AAC Buy-In at Home Carefully assessing how a device can meet communication needs is key to promoting its use with a client’s family and friends. Features
Free
Features  |   February 01, 2017
AAC Buy-In at Home
Author Notes
  • Karen Erickson, PhD, is the director of the Center for Literacy and Disability Studies, a professor in the Division of Speech and Hearing Sciences, and the Yoder Distinguished Professor in the Department of Allied Health Sciences in the School of Medicine at the University of North Carolina at Chapel Hill. She is a member of the National Joint Committee for the Communication Needs of Persons With Severe Disabilities. erickson@unc.edu
    Karen Erickson, PhD, is the director of the Center for Literacy and Disability Studies, a professor in the Division of Speech and Hearing Sciences, and the Yoder Distinguished Professor in the Department of Allied Health Sciences in the School of Medicine at the University of North Carolina at Chapel Hill. She is a member of the National Joint Committee for the Communication Needs of Persons With Severe Disabilities. erickson@unc.edu×
  • Lori Geist, PhD, CCC-SLP, is an assistant professor at the Center for Literacy and Disability Studies in the Division of Speech and Hearing Sciences in the Department of Allied Health Sciences in the School of Medicine at the University of North Carolina at Chapel Hill. She is an affiliate of ASHA Special Interest Group 12, Augmentative and Alternative Communication. lori_geist@med.unc.edu
    Lori Geist, PhD, CCC-SLP, is an assistant professor at the Center for Literacy and Disability Studies in the Division of Speech and Hearing Sciences in the Department of Allied Health Sciences in the School of Medicine at the University of North Carolina at Chapel Hill. She is an affiliate of ASHA Special Interest Group 12, Augmentative and Alternative Communication. lori_geist@med.unc.edu×
  • Penelope Hatch, PhD, CCC-SLP, is an assistant professor at the Center for Literacy and Disability Studies in the Division of Speech and Hearing Sciences in the Department of Allied Health Sciences in the School of Medicine at the University of North Carolina at Chapel Hill. She is an affiliate of SIG 12. penelope_hatch@med.unc.edu
    Penelope Hatch, PhD, CCC-SLP, is an assistant professor at the Center for Literacy and Disability Studies in the Division of Speech and Hearing Sciences in the Department of Allied Health Sciences in the School of Medicine at the University of North Carolina at Chapel Hill. She is an affiliate of SIG 12. penelope_hatch@med.unc.edu×
Article Information
Augmentative & Alternative Communication / Features
Features   |   February 01, 2017
AAC Buy-In at Home
The ASHA Leader, February 2017, Vol. 22, 46-51. doi:10.1044/leader.FTR1.22022017.46
The ASHA Leader, February 2017, Vol. 22, 46-51. doi:10.1044/leader.FTR1.22022017.46
Allison’s school team was ecstatic. After months of working to secure funding for a speech-generating device (SGD) for her, it finally arrived. The team got to work learning how to model use of the device and support Allison in using it. They saw the impact right away.
Three months later, the mood was different. Allison was making progress with the SGD at school, but she never used it at home. The speech-language pathologist called and met with Allison’s mother to make sure she felt comfortable using the SGD, but each morning the team found the SGD untouched. Weeks passed with no success.
Then one day Allison led the team in a promising new direction. She initiated a story about her father’s involvement in a tree-cutting mishap. Allison couldn’t stop laughing as she used gestures, vocalizations and the SGD to tell her SLP about the tree that crashed through a window.
Team members built on this success: They encouraged Allison to use her SGD to tell about other people making mistakes or causing trouble. Yes, her team actively taught her to tattle, and they intentionally made mistakes to get her laughing and using the SGD. Yet even while Allison grew skilled at tattling and using her SGD at school, she and her family left it in her backpack night after night.
Then Allison’s little brother did something wrong. And Allison independently took her SGD out of the backpack to tell her mother. The SGD came out of her backpack every night after that!

Even when we share reasons for AAC use with families, it doesn’t necessarily lead to enthusiastic AAC adoption, and what resonates with one family may not necessarily resonate with another.

Allison’s team is not alone in this sort of difficulty with home adoption of an SGD. It can be frustrating because SLPs well recognize how families’ everyday activities provide opportunities to practice new skills. From shared meals to daily routines and leisure time, family life offers frequent chances to talk, listen and learn.
When clients require augmentative and alternative communication (AAC) systems, SLPs invest countless hours fully evaluating needs and abilities, identifying the most suitable SGD options, writing lengthy reports to secure funding, and ensuring access to robust vocabularies. They also work tirelessly to help clients learn to use the SGD, yet a common area of struggle is getting parents and clients to buy in beyond the clinic or classroom.
So what can SLPs and other early interventionists do to promote this important buy-in among clients and families? Most obviously, we emphasize reasons to use AAC that are highly motivating and lead to early success in the home. But even when we share these reasons with families, it doesn’t necessarily lead to enthusiastic AAC adoption, and what resonates with one family may not necessarily resonate with another.
This is where assessment, customization and ongoing family training come in. When we invest time in understanding how an SGD might fit with the client’s communication in daily family and social life—where specifically it can improve or add to current communication and where it won’t—we’re more likely to see home use of the SGD. Let’s take a closer look at how and why.

When we invest time in understanding how a speech-generating device might fit with the client’s communication in daily family and social life, we’re more likely to see home use of the SGD.

Guiding questions
To promote integration of the SGD into family life, SLPs can keep two simple questions in mind:
  • Does the SGD allow the client to communicate something that cannot already be communicated by some other means?

  • Is the new SGD more efficient and easier to use than other, existing means of communication?

