Living and learning with equipment: how the DSSU Loans Service supports improved educational outcomes for students with disabilities

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1 Living and learning with equipment: how the DSSU Loans Service supports improved educational outcomes for students with disabilities Presented by: Susan Cassidy, Speech-Language Therapy Adviser Disability Services Support Unit Department of Education and Training Presented at: Living with Equipment in 2011 Symposium Medical Aids Subsidy Scheme, Queensland Health August

2 Aim To explain the purpose and function of the DSSU Loans Service To demonstrate how the use of the DSSU Loans Service supports a best practice approach in the area of AAC intervention To demonstrate how this service works in collaboration with other resources and services to support students to use assistive technologies and AAC to live and learn To ask how we can improve these services 2

3 The purpose of using AAC To enable a person to meet their varied communication requirements as: intelligibly specifically efficiently, and in as socially valued a manner as possible in order to understand others and to be understood. (Porter, 1997) But let me take you back a step to present Gayle Porter s view on the purpose of using AAC. This purpose focuses attention on the student's functional communication requirements, with the AAC system, symbols, aids, techniques and strategies evaluated in terms of their effectiveness in enabling the student to meet these requirements. Therefore, the aim is never to use a particular AAC system. The real task is to assist the student to problem-solve ways to understand other people s messages and convey their own message to others. Communication requirements are individual in that they reflect each student s personal needs, motivations and goals. Janice Light (in 1989) said The communication aids employed are the tools in the process; the central issue is the effectiveness of the interaction. Hence, while this presentation seemingly focuses on the tools in the interaction, we must acknowledge that these are essentially meaningless, unless the interaction is effective and successful for the AAC user. 3

4 What is the DSSU Loans Service? DSSU - Disability Services Support Unit, Department of Education and Training Build and share knowledge and skills Grow and promote evidence-based practice Lead and advocate in inclusive education Create and maintain partnerships Align policy and practice Firstly, what is DSSU? DSSU is Disability Services Support Unit, the Department of Education and Training s statewide resource centre for supporting staff supporting students with disabilities in Education Queensland schools. It has the following roles Build and share knowledge and skills Grow and promote evidence-based practice Lead and advocate in inclusive education Create and maintain partnerships Align policy and practice

5 What is the DSSU Loans Service? Collection of specialised resources and equipment for trial and use by school teams with students with disabilities. The collection includes: Assistive technologies (including speechgenerating devices) Positioning and mobility aids Adaptive equipment for Activities of Daily Living Assessments DSSU administers a state-wide loans facility that comprises a collection of specialised resources and equipment for use with and by students with disabilities. A broad range of equipment and resources are available including assessments, programming resources, positioning and mobility aids, assistive technologies, and adaptive equipment for activities of daily living. Loans are available to EQ staff to support students with disabilities in Queensland schools. Some EQ staff (AVTs: PI, VI and HI) can also borrow from DSSU Loans for students with these disabilities in non-eq schools to whom they are providing support. 5

6 DSSU Loans Service - purpose To provide education teams with access to a pool of specialised equipment and resources: to facilitate improved educational outcomes for students with disabilities to assist schools to plan for educational adjustments to facilitate trial of equipment to assist decision making about the most appropriate equipment for each student s individual needs, prior to purchase to improve access, participation and achievement of students with disabilities in curriculum activities 6

7 DSSU Loans Service - process Student need for specialised equipment loan is identified by education team (including the student and his/her family) Collaborative consultation occurs at the school level with specialist support staff (e.g. advisory visiting or support teachers, therapists and nurses) and results in a decision about appropriate equipment to trial The team checks the DSSU Loans online catalogue on DSSU Professional Community at to ascertain availability of item/s A team member assumes responsibility to complete DSSU borrowing form to apply for item/s of equipment All information about DSSU Loans can be found at this website on the DSSU Professional Community the DSSU Loans Service Guidelines document is currently being revised and will be published on this website prior to the end of 2011.

8 DSSU Loans Service process (cont.) Team plans for equipment trial/s with a focus on functional goal setting (within the school and other environments) specifically for the period of the trial. Data is collected and equipment trial outcomes are evaluated collaboratively to inform decision-making regarding equipment prescription. Team works collaboratively to implement strategies to use equipment effectively to make adjustments / enable the student to participate and achieve at school and in other environments. Ongoing review is built into the student s educational program. 8

9 AAC intervention Abilities and barriers Individual Support team Communication contexts and opportunities Learning Environment The focus of the DSSU Loans Service is on the student and the education team. At first this may seem at odds with the person-centred approach for assessment and implementation of AAC that is used by many SLPs across many agencies. However the education team of course includes the student and the student s family. It starts with the individual. Information gathering is the assessment phase information is gathered formally and informally from all members of the team to generate a range of options. This model focuses on gathering information about the student s abilities and about any barriers that may exist (physical, attitudinal, environmental, social, etc) to the implementation of AAC. When considering the options the team also needs to consider the contexts (the classroom, the playground, the library, the sports field) in which the student will be operating and the communication opportunities that exist within these contexts. The team also examines the learning environment e.g. what is being taught in the classroom on a day-to-day basis, the different areas of the curriculum (English and literacy, maths, science, PE, HRE, SOSE, art, etc), the learning materials, the units of work in each curriculum area, the vocab needed, the different communicative functions required, the different modes that could be used, etc). Also built in is evaluation of the system and strategies, and regular and ongoing review. For many students attending Education Queensland schools, DSSU Loans Service helps support this model by providing access to trial of a range of options that the school team may be considering. 9

