Training the Essential Team Members

Brandon Eddy

1/26/2017 5:54 AM

Suzie is a young AAC user with spastic quadriplegic cerebral palsy (GMFCS V) whose parents are divorced. Suzie spends most of her family time with her mother and baby sister, and a weekend each month with her father. Her mother is very busy with a part-time job, and when she is at home, she is frequently caring for the baby sister. Suzie’s aunt serves as a respite-worker six hours a week, usually on the weekend so that her Suzie’s mother can take care of other tasks. Suzie’s mother tries to work with the AAC device, but due to all the demands placed on her Suzie does not have many opportunities each day to practice using her device. Her mother wishes to be an integral part of the AAC process, but is having difficulty completing recommended home-practice activities.

Does this sound familiar to you? It is well known that parents of children with disabilities are at higher risk for separation, and working with a child with a complex social situation is not uncommon. Situations such as Suzie’s demonstrate the need for close collaboration with the interdisciplinary team to maximize the number of communicative opportunities as well as identifying additional supports for Suzie’s mother and family. Providing the training necessary to those who will implement AAC with the greatest frequency and fidelity is a crucial part of interdisciplinary AAC teamwork.

Some essential team members who require support in AT use include teachers, paraprofessionals, family members, and the client. These individuals have the most opportunities to provide models of AT use and to encourage its use in the most important settings. These team members are critical members of the team and must be involved in all phases including evaluation and treatment. It has been shown that staff members not involved in assistive technology assessment often do not to use technology with the student as intended (Todis & Walker, 1993). Further, only 19% out of 405 surveyed teachers believed they had adequate training in assistive technology (Derer et al., 1996).

As we have highlighted in previous posts, uniting the team under a shared vision may result in providers being more likely to support AT implementation, working jointly towards completing shared goals, and improve understanding of team member responsibilities. Copley & Ziviani (2004) suggest that as the primary service providers, school teams possess critical assessment information and must be ultimately responsible for implementing assistive technology tools. As such, it is critical that school staff feel competent and confident in their abilities to carry out these tasks.

Training teachers, paraprofessionals, and other school staff is highly beneficial as these professionals can provide the greatest frequency to practice skill across the school day. As demonstrated in the example at the beginning of this post, providing training to these team members may maximize the opportunities for the client to practice and hopefully prevent device abandonment. Further, the high turn-over rates of instructional assistants and sometimes a new teacher annually means there is frequently need for training new staff and aligning goals. When clinicians are unable to meet in-person with team members, free tools such as Google Hangout, OoVoo, and other web-based video-conference tools provide the opportunity to train team members who must better understand how to use these tools effectively. When considering this option, it might be important to preface conversations with focusing on training and excluding sharing PHI as some of these web-based platforms may not be HIPAA-approved. Recall that this must be a reciprocal learning relationship; therapists often have much to learn from the experiences of school-based staff.

Clinicians shared some of their favorite training activities to engage school staff in a recent discussion on the ASHA SIG 12. One of the common themes expressed was getting hands-on time with the device. This allows each professional the opportunity to interact with the device and learn how it operates in a supported environment (e.g., clinician demonstrating, modeling, mentoring, encouraging). One of the activities listed was titled “tea time” and was an opportunity where the school team would get together and enjoy “tea” (or perhaps another preferred beverage) and only talk using the child’s AAC device. This seemed like an excellent activity in which providers can enjoy an adult activity while practicing approaches such as milieu techniques, expanding, recasting, or target specific goals that the client is working on. Whichever activity selected, it is essential that staff leave feeling empowered, competent in their requested task, and comfortable with interacting with the AT tool.

Engaging caregivers in these trainings is equally important, regardless of the complexity of their social situation. Caregivers who are informed can provide critical insight to the team about their child (e.g., upcoming surgeries, sensory preferences, spontaneous forms of communication, purposeful movements that can become access sites, motivators, etc. [this is a much more diverse list than other members of the team!]), and can practice these skills when they have the opportunity. Further, caregivers are often tasked with sharing information with new service providers, and we must keep caregivers in-the-know so that they can provide accurate information and share the team vision.

Clinicians should also realize that their colleagues in other rehabilitate professions (e.g., OT, PT) play a critical role in encouraging families to consistently bring their AT tools and use them with different providers. When receiving an AAC tool, some families may not understand right away how these communication tools can be used in various settings. If our colleagues in OT and PT can work with our families and demonstrate how these tools can be used during their sessions, families may understand the necessity to bring the tool everywhere to access communication. As a reciprocal exchange, our OT and PT colleagues are essential in teaching us about fine motor abilities necessary to access direct selection or gesture tools on devices, considerations for size and weight of devices, and types of cases, straps, or mounts that would be beneficial (Wilkinson & Young Na, June, 2015).

Let us not forget the most important team member of all: the client. Recall from earlier posts that each member of the team must be part of the decision making process and share their expertise; no one has more expertise in the client than the client (and given the appropriate tools and training we hope to unlock their ability to express that). It is important to keep in mind that our clients should have decision-making powers over what they want to work on, and this becomes increasingly important as the child continues to age. If the client can select their goal, then we are likely to find better motivation and teamwork.

Keeping everyone on the team motivated an interested in utilizing assistive technology tools requires persistence and dedication. Carole Zangari, CCC-SLP, created several free printable bookmarks and tags that you can share with your team as reminders of the importance of AAC tools and practice (tool 1; tool 2; tool 3). As we discussed above, holding trainings can be an effective way to promote motivation and engagement. What are some of your favorite training activities or motivating tools?


Resources:

Copley, J. & Ziviani, J. (2004). Barriers to the use of assistive technology for children with multiple disabilities. Occupational Therapy International, 11(4), 229-243.

Derer, K., Polsgrove, L., & Rieth, H. (1996). A survey of assistive technology applications in schools and recommendations for practice. Journal of Special Education Technology, 8(2), 62-80.

Todis, B. & Walker, H. M. (1993). User perspectives on assistive technology in educational settings. Focus on Exceptional Children, 26(3), 1-16.

Wilkinson, K. & Young Na, J. (June, 2015). Interprofessional practice in developing an AAC system for children with Down syndrome. Perspectives on Augmentative and Alternative Communication, 24, 114-121.

Speech-Language Pathologist,Educator,Occupational Therapist,Physical Therapist,Researcher,Other,teamwork

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