Tuesday, April 8, 2014

Meaningful and Evidence-Based Goals - Part One AAC

When writing communication goals and objectives for learners with complex communication needs one place
to start is the research.  What does it say about the skills needed to be a competent communicator?

In 1988 Janice Light et al wrote of four competencies for AAC users: Linguistic, Operational, Social, and Strategic.  I would add one other for our more involved AAC users - Self-Advocacy.  Breaking down an overall goal to increase communicative competencies into these five parts is a great way to make sure you are addressing all areas of need.

Linguistic: this competency focuses on actual language skills.

  • Early Communicator: the goals for these students might be tricky, we want to presume competence while at the same time being sure to build skills that will lead to functional, generative communication beyond requests.  It is never too early to start to build core vocabulary use in our students regardless of their skills so modeling core vocabulary through aided language stimulation is important regardless of skills level.  The early communicator should have access to a more robust vocabulary than just a few objects or pictures of items.  Even if you are working on making a choice between two real items or photographs this should be paired with use of core words.  For example, perhaps your student is working on choosing an activity and you are showing them two items.  Instead of writing a goal that says that the student will make a choice from a field of two write that, "Given a choice of two photographs of items, one of which has just been used and one of which has not been used with the the symbol for "more" attached to the first and the symbol for "different" attached to the second, Jane will choose an item by reaching for it independently three times in a fifteen minute session."  Another idea is to use a voice output communication aide (such as a Big Mac Switch) paired with a core word such as "all done" and write an objective such as, "Given a switch with a voice recording paired with the picture symbol for "all done" Joe will indicate when he is done with an activity following a natural and gestural cue by activating the switch at least four times per day at the completion of an activity."
  • Emergent Communicator: this is where we start using early core words such as more, stop, go, like and don't.  We can write out benchmarks in a such a way that we reinforce modeling and teaching of these or other core words such as, "Given her communication system and ongoing aided language stimulation during highly motivating activities, Jane will use two different core words from the following list {more, stop, go, like, don't} to appropriately communicate an idea with no more than one gestural prompt."  As you can see the use of  aided language stimulation and the prompt hierarchy, both best practices, are embedded into the benchmark.  Another goal for an beginning communicator might be, "Given his communication system of 9-12 core words and ongoing aided language stimulation across the school day Joe will communicate for three different purposes (such as greeting, commenting, requesting, labeling, asking and answering questions) during a 20 minute group activity with no more than two indirect verbal cues (hints). 
  • Functional Communicator: more skilled communicators this might be a benchmark about combining words into phrases, knowing how to ask different kinds of questions.  As you can see nowhere in these samples are the common "80% accuracy" or in "4 out of 5 trials" because real communication isn't about percentages and real communication doesn't happen in trials.  Real communication is a living and evolving endeavor.  

Social: this competency focuses on social interactions and pragmatics.

  • Early Communicator:  For the very early communicator social communication is able creating social closeness.  Some ideas for objectives might be to make eye contact when a new person arrives, to reach out to a communication partner physically or by using a talking switch to gain attention or to engage in joint attention during a play or leisure activity by shifting eye gaze from the activity to the communication partner and back.  Again we must use aided language stimulation and core words with these early communicators.
  • Emergent Communicator: this benchmark might be about greeting and taking leave, but there is so much more to social language!  At this level the communicator knows that communication through body language and eye gaze are all about connection as well as getting needs met.  We can move our students beyond this by giving them access to core words such as "like" and "don't like".  An objective might be, "Given his communication system and intensive aided language stimulation, Joe will use the core words, "like" and "don't like" to indicate preferences and opinions in naturally occurring situations across the school day at least three times per week with natural and verbal cues." 
  • Functional Communicator:  You can write social benchmarks about making relevant comments, expressing opinions, engaging in conversational turn taking or beginning and terminating topics.  A sample might be, "Given her communication system and visual supports, Jane will make at least three relevant comments about a discussion topic or passage read allow in a 20 minute period with 100% independence" or "Given her communication system used Jane will wait for a response to a question or comment before activating another button at least four times per day with no more than one verbal cue across all settings."

Operational:  this competency focuses on the ability to handle the actual physical use of a system.

