AAC use and service provision: A survey of New Zealand speech-language therapists

Voices from the field: exploring service providers' insights into service delivery and AAC use in Canada

Use of augmentative and alternative communication (AAC) often relies on the involvement of AAC service providers; however little is known about how AAC services are delivered across Canada. This study aimed to explore AAC service provision and factors influencing use of AAC from the perspectives of service providers across Canada who are involved in providing and/or supporting use of AAC systems. The 22 participants from nine (of the 10) provinces participated in online focus groups. Participants were speech-language pathologists, occupational therapists, communicative disorders assistants, and a teacher. Transcripts of the audio recordings were analyzed using reflexive thematic analysis. Four themes were generated that reflect service-related factors contributing to the use of AAC in Canada: Support of Organizational Structures, Concordant Relationships and Goals, Making the Right Decisions, and Influence of Knowledge and Attitudes. These themes highlight how government systems, key stakeholders, assessment practices, and knowledge of AAC influence service provision and use of AAC. Voices from across Canada highlighted shared experiences of services providers as well as revealed variability in service delivery processes. The findings bring to attention a need for further research and development of service provision guidelines to support consistency, quality in practice, and equity in AAC services.

The confidence and competence of speech language pathologists in augmentative and alternative communication: a scoping review

Augmentative and alternative communication (AAC) is a core component of speech pathology practice. However, international literature has highlighted that speech language pathologists (SLPs) may not feel confident or competent in this area. Confidence and competence are critical factors in therapy as they can impact the quality-of-service provision. The purpose of this scoping review was to investigate the confidence/competence of SLPs in AAC. A systematic scoping search was conducted using four databases to identify relevant literature. The first two authors reviewed 30% of abstracts and the remaining 70% were reviewed by the first author. Full-text screening applied the same review approach. Data was then extracted and organized according to the research questions. Thirteen studies were included in the review. All thirteen used self-assessment to measure confidence or competence with one study also using an objective evaluation. Overall, confidence and competence levels varied based on the specific clinical task and etiology of the client in addition to being influenced by prior training, clinician age, workplace and AAC caseload. While current research provides a snapshot of the SLP workforce, it is limited in that the research predominantly uses self-assessment measures, is cross-sectional and is quantitative in nature. Further research into the confidence and competence of SLPs in AAC is required, specifically how confidence and competence can be defined and developed.

A retrospective chart review of the patient population accessing augmentative & alternative communication at an urban assistive technology center

The purpose of this study was to 1) identify and describe the population seeking alternative and augmentative communication (AAC) evaluations at an assistive technology (AT) center in the Midwestern United States and 2) describe the AAC device features or services participants identify as most important at their initial AAC evaluations. Charts of 53 participants seeking AAC interventions at an AT center in the Midwestern United States were retrospectively reviewed. Information from the QUEST 2.0 was used to determine what AT features were identified as most important. The majority of participants seen at the AT center had progressive diseases. Across all of the participants, ease of use and effectiveness were identified as the "most important" aspects of an AAC device satisfaction. These findings highlight the importance of determining who is accessing AAC services across AT centers to determine whether barriers to AAC services exist. Moreover, patients report regarding what variables they deem as most important reflect the fact that excellent service-delivery may not overcome the importance of other variables, such as ease of use that impact AAC use.

"I don't think you can really understand it until you put it to action": school-based SLPs' reflections on graduate and continuing education in AAC

Graduate programs have made strides to improve augmentative and alternative communication (AAC) learning opportunities for pre-service speech-language pathologists (SLPs). In addition, a number of continuing education opportunities are available to practicing SLPs; however, many still report feeling underprepared to serve clients with AAC needs. The purpose of this study was to describe school-based SLPs' perspectives regarding their graduate training, on-the-job experience, and ongoing professional development needs related to AAC. Semi-structured interviews were completed with 17 school-based SLPs. Interviews were recorded and transcribed verbatim. Using a phenomenological approach, key themes emerged related to AAC knowledge and skills including a need for SLPs to rely on a framework for decision making, the importance of interprofessional training, and difficulties with staying abreast of new technology. The researchers present recommendations of principles and concepts for instructors to include in graduate AAC courses, as well as professional development considerations.

