Creating Communication Environments

1. Creating Communication Environments An Overview Developed by Judi Cumley and Mary Wirkus Wisconsin Assistive Technology Initiative

2. Learner Outcomes • Understand the foundations of functional and interactive communication • Identify target activities and strategies for eliciting active participation by student(s) • Select communication opportunities that are natural and appropriate • Arrange the environment to promote communication • Identify the steps in a “least to most” prompt hierarchy

3. Agenda • Background of “Creating Communication Environments” (CCE) • Purposes of Communication • The Three Main Ingredients of Creating a Communication Environment • Activity • Environment • Partner • The Prompt Hierarchy • How Can This Be Useful for YOU?

4. Background Information • CCE is based on ECT (Environmental Communication Teaching) - developed by Dr. George Karlan at Purdue University • Developed for a classroom TEAM • Emphasis on eliciting communication within natural environments • Originally developed as a 5-day training program for school-age children who use or need AAC • Replicated throughout the country for children and students of all ages & disabilities (CCE in Wisconsin since 1999)

5. Crying Eye contact Sounds Words Pointing Falling asleep Screaming Communication boards Picture exchange system Voice output systems Gestures/signing Hair-pulling Everyone Communicates… • Silence

6. Communication Purposes • Expressing Wants and Needs *Once desired action or object is achieved, communication ends • Social Interactions including Social Etiquette *Social vocabulary is difficult to provide, but vital for social acceptance • Greetings, Conclusions, “manners”, etc . Exchanging Information * Starts as “joint attention” then develops into more complex interchanges with content or topic specific vocabulary Janice Light 1988, 1997, 2005

7. Changing Purposes of Communication Infancy Secondary Elementary Sharing Information Sharing Information WANTS & NEEDS Sharing Information Social Interactions & etiquette Social Interactions & etiquette WANTS & NEEDS Social Interactions & etiquette WANTS & NEEDS The importance of different communication purposes changes over our lifetime J. Cumley, 2001 Based on J. Light, 1988, 1997, 2005

8. If we only have to think about encouraging our students to communicate for three different purposes, why is it so HARD…..what can make it easier?

9. AAC Augmentative/Alternative Communication *refers to the ways (other than speech) that are used to send a message from one person to another (ASHA, 2005) Examples • Communication boards/books/picture symbols • Speech Generating Devices (SGDs) • Picture Exchange Communication System (PECS) • Morse Code • Eye Gaze • Picture Schedules

10. AAC can be a vehicle for developing:expressive languagereceptive languageliteracycontrol over the environmentcommunication initiation

11. AAC is not…. A last resort “Giving up” on speech Only for those of a certain IQ or Age Only the job of the speech-language pathologist

12. Myths and Misconceptions: Young Children with CCN (Complex Communication Needs) Myth and Misconceptions AAC hinders or stops further speech development The Evidence AAC approaches (signs, picture symbols, VOCAs*) do NOT hinder speech development. In fact, speech often increases during AAC treatment approaches *VOCA= Voice Output Communication Aid From: Augmentative Communication News, Volume 18, Number 2, June, 2006

13. Myths and Misconceptions: Young Children with CCN (Complex Communication Needs) Myth and Misconceptions There is a representational hierarchy of symbols from objects to written words The Evidence Children can learn to understand and use a variety of symbols at a very young age (e.g., sign language) through repeated exposure to the symbol and its referent in natural contexts From: Augmentative Communication News, Volume 18, Number 2, June, 2006

14. Myths and Misconceptions: Young Children with CCN (Complex Communication Needs) Myth and Misconceptions Children must have certain skills to benefit from AAC (e.g., be at a certain age, have a particular cognitive or linguistic level, etc.) The Evidence There are NO prerequisites for communication. AAC focuses on all aspects of communication and communication begins at birth. AAC is an appropriate intervention approach for anyone with CCN. From: Augmentative Communication News, Volume 18, Number 2, June, 2006

15. Myths and Misconceptions: Young Children with CCN (Complex Communication Needs) Myth and Misconceptions AAC is a last resort and means professionals are “giving up” on speech The Evidence The “Wait and See approach” is not an effective way for teams (e.g., speech-language pathologists, teachers, paraprofessionals, parents to develop communicative competence) From: Augmentative Communication News, Volume 18, Number 2, June, 2006

16. Using AAC effectively Communication partners must model AAC use Use of a penlight or finger on paper displays (aided language stimulation) Sit next to individual with device to facilitate modeling Use it as both a receptive and expressive tool Be natural-focus on communication, not the device/board AAC must be engineered into the environment Displays mounted around the room/school/home ACCESS to communication wherever student “is” Pool Playground Home Out shopping Bathtub School or instructional settings

17. When designing AAC overlays, be sure to include... Vocabulary that reflects all 4 categories Wants & Needs Exchanging Information Social Closeness Social Etiquette Use a communication board to talk to each other. Does it contain the 4 purposes of communication?

