find using themobile phone “too difficult” to use.They liked the functionality to add pho-tographic images to the message andwere interested to know about theirchild’s activities in school.

NEXT STEPS

This work is part of a series of projectsinvestigating ways to support narrativein AAC. This study showed the poten-tial of using a mobile phone to collect

data for subsequent automatic storygeneration and work is currently underway to take this idea further.

Rolf Black, Research Assistant

Professor Annalu WallerChair of Human Communication Technologies

Professor Ehud ReiterChair in Computing Science

Dr Nava Tintarev, Research Fellow

ACKNOWLEDGEMENTS

The authors would like to thank the chil-dren, their parents and school staff, whoparticipated in this study and who so will-ingly gave us their time, help and support.We would also like to thank JoeReddington, Steven Knox and AlanClelland for their work on realising themobile phone application.

We would like to thank DynaVox Inc. forsupplying the Vmax communication de-vices to run our system on and SensorySoftware Ltd for supplying us with TheGrid 2 VOCA software to enable the manu-ally prepared access to the narratives.

This research was supported by the Re-search Council UK’s Digital EconomyProgramme and EPSRC (Grant numbers EP/F067151/1, EP/F066880/1, EP/E011764/1, EP/H022376/1, and EP/H022570 /1).

REFERENCESBercow, J. (2008) Bercow Review of Services

for Children and Young People (0-19) withSpeech, Language and CommunicationNeeds. Nottingham, DCSF Publications, 140.

Black, R., Reddington, J., Reiter, E., Tintarev, N. &Waller, A. (2010) Using NLG and Sensors to Sup-port Personal Narrative for Children withComplex Communication Needs. First Work-shop on Speech and Language Processingfor Assistive Technologies (SLPAT), HumanLanguage Technologies: The 11th AnnualConference of the North American Chapterof the Association for Computational Lin-guistics, Los Angeles.

Black, R., Waller, A., Reiter, E. & Turner, R. (2009)“How was School Today…?” Evaluating thePersonal-Narrative-Telling Prototype: Prelimi-nary results. Communication Matters Symposium2009, Leicester.

McCabe, A. & Peterson, C. (1991) Getting thestory: A longitudinal study of parental stylesin eliciting narratives and developing narra-tive skill. Developing narrative structure. A.McCabe and C. Peterson. Hillsdale, NJ, Law-rence Erlbaum Associates, 217-253.

Polkinghorne, D. E. (1995) Narrative configura-tion in qualitative analysis. Life history andnarrative. J. A. Hatch and R. Wisniewski. Lon-don, Routledge, 5-24.

Quasthoff, U.M. & Nikolaus, K. (1982) What makesa good story? Towards the production ofconversational narratives. DiscourseProcessing. A. Flammer and W. Kintsch. Ox-ford, North-Holland Publishing Co.

Reiter, E. (2007) An Architecture for Data-to-Text Systems, ENLG-2007.

Reiter, E., Turner, R., Alm, N., Black, R., Demp-ster, M. & Waller, A. (2009) Using NLG to HelpLanguage-Impaired Users Tell Stories and Par-ticipate in Social Dialogues. ENLG2009, 12thEuropean Workshop on Natural LanguageGeneration. Athens, Greece, Association forComputational Linguistics.



Narrative Use in the Care Environment

SUZANNE PRIOR 1, ANNALU WALLER

1, ROLF BLACK 1 & THILO KROLL 2

1 School of Computing, University of Dundee, Dundee DD1 4HN, UK Email: [email protected] School of Nursing and Midwifery, University of Dundee, Dundee DD1 4HN, UK

“When people think I’m stupid, I tellthem my story” – Robert, 55

We are our stories. It is by telling ourstory (or narrative) that we share whowe are with others. It is by telling ourstory that we shape our identity. It is bytelling our story that we are more ableto understand ourselves and more ableto cope with changes in our circum-stances during our lifetime (McLean,2008).

People who cannot share narrative forwhatever reason may face difficulties inbuilding relationships and fitting intocommunities (Bercow Report, 2008), pre-senting a real risk of experiencing socialisolation.

