School of Speech Ep 17
[00:00:00] Announcer: Welcome to the School of Speech podcast presented by SpeechTherapyPD. com. School of Speech is designed specifically for the school based SLP to come together to discuss current topics, tackle difficult situations, and share our insights. Our goal is to bolster confidence, celebrate our triumphs, and foster a community that's Dedicated to the excellence in the school setting. 
[00:01:30] Carolyn Dolby: Hello and welcome everybody. I am Carolyn Dolby, your SpeechTherapyPD. com podcast host for School of Speech. School of Speech is designed for school based SLPs, so we can come together and explore current trends. We're going to be sharing insights and really champion our expertise. Our goal is to boost your confidence, Celebrate our triumphs and just foster a community dedicated to the excellence in the school setting.
[00:01:59] I am so excited about today's episode, which is AAC in Action: From Feature Matching to Trials to Implementation. And what a blessing to have Kathryn. I'm going to do this. Doug D'Agostino Russo. I did it so well before. 
[00:02:18] Kathryn: You got it. 
[00:02:19] Carolyn Dolby: Thank you, Kate. You are here to guide us as we put AAC in action. She is going to be sharing her expertise, starting with who, who benefits from AAC and will lead us through the assessment and implement implementation process, she'll be describing feature matching and what you needed to skip.
[00:02:37] Just skip. But you need to do that to consider what is wrong when choosing AAC systems. We're going to learn about dynamic assessment tools for planning intervention and also discuss how we can involve school team members and also caregivers throughout the entire process. Now, before we get started, I do have a little bit of housekeeping to go over.
[00:02:59] So each of these episodes are 60 minutes and will be offered for 0. 1 ASHA CEUs. I need to go over our disclosures. I'm going to let you guys keep jumping in on that chat, please. All right. Ms. Russo is an employee of New York City Public Schools. She's also receiving an honorarium from SpeechTherapyPD.
[00:03:20] com for her participation in this episode today. She for non financial, she is ASHA SIG 12 affiliate and a member of SIG 12 Professional Development Committee. For me, I receive a salary as a district level specialized support clinician for Cypher Independent School District. I'm also compensated for my graduate courses I teach at the University of Houston.
[00:03:43] And I am a consult for school districts across the nation, supporting their program development and staff training. I also receive compensation from SpeechTherapyPD. com for hosting this podcast. Non financial, I'm a member of the Texas Speech and Hearing Feeding and Swallowing Task Force. I'm a volunteer for Feeding Matters, and I'm a member of ASHA's special interest groups 13 and 16.
[00:04:07] All right, well, I want to give, keep, keep, keep coming in those chats because I while you're doing that, I want to I want us to get to know Kate a little bit more. I did just say that she is, she works for New York Public New York City Public Schools. She's a speech language pathologist. And an assistant assistive technology evaluator after receiving her master bachelor's and master's degree in speech language pathology from Loyola.
[00:04:33] Like, yo, oh, my goodness, Kate, what is wrong with me? University of Maryland. I know Speech Path needs help. She began working in special education schools with early elementary age students who use a variety of augmentative alternative communication systems and including alternative access.
[00:04:51] Kate has been interested in AAC since her undergrad studies and has developed her passion for alternative access as a very early professional. Welcome Kate. Yay. How are you? 
[00:05:03] Kathryn: Thank you so much for having me. I'm so excited to talk about AAC with everybody tonight. 
[00:05:08] Carolyn Dolby: I love it. Would you mind? Let's just get started.
[00:05:11] Tell us how you got on this journey for your love and you became such an amazing person with AAC. What's your journey? 
[00:05:19] Kathryn: So actually I first learned what AAC was in my undergraduate. Studies. So if you don't know, AC stands for augmentative alternative communication. And before I was in undergrad, I had never heard of this before.