10 The Participation Model (Beukelman & Mirenda, 2005) Focuses on the functional communication requirements of the potential AAC user compared with his/her same-age peers in various communication situations. It then determines what communicative interactions the person may need to engage in, as well as how interactions could be made more effective. The model considers the following: Existence of communication participation patterns Barriers to participation in communication situations The effectiveness of previous strategies to enhance participation New potential strategies to enhance participation The model just described, I feel, aligns with Beukelman and Mirenda s Participation Model (which incorporates the ICF) and focuses on the functional participation requirements of the AAC user in comparison with those of his or her same-aged peers. It considers the following 4 areas. Existence of communication participation patterns Barriers to participation in communication situations The effectiveness of previous strategies to enhance participation New potential strategies to enhance participation (A nice example can be found at Participation_model.pdf) In EQ schools, the SLP and school team have the opportunity to borrow and trial a range of SGDs with this student in this situation, and for many other opportunities. Raghavendra et al (2007) also advocate the use of the ICF and participation as best practice in AAC implementation when they say The ICF model acknowledges the fundamental premise of AAC practice: to facilitate interaction and communication and thus, participation.

11 Assistive technology teaming Queensland Identify team responsibilities and ongoing support Nominate a co-ordinator Establish AT goals Consider range of options Data gathering Consult with specialist organisations (LifeTec Qld, CPL s Assistive Technology Support Services, etc) to obtain information and advice Obtain recommended devices for trial (DSSU Loans, CPL, suppliers) In 2005 and 2006 a Queensland interagency collaboration project, run by Cerebral Palsy League, LifeTec Queensland, DSSU (Department of Education and Training) and Disability Services Queensland (now Communities) researched and developed an assistive technology interagency collaboration and teaming plan which reflected identified best practice in the literature.

12 Assistive technology teaming Queensland (cont.) Customise the device and set up for communication needs specific to the user Identify possible funding options (including MASS) and apply Train communication partners Measure outcomes Ongoing review Evaluation

13 What makes an effective trial? Using a collaborative team approach for identification, planning and ongoing support of AT equipment Assessment of the learner, their environments and the technology to inform the best fit Trial principles Setting specific goal and trial objectives, best practice principles including variety, duration and environments, identification of what will be measured and what constitutes a successful trial for this person i.e. functional goal-setting and outcomes evaluation Consideration of whether the expectations of the device match the reality of using the device? Haines & Sanche, 2000, Beigel, 2000, Kintsch & DePaula, 2002 This project also examined what specifically makes an effective trial of assistive technology and the crucial steps in the process. 13

14 MASS Communication Aids Trials Information and Performa In 2007/2008 the members of the MASS (Medical Aids Subsidy Scheme) Communication Aids Clinical Advisory Committee developed the MASS Communication Aids Trials Information and Proforma (available on MASS website ) Di Clarke, MASS Principal Clinical Advisor, Communication Aids, revised and updated this tool earlier this year. In 2008 the members of the MASS (Medical Aids Subsidy Scheme) Communication Aids Clinical Advisory Committee, many of whom had been involved in the interagency collaboration project and Assistive Technology Forums, developed the MASS Communication Aids Trials Information and Performa. This resource brought together in a comprehensive yet concise fashion, much of the great work that came out of the AT Forums and the interagency collaboration project. Di Clarke, MASS Principal Advisor, Communication Aids (who had also been a member of the interagency project and the original CACAC team) revised and updated this tool earlier this year. 14

15 MASS Communication Aids Trials Information and Performa Invaluable tool for assisting SLPs in their clinical reasoning and professional decision making regarding the trial of speech-generating devices Brings together all aspects of best practice for conducting trials including assessment (of the individual, environment and system characteristics), goal-setting, use in different environments with different communication partners, consideration of communication competencies, and evaluation by the whole team (including the user). Used widely by a number of EQ SLPs (in conjunction with DSSU Loans service) as part of the AT teaming process and for AAC prescription and intervention.