18. AAC: • Establishes a means of communication • Provides opportunity for social interaction • Promotes receptive communication • Encourages expressive communication • Decreases frustration • Provides opportunity for initiation

19. Think about YOUR students who are struggling to communicate effectively… What are some characteristics of their communication?

20. Common Characteristics of Students Using AAC • Rarely initiate interactions • Usual form of communication is NOT using a communication device • Gestural responses (head nods) to yes/no questions main form of communicating • May use “challenging” behaviors to communicate

21. Common Characteristics of Students Using AAC • Most vocalizations are unintelligible • Rarely interact with peers • Communication system may not be available when needed • Necessary vocabulary is not programmed or correct symbol is not available

22. Supporting AAC users….Create a Communication Environment • Expect all students to communicate • Recognize and respond to the student’s communication initiations • Arrange the environment to increase the likelihood for communication • Identify communication opportunities within natural routines and activities

23. Addressing Communication Challenges AND Creating a Communication Environment… • Requires changes in the… • Activities • Environment • Partner Communication Activities Partner Environment

24. “Incidental teaching episodes are brief, positive, and oriented toward communication rather than language teaching.” Dr. George Karlan

25. Selecting a Target Activity to Elicit Communication • Should be brief in nature, but occur 3-4 times per week • Requires communication (initiations) by the student • Activity should be process - not product oriented • Activity represents a class of activities • Art activities, cooking, reading books, snack • Variation in content from episode to episode, but same “core” vocabulary • Choices are offered during the activity • COMMUNICATION is the goal of the Target Activity!

26. Selecting Target Activities • Start by identifying a “target” activity • Student must have a reason to perform the activity • Activity must provide opportunities for success • Must be motivating • Must be functional and interactive • Must be age-appropriate • Must reflect family wishes/team consensus Describe your Target Activity on the Target Activity Form

27. The Target Activity Form- Sample Students come to table at snack time. Snack materials are on counter. Materials: food, placemats, napkins, straws, milk (white & chocolate), communication overlays for requesting snack items & standard vocabulary-more, all done, uh oh, help, etc. How is vocabulary represented: Activity Vocabulary: Wants/Needs: Social Interactions & Etiquette: Sharing Information:

28. Does your Target Activity have at least THREE opportunities for the student to initiate? • What does the student have to say to BEGIN the activity? • What does the student to have to say to CONTINUE the activity? • What does the student have to say to END the activity? If you can’t think of 3 statements the student needs to say to be engaged in the activity…. pick a different activity!

29. Communication Turns-example Snack Beginning:Student asks for snack items.(e.g., milk, cracker, napkin, straw, placemat) “I want….” “Can I have ….” “milk”, etc. Middle:Student asks for “more”, “help”, makes social, informational or etiquette comments to peers and adults “I want more ….”, “more ….”, “good …..” “I like …” “You want…” End:Student indicates when finished (asks to be excused, says “all done”, asks for clean-up materials, asks to go to transitional activity) “all done”, “clean up”, “no more”, “bye-bye”

30. The Target Activity Form- Sample Students come to table at snack time. Snack materials are on counter. Materials: food, placemats, napkins, straws, milk (white & chocolate), communication overlays for requesting snack items & standard vocabulary-more, all done, uh oh, help, etc. How is vocabulary represented: Activity Vocabulary: Wants/Needs: Social Interactions & Etiquette: Sharing Information: Student asks for snack items (e.g., Milk, cracker, napkin, straw, placemat) “I want …” “Can I have….” “milk” Student asks for “help” Student asks for “more…” Makes comments to peers and adults “I want more…” “I like ….” “good …” “You want …..?” Student says “all done” when finished “clean-up” “go play” “bye-bye”

31. Communication Considerations • How will the vocabulary be represented (e.g., objects, tangible symbols, photos, symbols, etc.) • List the vocabulary that must be available. Try to have vocabulary that represents • Wants/Needs • Social Interactions & Social Etiquette • Sharing Information

32. The Target Activity Form - Sample Students come to table at snack time. Snack materials are on counter. Materials: food, placemats, napkins, straws, milk (white & chocolate), communication overlays for requesting snack items & standard vocabulary-more, all done, uh oh, help, etc. How is vocabulary represented? Communication board with PCS symbols. Vocabulary for expansion & labeling. Student points w/some vocalizations. Teacher models & expands Activity Vocabulary: milk, straw, napkin, cracker, placemat… Wants/Needs:I, want, more, help, specific snack items Social Interaction & Etiquette:sit here, want some?, please, thank you Sharing Information:good, yucky, uh oh, all done Student asks for snack items (e.g., Milk, cracker, napkin, straw, placemat) “I want …” “Can I have….” “milk” Student asks for “help” Student asks for “more…” Makes comments to peers and adults “I want more…” “I like ….” “good …” “You want …..?” Student says “all done” when finished “clean-up” “go play” “bye-bye”