Communication partners experiences of communicating with adults with severe/profound intellectual disability through augmentative and alternative communication: A mixed methods systematic review

People with severe/profound intellectual disability experience challenges in communicating and require their communication partners to adapt to their means of communication. Augmentative and Alternative Communication (AAC) is recognised as a potential means to meet their communication needs. Interventions need to be aimed at both the individual and their communication partners. We conducted a mixed methods systematic review of the literature to synthesise evidence on communication partners experience of communicating with adults with severe/profound intellectual disability through AAC. Eight publications met the inclusion criteria, they underwent thematic synthesis where four themes emerged. A shared commitment to communication partnership is fundamental for the effective and efficient use of AAC. However, there was a disconnect between communication partners perceptions of their roles and responsibilities. This review prompts further research to explore communication partners perceptions of their roles and responsibilities in the use of AAC with people with severe/profound intellectual disabilities.

Reported Barriers to Augmentative and Alternative Communication Service Delivery and Learning Preferences Among Speech-Language Pathologists

PURPOSE

Speech-language pathologists (SLPs) report extensive barriers to delivering augmentative and alternative communication (AAC) services, including the knowledge and skills necessary for AAC service delivery. Although nearly all graduate programs report the inclusion of preservice training for SLPs to provide AAC services, existing research on SLPs' characteristics of AAC service provision does not reflect these changes. This study aimed to identify current AAC service delivery characteristics, barriers, and learning preferences reported by SLPs.

METHOD

A survey invitation was distributed to SLPs with American Speech-Language-Hearing Association (ASHA) Certificate of Clinical Competence through social media and the ASHA Community discussion groups.

RESULTS

Participants were 530 SLPs who predominantly identified as general practice SLPs. Participants reported 1%-25% of their weekly patient caseload has AAC needs for communication or receives AAC intervention. SLPs reported feeling at least "knowledgeable" in more than half of the targeted competency areas. The reported primary barriers to AAC service provision are knowledge, caseload, and time. Preferences for topic, format, and frequency and duration for AAC-related continuing education were highly variable among SLPs.

CONCLUSIONS

SLPs' barriers to AAC service delivery are consistent with research from the last 15 years, revealing a lack of systematic, organizational, and informational mechanisms to support SLPs as vital members of the AAC team. Those involved in post-service instruction and training must consider the training needs of SLPs with varying competence and their experience with AAC modalities, clinical practice backgrounds, and learning preferences. AAC-related training and continuing education must reflect SLP's daily practice, learning needs, and preferences.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23503809.

Predictors for Augmentative and Alternative Communication Clinical Service Provision: Closing the Gap

PURPOSE

At the core of the clinical services provided by a speech-language pathologist (SLP) is upholding the human right to communicate. Augmentative and alternative communication (AAC) modalities support communication across environments by offering temporary or permanent solutions. Barriers to AAC service provision include translation of knowledge into clinical practice, which remains problematic despite changes to AAC preservice training addressing the knowledge barrier. This study aims to understand the importance of factors impacting the provision of AAC clinical services.

METHOD

From the survey data of SLPs (N = 530) regarding current AAC service delivery practices, barriers, and professional development preferences in the United States, a hierarchical multiple regression identified the importance between individual and clinical practice variables of knowledge and current use of AAC modalities. A binomial logistic regression predicted the probability of one or more independent variables for barriers to AAC service delivery and learning preferences for AAC-related professional development.

RESULTS

The factors impacting SLPs' knowledge and barriers to practice are related to clinical practicum experiences. Engagement in AAC-related continuing education (CE) is the primary contributor to the use of AAC service provision. Predictors for barriers to AAC clinical provision are associated with clinical practicum experiences, the average number of patients seen weekly, and geographic region. Preference for CE topics and frequency depend on the work setting.

CONCLUSIONS

Hands-on clinical practicum experience addresses opportunity barriers in AAC service provision, contributing explicitly to the value of collaboration in AAC service delivery and highlights the importance of evidence-based professional development content. The findings from this study are reassuring in that clinicians are using AAC and suggest that high-quality professional development is an effective means to address the gap between knowledge generation and translation in the field.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23202170.

Parents' perception on the use of augmentative and alternative communication by children with complex communication needs in Malaysia

PURPOSE

Children with developmental disabilities who have complex communication needs (CCN) frequently need to use augmentative and alternative communication (AAC) to communicate effectively and efficiently. Speech-language pathologists (SLPs) often work closely with parents and other professionals when deciding on the best AAC system to introduce to these children. This study aimed to describe the use of AAC by children with CCN in Malaysia as reported by their parents.