People with Severe Speech and PhysicalImpairments (SSPI) who use augmenta-tive and alternative communication(AAC) face difficulties in sharing narra-tive (Waller and Newell, 1997). One of thereasons for this is the inherent difficultyin sharing narrative. Narrative is a com-plex linguistic skill and is developed froma very early age using scaffolding sup-port, a great deal of practice and beingsurrounded by storytelling.

This is a challenge for people with SSPIwho may spend many of their earlyyears learning to share needs based in-formation (e.g. “I’m hungry”) on complexAAC systems. This means there is of-ten little time for developing narrativeskills. In addition, AAC devices are notbest suited to storytelling, despite thefact that a story will often be repeated.It is often difficult to capture stories –

they tend to emerge during conversa-tion and seem to vary in the way theyare told.

Even if stories are stored on an AACdevice, finding a story can present chal-lenges due to the shifts in topics overthe course of a conversation. Storiesare often stored as monologue narra-tion on AAC devices, limiting thepotential for interactive conversation.

Finally stories are usually ‘held’ by fam-ily members/carers; this presents aproblem when the story ‘guardians’ arenot around to relate stories on behalfof the non-speaking individual.

The CHRONICLE project aims to createnarrative support for adults that will helpto elicit lifelong narratives, help in re-trieving narratives and facilitateinteractive conversation. To do this, theproject will build on previous researchand develop and evaluate a narrativeAAC software system. However, be-fore any software can be developed,there needs to be an understanding ofhow adults who use AAC and their speak-ing peers currently tell stories.

BACKGROUND

There is little research available on theuse of narrative by adults who use AAC.Bloch (2004) set up video recordingson conversations between adults withcommunication impairments and ver-bal communication partners. Blochinvestigated how AAC could be usedto help in communication breakdownswith adults with Dysarthric speech. Luo

(2008) asked adults who use AAC toshare a story with a communication part-ner; the study found that AAC couldshare stories but often used residualspeech to do so.

To date, we know of no study which hasexamined the differences in narrativesharing between adults with SSPI andtheir peers in day and residential carecentres. Murphy (1998) looked at com-munication in a care centre as a whole,but did not look specifically at story tell-ing.

This is an important comparison to makein this project, as an understanding ofnarrative use in the environment will becrucial in producing a good piece ofsoftware.

METHOD

The purpose of this study was to under-stand how adults (speaking andnon-speaking) share narratives withintheir community. The objective was toidentify the requirements for narrativesupport through observation of how resi-dents in a day and residential care centrein Scotland communicated. This obser-vation employed ethnographictechniques.

Ethnography refers to a form of re-search in which the researcherbecomes embedded in the environ-ment they are studying. In this study theresearcher spent two months in the cen-tre and over this time become acceptedas a member of the community. In or-der to integrate into the environment the



researcher volunteered in activities andassisted staff in setting up and clearingaway.

The first week of the study involvedpassive observation and allowed the re-searcher the opportunity to develop anunderstanding of how the care centreoperated and to identify potential par-ticipants for the study. The followingseven weeks were spent observing andrecording communication in the envi-ronment.

The participants were five adults whoused AAC (two female and three male)and five adults with functional speech(one female and four male). The partici-pants were representative of theenvironment and all had some level ofphysical disability and learning disabil-ity. Seven of the participants were ableto provide informed consent using amodified consent process (Balandin etal., 2006) and were given a participantinformation sheet to keep.

The other three participants requiredparental consent to take part; all ofthese participants gave verbal assent.During the study one participant fromthe functional speaking group decidedto withdraw from the study after 30 min-utes of recording. A replacementparticipant was then invited to participate.

In order to record the conversations inwhich the participants engaged, a direc-tional Dictaphone was fitted via a mountto the wheelchairs of nine of the par-ticipants and to the walking frame ofone participant. The dictaphone had alarge button which could switch the re-cording on and off and a light was set toflash when the device was not record-ing. Participants were shown how toswitch the recording on and off. Theresearcher and a member of the staffat the centre ensured that the partici-pant had the control over what to record.Participants were audio recorded for aperiod of five hours over 1 or 2 days.

