*The RCSD partnerships across the province are being eliminated by the provincial government as of September 1, 2020.  As a result, the information on this page will no longer be valid.  The website is being maintained for one year to allow partners to continue to access the resources*

Augmented and Alternative Communication Systems: Assessment and Implementation

A Guide to Best Practice and Collaboration Amongst Partners

Glossary of Acronyms 

  • AAC: Augmentative and Alternative Communication
  • AHS:  Alberta Health Services
  • ACETS:  Augmentative Communication and Educational Technology Services – Department in AHS Alberta Children’s Hospital
  • AADL:  Alberta Aids to Daily Living – Government of Alberta department/service
  • CRS:  Children’s Rehabilitation Services –department in Alberta Health Services in Central Alberta
  • ICAN:  I CAN Centre for Assistive Technology – department in AHS Glenrose Rehabilitation Hospital
  • OT:  Occupational Therapist
  • PT:  Physical Therapist
  • SETT:  Student, Environment, Task, and Tool – An assessment framework that promotes collaborative decision making
  • SLP:  Speech Language Pathologist

Team Members

Family Team Members

Members of this part of team may include the student, parents/guardians, caregivers, and other family members.

School-Based Team Members

Members of this part of team may include the classroom teacher, educational assistant, specialty teacher (learning assistance teacher, inclusion lead teacher, student support facilitators, learning support teacher, etc.), school administration, and community or family school liaison/wellness/social worker.

District Team Members

Members of this part of team may include education technology specialist, assistive technology specialist, student services/inclusion director/coordinator, district psychologist, and IT specialist

AHS Children’s Rehabilitation Services Team Members (AHS-CRS)

Members of this part of team may include: Intake Social Worker, Core SLP/OT/SLPA, Complex Communication and Mobility Consultants (SLP/OT/PT)

Other Team Members

Members of this part of the team include low incidence consultants such as those for the Deaf and Hard of Hearing, Educational Audiology, and for the Blind and Visually Impaired. These may also include SLPs, OTs or other therapists in private practice serving students with AAC needs.

 

AAC Assessment Process

Some Principles of AAC Best Practice

Among the many principles of best practice in identifying, assessing and implementing Augmentative and Alternative Communication systems for children, these are some important ones to keep in mind in our CARCSD:

  1. AAC systems are dedicated to communication. AAC systems including high tech devices (Accent, iPad Apps such as Touch Chat, etc.) are a child’s voice and should have few other functions besides communication. Some AAC device users may benefit from access to other functions and features (environmental controls, access to social media, etc.), however, having games, You-tube, etc. on a child’s device may distract from and/or create an aversion to the AAC system.
  2. Aided Language Stimulation (modelling) is crucial. Learning to use a device effectively can be a long process.  It is not different than learning a first or second language.  An AAC language learner must be immersed in the AAC language. AAC users must be exposed to communication partners using AAC words and phrases many, many times before they will use these words and phrases themselves.
  3. AAC systems must be accessible to the user always. The AAC system is the child’s voice.  They must have access to their voice in all activities of daily life.  (Keeping a device at school only/home only, effectively takes the student’s voice away in the other environment).
  4. Parent and family participation in AAC use is vital. While many families don’t need AAC to communicate with their children at home, they can assist AAC communication with less familiar partners such as visitors to the home or people in their community.
  5. Selection of AAC requires a formal assessment by professionals. While collaboration among all team members is vital, Speech Language Pathologists and, often Occupational therapists and other health professionals offer essential services to determine an appropriate match between AAC system, features, and the child’s abilities, interests and needs. These professionals are key in assisting team members to find and implement the best AAC tool.
  6. Successful implementation of AAC systems require collaboration.  A formal implementation plan with clear and roles responsibilities is essential to supporting children to be successful in using AAC systems in daily life.

Roles and Responsibilities Among Partners

Identification

Identification of Student/Need

All team members (teachers, parents/guardians, caregivers, and/or current therapist and others) may identify concerns regarding significant communication needs of the child.

Once the need is identified, the SLP, family member, member(s) of the school team and others, as needed, will:

a)  collaborate to identify the specific communication challenges of the child and whether they would benefit from AAC system

b)  participate in planning meetings or case conferences to discuss the child’s communication needs, supports available and the AAC process.

Assessment

Functional Assessment of Abilities

Students’ communication abilities will be assessed to determine level of language functioning. Additional assessment in the areas of fine motor, cognitive, vision, hearing, etc. will be completed as necessary.