MATERIALS AND METHOD

An online survey distributed for this study was completed by 235 parents.

RESULTS

Most of the parents of children with CCN who participated in this study reported that their children used low-tech AAC systems. A majority of respondents were satisfied with their child's AAC system. Parental satisfaction was positively associated with the frequency of use and whether the use of AAC helped parents understand the child better. Challenges reported by parents when using AAC and the reason some families abandoned the use of AAC were similar. Examples of challenges include parents having limited time and the child lacking the motivation to use the AAC system.

CONCLUSION

The findings of this study suggest the importance of SLPs actively involving parents in the selection of their children's AAC system so they are agreeable with the system introduced and continuously supporting children and their families to encourage and sustain the use of AAC. Implications for rehabilitationSpeech-language pathologists (SLPs) can create communication opportunities for the child to use augmentative and alternative communication (AAC) and experience success, teach parents how to incorporate AAC into the family's daily routine and activities, and reduce the demands on parents by preparing the AAC materials and programming the AAC system where possible.SLPs can provide ongoing support to school teachers to equip them with the necessary knowledge and skills to support the use of AAC in the classroom.

Current preparation status in AAC: perspectives of special education teachers in the United States

Special education teachers are essential team members in the provision of services to students with complex communication needs. Professional competencies related to augmentative and alternative communication (AAC) practices have been outlined for special education teachers as part of their professional standards. Yet, it is unclear to what extent these professionals have knowledge and skills in this area. Given existing gaps in the literature, an anonymous, web-based survey was disseminated across the United States to gather information on special education teachers' self-reported knowledge and skills in AAC. A total of 1198 special education teachers from 46 states responded to the survey. Findings indicated that most special education teachers did not receive formal training in AAC during their teacher licensure preparation programs, resulting in low levels of self-reported knowledge and skills. Data also indicated that while influencing factors existed, special education teachers' knowledge and skills in AAC remained minimal. Implications and recommendations for stakeholders are discussed.

A Survey of American Speech-Language Pathologists' Perspectives on Augmentative and Alternative Communication Assessment and Intervention Across Language Domains

Purpose The aim of the study was to collect information about American speech-language pathologists' preprofessional training, practice, self-perceived competence, adequacy of resources, and interest in continuing education related to augmentative and alternative communication (AAC) assessment and intervention strategies addressing each of the five language domains: semantics, pragmatics, phonology, morphology, and syntax. Method An anonymous online survey of American speech-language pathologists was conducted. Results A majority of participants rated their preprofessional training for assessing semantic and pragmatic skills positively. Otherwise, a majority of participants rated preprofessional training for assessment and intervention negatively across language domains. High interest in continuing education opportunities addressing assessment and intervention was found across language domains. A discrepancy between responses to questions addressing semantic and pragmatic skills and responses to questions addressing phonological, morphological, and syntactic skills was consistently found for ratings of preprofessional training, practice, perceived competence, and adequacy of resources. In all cases, higher frequencies of positive ratings were found for questions addressing semantic and pragmatic skills. Conclusions Improved preprofessional training and continuing education opportunities are needed to support AAC assessment and intervention across language domains. Perspectives and practice patterns reflect a historical emphasis on semantic and pragmatic skills in the external evidence base, even though there are several recent journal articles addressing morphology and syntax in clients who use AAC.

School-Based Speech-Language Pathologists: Confidence in Augmentative and Alternative Communication Assessment

Purpose The purpose of this study was to examine confidence levels and identify predictors of increased confidence of school-based speech-language pathologists (SLPs) relative to different aspects of the augmentative and alternative communication (AAC) assessment process. Method Surveys were completed by 272 school-based SLPs. Questions were designed to capture demographic information and confidence in areas of assessment such as student capabilities, participation, and feature matching. Results There were variable levels of confidence across aspects of assessment. Respondents were less confident in tasks related to assessing students with severe physical impairments and incorporating aspects related to cultural and linguistic diversity in their assessment. SLPs were more confident assessing student participation and unaided communication. Additionally, respondents had less confidence in matching the features of high-tech speech-generating devices to their students. Self-identification as an AAC specialist, years of experience, percentage of caseload of students with complex communication needs, and length of longest continuing education experiences all contributed to predicting confidence in most areas of assessment. However, years of experience did not contribute to predicting confidence in feature matching. Conclusions Results from this study acknowledge that SLPs are likely to have varied degrees of confidence in aspects of assessment related to preparation, clinical experience, and self-identification of specialty. Findings from this study support increasing training opportunities in AAC assessment. As specialization was the strongest predictor of confidence, further research should investigate the characteristics and preparation of self-identified AAC specialists. This is an important first step in pinpointing ways to increase confidence in school-based SLPs.