Participants were encouraged to goabout their normal day to day tasks,switching the dictaphone when theycould do so. All of the recordings in-cluded at least one meal time and atleast one group activity. Initially partici-pants reported feeling very aware of thedictaphone:

*P1: remember ‘G’ that’s on

In most of the cases, after half an hourparticipants seemed to forget that thedictaphone was there and would actsimilarly to the way they had been ob-served behaving in week one.

Following the observation period, therecordings were transcribed andanonymised. The transcripts were pre-

liminary coded and examined for evi-dence of narrative use. A randomsample of 10% of the transcripts wasthen blind coded by a second re-searcher.

RESULTS

There was limited storytelling. Onlythree participants told stories at anytime. Two were AAC users; in both ofthese cases this narrative sharing wasprompted by a communication partner.One AAC user created the story duringthe course of the conversation. Theother AAC user shared stories on twooccasions, once as a monologue andone during the course of the conversa-tion. The participant with functionalspeech was not prompted to share astory and told a story for thirty minutes.It is interesting to note that the storythat was shared by the participant wasshared as a monologue and appearedto be told as rote from memory.

IMPLICATIONS FOR PROJECT

The preliminary findings of this studyreflect previous work with children:that there is limited time in the envi-ronment for storytelling; participantswere unused to telling stories; and thatstaff and other communication part-ners need assistance in being involvedin the storytelling process (Grove,2011).

The study also appears to show thatadults with functional speech alsostruggle in telling stories and could ben-efit from developing their storytellingskills. As a result of this, a regular timehas been established in the centre’sweekly schedule for a story tellinggroup. This group has a dual focus, itassists with the design plans for thesoftware while at the same time en-couraging peer-to-peer interaction(Prior et al., submitted).

Further information and updates on theproject’s progress is available at http://chronicle.computing.dundee.ac.uk

Dr Suzanne Prior, Researcher

Professor Annalu WallerChair of Human Communication Technologies

Rolf Black, Research Assistant

Dr Thilo Kroll, Reader

REFERENCES

Balandin, S., Berg, N. & Waller, A. (2006) Assessingthe loneliness of older people with cerebral palsy.Disability & Rehabilitation, 28, 469-479.

Bercow Report 2008. A Review of Services forChildren and Young People (0-19) with Speech,Language and Communication Needs. Notting-ham, DCSF Publications.

Bloch, S. & Wilkinson, R. (2004) Theunderstandability of AAC: A conversation analy-sis study of acquired dysarthria. Augmentativeand Alternative Communication, 20, 272-282.

Grove, N. (2011) Identity and Friendship throughsharing stories. Lost for Words: Lost for Life.City PUniversity, London.

Luo, F. & Higginbotham, D.J. (2008) Personal Nar-rative Telling of AAC Users with ALS. 2008Clinical AAC Research Conference .Charlottesville, VA.

Mclean, K.C. (2008) Stories of the young and theold: Personal continuity and narrative identity.Developmental Psychology, 44, 254-264.

Murphy, J. (1998) AAC Users’ Interaction with theirPeer. Communication Matters, 12:1, 28-30.

Prior, S., Black, R., Waller, A. & Kroll, D.T. Submit-ted. Establishing an Environment to PromotePersonal Narrative Sharing.

Waller, A. & Newell, A.F. (1997) Towards a narra-tive-based augmentative communication system.

Waller, A., O’Mara, D., Tait, L., Booth, L., Brophy-Arnott, B. & Hood, H. (2001) Using written storiesto support the use of narrative in conversa-tional interactions: Case study. Augmentativeand Alternative Communication, 17, 221-232.

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Starting from Scratch

Setting up an AAC assessment service for children in Cornwall

ALISON WEBBChild & Family Centre, Treliske Hospital, Truro, Cornwall TR1 3LQ, UKEmail: [email protected]

INTRODUCTION

An AAC assessment service for chil-dren in Cornwall was jointlycommissioned by Health and CornwallCouncil in September 2009. The teamconsisted of the county AAC officer,Anne Williams (employed by CornwallCouncil for one day per week) and aspeech and language therapist, AlisonWebb (employed by Cornwall PartnershipTrust) for one day per week.