33. Video…..

34. Addressing Communication Challenges AND Creating a Communication Environment… • Requires changes in the… • Activities • Environment • Partner Communication Partner Activities Environment

35. Arrange the Environment to Increase the Likelihood of Communication • Common Strategies…. • Use motivating materials and activities • Materials should be in view but not accessible • Student should need assistance with some materials • Provide small or inadequate amounts of materials • Sabotage • Provide something the student doesn’t like/want • Use communication boards/devices & visual tools

36. Your Environment • Are there any environmental changes you could make to increase communication? • Activity-based environmental changes • Material location, amount, type • Communication-based environmental changes • Picture symbols, communication boards, device placement

37. Video- Note Environmental Arrangements

38. The Target Activity Form - Sample Students come to table at snack time. Snack materials are on counter. Materials: food, placemats, napkins, straws, milk (white & chocolate), communication overlays for requesting snack items & standard vocabulary-more, all done, uh oh, help, etc. How is vocabulary represented?Communication board with PCS symbols. Vocabulary for expansion & labeling. Student points w/some vocalizations. Teacher models & expands Activity Vocabulary: milk, straw, napkin, cracker, placemat… , Wants/Needs: I want, more, help, specific snack items Social Interaction & Etiquette: sit here, want some?, please, thank you Sharing Information: good, yucky, uh oh, all done Student asks for snack items (e.g., Milk, cracker, napkin, straw, placemat) “I want …” “Can I have….” “milk” Student asks for “help” Student asks for “more…” Makes comments to peers and adults “I want more…” “I like ….” “good …” “You want …..?” All students have snack placemat with specific snack vocabulary velcroed on top & core vocab. permanently on sides. Single small pieces of snack Straw on table, but out of reach Milk carton not open Wrong flavor of milk (sabotage) Student says “all done” when finished “clean-up” “go play” “bye-bye”

39. Addressing Communication Challenges AND Creating a Communication Environment… • Requires changes in the… • Activities • Environment • Partner (And that means YOU!) Communication Partner Activities Environment

40. What are some common characteristics of communication partners?

41. As a Communication Partner… What Can DISCOURAGE a student from communicating… --test, bombard, or demand responses (e.g., “what is this called” “what do we use a knife for?” “what do we call this?”) --use rhetorical questions (e.g., “you don’t want milk, do you?”) --use YES/NO questions --anticipate their needs so they don’t have to ask

42. As a Communication Partner… What else Can DISCOURAGE a student from communicating… --don’t give them regular access to their communication system(s) --when they make a choice, ask them again --use only teacher-directed activities so the student doesn’t HAVE to communicate --”GOOD TALKING!” as a reinforcer --use figurative language (“take your seat” vs. “sit”) --”rush” the student’s communication

43. Strategies to Promote CommunicationAdapted from Original ECT, Hodgdon, 1999 • Engage (get at their level, eye contact) • Establish attention • Proximity to child • Be in their line of vision • Watch for student to orient to you (attention shift) • Use visuals (present visual first) • Use meaningful gestures • Exaggerate movements to attract attention • Hold gestures (point long enough to mutual referent) • Less may be better! • Match student’s verbal output? • Expand by one

44. Strategies to Promote CommunicationAdapted from Original ECT, Hodgdon, 1999 • Wait for responses • Count to 5, 10 after a command/question • Stay engaged • Increase opportunities for initiation • Be consistent with labels (why?) • Modify the environment to create active participation, communication • Make sure the student has access to communication at ALL TIMES!

45. The most language learning will occur when your response is related to the student’s focus of interest or to what he has communicated.

46. YOU are part of the environment … When you use a prompt hierarchy you can: • Provide consistency across partners because of framework • Give students processing time • Be individualized • Provide only as much prompting as is needed

47. Prompt Hierarchy • Environmental Cue • PAUSE • Open Question • PAUSE • Prompt OR Request for Communication • PAUSE • Full Model • PAUSE • Incorporate descriptive feedback into each step

48. Descriptive Feedback • Use after the student has produced a communicative response (at any point within the hierarchy) • Descriptive feedback is specific to the student’s communication • “Oh, you asked for more juice, here’s your juice.” • “You want paint. Here’s some blue paint.” • “You asked to be all done. We need to do just one more, then we’re all done.” • “You looked at the cheese, here’s some cheese for your sandwich”.

49. Descriptive Feedback • Serves Three Functions • Acknowledges • Immediately acknowledges that the partner “heard” the student’s communication attempt • Confirms • Confirms that the message sent by the student is the same as the message understood by the partner. • Models • Can be used to model an expanded version of the communication message.

50. Prompt Hierarchy Step #1Environmental Cue • Set up the environment to signal to the student that an activity is about to begin. • Lining up at the door • Getting everything ready for an activity & then waiting…….. • Art materials prepared but out of reach • Desired items visible but inaccessible • Cutting the pizza up and waiting • If student responds, provide... Descriptive Feedback