To answer these questions, we need to first understand the dynamics of the client’s family. Encourage clients and their family members to describe all the ways they already communicate with each other. Often, clients communicate more successfully with their family members than the professionals in their life. Parents and other family members often understand body movements, vocalizations, facial expressions and unconventional gestures that are used across typical routines.
While it may seem logical to replace these existing forms of communication with the new SGD, this may not be the best starting point. Consider clients who can already request their favorite things by pointing to them. They are unlikely to be enthusiastic about the idea of communicating these same wishes by navigating to words on a new SGD. In fact, they may even feel the SGD is making it more difficult to achieve the same result (which, ultimately, it may be; time will tell), contributing to early dissatisfaction.
When exploring reasons to communicate, assess the value added by the new SGD. It’s beneficial to observe and learn about all of the ways communication happens in the home, identifying times when communication breaks down or unmet desires are revealed. Targeting these breakdowns or unmet desires is the key to effective use of an SGD in the home. That’s the payoff of flexible, creative thinking.
What might be some key motivators of SGD use? Successfully negotiating to stay up past bedtime, teasing a sibling, playing a favorite game or even tattling, as was the case for Allison. Find an initial reason or two and use them wisely, keeping in mind the initial goal of early success and buy-in from clients and their families.

Parents and other family members often understand body movements, vocalizations, facial expressions and unconventional gestures that are used across typical routines. When it comes to using an SGD, we need to set realistic expectations for families.

Keeping it simple
We all want the best for our clients, but when it comes to using an SGD, we need to set realistic expectations for families. Ultimately, it’s rewarding to see clients communicating in increasingly complex ways, expressing novel ideas on myriad topics. But we also need to avoid overwhelming clients and families in the beginning.
Providing families with extensive lists of the many ways a new SGD can be used may send an unintended message that the current communication in the home is less acceptable and should be replaced. Also, parents may be overwhelmed if they feel they should use the new SGD in every instance possible.
Expectations like these left one mother, Carolyn, feeling overwhelmed early on. Reflecting on the experience getting started with an SGD with her daughter, Meera, Carolyn recalled being told that they should use the SGD at all times. As a result, Carolyn felt disappointed in herself and Meera when access and use fell short. It also left her feeling judged by the school team. Instead, Carolyn wanted to “celebrate all of the successes, anytime it’s used, not focus on the times it’s not.”
Over time, Meera’s use of her SGD has evolved to best fit her needs: At school, she uses her SGD in class, and with family and friends she often uses use her natural speech and a personalized sign system. She also uses her SGD with family and friends when she’s interacting over the phone or video chat—powerful communication motivators that support continued learning. The SGD also comes in handy when communication breaks down or she wants to be more precise in her message. For Meera and her family, the SGD adds value for these key reasons.

Involving the client’s family throughout the assessment and decision-making process is key to SGD adoption success.

Making it worthwhile
The experiences of Carolyn and Meera are similar to those of Colin and his mom, Deby. Colin’s SLP recommended and secured an SGD for him when he was 3 years old. She worked with his preschool teachers and his family to implement use of the SGD. Although Deby was never afraid of the technology and was quite comfortable programming her son’s SGD, her challenge was integrating the SGD into a very busy home life.
Deby describes Colin as “an excellent nonverbal communicator,” and the SGD is difficult for him to access when he is fatigued or not feeling well. So, the SGD did not provide added value during everyday routines. In fact, Colin saw it as work, and once he finished his school day, he was tired and did not want to engage in any additional work.
However, Colin’s motivation to use his SGD at home and in the community grew over time as he and his team identified unique uses of the SGD. For example, Colin had few ways to engage in and maintain close relationships, to express specific or nuanced information, and to communicate with unfamiliar communication partners. As Colin learned to use his SGD to communicate for these purposes, he learned it was worth the effort to use it at home. When Colin’s team asked themselves those two important questions (does the SGD allow the client to communicate something that cannot be communicated by some other means and is it more efficient and easier to use than other communication means?), they successfully identified motivating and authentic reasons to use the SGD at home.
Colin began requesting his SGD at home around the age of 8 or 9 to make humorous and sarcastic remarks to his siblings that he could not communicate with gestures and facial expressions alone. He also became interested in communicating with his care providers and physicians who were less familiar with his unaided communication.
As Colin’s circle of communication partners continues to grow, he uses the SGD to display his sense of humor, to express sadness, frustration or anger with age-appropriate language (not always appropriate for school), and to text and email friends he no longer sees regularly. It is still physically taxing for Colin to use the SGD, so honoring his unaided communication is critical. But when he feels his unaided communication is not adequate for the situation, Colin does not hesitate to request and use his SGD.
Involving the client’s family throughout the assessment and decision-making process is key to SGD adoption success. SLPs and vendors can provide targeted training on the SGD, but they must also show families how to model the use of the SGD for purposes the family selects. While some tech-savvy families may invite more detail, many others get lost in the technical details. This can jeopardize early confidence operating the SGD and may lead to thinking it is complicated, hard to use, and perhaps best left to the “AAC experts.”
Focusing on highly motivating reasons—and encouraging clients to model and use the device for a variety of purposes—sets everyone up for success.
1 Comment
February 12, 2017
Barbara Weber
Well done!
This article brings up excellent points about building family capacity. Integration of the family's needs and how to help a SGD fit those needs are critical considerations.
Submit a Comment
Submit A Comment
Name
Comment Title
Comment


This feature is available to Subscribers Only
Sign In or Create an Account ×
FROM THIS ISSUE
February 2017
Volume 22, Issue 2