We realised early on that the only waywe could provide an efficient servicewas to involve the child’s local team –the speech and language therapist (SLT)would have the key role. Therefore wedecided to only accept referrals fromthe child’s speech and language thera-pist, who would be participating in theassessment alongside the AssessmentTeam. This placed pressure on the al-ready stretched community services.Some children referred were only re-ceiving an SLT session once a term.

As technology was evolving so quicklywe did not invest in a pool of equip-ment to loan, but relied on triallingequipment from the suppliers. As westarted to recommend more main-stream equipment, such as iPads andtouch screen tablets, this became moredifficult, and we would have benefittedfrom a small store of these items fordemonstration and loan purposes.

An AAC Assessment Service had beenpiloted in Cornwall five years previously,but dissolved after eighteen monthsdue to lack of funding. We spent threemonths devising referral guidelines andforms for our referral pack based onthe forms previously used in the serv-ice and the Background Informationforms devised by the ACE Centre.

We felt that video was a vital part of theassessment, but this proved difficultfor the community therapists to sup-ply, due to lack of access to videocameras, and IT difficulties withdownloading onto the NHS drives, oronto disks.

The earlier referrals to our service didnot meet our entry criteria (see Appen-dix 1), mainly because of lack of arobust low tech communication systemin place, support from the school orfamilies, or experience of speech out-put devices such as Clicker 5 softwareor BIGmacks. It became evident thatthere was a need to help the commu-nity SLTs to develop their undertsandingand use of these systems. We took ontwo or three of the referrals to help theSLTs work through the skills requiredto reach our criteria. We also providedeach clinic setting with some mid techaids, such as BIGmacks and iTalk2 aids,and training in programming and usingthem. We have since run a rolling pro-

gramme of training for the communitySLTs.

BARRIERS TO THE PROJECT

• Multi-Agency working: we had diffi-culty sending emails andcorrespondence to one another asthe two systems did not ‘talk’ to oneanother; we could not share files; wedid not have a base to keep equip-ment and sometimes did not have thepiece of documentation we neededin the right place!

• Lack of time.

• Lack of resources: no admin supportor equipment.

• Lack of Occupational Therapy (OT)expertise: many of our clients had notseen an OT at all.

• Lack of a team leader with some stra-tegic overview.

• Inappropriate referrals (see above).

WHAT WE HAVE CHANGED OVER TIME

Referral system

We have become much stricter with ourcriteria, and use a triage system to ac-cept or reject referrals. The system isnow much faster and children can ex-pect to complete an assessment andreceive their aids within a shortertimescale.



Documentation

We have scaled down the backgroundinformation form and made it clear tothe community SLTs that other peoplecan complete certain sections.

Service Pathway

We have revised our service pathway toconform with National standards, in par-ticular adhering to timescales andinforming people of those timescalesin advance.

The team

It now consists of: Team Leader, MelMeadows; SLT, Alison Webb (one day perweek, Cornwall Partnership Trust); AACOfficer, Anne Williams (one day perweek, Cornwall Council); and OT, AnnNicol (two days per week, Royal Corn-wall Hospitals Trust).

WHAT WORKS

• Casework meetings

• Objective sheets

• Triage

• Drop-ins

• SLT involved

• Programmer identified

• Equipment list

• Team leader

• Discharge from Team

• Three heads are better.

WHAT DOESN’T WORK

• Not having a loan store• Only having one day a week• Video storage• Cross agency documents• Not having an overall leader• Having two people with the same

name/initials!

Alison WebbSpeech & Language Therapist

APPENDIX 1 - CRITERIA

Entry Criteria

The child is identified as requiring ahigh tech communication aid and isactive on a Speech and Language Thera-pist’s caseload.

The therapist must provide evidence of(including video):

• Comprehension level above expres-sive ability.

• A clear and demonstrated ability tounderstand cause and effect (e.g.purposeful use of switches, eyepointing, verbalisation, body language).

• Intentional communication (e.g. Char-lotte Child CommunicationDevelopment profile).

• Reciprocal turn taking in gesture orsound, even if at a basic level.

• The ability to generate one form ofconsistent and reliable movementwith e.g. hand, eyes, foot.

