Training and Intervention in South Africa Augmentative and alternative communication (AAC) interventionists the world over have much in common. Yet the heterogeneity of the U.S. populations creates the question: How is what we do at the Centre for Augmentative and Alternative Communication (CAAC) at the University of South Pretoria in South Africa different from what the ... World Beat
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World Beat  |   August 01, 2007
Training and Intervention in South Africa
Author Notes
  • Erna Alant, is a professor at the University of Pretoria, South Africa, and director of its Centre for Augmentative and Alternative Communication. Contact her at Erna.Alant@up.ac.za.
    Erna Alant, is a professor at the University of Pretoria, South Africa, and director of its Centre for Augmentative and Alternative Communication. Contact her at Erna.Alant@up.ac.za.×
Article Information
Augmentative & Alternative Communication / International & Global / World Beat
World Beat   |   August 01, 2007
Training and Intervention in South Africa
The ASHA Leader, August 2007, Vol. 12, 11-12. doi:10.1044/leader.WB2.12102007.11
The ASHA Leader, August 2007, Vol. 12, 11-12. doi:10.1044/leader.WB2.12102007.11
Augmentative and alternative communication (AAC) interventionists the world over have much in common. Yet the heterogeneity of the U.S. populations creates the question: How is what we do at the Centre for Augmentative and Alternative Communication (CAAC) at the University of South Pretoria in South Africa different from what the majority of ASHA members do? The most obvious difference is the lack of resources in South Africa and other developing countries—less financial support for AAC intervention and devices, and less human resources in terms of training and expertise for implementation and maintenance.
If this were the only difficulty, solutions would come easily merely by supplying devices and training to those in poorer countries. Issues of cultural identity, however, are critically important in working for sustained and meaning-based intervention within Africa. Quick solutions include adapting existing symbol sets to accommodate cultural diversity, encouraging the use of more affordable devices, supplying new and used AAC devices to users and families, and training local experts in the use of AAC strategies. These actions are valuable, but demonstrated outputs are slow to manifest.
The socio-cultural context within which the use of AAC should be supported must be better understood by interventionists. Socio-pragmatic rules governing interactions are culture-specific. AAC intervention remains artificial and superficial when transposing Western notions of what comprises appropriate and successful interactions onto clients from an African cultural background. As interventionists, we need to learn from and build on the insights from within developing countries, and develop a base of appropriate knowledge beyond the more widely publicized Western concepts (Thorburn & Marfo, 1990). We need to increase our understanding of the richness as well as the limitations of the socio-cultural contexts in which our clients and families operate, and avoid the pitfall of “adopting a paradigm in which one socio-cultural group is considered normative and all others diverse” (Barrera & Kramer, 1997, p. 217).
Children from traditional African backgrounds are in general not encouraged to initiate verbal communication or question adults (Geiger & Alant, 2005). Greater communicative independence is acceptable and desirable in peer interactions (Swadago, 1995). However, children with severe or multiple disabilities often have little opportunity to engage in peer group interactions, and spend most of their time with caregivers. The sensitivity of interventionists to such issues will greatly influence the extent to which clients can make AAC “their own,” and incorporate strategies and techniques into everyday life. Table 1 (p. 12) provides some more specific examples of cultural aspects that affect the AAC intervention process. For more detail on the issues of implementation in developing countries please consult Alant & Lloyd (2005).
What are the realities of AAC intervention and research in South Africa? Perhaps most important is awareness of the constant tension in integrating the intervention traditions of the West with the non-directive, meaning-focused interaction context of the more traditional Africa and its variations and transformations. Africa is highly heterogeneous. In addition, poverty and health issues such as HIV/AIDS impose serious burdens and challenges. The need for specialized services and provisions for people with disabilities is vast. Although South Africa has made significant strides in ensuring human rights for all, the process requires continuous monitoring.
The CAAC (www.caac.up.ac.za), the only centre of its kind in Africa, conducts five degree programs. These range from an accelerated certificate for teachers on inclusion of children with severe disabilities to an honors, master’s, and PhD program in AAC, as well as a multi-professional master’s course in early childhood intervention. All are conducted through distance education with some required on-site visits.
In addition to graduate training, the CAAC trains young children and adults who have severe communication problems. The two main community training programs are the leadership program for young adults who use AAC (the Fofa project) and the teacher training project aimed at facilitating inclusion of children with disabilities in the classroom. The CAAC also consults with rehabilitation teams to support them in problem-solving challenges encountered in intervention with people with little or no functional speech and their families.
The Fofa Project
Fofa—“to fly” in Northern Sotho—reflects the ethos of empowerment. The project goals are to improve AAC users’ personal communication using their devices; to facilitate the development of empowerment and leadership skills; and to expose participants to options for employment and independence.
The training program, based on the Augmentative Communication and Empowerment Supports (ACES) model developed at Temple University in Philadelphia, had to be substantially modified to be relevant in South Africa. It was impossible to provide AAC users with dedicated communication devices because of high costs and a lack of local infrastructure for maintenance and repair. Therefore, we selected non-dedicated devices with appropriate software.
The annual one-week immersion training program focuses on communication competence (60%), empowerment (25%), and employment issues (15%). Most of the training is presented by CAAC staff, but we also make use of disability stakeholders and relevant government officials (for example, labor consultants) to ensure AAC users’ exposure to social networks and skill-building. The ultimate aim is to use the participants as expert trainers for future training sessions.
Teachers Training Project
The centre’s long-term objective with the Teachers Training Project is to broaden teachers’ understanding of inclusion and how to achieve it. Important pillars in this process are to:
  • Build teachers’ knowledge and skills about the importance of communication during the early years