[00:05:35] I knew I wanted to be a speech pathologist and I knew I wanted to work with people with various disabilities. I really wanted to work in a special education setting, but I didn't even know this existed until I had to go and do those observation hours that we all have to do the 25 hours. So I went to a special education school.
[00:05:54] I was scheduled to do 1 hour of observation and I ended up skipping my classes for the day. The speech therapist was such a wonderful woman. She let me stay the entire day and. Learn about all of the devices see people using eye gaze and explain to me that speech language pathology doesn't just deal with speech.
[00:06:16] I think when we're people here that were speech pathologists, they think, oh, you work with people who have lists. You work with people who can't say there are, but we work with so many different things. And 1 of those things is helping people who communicate differently find. A communication toolbox. So after that, I wrote every paper about AC.
[00:06:37] When I went to graduate school, I said, you know, I need to have an internship. That's all. This is what I want to do. And I was very lucky Loyola University. Maryland really helped me find the types of internships that I wanted. And then. I just really started searching out career opportunities where I could practice those skills.
[00:06:57] And I took a lot of continuing education courses and things like that. And by no means do I consider myself an expert. I think I'm just somebody who's very excited about AC. So I'm always trying to learn more and share that excitement and enthusiasm with other professionals so that we can do the very best for the clients that we serve.
[00:07:23] Carolyn Dolby: Wow. All right. So I was just going through the chat and I'm noticing everyone's really averaged about a three. So, everybody. Yeah. So we, and the heavy hitter, what people are really wanting to know more about, which I think comes to no surprise, like, How do we keep the AAC device out of the backpack?
[00:07:44] How do we make sure that that we get the buy in from the staff? Another one, another good one. How do we train the parents and the staff to make sure they're using it correctly? And also trialing. Oh, oh yeah. There was one about trialing AAC devices when they're bilingual. I don't know if we can touch on that.
[00:08:02] Okay. All right. All right. 
[00:08:07] Kathryn: Well, so where would you like me to start? 
[00:08:09] Carolyn Dolby: I know, right? I'm like, where do we go? Well, who benefits from AAC? I know I already asked you that question. 
[00:08:15] Kathryn: Well, this is a great question because people ask me all the time. So a little background, I have three days of the week as a treating therapist.
[00:08:23] So I have a caseload and the other two days of the week, I support teams across the city doing a AAC evaluation. So I support them in choosing what. Programs to trial teaching them some techniques to use during the trial process and then helping discuss what they think is working and not working.
[00:08:42] So we'll talk a little bit about those feature matchings and what I'm looking for. And you know, recommending people look for, but a lot of times when I go in, people will say, oh, somebody on the team mentioned we should look into, but I don't know if they're a candidate. But the thing I have to say to them is everyone is a candidate for AAC.
[00:09:01] Everyone can benefit from AAC. And we all actually use some augmentative or alternative communication supports every single day, whether or not we are communicators who primarily use speech and mouth words. So think about how sometimes we choose not to call a person. We think it's easier to send a text or an email.
[00:09:21] Or maybe we send an emoji to say that we like that idea for dinner. Also sometimes you might go out to a restaurant and just point, Hey, I think I want that milkshake. That one in the picture looks great. These are all different methods that we're using. So that's a good example that you can say to people on your team either caregivers or school staff who might not think that AAC is appropriate for everyone.
[00:09:47] And then when we're talking about AAC and who might benefit. We need to think about how our students or older adults are communicating and what they're communicating about. And are they able to communicate efficiently and spontaneously in every situation that they might have? So some of these people might use speech, but maybe they are not very intelligible.
[00:10:12] So having AIC will help them when there's those communication breakdowns. Or maybe they struggle to communicate with unfamiliar people. In that case, AAC might help in providing a communication context. Maybe the pictures are helpful for both people. And then also keeping in mind that can really support receptive language as well.
[00:10:35] Even for my students who primarily use speech, I always have supports available for them to explore and then I'm always modeling on it. So that it's. almost like a visual that they can see what concepts we're talking about and how I'm you know, putting words together so they can see almost like a sentence strip, they see the visual in that way.
