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Nancy B. Robinson, Ph.D., CCC-SLP & Linda A. Boone,
California State University, Chico
Speech Pathology and Audiology Program
Chico, CA 95929-0350
Phone: (530) 898-6848
Collaboration and team work are considered best practice for effective augmentative and alternative communication (AAC) services for children with severe communication disorders in school settings (Beukelman & Mirenda, 1998; Swan & Morgan, 1993). Often, large caseloads and inadequate professional training in augmentative communication limit the services provided to children with severe communication disorders who may benefit from an AAC system. In many school districts, personnel who are responsible to complete assessments in assistive technology (AT) and/or AAC are limited a few specialists. An additional barrier to effective team work in AT and AAC is the limited number of special education and related services professionals who are available to complete adequate assessments and problem-solving needed to select appropriate AAC systems (Church & Glennen, 1991).
In recent years, the American Speech-Language and Hearing Association required that professional training programs in Speech-Language Pathology offer training in AAC at the graduate level. Many university training programs have expanded AAC course offerings to address the problem of lack of professional skills in AAC and the resulting limitation in access to AT and AAC for individuals with severe communication disorders (Baumgarten, Johnson, & Helmsetter, 1990; Romski & Sevcik,1996). Additionally, the
Reauthorization of IDEA has strengthened the requirements for schools to provide for appropriate technology and augmentative systems for children with disabilities.
This presentation will demonstrate the successful development of collaboration and combined resources of a university-based speech and hearing training program and school-based professionals to increase access to AAC systems for individual students with severe communication disorders. A specific case-study will be presented to demonstrate the steps in the development of effective team work and partnership. Steps outlined and discussed include the following:
1. Home-based and school observations with family members and the child to determine family priorities and school concerns in the development of communication (Lund, & Duchan, 1993; Owens, 1995).
2. Collaborative team staffing with university faculty, graduate students, and school personnel to identify family priorities, assessment issues, communication needs, and follow-up steps.
3. Interdisciplinary team AAC assessment with the child, family, university and school professionals and graduate students.
4. Joint intervention planning with family, school, university, and graduate student clinician.
5. Intervention with and development of AAC system to include high and low technology options, as appropriate for all of the individual's communicative environments.
6. Follow-up evaluation with family, school, university faculty and student clinician each semester, one-four semesters.
The implementation of each of the above steps will be illustrated as they were applied in a specific case study, with a young girl, J.P., diagnosed early in life with Trisomy 9p. Characteristics of Trisomy 9p include enopthalmos (recession of eyes), facial anomalies, cleft lip and palate, microcephaly, moderate to severe hearing loss, heart defects, and absence of the corpus callosum. The young girl who participated in the collaborative process is now nine years old and has received extensive speech therapy with minimal improvement in her speech intelligibility.
J.P.'s mother, who contacted the university clinic to explore alternative communication methods for her daughter, originally reported concerns. Professionals involved in her team of providers included her family, the school-based SLP, school psychologist, classroom teacher, university-based speech pathology and audiology faculty members, and SLP graduate students.
Initially, J.P. was observed in her home setting and interviews were completed with her mother and her classroom teacher to determine priorities for communication evelopment. Assessment and school reports indicated that J.P. attempted to communicate verbally and gesturally, with limited intelligibility. Her speech was characterized by frequent use of vowels and omission of many consonants in words and phrases. Her speech was also perceived as hypernasal, possible indicative of velopharyngeal insufficiency. Her oral motor structures were evaluated to be structurally adequate, although she showed some difficulty in positioning her mouth for sounds and words.
A team staffing was conducted with school and university faculty and students to develop a plan for AAC assessment and intervention.. Following the development of the plan, J.P. was further assessed by school personnel with specialty skills in AT and determined to be eligible for an AAC device. Subsequently, she was enrolled in the university speech and hearing clinic. In addition, she receives special education and related services, including weekly speech therapy at school. Coordination of school and university speech therapy is maintained by regular consultation between J.P.'s mother, the classroom teacher, school SLP, SLP student clinician, and the university supervisor. The initial focus in speech therapy at the university clinic is to develop her AAC system in partnership with school personnel. The long-term goal is to transition AAC and speech therapy services to the school setting.