• Communication system in place(e.g. chart/books/signing) and beingused effectively across two settings.

• Experience of appropriate use of aspeech output device, e.g. BIGmack,Clicker, GoTalk.

• Firm commitment from parents/carers to support AAC, e.g. in theform of an AAC home/school agree-ment.

• The child has an up-to-date commu-nication passport in place.

Re-Entry Criteria

1. If the young person’s initial referralwas rejected because the criteriawere not met, a re-referral will beaccepted if there is clear evidencethat the criteria have now been met.

2. If the young person has been throughthe CAACAT Care Pathway and hasbeen discharged, a re-referral can bemade if:

• Access has changed (e.g. if seat-ing, mounting has changed, orphysical skills have altered).

• The equipment needs to be re-placed (hardware/software) – it nolonger meets the young persons’sneeds; the equipment has becomeobsolete and cannot be repaired;

APPENDIX 2CORNWALL AUGMENTATIVE COMMUNICATIONASSESSMENT TEAM (CAACAT) CARE PATHWAY

continued overleaf...



the young person has a progres-sive condition.

• The young person is transitioningfrom Primary to Secondary Education.

• There is a sudden, unplannedchange to the Child Support Team,i.e. changes in personnel, e.g. 1:1support, SLT.

Extended assessment Criteria

The Young Person will normally be dis-charged back to the local team followingthe six monthly review.

A period of extended assessment maybe agreed if:

• The objectives agreed at the assess-ment are no longer appropriate and

new ones need to be agreed (i.e. thechild has made rapid/no progress).

• Access has changed (e.g. if seating,mounting has changed, or physicalskills have altered).

• If the equipment needs to be re-placed (hardware/software) – it nolonger meets the young person’sneeds; the equipment has becomeobsolete and cannot be repaired; theyoung person has a progressive con-dition.

• If the young person is transitioningfrom Primary to Secondary Education.

• If there is a sudden, unplannedchange to the Child Support Team,

i.e. changes in personnel, e.g. 1:1 sup-port, SLT.

• If further training is identified formembers of the CST.

Exit Criteria

• The high tech AAC device is beingused functionally and consistently intwo settings.

• An AAC device plan is in place, whichmeans that the local team know howto programme, troubleshoot andadapt the device as needed.

• The child has transitioned into AdultServices with our support.

• A final report and re-entry criteria hasbeen provided.

What is Communication Matters?

Communication Matters is the UK Chapter of ISAAC (InternationalSociety for Augmentative and Alternative Communication), somembers of Communication Matters are also members of ISAAC.Our Vision: A world where all individuals have a right to a ‘voice’through the provision of equipment and ongoing support services.

Our Mission: Communication Matters values people who useany form of communication and promotes the individual’s right toparticipate in all aspects of life by using their most appropriatemeans of communication to express their thoughts, feelings,needs and desires.

What are the benefits of Membership?Members of Communication Matters receive:• The Communication Matters Journal three times a year.• Reduced rate at Communication Matters Study Days.• Reduced delegate rate at the CM National Symposium.• Regular electronic newsletters with the latest news in AAC

developments, Road Shows, study days and more.• Access the members’ area of the CM website.• All the benefits of ISAAC membership.

How do I become a Member?You can become a UK or Overseas member of CommunicationMatters (and therefore of ISAAC) by contacting:Tel: 0845 456 8211 E: admin@communicationmatters.org.ukwww.communicationmatters.org.ukIf you wish to become a member of ISAAC directly or subscribeto this Journal, please contact: ISAAC Tel: +1 416 385 [email protected] www.isaac-online.org

JOINING COMMUNICATION MATTERS & ISAAC

What is ISAAC?

• ISAAC stands for International Society for Augmentative and AlternativeCommunication.

• ISAAC is a big international organisation that focuses on AAC.• ISAAC was formed in 1983 and has over 3,600 members.• ISAAC members live in more than 50 countries around the world.• There are ISAAC Chapters in Australia, Canada, Denmark, Finland,

French-speaking Countries, German-speaking Countries, India, Israel,Italy, Netherlands-Flanders, Norway, Sweden, UK and USA.