A survey on the awareness, accessibility and funding for augmentative and alternative communication services and devices in Saudi Arabia

PURPOSE

To develop and distribute a survey to obtain information on the awareness, accessibility and funding for augmentative and alternative communication (AAC) services and devices within the Kingdom of Saudi Arabia (KSA).

METHOD

The survey targeted three groups of people which included individuals with disabilities and their families, healthcare providers such as medical doctors and nurses and the third group included community members. Survey preparation and administration were performed online via a survey website in order to access a wide range of participants across KSA.

RESULTS

Results revealed different awareness levels for AAC among the three groups (χ² = 45.053, p < .001) with healthcare providers showing a higher degree of awareness compared to the remaining two groups. Moreover, AAC services and devices were found to be accessible within KSA, with no differences in obtaining AAC services and devices among different regions (χ² = 14.204, p = .164).

CONCLUSION

Although numerous AAC users were able to obtain AAC devices, they identified barriers including a lack of sufficient awareness of the importance, associated expenses, funding constraints and a lack of Arabization of AAC devices. Implications for RehabilitationAugmentative and alternative communication (AAC) methods allow individuals with communication difficulties to interact and socialize with those around them.The general authority of statistics in Saudi Arabia has shown that Saudi Arabia has an increased number of individuals suffering from severe to extreme communication disorders compared to other countries around the world. Consequently, the need for AAC in Saudi Arabia cannot be underestimated.This study demonstrates the importance of the awareness of AAC among different stakeholders in Saudi Arabia including AAC users, healthcare providers and community members so that individuals with communication problems can receive maximum benefit from AAC.Given that most healthcare providers in Saudi Arabia are prescribing non-tech and low-tech AAC methods indicates the importance of training on AAC for healthcare providers serving patients with communication disorders.

Training Direct-Care Staff to Provide Communication Intervention to Adults With Intellectual Disability: A Systematic Review

PURPOSE

The aim of this review was to summarize and evaluate studies on training direct-care staff to provide communication intervention to adults with intellectual disability.

METHOD

Systematic searches identified 22 studies. These were summarized and evaluated in terms of (a) participants; (b) settings; (c) training aims and procedures; (d) research designs; (e) reliability, integrity, and social validity; (f) outcomes; (g) generalization and follow-up; and (h) certainty of evidence.

RESULTS

A total of 437 staff and 254+ adults with intellectual disability participated. Staff training most frequently involved combinations of verbal instruction, role play, modeling, practice, and feedback. Reliability was assessed in 18 studies with acceptable standards for most of these studies. Treatment integrity and social validity were assessed in 1 and 3 studies, respectively, with positive outcomes. Generalization and maintenance were assessed in 5 and 8 studies, respectively, with predominantly positive outcomes. Most studies reported positive outcomes for staff and positive or mixed outcomes for the adults with intellectual disability. Certainty of evidence was rated as conclusive in 1 study, suggestive in 14 studies, and inconclusive in 7 studies.

CONCLUSIONS

There is sufficient evidence to conclude that direct-care staff can be taught to provide effective communication intervention to adults with intellectual disability. Professionals involved in providing training and support to direct-care staff could expect positive outcomes from multicomponent training programs that include opportunities for practice and feedback.

Low cost assistive technology to support educational activities for adolescents with cerebral palsy

INTRODUCTION

The concept of assistive technology covers several areas of action; one of them is communication with the elaboration of accessible solutions to overcome daily difficulties. It contributes to the resumption of functional abilities, expanding and facilitating inclusion and independent living.

OBJECTIVE

To analyze the usability of a low cost prototype device to support educational activities of adolescents with cerebral palsy.