Family Team Members:  Provide details regarding functionality, social communication, peer interactions, and family interests.

School Team Members:  Teachers, educational assistants and other school personnel involved with a student for whom AAC is being considered, will provide details regarding functionality, social communication, peer interactions, and curricular outcomes to the Children’s Rehabilitation Services Team (SLP and OT).

District Team Members:  Provide information regarding behavioural, academic, and psychological education or neuropsychological assessments.

AHS-CRS Team Members: SLP and OT ( if necessary) will complete an assessment for AAC through observing and working with the student, and gathering relevant information from other team members.  SLP will determine level of communicative function.  OT will identify additional concerns such as access (the ability or method by which a student is able to use an AAC system), looking at fine motor and sensory issues.  Children’s Rehabilitation Services may refer to Service Centre Level 3 (ICAN Centre or ACETS) if needed.  **Low Incidence Consultants will provide input, recommendations, and assessments as required.

Assessment of AAC Needs (SETT)

All team members will provide information for the SETT process (student, environment, task, and tools).

Family Team Members:  Complete the SETT questionnaire in preparation for the SETT meeting.

School Team Members:  Complete the SETT questionnaire in preparation for the SETT meeting.

District Team Members:  Assist school based team in completing the SETT questionnaire in preparation for the SETT meeting as needed.

AHS-CRS Team Members: SLP (and perhaps OT) will compile information and lead the SETT process. Ensure the other partners have copies of the AHS SETT questionnaire in advance of the meeting.**Low Incidence Consultants will provide input, recommendations, and assessment as required, including information pertaining to SETT.

Development of Goals

Identification of curricular, communication/social and accessibility goals to align with or supplement existing learning plan.

Family Team Members:  Family will participate in developing communication and access goals.

School Team Members:  Members will participate in developing curricular goals.

District Team Members:  Support as needed.

AHS-CRS Team Members: SLP, in collaboration with other team members, will lead the team in identifying and forming communication goals.  OT, in collaboration with other team members, will determine access goals

AAC System Trials and Initial Programming

Based on the SETT and the identified goals, an AAC system will be programmed and trialed.

All team members will collaborate and assist in locating an AAC system to be used for trial (create a paper based system, borrow a tablet based system from the school division or AHS, purchase an app, referral to Service Centre Level 3, etc) and develop a lending agreement.

Family Team Members: Develop an understanding of the purpose, use, and maintenance of the AAC system.  In collaboration with the SLP and school staff, the parents/caregivers will plan for the inclusion of the AAC system in daily activities.  Monitor and record success and challenges regarding the use of the device.  Collect Data to provide information to the SLP.  Consent to a lending agreement for the use of the trial device

School Team Members: Develop an understanding of the purpose, use, and maintenance of the AAC system.  In collaboration with the SLP and family, the teacher and other involved school staff will plan for the use of the AAC system during curriculum activities and social communication opportunities.  Monitor and record success and challenges regarding the use of the AAC system following protocols and communication goals set collaboratively with the SLP.  Collect Data to provide information to AHS (Anecdotal observations, Checklists, video) as requested.

District Team Members: Develop capacity of the school-based team for the use, programming and maintenance of the device.  Provide support as needed

AHS-CRS Team Members:  SLP provides recommendation of vocabulary sets/pages to be used, provides initial training and support for use of the AAC system.  When necessary, OT will provide recommendations for AAC system placement, etc.  CRS will assist other team members in developing appropriate methods for data collection. **Low Incidence Consultants will provide input as required.

Implementation Plan

AAC System Review

The successes and challenges of the chosen AAC system will be reviewed. If the review is not successful, the SETT will be explored again.  If the review suggests continued use of the tool/device, proceed to the following:

Evaluate progress towards learning plan goals, communication goals, and social goals.

Family Team Members: Send data to AHS therapists.

School Team Members:  Send data (anecdotal records, checklist, video, etc.) to AHS therapists. Evaluate progress towards learning plan goals.

District Team Members: Provide support as needed.

AHS-CRS Team Members:  Analyze data to determine whether the AAC system was appropriate and develop a plan forward.

Select and Acquire AAC System

This may be done through family, school, or outside agency.

Children’s Rehabilitation Services therapist support the school and family in developing a personalized low tech or “no tech” AAC system or other communication book.