16 DSSU Loans Service the positives Aims to be a service that is equitable, transparent, consistent, sustainable and responsive. Aims to work with other services/agencies (within and outside EQ) to assist students with disabilities to live and learn. Can be considered as a contributing/supporting service to documented best practice for AAC implementation and AT prescription, evaluation and collaborative decision making. 16

17 DSSU Loans Service the negatives Can be restricted by: budgetary and funding issues waiting lists the reality of working in schools teaming issues technology issues currency issues service issues 17

18 Still a long way to go However, without a properly resourced coordinated approach to the provision of AAC services across the policy domains of education, health and social services the full benefits of these investments in policy, technology and understanding will not be felt. (Hodge, S. 2007, p. 470) We all are constantly trying to improve our services for our clients and students and also trying to do this in a cross-service interagency way (but sometimes it seems this is only happening at the grass-roots level of individual professionals and AAC users, not necessarily at a systemic and resourcing level). The research shows that the AAC community still has a long way to go. Hodge in her UK 2007 study into why the potential of AAC users was not being realised, despite significant investment in effort and resourcing, improved technology, and more expansive training of professionals and communication partners, concluded that

19 Still a long way to go Adult AAC user research priorities: preparing people who use AAC to succeed in situations such as maintaining friendships, dating, and finding jobs; improving service delivery of their AAC devices; improving technology in high tech and low tech devices; increasing public awareness of people who use AAC; improving methods of teaching reading skills to people who use AAC; and improving AAC communications training for all healthcare professionals. (O Keefe et al. 2007) Another study in Canada by O Keefe et al in 2007 asked adult AAC users to identify their own research priorities, in light of the research that had been previously undertaken in the literature by the AAC community. They came up with this list

20 Perhaps a long, long way.. The Equipping Inclusion Studies: Assistive Technology Use and Outcomes in Victoria some significant findings 75% of people surveyed had unmet need for assistive technology solutions (devices, personal care and/or environmental modification) Lack of assistive technology is a major barrier to the achievement of participation as detailed in international, national and state disability policies People living with disabilities require an average of eight assistive technology devices to participate in life Best outcomes occur when people are supported to construct their own individual solution which for most people includes devices, personal care, and environmental modifications From a government affordability perspective, important improvements can be achieved at modest cost for many AT clients (Layton et al. 2010) Layton et al. in 2010 published The Equipping Inclusion Studies: Assistive Technology Use and Outcomes in Victoria. Some of their findings have cause for the rest of the Australian AAC community to examine their services and to ponder on how we can make significant improvements for AAC / AT users.

21 The future 1. The time for AAC is now: The right to communicate is a basic human freedom. 2. One is never enough: Individuals with complex communication needs require more than one device, one communication partner, one communication strategy, one communication environment. 3. My AAC must fit my life: AAC systems must be highly individualized and appropriate to individual needs. 4. AAC must support FULL participation in ALL aspects of 21st century life: AAC must support a wide variety of interactions across all ages and interests. 5. Nothing about me without me: Individuals who use AAC have a right to be meaningfully involved in every aspect of AAC research, development, and intervention. (Williams et al. 2008) And lastly, I just wanted to leave you with some words from prolific writer and AAC user, Michael Williams. In 2008 he and some colleagues examined what AAC users from the previous 25 years had been saying in the research to formulate five individual and societal individual and societal challenges for the next 25 years 21

22 References Beigel, A. (2000) Assistive Technology Assessment: More than the Device. Intervention in School & Clinic, 35 (4): Beukelman, D., & Mirenda, P. (2005) Augmentative and alternative communication. Supporting children and adults with complex communication needs (3 rd ed.) Baltimore: Paul H. Brookes. Haines, L., & Sanche, B. (2000) Assessment Models and Software Support for Assistive Technology Teams. Diagnostique, 25 (4): Hodge S. (2007) Why is the potential of augmentative and alternative communication not being realized? Exploring the experiences of people who use communication aids. Disability & Society, 2007 Aug; 22 (5): Kintsch, A, & DePaula, R. (2002) A Framework for the Adoption of Assistive Technology. Retrieved from Layton, N; Wilson, E; Colgan, S; Moodie, M & Carter, R. (2010). The Equipping Inclusion Studies: Assistive Technology Use and Outcomes in Victoria. Burwood: School of Health and Social Development and Deakin Health Economics, Deakin University.

23 References Light, J. (1989). Toward a definition of communicative competence for individuals using augmentative and alternative communication systems. Augmentative and Alternative Communication, Volume 5, Issue 2 June 1989, pp O'Keefe B.M.; Kozak N.B.; Schuller R.; Research priorities in augmentative and alternative communication as identified by people who use AAC and their facilitators. AAC: Augmentative & Alternative Communication, 2007 Mar; 23 (1): Porter, G. (1997) Integrating AAC into programs applying the principles of conductive education. Conductive Education News, 12(3), 2-8. Raghavendra P; Bornman J; Granlund M; & Bjorck-Akesson E; The World Health Organization's International Classification of Functioning, Disability and Health: implications for clinical and research practice in the field of augmentative and alternative communication. AAC: Augmentative & Alternative Communication, 2007 Dec; 23 (4). Williams M.B.; Krezman C; & McNaughton D; Reach for the stars : five principles for the next 25 years of AAC. AAC: Augmentative & Alternative Communication, 2008 Sep; 24 (3).

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