The assessment as an opportunity for team consolidation

Frequently by the time the assessment for an AAC system is being conducted, the child’s AAC or special education team has already been formed and assessments in other areas completed. If this has not occurred, as is sometimes true in the case of accident victims or children with solely a communication impairment such as apraxia, then the team will probably be assembled at this point in order to do the assessments. The assessment process is a particularly critical period for a team because the information being gathered and shared will become the basis for the final choice of AAC and its accompanying instructional program. At this point, the team is usually still without the pressure of having to make any important long-term decisions. Thus,it presents an excellent opportunity for team members to get to know each other well, and to learn how to work together effectively.

During the assessment process, it is important to:

• Obtain all relevant information from everyone who can contribute. This includes family members and others close to the child, teachers and other professionals, and persons who are or will be a significant part of the child’s life, such as a recreational specialist.

• Share this information so that all team members have the same background on which to base subsequent decisions.

• Use arena assessments whenever possible, as opposed to therapists conducting separate assessments.

• Get used to and adjust to different members’ personal working and meeting styles, and develop interpersonal relationships that are respectful, comfortable and open.

• Begin to learn about each team member’s expectations, fears and hopes for the child.

Arena assessments occur when more than one therapist conducts an evaluation simultaneously, with at least one family member also present. Arena assessments are ideal for fostering openness and trust among team members. With everyone participating and witnessing the same event, sharing of information occurs naturally and participants become more aware of each others’ particular goals and concerns for the child. Arena assessments provide an excellent opportunity for all team members to have equal access to information and establishes a shared background on which future discussions can be based. Even when arena assessments are not possible, at least one family member should be present during every evaluation since this is an ideal way for family and professionals to share information and learn about the child together.

One of the most important considerations in selecting an AAC system is that it conform to the desires of the child, and the child's family and other close partners since these are the persons whose lives are most affected by the choice of AAC. Naturally, the extent to which the child has opinions which can be taken into account depends on characteristics of the child, as well as the ability of adults to identify any indications of preference that the child might make. Note that the child does not have to explicitly state a preference; adults can utilize implicit information such as how often and how long the child uses a particular form of AAC, and whether he or she appears to enjoy learning or using it (Soto, Belfiore, Schlosser, & Haynes, 1993).

Help me—and everyone who reads this site—by mailing your suggestions, criticisms and personal experiences to Ruth Ballinger at yaack@iname.com

It is crucial that the preferences of the family be taken into consideration, or even given precedence over those of the professionals on the team, since they know the child best. Family members are the ones who have been and will remain responsible for the child after the current set of professionals are no longer working with the child. Moreover, professionals may be basing their judgements on seeing the child only in school or therapy situations. Even when professionals and specialists strongly disagree with the family for solid professional reasons, failure to give priority to the considerations of the family can result in the AAC system simply not being used, especially with friends and family (Angelo, Jones, & Koskoska, 1995; Hetzroni & Harris, 1996). (See Forging an effective AAC team.)

Some of the following issues have been identified as important to the child and family in the selection of an AAC system (Mirenda & Iacono, 1990; Parette, & Angelo, 1996).

• Families may not want their child to use AAC at all, or may not want their child to use it in public. They may feel that it stigmatizes the child, or signifies the end of all hope that the child will ever learn to speak. These fears are understandable, and it is important for professionals to respect their desire to protect the child. At the same time professionals can gently help the family realize the importance of AAC in allowing the child to participate at home, in school and in the community, and all the ways that AAC can help the child develop, especially cognitively and socially. (See When does a child need AAC? and Does AAC impede the development of natural speech?—and other fears.)

• Families may prefer unaided approaches (i.e. AAC that does not use external apparatus, for example sign language), or speech even if it is of limited intelligibility. They may feel it is more natural and intimate using a low or no-technology system with their child. They may be uncomfortable with electronic devices, especially with the programming, maintenance and repair that they entail. (See High tech vs. low or no-tech.)

• On the other hand, families may prefer high technology aids. They may feel that electronic AAC provides more power, flexibility and potential for growth. In addition, they may feel that use of a computer or voice output communication aid (VOCA) provides their child with a competitive edge in today’s computer-based society. (See High tech vs. low or no-tech.)

• The child may dislike the voice output of a computer or VOCA. Children are sometimes reluctant to use a voice that they feel does not represent themselves (Yinger, 1997). The child may refuse to use the device and prefer a low or no technology approach, and no one may know the reason why. (Thus, if a child is not using a VOCA for an unknown reason, it may be worthwhile experimenting with a different voice. Child voices of the same gender are good choices.)

• The family may want the professionals on the team to make all the decisions. By giving away their power in this process they can relieve themselves of the overwhelming pressure of making a selection that will have a life-long impact on their child. In this situation, the professionals on the team can help the family realize that their input is extremely valuable because they know their child best. Furthermore, the family can be made to understand that that the AAC process is an ongoing one and that no decision is irrevocable.

In situations in which the professionals disagree with the family, the ideal solution is for members of the AAC team to continue to gather information, then meet to hash out their differences, and finally come to a set of decisions on which everyone can agree. (See The AAC team—the most important component and Forging an effective AAC team.) One possible solution is to focus on different AAC systems at home and at school. For example, using speech with limited intelligibility at home and an alternative communication mode at school allows the child to maintain both academic growth at school and the comfort of using a faster and more intimate technique at home.

Help me—and everyone who reads this site—by mailing your suggestions, criticisms and personal experiences to Ruth Ballinger at yaack@iname.com

(See Multimodal communication.)

An interim solution is to utilize trial periods for different types of AAC, with agreed-upon methods for evaluating the degrees of success. More than one type of AAC can be tried out simultaneously, which is a faster way to evaluate multiple systems, although it can become confusing to the child. However, sometimes the best system emerges relatively quickly, after which it becomes the main focus of the intervention.

In cases in which no agreements, not even a temporary arrangement, can be reached, one of the parties, usually the family, may decide to resort to legal action. (See Legal assistance.)