[00:10:57] Carolyn Dolby: I love that. I love the part that you, you, I kind of, you blew my mind for a minute when I realized that We're all using AAC when you said when we use emojis, when we go somewhere, we, or maybe we just point and the other, the other person knows what we're wanting. And we just communicated. It's just, I think teachers and parents to need to know that is is for everybody, because I do know that sometimes we get some pushback from parents that feel that will keep them from.
[00:11:31] Being verbal communicators, but just bringing out the point that, hey, you use AAC daily and you still are a very good, efficient oral communicator. I think that was powerful. 
[00:11:47] Kathryn: Right. And that's an important thing. You brought up that myth. I think it's, Up to all of us to keep busting that myth that using AAC will prevent speech.
[00:11:57] There are so many studies that are proving otherwise. And then also for some of our students who may eventually use speech you can also phrase it to parents, like, this is going to help their receptive language. We are teaching them so much vocabulary so that when they choose whatever modality they want to use, they already know the words, you know, they already have, you know, Some words that they can use, whether it is through speech or the communication system like a speech generating device or picture supports.
[00:12:27] We don't want to leave that receptive language and learning vocabulary in the dust because while we're trying to figure out which system they want to use. And I also like to tell people it's a communication toolbox. We all use so many tools during the day. You know, if you're going to. I don't know, build something, you're going to use a screwdriver hammer for all sorts of different things.
[00:12:48] So we want to make sure that we have a good gestural system, good facial expressions, good and any type, whether it's high tech or low tech, just, you know, try something and see where it goes. 
[00:13:02] Carolyn Dolby: Well, I think that really leads into my question on, well, how do you know what application or system to trial? I mean, there's a lot out there.
[00:13:11] How would you, what do you do? What do you need to consider? 
[00:13:14] Kathryn: Yes. So, definitely you want to be considering feature matching. So, if you're not familiar with that, it is a term coined by Shane and Costello where basically you're matching the features of an AAC system to the strengths and needs of the student.
[00:13:31] So, what things are built into a program that will maximize their current abilities and then support them where they need a little extra help. So, things that you want to be thinking about are vocabulary organization. What languages are supported, what symbol types are there access methods. If the person may have difficulty using their hands, you might look at positioning and some other settings.
[00:13:59] So, for example, I'm thinking about vocab organization. There are so many different types of organizations, like. You might have visual scenes, which is a picture with language concepts embedded. And a lot of programs now do have visual scene displays built in. You just have to go through. The grid, you might have schematic or activity based programs where the words are related to a specific situation.
[00:14:28] So, you know, you go to the page for bubbles and you have all your top phrases and words about bubbles. Okay. You might have a taxonomic or categorical 1 where your base is core, but then the fringe is organized into categories. That's really great. If the person you're working with has a solid categorical knowledge already, that might be very easy for them.
[00:14:51] A linguistic vocabulary organization is when the words are organized by the part of speech, semantic relations, how the words go together and motor planning which sometimes people, I think, say programs that have a strong motor planning base seem to be more difficult. But we all rely on motor planning, especially people with disabilities.
[00:15:15] So you always want to keep motor planning in mind, even if. The core vocabulary organization of the program is not motor planning. Just keeping that in mind that words stay consistent. You might also have topical organization where the vocabulary is organized based on conversational topics. So it might be a little bit more phrase based.
[00:15:36] And then a lot of the programs nowadays have a mix of all of these. So you'll be able to find a little bit of each. And then, like I said, you'll also think of languages. If your student is bilingual. You obviously want to try to the best of your abilities to find a program that has both languages.
[00:15:54] And these are expanding every day. But sometimes you just can't find one. Some of the programs will translate using Google Translate. You can translate the board easily that way, but sometimes a language is just not supported in which case you can talk with the family about finding somebody to help you translate the board.
