Introduction to Supported Communication

1. Introduction to Supported Communication Pascal Cheng Harvey Lavoy Tracy Thresher 2014 Midwest Summer Institute: Inclusion & Communication for All June 23-24, 2014

2. Elements of Support for Communication Adapted from Cardinal 2006 Visual attention (look at keyboard) Emotional Support Attitudinal and behavioral supports Physical Support Communication support Positioning Technology and Equipment Partner skill and training Structured Activities Pointing skills of FC user

3. Topics Overview of Augmentative / alternative communication Definition and candidacy for FC Understanding movement and FC Overview of the FC training process Basic elements of the technique Simulated practice of facilitation technique Getting started activities for new facilitators Documentation of FC user skills incl. authorship

4. What is facilitated communication? Strongest therapy for people with no means of expression is sensational, controversial, revolutionary, technically subtle FC. It involves understanding movement lapses of people and providing physical support to help overcome them. Plastic nature of users of FC requires topnotch weaning of support towards ultimate goal of independence. Larry Bissonnette

5. Facilitated communication or supported typing is one of an array of augmentative and alternative methods of expression for people who cannot speak, or whose speech is highly limited (e.g. echoed, limited to one or a few word utterances), and who cannot point independently or reliably. What is facilitated communication/supported typing?

6. Facilitated Communication (FC) or Supported Typing is a form of alternative and augmentative communication (AAC) in which people with disabilities and communication impairments express themselves by pointing (e.g. at pictures, letters, or objects) and, more commonly, by typing (e.g. in a keyboard). Institute on Communication and Inclusion

7. Structured facilitator training process • Background info on FC • Simulated practice activities • Modeling by experienced facilitator • Initial practice with supervision from experienced facilitator • Regular practice with FC user and ongoing supervision from experienced facilitator

8. Communication partner activity • Participants will break up into pairs. One will play the role of the communicator. The other will be the listener with normal speech. The communicator will attempt to communicate a message. DO NOT SHARE WITH LISTENER • The message can be: • - A comment about the day • A question to the listener • Some news about something they have done recently

9. Activity directions: • 2. The AAC user must attempt to communicate the message without: • -speaking • -writing • -signing • -drawing • The communication partner will attempt to determine what the message is.

10. Activity Directions: • 3. After completion of the activity, the pairs will share their experiences with the larger group: (Communicator) What was it like trying to rely on limited means to communicate your message? • (Partner) How easy/difficult was it to understand the person’s message?

11. “The most important principles for supporting people to communicate have little to do with equipment or elaborate instructional techniques. They are the attitudes and skills of the people they are talking with: their communication partners…

12. “…The more supportive a communication partner is of a person’s efforts to communicate, the more effective that person will be.” Pat Mirenda

13. Guiding principles for supporting communication Access to all forms of AAC including FC is a basic civil right. Presumption of competence is the starting point for supporting people who have difficulty with communication.

14. The Right to Communicate The right to communicate is both a basic human right and the means by which all other rights are realized. All people communicate. In the name of fully realizing the guarantee of individual rights, we must ensure:  that all people have a means of communication which allows their fullest participation in the wider world; that people can communicate using their chosen method; and that their communication is heeded by others. TASH Resolution on the Right to Communicate, 2000

15. Presumption of Competence Assume that a child has intellectual ability, provide opportunities to be exposed to learning, assume the child wants to learn and assert him or herself in the world... Presuming competence is nothing less than a Hippocratic oath for educators. It is a framework that says, approach each child as wanting to be fully included, wanting acceptance and appreciation, wanting to learn, wanting to be heard, wanting to contribute. Douglas Biklen, 2012

16. Larry Bissonnette “Fastening labels on people is like leasing cars with the destinations determined beforehand.”

17. Anne McDonald, Annie’s Coming Out, 1980 “Unless someone makes a jump by going outside the handicapped person’s previous stage of communication, there is no way the speechless person can do so. Failure is no crime. Failure to give someone the benefit of the doubt is.”

19. Christy Brown – “My Left Foot” “This is Christy Brown, my son. Genius. “ Christy’s father.

20. Understanding Augmentative/alternative communication and FC

21. What is AAC? Augmentative and Alternative Communication (AAC) refers to all forms of communication that enhance or supplement speech and writing. In simpler terms:

22. Vt. AAC Resource Guide • Augmentative Communication • supplements or adds to verbal and nonverbal communication. • Alternative Communication is for people with no verbal and minimal nonverbal output.

23. Examples of AAC Gestures Body actions Head shaking Facial expressions Signing Use of communication board Use of electronic device Eye gaze

24. Many ways to communicate

25. Total Communication Approach: A full system of strategies which might include sign language, simple gestures and facial expressions, single words and phrases, and use of electronic devices.

26. Specialized forms of AAC Sign language Selecting through touching, pointing, etc. pictures, symbols, words and letters to communicate a message

27. Specialized communication aids

28. What isthe best physical access strategy ?

30. Using an eye gaze board

31. Pointing skills are often required to use communication aids and devices.

32. What is Facilitated Communication/Supported Typing? Facilitated Communication/supported typing is a form of augmentative alternative communication (AAC) in which people are provided with physical support to help them develop effective pointing skills for communication using pictures, symbols, letters and words.

34. The level of complexity of pointing skill needed depends on what is being communicated and what communication aid/device is being used.

35. Choosing what methods or modes of communication to use

36. Using multiple modes: • I might greet someone with a hand wave • I might show them some pictures of my vacation to share information • I might point to a picture or word for a snack I want • I might make a comment or share an opinion by spelling a message out

37. Larry – Speech and Typing “Personally, my speech relays to others what my stomach needs while my typing promotes what my brain visualizes as intelligent thought.”

38. Within any activity, people will be communicating for different purposes: Expression of needs/wants Sharing information Social Closeness relationships Social Etiquette social routines

39. What kind of communication happens at a restaurant?

40. Who can benefit from the use of FC/supported typing?

41. FC is helpful for those who cannot speak or whose speech is highly limited (e.g. echoed from others or limited to one or a few word utterances) and for who people who cannot point independently or reliably.

42. Assessment The assessment process for FC involves determining if there are specific physical/movement problems affecting a person’s ability to point independently or reliably and if so, what physical support strategies can help the person to overcome those problems and improve their pointing skills.

43. Examples of movement difficulties • Difficulty isolating an index finger • Pointing without looking • Pointing too quickly • Difficulty with extending arm/hand • Initiating movement to point • Difficulty with new motor tasks, i.e. typing novel communication • Hitting the same selection or series of selections, e.g. automatic words and phrases, repetitively

44. Q W E R T Y U I O P delete A S D F G H J K L Z X C V B N M , . space Observe the person doing a variety of activities involving pointing. Look for physical problems that might be affecting pointing.

45. Point to the picture of “pizza”.

46. Can you point to the word, “milk” Milk Juice Tea Soda Which drink comes from a cow?

47. Let’s try typing the name of the town you live in…

48. Determine physical support strategies that will help to remedy the problems and improve the person’s pointing skills

49. The person may not be able to isolate an index finger and may need physical support initially to develop this skill.

50. The person may also be unable to pull the hand back after making a forward movement and/or sequence forward and back movements unless the pointing hand or limb is steadied and supported….but not directed.