ISAAC’s Vision: AAC will be recognised, valued and used throughoutthe world.ISAAC’s Mission: To promote the best possible communication forpeople with complex communication needs.

What does ISAAC do?• Advocates for augmented communicators & their families.• Supports the use of AAC around the world. This includes countries

that do not know about AAC.• Has an exciting awards & scholarship program for members.• Encourages the development of AAC products & services.• Produces a series of books for people involved in AAC.• Has an international conference every two years.• Sponsors a peer-reviewed scientific journal – Augmentative and

Alternative Communication (AAC). Visit the website at: www.isaac-online.org/en/publications/aac.html for more details.

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Possible New Ways of Scanningfor Switch Users

JORIS VERRIPSEmail: [email protected]

Some people depend on switches tocommunicate with the help of syn-thetic speech and a computer.Commonly, they have a neurologicalcondition such as cerebral palsy oramyotrophic lateral sclerosis. Row-col-umn scanning is used often, but isinherently slow, therefore text inputwith switches can be quite frustrating.

In this article, two alternatives are com-pared experimentally with a copy task,using three able-bodied test subjects:

(i) Oriented Scanning requires fewclicks but significant visual attention.

(ii) In Alternative Morse Code most con-secutive characters have relatedcodes, that are displayed on screen,but these codes have to be learned.

THE PROBLEM

How to input text at a high rate with asingle switch, and by a method thatwould be rapidly learned and would beerror tolerant as well, has been called‘the single key challenge’ (MacKenzie,2009). The ‘input rate problem’ (Alm,Todman, Elder and Newell, 1993) is a bitmore general, includes other accessmethods, and has been studied for along time in Augmentative and Alterna-tive Communication (AAC).

Morse Code, defined in 1836 by Vail, andwidely applied until about 1960, almostsolves this problem because it is fast1.However, Morse Code is neither easilylearned nor is it error tolerant, as many aformer boy scout can testify. One might

simplify Morse Code and throw outcodes that are hard to learn. This is theapproach of Oriented Scanning thatpresents the result in a scanning matrix.

One might also maintain the code butchange its assignment to the alphabet,to facilitate learning it. This is the ap-proach of Alternative Morse Code, thatcan be displayed on screen as well.Both techniques might be helpful forprint-disabled switch users, might be us-able elsewhere and are described below.

The two techniques were compared witha copy task employing two switches andthree different able-bodied test subjects.

ORIENTED SCANNING

Oriented Scanning can be operated witha single switch that must be clicked forvertical movement and held down forhorizontal movement, usually accom-panied by acoustic signals. Using twoswitches feels more natural; one switcheffects a movement Down, and theother effects a movement Right.

In the scanning matrix of Figure 1, tencells have two distinct meanings each.The cell labelled ‘d\e’ reads ‘d’ whenaccessed from the left with Down Rightand Pause. The same cell means ‘e’when accessed from above with RightDown and Pause. One might say thatthese cells are oriented, whence thename Oriented Scanning, a variant ofactive row-column scanning2. This trickappears to be new and is combined withstored words and with selective delays,as detailed below.

To select ‘m’ with the display shown inFigure 1 requires Down Down Right anda Pause of, say, 240ms (milliseconds).In the same circumstances, to select‘s’ will require Down Down Down and aPause of 400ms. Pauses are 66% longeron the margins, where the selection di-rection may change. Long codes suchas ‘j’ or ‘k’ are more error prone and havea longer pause as well. Selection se-quences or codes consist of a series ofDown, followed by a series of Right, orthe reverse, followed by a pause, andincluding empty series.

[1] In the past, professional telegraphers achievedrates over 40 words per minute. Such rates seemimpossible to achieve in AAC and should inspireresearch into Morse Code.[2] Active (or ‘step’) scanning means that a switchclick moves a focus, unlike passive (or ‘auto’) scan-ning where the focus is moved by the software andchanges direction or stops (and reads a characterthen starts anew) by clicks. Many variants of scan-ning exist and for some users, active scanning maybe slightly faster than passive scanning.