[00:16:16] And maybe it'll end up being light tech, but that's better than nothing. But as always, if you are able to find the language, like Spanish. French tend to be on most programs. Chinese is becoming more readily available. Some programs also have Danish and German and Japanese. So checking that out access methods is huge.
[00:16:38] So, you know, if you know that visual skills are a strength for an individual who's not able to use their hands very well, definitely consider a program that supports eye gaze and that you're going to be looking more at a dedicated device that has that access method. You know, if you don't have the ability to maintain the pressure on a switch, but you're looking at switch scanning, you might look at a different type of switch.
[00:17:04] And then, you know, thinking about what the person's diagnosis is. We never really want to focus on the diagnosis, but that can really help you. Like, do you need to be thinking about a different access method down the road? Do you need to be thinking about multiple access methods so that they're always able to access it?
[00:17:20] And then, you know, what settings can you play with? Like dwell time? Background color? Can you change the grid size? And things like that. And then, you know, just playing around with the different programs that are out there, going on YouTube and watching videos of people playing with the different, you know, Vocabularies or even on the manufacturer websites, you can get so many webinars about the specific products.
[00:17:45] And that's a great way to learn what features are available. And then if you're ever not sure, you can always call in the area rep for 1 of the programs. They would love to come and help you and show off what they have. And it's a great way to learn hands on what's available in the different devices.
[00:18:04] Carolyn Dolby: I like that. That I what I like what you when you started out, you immediately said when you're going to feature match, you need to start with their strengths and then I like the way that I think we're going towards. We really want to be strength based in everything. I mean, what is the strength of the child?
[00:18:22] I think that was powerful. Thank you for adding that. 
[00:18:25] Kathryn: Of course, you want to make it successful for the kid or the adult. You don't want them to feel like this is it's, you know, First off, it's hard. They're learning a new thing, so it is going to be hard, but you don't want to make it so hard that they're not excited about trying it out.
[00:18:39] So trying to find something that hooks them in and makes it easy for them because of their strengths is a great way to get them excited about AAC. 
[00:18:49] Carolyn Dolby: Absolutely, and I missed 1 question, not a question, but if we, if we can put in Gestalt Language Processors and AC to if you have any little tips for us on that would be great to. 
[00:19:01] Kathryn: Sure.
[00:19:01] I mean, there's a lot of different, things going on out there, everyone's kind of talking about it. But I would say the main thing that you want to think about when using AAC with anybody, whether they're an analytical processor, or adjust all language processor is thinking about the communicative competence model.
[00:19:19] So. That was developed by Janice Light, and it looks at social competence, linguistic competence, operational competence, strategic competence, and now we're starting to also include the psychosocial competence. So thinking about if the person is a just all communicator, thinking about what competence, the just all is surveyed.
[00:19:39] So is it a linguistic thing? Is it so they can interact socially and then working to. Make sure that they have efficient ways to communicate across all the competencies. So, there's not a lot of solid research out there yet about, you know, what we should be doing in terms of programming a device.
[00:19:58] But I think the main thing that we should focus on is, how can we make somebody competent and support them across all the competence areas and making sure they're able to communicate for all the functions to repair communication breakdowns? Et cetera, whether that's using a gestalt or, you know, a more traditional analytic where you're putting words together.
[00:20:20] Carolyn Dolby: Gotcha. 
[00:20:21] Yeah, we do have a question come in. I know that you, that we both agree that everyone would benefit from AAC because we all are using it, but the question is, is there a main population that really benefits from the A, from AAC, AAC systems? . 
[00:20:36] Kathryn: I wouldn't say there's a main population, but I will say that the sooner you can start using with a person, the more likely they are to become a more competent user to use it long term and not abandon it.
