Communication Assessment for People who engage in Behaviours of Concern (BoC) Module 2 : Communication Assessment

1. Communication Assessment for People who engage inBehaviours of Concern (BoC)Module 2 : Communication Assessment Hilary Johnson, Nick Hagiliassis, Barbara Solarsh, Teresa Iacono, Jo Watson, Teena Caithness Office of the Senior Practitioner, Disability Services, Victoria

2. Building the Foundations for Effective Commn for Victorians with BOC Subject to Restrictive Practices 1. Identify the foundations of effective communication assessment through the development of a resource kit to support assessment and intervention in relation to communication and behaviours of concern, Increase the capacity of speech pathologists to provide practice support to direct disability staff and others involved in the support of people subject to restrictive interventions. 3. Undertake an evaluation of the tool kit in a natural practice setting i.e., a residential support service

3. Communication and Behaviour of Concern (BOC) Can’t remember where this image is from… Bio Psycho Social Developmental Model Holland & Jacobson, 2001 in McVilly (2002)

4. Incident Report Martin pushed his chair away from the packing table. He stood up. Martin glared at Tim (staff member) and raised his clenched right fist. Tim told Martin to “Calm down”. Martin then walked over to Tim, hit him in the head with a closed fist and then punched the wall. What more would you like to know?

5. Martin seems to be always looking around checking things out. More about Martin I used to be frightened of Martin. Now we get along fine. I would describe Martin as a hard worker. Once he has seen the job done once he can copy it. We can tell if he’s having a good day Martin doesn’t talk. He has a book with pictures but I’ve never used it. We just get along by talking and pointing to things. You can ask Martin a question and he’ll nod for “yes”

6. Information from Tim Tell me about the incident We’d only just gone into the packing room. Martin knows the routine. The job was set out on the table. The clients organised themselves and sat down. Then there was a telephone call and a knock on the door. I knew Martin wanted to start work, he pointed to the boxes and nodded. I said that everyone had to wait. Shona had answered the phone and I needed to answer the door. Then Martin reacted by pushing his chair away from the table, standing up, threatening me with a clenched fist, and then he hit me.

7. Small Group Work What do you know about Martin?What questions would you like to ask staff?What are Martin’s strengths and abilities?Is there anything you would like to explore further?What areas would you include when providing a communication assessment for Martin?

8. Summary

9. Communication Assessment (BoC) Basic principles of speech pathology assessment apply.Key areas to consider:1. Identify the potential communicative functions 2. Profile communication abilities3. Observe current environmental barriers and identify solutions

10. Opportunity BarriersThe Participation Model (Beukelman and Mirenda, 2005)

11. Opportunity Barrier Attitude

12. Access BarriersThe Participation Model (Beukelman and Mirenda, 2005)

13. Let’s hear what Martin has to say… If Martin could talk – what do you think he would say about the incident? I was ready to work. I like to keep busy. I saw the work on the table and sat down. I know this work, we had done it before, many times. I pointed to the work and nodded at Tim. I wanted to start. Tim said everyone had to wait. I was angry. I don’t like waiting, especially when I know what to do. I lost it.

14. Information from Tim Tell me about the incident We’d only just gone into the packing room. Martin knows the routine. The job was set out on the table. The clients organised themselves and sat down. Then there was a telephone call and a knock on the door. I knew Martin wanted to start work, he pointed to the boxes and nodded. I said that everyone had to wait. Shona had answered the phone and I needed to answer the door. Then Martin reacted by pushing his chair away from the table, standing up, threatening me with a clenched fist, and then he hit me.

15. Development of Hypotheses Think of at least 5 reasons to explain why Martin hit Tim. # 1 ___________________________________ # 2 ___________________________________ # 3 ___________________________________ # 4 ___________________________________ # 5 ___________________________________

16. http://www.bedtime-story.com/bedtime-story

17. ‘A communication disability does not just belong to the individual. It belongs to the entire environment of which the individual is the focal point.’ Sandwell - Communication Aids Centre, UK

18. Communication Assessment Kit (BoC) Suitable for use by speech pathologists 23 Tests divided in 10 sections (see sheet) Items meet most criteria for inclusion Information can be obtained from the individual and or informants Formal and informal measures are included that require skill in Administration Scoring or recording responses interpretation

19. Criteria for inclusion Provides information in one of the key areas identified Identification of the functions of the BOC Profile of communication Social and physical barriers and enablers Appropriate for 1 or more of the following groups: Children / adults with Dev Disabilities including ID,CP & autism Children / adults with acquired disability including ABI, aphasia, degenerative neurological conditions Available at no or reasonable cost Easy to obtain Information on validity & reliability if possible

20. Assessment Kit: Domains Including factors Cultural CALD Education Refugee Socio-economic Person at risk Homelessness Drug and Alcohol Malnutrition Medication Criminal Justice Personality / Attachment Bio-Psycho-Social-Developmental Model