OR

Family purchases tablet and AAC app chosen based on assessment/SETT and in consultation with all team members

OR

AHS Children’s Rehabilitation Services therapists support the family in submitting an application to Alberta Aids to Daily Living (AADL) and/or seek support of an AADL Service Centre Level 3 to obtain the desired AAC system.

Implementation Plan

Develop a plan for use of the AAC system for at home, at school and in the community

Family Team Members:  Assist in the development of academic, communication, and social goals.  May be responsible for the initial personalizing AAC system.

School Team Members: Develop goals for the integration of the AAC system into curriculum outcomes.  Build assessments to monitor the achievement of these goals.  May be responsible for the initial personalizing AAC system.

District Team Members: Support as needed.

AHS-CRS Team Members:  SLP and OT (when necessary) provide training and support for the use of AAC including how to model navigation and use of the AAC system as a language. AHS Children’s Rehabilitation Services staff will set up visits to support implementation of the device.  SLP and OT will explore with school personnel and family how to incorporate the use of the AAC device into activities of daily living.  SLP and OT will make recommendations for the personalization of AAC system.

Review

Refinement of Personalization of AAC System

Ensure the use of the system aligns with learning plan goals.

Family Team Members:  May be responsible for the continuous personalization of the AAC system.

School Team Members: May be responsible for the continuous personalization of the AAC system.

District Team Members: Support as needed.

AHS-CRS Team Members:  SLP and OT will make additional recommendations for the continued personalization of the AAC system.

Learning Plan Review

Ensure communication and rehabilitation goals align with existing learning plan goals.

Review the evidence collected. Based on the analysis of this evidence, revise goals for student growth.

Family Team Members: Contact AHS staff with additional questions or further requests for support regarding use of the AAC system with their child.  Suggest programming changes/ additions to assist the child in future success.  Provide input for the development of subsequent goals.

School Team Members:   Contact AHS staff with additional questions or requests for further support, to update communication goals, etc.  Suggest programming changes or additions to assist the child in future success.  Discuss successes and challenges with the parents.

District Team Members:  Assist school teams in reviewing evidence collected.  Supports as needed.

AHS-CRS Team Members: Respond to requests for additional follow up and/or explore the need for changes as the student learns, grows and requires.

Appendix A:  The SETT Framework

Adapted from I CAN Centre for Assistive Technology, Glenrose Rehabilitation Hospital www.albertahealthservices.ca/icancentre.asp

The SETT Framework can guide decisions about assistive technology needed by students. The SETT Framework was developed to help school teams gather information needed to make decisions around the assistive technology needs of their students. This framework starts by focusing on the needs of the Student, within specific Environment(s), in order to participate in Tasks, which then leads to potential Tools which can be used within that environment, to accomplish the tasks identified by the school.

An important premise of the use of the framework is that the Learning Team, that is, the classroom teacher, the educational assistant, the special educator, the clinicians, the parents, and the student, are in the best position to determine what the needs of student are that might be met by the use of assistive technology. Without the full participation of the Learning Team, the decision-making process is at risk of missing some of the critical components to ensure that appropriate decisions are being made for that student.

Why do we use this Framework?

The SETT Framework helps to address concerns such as:

  • What hardware and/or software is the “best” for the school to purchase. This is NOT a readily answerable question without considerable exploration.
  • Ongoing problems with technology abandonment or under-utilization. Too often students who receive technology fail to use it or do not know how to use it effectively.
  • Poor outcomes: Expected changes in communication, participation levels and productivity do not materialize, as expected by the classroom teacher or the Learning Team.
  • Sometimes, even when the features of the technology are well matched to the needs and abilities of the student, the tools may not be environmentally useful: “It may be a great tool, but it doesn’t work in OUR classroom”.

How does the SETT Framework work?

  1.  The SETT Framework is essentially a means to analyze what the student needs to do that he or she is not presently able to do in a particular environment. So the first thing to consider is the STUDENT
  • What does the student need to do?
  • What are the student’s special needs?
  • What are the student’s current abilities?

Knowing the student’s strengths, needs and preferences is critical to matching this information with the appropriate tools and strategies for his/her learning.

2.  Then, the team looks at the ENVIRONMENT in which the student needs to participate. Questions about the environment include:

  • What materials and equipment are currently available in the environment?
  • What is the physical arrangement? Are there special concerns?
  • What is the instructional arrangement? Are there likely to be changes?
  • What supports are available to the student?
  • What resources are available to the people supporting the student?