[00:20:52] So, if for any reason you feel like somebody just needs a little extra support, introduce some kind of AC and it could just be a light tech board. You could print the the homepages of so many of the devices that are out there. And you can use that. You could go on project core. And project scores website has tons of free boards based on like a 36 universal core words.
[00:21:18] And they have them and set up in different ways. But anyone that you think that you can, it will enhance their ability to participate in their community with their family in their school, in their home activities, or their community activities. Definitely consider AAC for them. 
[00:21:37] Carolyn Dolby: I'm going to pop that I just I just put project core in just to see what it is and make sure that people see that.
[00:21:42] So it was project P. R. O. J. E. C. T. 4. and if you put that takes you right to it, but I'm gonna put it in the chat as well. 
[00:21:51] Kathryn: And that's developed by some researchers at UNC and there's also some great learning modules on there. Sometimes I'll send them to caregivers or other support staff, because it's a great way to learn about core words and the importance of teaching and using them and also some of the implementation strategies that, you know, we all talk about till we're blue in the face and sometimes hearing it from a different person can help.
[00:22:17] These people understand and use the technique a little bit better. 
[00:22:22] Carolyn Dolby: Perfect. What how do you determine what system is going to be the best fit? 
[00:22:28] Kathryn: Sure. So typically during a trial period, you know, you've already looked at. All of the different features of the different programs and thought, you know, okay, I'm going to try something with motor planning because they have some really good routines and patterns that they pick up on very quickly, but they do have a good categorical knowledge.
[00:22:49] So I do want to try something with categories and I want to make sure, you know, say they're bilingual in Spanish. I want to make sure that both are available. What I might do is narrow it down to 2, maybe 3 programs, and then we start trialing, you know, I just take my best guess and I stick with it for a few sessions.
[00:23:10] And it kind of is up to the way your sessions are run and how often you see the child and what the classroom is able to do and how your school system or private practice or facility works. But something that. Helps me and I've told other people is you can do it 2 ways. You can, you know, pick I'm going to use program 1 for X amount of time and I'm going to be looking at all this data.
[00:23:38] Are they using it to request comment? Protest ask questions? How much support do they need? Do they need gestures? Are they able to navigate? 2 or 3 hits by themselves. Are they able to, you know, create a little bit of a spontaneous message? That's more than 1 word. And then moving to program 2, looking at all those things.
[00:23:58] And at the end of the period. Comparing and contrasting, you know, which 1 were they more spontaneous with? Which 1 did they use more language functions? Or, you know, depending on your timing, sometimes you might have to try both programs in 1 session. And again, you're looking at the same thing. But, you know, I'm trying not to change up things too fast.
[00:24:19] Because. You know, you're looking at a brand new thing. It's not like you went to algebra the 1st day and you understood everything from just seeing it 1 time. So, keeping that in mind that we need to introduce it really be modeling. And then again, don't be afraid to try something new or different just because.
[00:24:38] You may be working with a student who everyone has said, oh, I've tried that. It didn't work. Don't be afraid. You can still try something. Maybe it wasn't the right time for that student. Maybe they weren't interested. Maybe, you know, some other skills, maybe they were really working on their motor skills, and they didn't quite buy into that, but just having it available is really helpful.
[00:25:01] And then also just 1 thing I do want to mention is when you are trialing, keep in mind your grid size. You don't have to go too small. Go as big as you possibly can, unless you know that the person has some visual deficits, in which case then maybe you might have to go with a bigger icon, but generally the bigger your grid, the less navigation, the easier it is to find a word and make a message quicker.
[00:25:27] So, when you're trialing things, try and make sure you're trialing as big of a grid as you possibly can. And then when you're trailing 2 programs, make sure that the levels that they're on, if you're using a program that has multiple levels are kind of the same. So you don't want to be trialing 1 program with say, 20 icons versus 1 with.
[00:25:50] 100, try and meet them in the middle, maybe like 60 and 75. so as close as they possibly can and I know different programs. Might have grids in different ways, but just trying to get them as close as possible. So that, you know, it's not just okay. That icon is so huge. It's easy for them to get to. 