METHODS

A descriptive observational study. The evaluation of a prototype device was made through a validated questionnaire, Quest Version 2.0, on the level of the user's satisfaction with an assistive technology, composed of 12 evaluation items. The questionnaire was filled out by the educator based on the observation of four wheelchair-bound participants diagnosed with cerebral palsy according to the international classification of diseases and health-related problems, ICD-10, who attend a coexistence and teaching institution in the state of São Paulo, Brazil.

RESULTS

The device developed was considered an assistive technology, which provided an experience with a positive level of satisfaction for the participants.

CONCLUSION

The tested prototype contributes to communication and interaction allowing adolescents with cerebral palsy to participate in educational activities. Implications for Rehabilitation The device assists the individual in the educational activities and can positively influence their development, observe the individual number 5, who has an important limitation in coordination and fine movements, placing the role of the task in the vertical position offers a new perspective to perform the task, this stimulates him to try to perform the work, so the challenge was adjusted to the demands of each individual which can contribute to its neuromotor development, the amplitude of the distal movements and the manual ability, since it must look for alternatives to complete the task requested.

Beliefs and habits: staff experiences with key word signing in special schools and group residential homes

Even though use of aided augmentative and alternative communication (AAC) by staff has been extensively researched, few studies relate to unaided AAC strategies such as key word signing (KWS). We explored the KWS views of two groups: direct support staff in group residential homes and teachers from special education secondary schools. We examined transcripts from individual semi-structured interviews with five direct support staff and five teachers using thematic analysis. Participants discussed consistency of KWS use and reasons for implementing KWS. Compared to direct support staff, teachers described more use of KWS throughout the day with more individuals with intellectual disability. Teachers discussed use of KWS to facilitate students' present and future interactions, while direct support staff primarily discussed immediate effects. Participants experienced KWS implementation as a learning process and aimed to turn the use of manual signs into a routine habit. This required considerable self-monitoring, and the effort that this continuous self-feedback required, combined with environmental factors, could hinder KWS implementation. These preliminary findings suggest that preservice KWS training and on-site KWS assistance may need to be enhanced.

Eye Gaze Technology as a Form of Augmentative and Alternative Communication for Individuals with Rett Syndrome: Experiences of Families in The Netherlands

This paper provides a brief report on families' experiences of eye gaze technology as one form of augmentative and alternative communication (AAC) for individuals with Rett syndrome (RTT), and the advice, training and support they receive in relation to this. An online survey exploring communication and AAC was circulated to 190 Dutch families; of the 67 questionnaires that were returned, 63 had answered questions relating to eye gaze technology. These 63 were analysed according to parameters including: experiences during trial periods and longer-term use; expert knowledge, advice and support; funding; communicative progress; and family satisfaction. 20 respondents were using or had previous experience of using an eye gaze system at the time of the survey, 28 of those with no prior experience wanted to try a system in the future. Following a trial period, 11 systems had been funded through health insurance for long-term use and two families had decided a system was not appropriate for them. Levels of support during trials and following long-term provision varied. Despite frustrations with the technology, satisfaction with the systems was higher than satisfaction with the support. The majority of families reported progress in their child's skills with longer term use. These findings suggest that although eye gaze technologies offer potential to individuals with RTT and their families, greater input from suppliers and knowledgeable AAC professionals is essential for individuals and families to benefit maximally. Higher levels of training and support should be part of the 'package' when an eye gaze system is provided.

Alternative service delivery models for families with a new speech generating device: Perspectives of parents and therapists

PURPOSE

Research has revealed limitations in the provision of in-person services to families with a new speech generating device (SGD), both in Australia and overseas. Alternative service models such as parent training, peer support and telepractice may offer a solution, but their use with this population has not been researched to date.

METHOD

Using interviews and focus groups, this study explored the experiences and opinions of 13 speech-language pathologists and seven parents regarding alternatives to in-person support and training for families with a new SGD. Data were analysed using grounded theory. Themes explored in this paper include the benefits and drawbacks of alternative service models as well as participants' suggestions for the optimal implementation of these approaches.

RESULT

Participants confirmed the utility of alternative service models, particularly for rural/remote and underserviced clients. Benefits of these models included reduced travel time for families and therapists, as well as enhanced information access, support and advocacy for parents.