  • Early Communicator: for the very early communicator operational skills focus physical skills needed to access communication and on building the cognitive connection that whatever means of communication we are offering is meant to be used to share a desire, thought or idea.  For example this might be where we write a goal such as, "Given aided language stimulation of core vocabulary words, Joe will look at the communication display for a minimum of two seconds before looking away at least 10 times per day, across the school day" or "Given a single message voice output communication device paired with a core word symbol Jane will look at the symbol, reach and press down on the switch to activate the message given a light physical cue at least three times in a fifteen minute session, twice per day." 
  • Emergent Communicator: for the emergent communicator this is a great place to write benchmarks for accurately linking between pages of a dynamic display device or turning the pages of a communication book for example an objective might read, "Given her communication book and a natural or indirect verbal cue (hint), Jane will independently turn the pages of her book to the page she needs to start or continue her message at least five times per day across all school and community settings."
  • Functional Communicator:  For a user with more experience and skill this might be turning up and down the volume at relevant times or alerting an adult when the low battery alert appears. For example, "Given visual supports and direct instruction, Jane will turn up and down the volume on her communication device given natural (i.e. turning it down when entering the library) or indirect verbal cues (i.e. turning up the volume if someone comments they can't hear her) at least twice per week across all school and community settings."

Strategic:  this competency focuses on the ability to notice and fix communication problem, as skill all of us, not just AAC users need to practice!

  • Early Communicators: this benchmark might be about gaining attention of a communication partner before communicating a message.  Another idea for a strategic benchmark for this level of user is to start to teach a "none of these" option when offering choices.  So frequently we offer two choices without giving the student a way to say that we are offering the wrong choices.  For an early communicator a "none of these" benchmark might look like this, "Given ongoing modeling and the creation of a choice making opportunity when an item Joe is indicated a desire for through positive affect or visual attention and a choice between two other items and "none of these" symbol, Joe will choose "none of these" by looking at the symbol when the item he desires is not offered at least once per session with gestural and verbal cues." You will of course then need to offer Joe another choice with the preferred item in the array! 
  • Emergent Communicators:  Similar to learning to use a "none of these" symbol for early communicators learning to use a "the message I want is not here", "ask me yes or no questions" or "I need a new word/message on my system" is a great place to start for strategic skills for an emergent communicator.  Another important thing to consider as an objective for this level of communicator is frustration toleration for when a communication partner does understand (i.e. not having a meltdown when your communication partner doesn't get it).  
  • Functional Communicators: For more advanced users this objective could be about using a message to say, "What I want to say is not here"  and for even more skilled users it might be learning to say "You don't understand" or even a cold, warm, hot system of giving hints to communication partners when a message isn't easily understood.  For an eye gaze device user it might be reminding people not to stand behind her while she communicates (as their eye gaze might interfere with hers).  An example of a benchmark might be, "Given her communication device and an unfamiliar communication partner, Jane will independently use communication repair strategies such as explaining how her communication system words, asking for additional time time compose a message or requesting the communication user give her space as appropriate at least twice per two week data collection period."  Beyond that using hints to tell about a person, place, thing or event that is not on your device. 
Self-Advocacy: this "bonus" competency is a must for alternative communicators with more complex needs.
  • Early Communicator:  This learner might focus on a student asking to "stop" before he or she becomes frustrated.  This may take an attuned communication partner who can offer the "stop" sign symbol or switch with symbol before the student is "in the weeds".  
  • Emergent Communicator:  this learner might focus on sharing a physical or emotional need.  The student might work on requesting a break, food, drink or hygiene care.  Using a format like, "I am upset because/you can help me by" might be helpful.
  • Functional Communicator:  For some students working on communicating, "Don't talk to me like a baby" or "I'm not stupid" might be appropriate.  Additionally it can work on getting physical needs met, like asking to eat, drink or take a break.  For more advanced users it might be about asking for an explanation, giving detailed instructions to meet care needs (get a napkin from the front pocket of my bag and wipe my mouth) or reporting neglect and abuse (something happened on the bus, I was scared) .  The skill set being worked on is the learner identifying, expressing and directing others to meet their needs, physical and emotional.  


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