[00:26:09] Carolyn Dolby: We did have a question come in what would you trial or are complex.
[00:26:14] High support needs students who are very in in very early development, like, maybe pre linguistic, not yet consistently responding to auditory or visual stimuli. Oh, excuse me and not yet imitating actions or sounds. 
[00:26:30] Kathryn: Sure. So if they are able to use their hands, obviously any type of board or device can work if they're really early learners.
[00:26:40] And you think, you know, hey, having all of the words available on the screen is difficult. You can always use masking. So hiding some of those words. A lot, all, a lot of the programs have masking built in to them. Now, if you're using a light tech board, you know, take some painters tape and just cover them or cover it with a post it note or a black piece of paper if.
[00:27:03] You know, access is an issue. You're not sure if they're going to be using their hands, their eyes, things like that. I would look into partner assisted scanning. This is 1 of my favorite methods. People always joke with me that I use partner assisted scanning, like, every day to give anyone an option, but basically you are providing the visual and auditory scan of choices or messages that they could say, and then working to, with people to identify what the agreed upon responses. So some people, you might say, do you want to play the music, stop the music or something different? And you're looking to see if they blink if that's the agreed upon thing. Maybe they look to the side. Maybe they raise their hand a little bit, or maybe they vocalize.
[00:27:49] So those are some ways that you can introduce it to some of our early learners who are still learning to use their bodies still learning. New vocabulary. And like I said, partner system scanning is a great way to introduce vocabulary, especially vocabulary that you might not use often. 
[00:28:06] Carolyn Dolby: Can we go back to the grid size?
[00:28:08] Sure. So, one of we have I found that the sole reason that many parents will give AAC another try with their child is because I'm, I am willing to change the grid size. They make larger buttons for the child for a short period of time while they get acquainted and quickly allow access to more buttons per page.
[00:28:27] And same, and then moving on with that when do you usually change the grid size? What are you looking for when it's time to change the grid size? 
[00:28:37] Kathryn: Sure. So like I said, I try to go as big as I can from the get go. And I'm always having conversations with caregivers and support staff that one of the reasons why I want as big of a grid as possible is there's less navigation.
[00:28:53] So sometimes I'll say to them, okay, we're going to use the smaller grid. And we're going to try and find this word and counting how many buttons it takes to get there, and then we'll go to the larger grid and say, okay, how much longer? So I might talk to them and say, you know, it was a lot faster on the larger grid thinking about if your child gets frustrated, it might be a lot easier.
[00:29:14] There's less frustration. And then I also want them to know that, yes, we could start smaller. And of course, if that's the best way that you can get buy in. Definitely do that. Sometimes we have to make a decision that might not be the best vocab at that moment, but it's the best way to get communication partners involved, which is also going to have long term benefits, but you just have to explain, you know, the motor plan might change a little bit, and then that can be a little bit difficult.
[00:29:43] But if you just have those consistent conversations with. the people who are the communication partners. And also the people that you're working with, the actual AAC users have so much great information for you. A lot, you can, you know, hold up two devices, two light tech boards and say, you know, which one did you like best?
[00:30:03] And 99. 9 percent of the time when I ask someone that, they always pick the one that I would have recommended anyway. So, And then sometimes I'll even show them with two different grid sizes and say, you know, which one did you like? And the majority of the time they'll go for the larger grid. And that's very powerful for some of these you know, communication partners who are not so sold on the grid size with it being bigger.
[00:30:28] Carolyn Dolby: Another question about key guard. Do you use key guard often? 
[00:30:33] Kathryn: Sometimes I do use key guard. Sometimes I'll also use a touch guide. So, you know, sometimes you might have it exactly around each key, but sometimes you might have it be a smaller hole than the actual key. So, they have to get to a specific spot.