CONCLUSION

Participants viewed the provision of ongoing professional support to families as critical, regardless of service modality. Additional issues arising from this study include the need for development of organizational policies, resources and training infrastructure to support the implementation of these alternative service models.

Communication intervention in Rett syndrome: a survey of speech language pathologists in Swedish health services

PURPOSE

To investigate communication intervention that speech language pathologists (SLPs) provide to people with Rett syndrome.

METHODS

A web-based survey targeting all Swedish SLPs working with people currently receiving support from habilitation services.

RESULTS

The SLPs reportedly followed recommended practice in the following aspects: (1) Information on communicative function was collected from several sources, including observation in well-known settings and reports from the client s social network, (2) Multimodal communication was promoted and, (3) Responsive partner strategies were largely targeted in the intervention. However, few instruments or standard procedures were used and partner instruction was given informally. Most SLPs used communication aids in the intervention and their general impression of using communication aids was positive. Further, augmentative and alternative communication (AAC) was estimated to increase and clarify communicative contributions from the person.

CONCLUSIONS

Communication aids were reported to have a positive influence on communicative functions. Swedish SLP services followed best practice in several aspects, but there are areas with potential for development. Tools and best practice guidelines are needed to support SLPs in the AAC process for clients with Rett syndrome. [Box: see text].

A scoping review of interventions to supplement spoken communication for children with limited speech or language skills

BACKGROUND

Augmentative and Alternative Communication (AAC) is used for treating children with severe disorders of speech-language production and/or comprehension. Various strategies are used, but research and debate on their efficacy have remained limited to a specific area and have rarely reached the general medical community.

OBJECTIVE

To systematically evaluate outcomes of AAC interventions in children with limited speech or language skills.

METHODS

Searches were conducted (up to December 2012) in the MEDLINE, EMBASE, PsycINFO, CINAHL, DARE, and Cochrane Library databases. Furthermore, relevant journals were searched by hand. References from identified studies were examined. Only RCTs were considered. Trial quality was assessed according to a standardized and validated set of criteria.

RESULTS

Fourteen of 1661 retrieved papers met inclusion criteria. A total of 666 children were included in the review and 7 papers involved only children <5 years old. Papers were of average quality and all but one had been published during the previous 10 years by one of 8 research groups, 5 of which from the United States. Seven studies directly addressed AAC use by children with different disabilities. Seven studies enrolled typically developing children: 5 evaluated the use of AAC technologies by children without disabilities in order to obtain results that could be used to improve interventions in peers with disabilities, and 2 evaluated peers' attitudes towards children who used AAC. Both interventions and outcome measures varied widely between studies. Overall findings demonstrate the effectiveness of the AAC interventions considered, but the focus on RCTs alone appears too restrictive.

CONCLUSIONS

Solid evidence of the positive effects of AAC interventions in children with severe communication disorders must be generated, and different methods are needed besides RCTs. Moreover, it is important that knowledge, research, and debate extend to the medical community in order to ensure clinically effective AAC provision for these children (and their parents).

Perceptions of the design of voice output communication aids

BACKGROUND

Voice output communication aids (VOCAs) are a key form of aided communication within the field of augmentative and alternative communication (AAC). In recent years, rapid developments in technology have resulted in an explosion of devices available commercially, yet little research has been conducted into what people who use VOCAs think about them.

AIMS

The aim of this research was to explore the perceptions of communication aid design from the perspective of end users and AAC professionals, with the objective being to inform and influence the design of future devices.

METHODS & PROCEDURES

A two-part study was conducted: interviews were undertaken with people who use VOCAs, and questionnaires were distributed to those who use aided communication and to AAC professionals. Analysis of the interview data was carried out using a qualitative method based on framework analysis, whilst descriptive statistics were generated from the questionnaire data. Interview participants were an opportunity sample of VOCA users within a defined region of the UK. Those recruited were over the age of 12 years and able to engage in the interview process; they were identified through the caseloads of local Speech and Language Therapists specializing in AAC. The questionnaire was marketed to the AAC community throughout the UK. Respondents were self-selecting as those using aided communication, their carers and AAC professionals.