Figure 1 Oriented Scanning with a focus that is movedby switches; Bs=Backspace, Sp=Space,F1 to F3 speak and edit a line of text


Figure 4 Input rate with Oriented Scanning by the first test subject (MN) Figure 5 Input rate with Alternative Morse Code by the first test subject (MN)

Figure 6 Summed input rates with Alternative Morse Code andOriented Scanning by the first test subject (MN)

Figure 2 Oriented Scanning with text prediction after ‘h’, selected by Right Down Down;Down Down Down Down will now select ‘help’, the fourth word in the prediction list

Figure 3 Alternative Morse Code

tcejbustseT etunimrep.srahCdetneirOhtiw

tsrifnigninnacS;DS;ruoh

secapskcaBlatot

htiwetunimrep.srahCniedoCesroMevitanretlA

;DS;ruohtsrifsecapskcaBlatot

detneirOhtiwegarevAhtiwegarevA<gninnacS

edoCesroMevitanretlA

htiwahpla,tsetnekoT]i[SA>]i[SO

SA,SO,SA)NM(1,SOsnim03x2,SAsnim03

SAsnim03

261;1.4;2.71 951;2.4;5.32 1 500.0<P

SA,SO)BM(2 571;8.4;4.32 721;6.3;3.82 1 500.0<P

,SO,SA,SO)DvJ(3sm062=emitesuap

651;1.3;7.61 901;66.4;1.12srorrellatcerroctondid

1 10.0<P

Table 1 Average input speeds; Standard Deviations; number of Backspaces; and some statistics (OS = Oriented Scanning; AS = Alternative Morse Code)


Figure 2 shows the display when textprediction is activated. Here the upperleft triangle contains 27 cells with 45different items that can all be selectedwith at most six clicks and one pauseand that includes numerals to also ac-cess word prediction.

The display shown in Figure 2 is muchharder to use than Figure 1 becauseword prediction easily distracts, be-cause there are more items to choosefrom, and because the ordering of char-acters is rather complex.

In Figure 1 characters are ordered al-phabetically and from left to right, butin Figure 2 they are ordered first by fre-quency, then alphabetically, alongdiagonals rising from left to right. Indi-vidual characters can be hard to find ina split second and this ordering is notlearned easily.

See a video of this method at:w w w . d e p r a t e n d e c o m p u t e r . n l /videoorientedscanning.mp4

ALTERNATIVE MORSE CODE

Another method for text input withswitches may be called AlternativeMorse Code. Both this and OrientedScanning, as far as I know, are new tech-niques.

In Alternative Morse Code, relatedcodes are assigned to nearby charac-ters and the codes of frequentcharacters such as Space, Backspace,E, A, I, N, and O are short. As with allforms of Morse Code, it is extremelycompact, and therefore must be errorprone. When we compare the code for‘r’ with Figure 1 we find ‘ . . – ’ instead ofRight Right Right Down Down – quite adifference. For some other charactersthe difference is slight.

If we use character frequencies ofmodern printed English (using Wolfram’sAlpha) and add 18% for Space and 11%Backspace, based on measurementsduring development, we find 2.66 clicksper character with the display shown inFigure 1 and 2.40 clicks per characterwith the display shown in Figure 3. Bothtechniques require few clicks per char-acter and can be assessed with eitherone or two switches.

Mathematically speaking, and with X*meaning “repeat X any number of timesincluding zero” we may say: (Alterna-tive) Morse Code = (. or -)* Pause andOriented Scanning = (Down*Right*) or(Right*Down*) Pause. Clearly, correctcodes always terminate with Pause.

TESTING HYPOTHESIS

We formulated the hypothesis that “in-put with Oriented Scanning will be asfast as with Alternative Morse Code inthe first hour and with a copy task”. Wecarried out exercises to test the hypoth-esis.

Three different able-bodied test sub-jects copied English texts3 from paperusing the display shown in Figure 1, twoswitches, a pause time of two hundredtwenty milliseconds, selective delays,and for exactly one hour.

The same exercise was done with thedisplay shown in Figure 3, with the sametexts, the same pause times, and withstretched pauses after codes of lengththree.