  • Expose teachers to the different ways in which optimal communication stimulation can be provided by using multiple communication means (e.g., speech, objects, gestures, and graphic symbols)

  • Transfer monitoring and self-reflective skills to the teachers

CAAC presents the training to 100 teachers in the GaRankuwa region, an underdeveloped and under-resourced region in the North West Province of South Africa. Some of the outcomes to date include development of manageable and sustainable methods of documenting and monitoring the learner’s individual progress, increased competence in multi-level teaching strategies such as Aided Language Stimulation, and modified attitudes toward the inclusion and the presence of children with disabilities in mainstream classrooms.
Rehabilitation Team Consultations
CAAC conducts consultations once a week, working with families and service providers to help overcome communication barriers of individuals with little or no functional speech. Emphasis is on input from patients and from professionals and non-professionals to ensure meaningful and functional outcomes. The CAAC team provides expertise regarding communication methods and devices to supplement or replace speech, and suggests which methods might be best matched to a client. Implementation of these recommendations is the responsibility of the client and his/her team, with phone support from the CAAC when necessary.
Many ASHA members have played important roles over the years in supporting the CAAC’s training and research efforts. Lyle Lloyd has been involved in the training and research activities of the CAAC on a consistent basis. Mary Ann Romski, Rose Sevcik, Diane Bryen, and various other colleagues have supported the team during difficult periods. As globalization increases, one can’t help but acknowledge the impact that the United States makes on development in less-developed countries.
Table 1. AAC intervention in South Africa: Issues to Consider
  • Aspect, Action, Examples
  • Vocabulary, Including culturally appropriate vocabulary on communication boards and devices,
    • Including “spaza shop” on a communication board for African clients
    • Ensuring that the child’s mother-tongue is used on the communication board to facilitate interaction at home
  • Symbols, “Africanizing” line drawings such as PCS,
    • “Taxi” depicted as a mini bus rather than a sedan car
    • Ensuring manual signs taught are appropriate for a specific geographical area
  • Devices, Making devices more relevant and affordable for clients from lower socio-economic backgrounds,
    • Digital voice output devices in particular are relevant due to their flexibility to accommodate different languages
  • Interaction styles, Showing an awareness of and sensitivity to culturally appropriate interaction styles,
    • Children from traditional African backgrounds are often required not to make eye contact with adults
    • Children might not be expected to initiate interaction with adults
  • Intervention activities, Selecting appropriate activities as a basis for intervention,
    • Caregivers from traditional African backgrounds engage in caregiving routines but not in play with their children
  • Partners, Involving the appropriate interaction partners in intervention,
    • Due to HIV/AIDS and other chronic illnesses, the main caregiver might not be the biological parent. This clearly can add a different dimension to the intervention process.
    • Children from traditional African backgrounds engage in verbal conversation with peers rather than with adults.
References
Alant, E., & Lloyd, L. (Eds.) 2005. AAC and severe disabilities: Beyond poverty. London: Whurr Publications
Alant, E., & Lloyd, L. (Eds.) 2005. AAC and severe disabilities: Beyond poverty. London: Whurr Publications×
Barrera, I., & Kramer, L. (1997). From monologues to skilled dialogues: teaching the process of crafting culturally competent early childhood environments. In Winton, P. J., McCollum, J.A., & Catlett, C. (Eds.), Reforming personnel preparation in early intervention: Issues, models and practical strategies (pp. 217–251). Baltimore: Paul H. Brookes.
Barrera, I., & Kramer, L. (1997). From monologues to skilled dialogues: teaching the process of crafting culturally competent early childhood environments. In Winton, P. J., McCollum, J.A., & Catlett, C. (Eds.), Reforming personnel preparation in early intervention: Issues, models and practical strategies (pp. 217–251). Baltimore: Paul H. Brookes.×
Geiger, M., & Alant, E. (2005). Child-rearing practices and children’ communicative interactions in a village in Botswana. arly Years, 25(2), 183–191. [Article]
Geiger, M., & Alant, E. (2005). Child-rearing practices and children’ communicative interactions in a village in Botswana. arly Years, 25(2), 183–191. [Article] ×
Swadago, G. (1995). Training for the African mind. International Journal of Intercultural Relations, 19(2), 281–293. [Article]
Swadago, G. (1995). Training for the African mind. International Journal of Intercultural Relations, 19(2), 281–293. [Article] ×
Thornburn, M. J., & Marfo, K. (1990). Practical Approaches to Childhood Disability in Developing Countries. Kingston, Jamaica: Project Seredek and 3D Project.
Thornburn, M. J., & Marfo, K. (1990). Practical Approaches to Childhood Disability in Developing Countries. Kingston, Jamaica: Project Seredek and 3D Project.×
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August 2007
Volume 12, Issue 10