For example, the answers to the last two questions alone may determine whether there is enough support for a complex tool in that environment.

3. Next, the team needs to create a detailed analysis of the TASK(S) that the student needs to accomplish in that environment. Start by looking at:

  • What activities occur naturally in the environment?
  • What is everyone else doing?
  • What activities support the student’s curricular goals?
  • What are the critical elements of the activities?
  • How might the activities be modified to accommodate the student’s special needs

This leads to the question of how technology might support the student’s active participation in those activities. All of these questions are then considered before attempting to identify the features or components of the tools needed to complete these tasks.

4.  Finally, after reviewing all these factors, the team can investigate the assistive technology TOOLS:

  • What no-tech, low-tech, or high-tech tools should be considered when developing a system for a student with these needs and abilities, doing these tasks, in these environments?
  • What strategies might be used to invite increased student performance?
  • How might these tools and strategies be tried out with the student in the customary environments in which they will be used?

Together, the team can create a plan to trial the suggested tools and strategies. If done well, the plan will help to evaluate the tools so that effective technology decisions can be made for the student – decisions which may range from whether to implement low-tech strategies or to evaluate a high-tech system or a combination of these options. The student’s needs, in the context of the reality of their environment, lead and define the process.

Appendix B:  SETT Questionnaire with Guiding Questions

Area of Concern:

STUDENT/SKILLS

What are the child’s strengths and needs related to communication?

Medical Status:

Diagnosis, developmental skills, seizure activity, medication

Strengths:

How do you describe the student to others?

The student’s current communication abilities:

How does this child communicate his/her messages?

What is this child’s receptive and expressive language skills?

How well is the child understood (intelligibility)?)

If there are communication breakdowns, how does the child try to get his/her message communicated?

Does the student initiate communication and take turns?

Sensory influences or challenges that impact communication:

Are there hearing issues?

Are there visual concerns?

Does the child seek or avoid sensory information?

Mobility/Positioning/Gross Motor:

How does the child move?

If the child uses a mobility support, what do they use?

Fine Motor:

How does the child reach and point?

What body part is used to point?

Does the child use switches? How does the child use switches?

Literacy Skills:

What symbols are meaning to be ful to the child (pictures, photos, logos, text)?

Cognition:

How would you describe level of alertness and attention?

What is the child’s understanding of concepts, numbers and letters?

Academics:

Computer Use:

Does the child use a computer or iDevice?

For what activities?

Telecommunications:

Does the child use a telephone or Skype?

ENVIRONMENT

Where does client go? Who and what supports him/her?

Home/School/Community:

What is the child’s daily schedule?

Who are the child’s primary communication partners in each setting?

How do different communication partners support communication interactions?

What are daily communication opportunities?

Resources/Equipment:

Who are the primary team members?

What tools and resources are available to the child (Core or Context Specific)?

Does the child have vocabulary to support communication in the different environments?

Environmental Factors:

How do things in the environment impact the child? (lighting, noise, busyiness, expectations)

Does the child require prompts and modeling for communication?

Enhanced Team:

TASKS

What are the communication tasks we would like the child to do?(Goals)

Communication Functions:

Initiate

Request

Comment

Continuation

Ending

Repair

Denials/Reject

Exchange information

Social Etiquette

Social Closeness

Narrowing the focus:

What is the current priority?

TOOLS

What tools or strategies may support client with his/her goals at home or at school?

Tools Tried in the Past:

What tools have been tried and if they have been discontinued, why?

What are no-tech and low tech strategies and tools that are used?

New Ideas for Today:

Comment on possible Simple Speech Generating Devices or Speech Generating Devices with Levels

Device Features Needed:

Mounting Needs:

Plan:

Appendix C: SETT Questionnaire-Blank

Please click below for the blank questionnaire:

SETT Questionnaire Blank

Please Note: Services may vary according to staffing structure in a school or community.

*This website is a record of a constantly evolving partnership. It is as accurate as possible at any given time and will be regularly updated to reflect changing processes and information.  However, be advised that there may possibly be a lag updating the website with the most current information and processes.

*The RCSD partnerships across the province are being eliminated by the provincial government as of September 1, 2020.  As a result, the information on this page will no longer be valid.  The website is being maintained for one year to allow partners to continue to access the resources*