All subjects slowly read those texts firstto limit effort of spelling and to limitthe effect of starting with one tech-nique. All subjects tried both systemsfor ten minutes each before the trial toget used to them and to the switches.Pause time was neither varied noroptimized individually4, and all errorshad to be corrected.

Short breaks were allowed on demandand users were interviewed.

RESULTS

Both techniques performed rather well.As might have been expected, test sub-jects verified codes on screen.

Figures 4 to 6 show results for the firsttest subject. Table 1 shows average in-put speeds in two conditions as well astoken tests on individual data points. Ta-ble 2 shows comments.

Our hypothesis was rejected threetimes, and each time in favour of Alter-native Morse Code.

Both Alternative Morse Code and Ori-ented Scanning represent interestingalternatives to row-column scanning fortext input with switches. Both appear tobe easy to learn.

Joris Verrips

DECLARATION OF INTEREST

The author is designer, programmer anddistributor of Alternative Morse Codeand of Oriented Scanning.

ACKNOWLEDGMENTS

Thanks to test subjects Mente Nauta,quality manager; Marjo Biesboer, speechlanguage pathologist; and Jack vanDillewijn, psychologist.

Figures 4 to 6 were made withMathematica. Thanks to Piet vanBlokland for the idea of Figure 6.

The photograph is courtesy of AnnieVerrips.

VIDEOS

The following website has several vid-eos on communicating with switches:w w w . d e p r a t e n d e c o m p u t e r . n l /results.htm

For more material including footnotes,references and a rationale of the experi-ment, go to: www.depratendecomputer.nl/comparisonfulltext.pdf

[3] From McKenzie, 2009, the first thirty lines with allword lengths below six.[4] Pause time after training is considered optimal atabout 1.6 times reaction time, see Simpson, Koesterand Lopresti, 2006. They quote evidence that indicatesthe fraction (scan rate/reaction time) should be 0.65.Scan rate is not exactly the same as pause time.

tcejbuS stnemmoC

)NM(1 gnivomehtybdetcartsidleef"esuacebedoCesroMevitanretlAsreferP.)setunim03retfasm062otdetpada(trohsootemitesuaptleF."gninnacSdetneirOfosucof

)BM(2 ."tcelesottratsuoyerofebhtaptcerrochcraesotgnivahekilsid"esuacebedoCesroMevitanretlAsreferP

)DvJ(3 ."ylisaeeromsetamotuati"esuacebedoCesroMevitanretlAsreferP

Table 2 Comments of test subjects

Introducing the

SWIFT

®

The pocket-sized Lightwriter® Swift maintains eye contact communication with its dual screen technology, enhanced sound quality and rapidly employed, naturally sounding speech whilst being small enough to be out of sight when support for communication is not required.

CM0312

Connect with us!

Available to pre-order now from

01954 281 210 www.toby-churchill.com

Illustration only

Sensory Software International Ltd. 4a Court Road, Malvern, Worcestershire, WR14 3BL, UK+44 (0)1684 578868 [email protected] www.sensorysoftware.com

Home Communication Internet apps

Facebook Media apps

Environment control Email and SMS Much more…

Fast Talker 2: Powerful communication and accessible apps• Free grid set for use with The Grid 2• Download from grids.sensorysoftware.com• Use on any Windows device

Take control of your world

IT DOESN’T ALWAYS HAVE TO BE BLACK! With DAESSY MOUNTS you can now choose to match your Mount to your Communication Aid/Wheelchair/

Sports Team/Favourite Colour etc*

RedRed BlueBlue OrangeOrange

GreenGreen PinkPink

BlackBlack PurplePurple

Mounts & More offers the full range of Daessy Mounting Systems for Communication Aids, Laptops, iPad™, Switches etc. Please visit our website for more information.

www.aacmounts.com

*Colour options only available with Side-Folding Mounts and M-Series. See website for full details

Mounts & More Limited4 Willow Park | Upton Lane | Stoke Golding | Nuneaton | Warwickshire | CV13 6EU | England

T +44 (0)1455 212777 F +44 (0)1455 212677 E [email protected]

CMJ Vol 26 No 2 - Communication Matters

Documents

Transcript of CMJ Vol 26 No 2 - Communication Matters