21. Identify communicative functions of behaviours • Example from the kit: • DEWART, H. & SUMMERS, S. (1995) ThePragmatics Profile of Everyday Communication Skills in Adults. (Revised) Berkshire: NFER-Nelsonhttp://wwwedit.wmin.ac.uk/psychology/pp/index.htm • A. COMMUNICATIVE FUNCTIONS • RESPONSE TO COMMUNICATION • C. INTERACTION AND CONVERSATION • D. CONTEXTUAL VARIATION

22. Range of Assessment tools • Include a range of assessment types • Structured norm based tests • Informant interviews • Structured sampling strategies • Structured observation • Informal Assessment

23. Work in Pairs Write some guidelines about how you would select assessments from the kit.

24. NSW DHS Assessment Processes (DRAFT)courtesy Donna.White@dadhc.nsw.gov.au Reviewing the Service Request Consent Assessment outcome Personal safety Indirect Assessment Direct Assessment Writing report

25. Communication Skills of Individuals • Receptive communication skills • Speech Production and intelligibility • Expressive communication skills • Pragmatic communication skills • Literacy skills

26. Communication Skills: Receptive Skills Understanding questions Yes/ no questions –acquiescence or “yea saying” Either / or questions – recency Leading questions Repeated questions ‘Short-answer’ or specific questions Questions with a negative or double negative Questions with complex or abstract vocabulary and sentence structure Multiple questions

27. Communication Skills: Receptive Skills Understanding instructions Understanding information The meaning and definitions of some words Ambiguous words and sentences Figurative language Problem solving

28. Communication Skills: Expressive Skills Syntax • sentences fragmented, illogical, morphological errors Semantic • ‘survival’ vocabulary • word finding problems • use non-specific language (e.g. thing, stuff) • difficulties with using slang Narrative

29. Communication Skills: Pragmatic Skills Strengths • turn-taking strategies • greetings and conversational initiations • maintain and expand conversational topics • requests for clarification. Difficulties • Inability to ‘code switch’ • inappropriate non verbal behaviours Environment and conversational partners • power or status differences • communication breakdowns

30. Range of Assessment tools • Include a range of assessment types • Structured norm based tests • Informant interviews • Structured sampling strategies • Structured observation • Informal Assessment

31. Relationship between medical & BOC http://www.cddh.monash.org/products-resources.html The CDDHV have developed a number of Fact Sheets on topics and issues related to developmental Disability Medicine. http://www.healthinsite.gov.au/topics/Intellectual_Developmental_and_Learning_Disabilities http://www.intellectualdisability.info/

32. Relationship between Mental Health Issues Adults Anything by Nick Bouras and Geraldine Holt (UK) The ESTIA Centre http://www.estiacentre.org/freepub.html First Aid Mental Health http://www.mhfa.com.au/documents/manuals/id_manual_March09.pdf Children and Youth Inspire Foundation www.inspire.org.au delivers online programsfor young people that prevent youth suicide and improve mentalhealth and wellbeing. Includes a library with access to past documents. Maybeuseful for students with mild ID.

33. Relationship between sensory & BOC Positive Solutions in Practice From Seclusion to Solutions Issue No 2 2007 OSPSensory environments Sensory rooms Multi-sensory rooms “In order to reduce behaviours of concern additional therapeutic strategies are needed.” Positive effects on behaviour

34. Relationship between CALD & BOC http://www.adec.org.au/ Raising Kids Together November 2008 http://www.dadhc.nsw.gov.au/dadhc/People+with+a+disability/Raising+kids+together.htm Sudan, Afghanistan, Iraq http://www.dhi.gov.au/Multicultural-Mental-Health-Australia/default.aspx

36. CHILDREN ONLY ADULTS ONLY KIERNAN, C. & REID, B. (1987) Pre-Verbal Communication Schedule. Berkshire: NFER-Nelson No longer available BLOOMBERG, K.,WEST, D. Johnson, H. & IACONO, T (2009).The Triple C Checklist of Communication Competencies – Assessment Manual and Checklist. Melbourne, CRC

37. The Triple C Checklist of Communication CompetenciesBloomberg, K., West, D., Johnson, H. & Iacono, T. (2009) up ua ii sb se UP – Unintentional passive communication UA – Unintentional active communication II – Intentional informal communication SB – Symbolic (basic) communication SE - Symbolic (established) communication

38. interAACtion & Triple C stagesBloomberg, K., West, D., Johnson, H. & Iacono, T. (2009) up ua ii sb se preintentional intentional unintentional intentional non-symbolic symbolic 1 2 3 4 5 6

39. Communication & BOC In recognition of the growing evidence1 supporting a significant link between communication difficulties and challenging behaviour, comprehensive assessment of behaviour should be informed by a recent and detailed communication assessment (ideally undertaken by a qualified Speech Pathologist). 1Balandin, S. (2002) Editorial, ISAAC Bulletin, 67, 2. NSW Department of Ageing, Disability and Home Care Behaviour Support: Policy and Practice Manual. Guidelines for the provision of behaviour support services for people with an intellectual disability. Part 1: Policy and Practice January 2009 p.21