OUTCOMES & RESULTS

Eighteen people participated in the interviews. Questionnaires were completed by 43 people who use aided communication and 68 AAC professionals. The data suggest that current devices are considered to be neither reliable nor durable by users and professionals. Although features given a higher importance ranking are more likely to be perceived as available, a number of important design deficits are identified by users and/or professionals. Simplicity of design (and use) and the desire for devices which support communication that is as fast and spontaneous as possible also emerge as key requirements. Synthesis of the data produced a framework with three main themes covering the range of issues which influence the successful use of a VOCA: specific aspects of the design of a device; the consideration of the wider picture around the person; and the personal context in which someone uses their device.

CONCLUSIONS & IMPLICATIONS

Although the original aim of the project was to establish the user requirements of VOCA design, the data indicate that the characteristics of the device cannot be considered in isolation. Those factors uncovered highlight questions about whether the design of communication aids is truly effective in meeting the needs of the people who use them. Based on these data, an initial specification for future device design is proposed.

Non-electronic communication aids for people with complex communication needs

Non-electronic communication aids provide one form of augmentative and alternative communication (AAC) for people with complex communication needs. The aim here was to explore non-electronic communication aids as one AAC option and research challenges. This aim was addressed by reviewing funding for the provision of AAC systems, data from an Australian pilot project providing non-electronic communication aids, an audit of aided AAC published studies (2000-2009), and discussion of the review literature. Combined, these sources indicate that although there is great demand for non-electronic communication aids, funding schemes, both in Australia and internationally, have focused on electronic communication aids. Such funding has usually failed to meet the total device costs and has not provided for adequate speech-language pathology support. Data from the pilot indicated the demand for non-electronic communication aids, and patterns suggest potential factors that govern the types selected. Despite the high demand for non-electronic aids, the research literature has tended to focus on electronic communication aids, including within intervention studies and addressing design features and long-term outcomes. Concerns about ensuring that AAC systems are chosen according to the assessed needs of individuals are discussed within the context of limitations in outcomes research and appropriate outcome measures.

Speech-language pathologists' views on mentoring by people who use speech generating devices

Learning to use a speech generating device (SGD), also known as a voice output communication aid (VOCA), is a challenging experience for new device learners. These learners typically rely on training from speech-language pathologists (SLPs) and may not meet other users who are competent SGD communicators. The aim of this study was to explore SLPs' perceptions of the important components of a program where adults who use an SGD mentor new learners. A total of 17 SLPs experienced in augmentative and alternative communication (AAC) participated in one of three focus groups. The focus group discussions were analysed for content themes and these were verified with participants. Thematic analysis revealed that experienced SLPs perceived that a mentoring program to improve SGD use might help people new to using SGDs. Participants were positive about SLPs collaborating with SGD mentors to support new learners. They suggested ways in which SLPs could provide assistance and guidelines for establishing a mentoring program. Potential benefits identified for new learners included opportunities to view successful use of an SGD in everyday settings and to receive support and guidance. Benefits for mentors included the satisfaction of helping new learners.

Long-term outcomes for individuals who use augmentative and alternative communication: Part III--contributing factors

In order to improve outcomes for individuals who use augmentative and alternative communication (AAC), it is important to understand what factors contribute to or detract from positive outcomes. Seven young men who had used AAC systems for at least 15 years, their family members, and professionals who had worked with them, participated in the study. Qualitative interviews were used to identify contextual factors that may have contributed (both positively and negatively) to the young men's outcomes. Factors that impeded positive outcomes included: attitude barriers, cultural differences, technological barriers, and service delivery limitations. Contributions to positive outcomes included: community support, parent and family support, personal characteristics, and appropriate and high-quality AAC services. The results are discussed with implications for clinical practice and directions for future research.

Preparation in augmentative and alternative communication: an update for speech-language pathology training

PURPOSE

To report on data from the current survey about academic and clinical education in augmentative and alternative communication (AAC), as well as to compare these findings with earlier surveys in an attempt to identify any changes being made as programs in the United States implement the new certification standards of the American Speech-Language-Hearing Association in the area of speech-language pathology.

METHOD

A survey was sent to all speech-language pathology training programs in the United States via e-mail directed to program directors or faculty teaching in AAC.

RESULTS

A total of 168 surveys were returned, for a return rate of 57.93%. Seventy-three percent of the respondents had a separate course in AAC, and 80% indicated AAC content was infused in other courses.

CONCLUSIONS

Academic preparation in AAC, while varying across academic programs, has in general increased over the past decade. Data also suggested a continuing critical need for more academic and clinical preparation in this area.