[00:30:46] I do sometimes use key guards. You know, it really just depends on the student. There are also some other access settings that you can change. If you don't have a key guard readily available, you know, you could try dwell time and release time. So dwell means you're adjusting how long a person has to have their hand or their eyes directly on the icon before it activates.
[00:31:11] And then release time is, you know, how long it has to be released before you can activate another button because some, you know, we have some people who are tapping either purposely because they want to tap or stim or regulate or hear a word, or, you know, maybe part of their disability is a tremor and, you know, Or some kind of spastic movement, so they can't help that they hit it a few times.
[00:31:34] So those are some things that you can think of. Another thing that's helped me a lot this year, I've gotten so into this, is trying out increasing the button margin. So that's usually in your settings, and basically it widens the gap between your icons. It gives the illusion of a bigger border almost kind of like a visual key guard.
[00:31:56] So that's something that you can try if you don't have access to a key guard. You could also use wiki sticks, which are like these. Pieces of string that are covered in wax and sometimes I've laid those over a device or, you know, used it to make a little square around our target word for the day.
[00:32:14] That makes it a little bit easier. And I've seen people, you know, make keyboards, key guards on the go out of like rubber bands. So there are so many things you can try if you don't have access to a key guard. Right at that moment, and you need to try it out. 
[00:32:31] Carolyn Dolby: Wow. That's great. I think, you know, I think you've how, how long is your trialing period?
[00:32:39] Kathryn: So, that's one thing that kind of will depend also on how your facility or school system does things. But if I am, for my caseload, I trial for a few weeks and I always let the parent know. You know, from the get go, I have a lot of AAC supports that I use throughout my sessions. I'm going to be trialing some things with them.
[00:33:01] And, you know, please feel free to zoom into a session, come see a session, so you can see what this looks like and see it in action. And then for, you know, I always want to get at least a week to two weeks of really good data for each of the programs that when I'm personally trialing them with my personal students but sometimes it is like, so quick and fast, like, they just show me.
[00:33:27] I don't want to use another program. Like this makes sense to me. I'm also lucky that in the school that I work with we have a predominantly all AAC users. My co workers and I are like so obsessed with AAC. We're constantly supporting our teachers with it. So they, our teachers are pretty comfortable if we're like, Hey, do you mind letting them use Trying out this in the classroom and just letting me know which ones works out the best, or I'm going to let you borrow my iPad for the day.
[00:33:54] Can you just let me know when I'm supporting teams? Usually that's part of a formal evaluation process. So it does make it a We have to go a little bit faster because we have to finish it between that evaluation window. But also keep in mind, sometimes it can take a while to determine. And if you're going the insurance route, definitely don't worry if you're taking a long time because.
[00:34:19] You want to make sure you're finding something for the students. So there was a student that I did go the insurance route for and the family. That's what they wanted to do. And I think it took us a school year and a half to figure out what works best for the student. But this was a student with multiple disabilities We had access issues, so we tried every access method on for the son.
[00:34:41] But family was so involved and it was really great to get their perspective and have them say, you know, that's the method. Like, that's what we think is working best for her. So. You know, I'm sure that was a very big response. Yeah. But it kind of depends on your facility Sure. And the student who, your or adult that you're supporting.
[00:34:59] And you know, sometimes you'll get to that answer very quickly because they'll let you know. 
[00:35:05] Carolyn Dolby: Yeah. Yeah. All right. Do you wanna where do we go now? Reviewing dynamic assessment tools? Sure. Yeah. Then get into planning intervention. I know we want to know we want to know all the techniques. We we need all the secrets 
[00:35:20] Kathryn: Yes.
[00:35:21] So dynamic assessment, of course, you're using it in all aspects of your practice, but it is so important during AAC especially because we can look at so many things. Before I was talking about the competence areas, the core competences. So your social competence, your linguistic competence, operational, strategic, and now the psychosocial.
[00:35:45] So a lot of our dynamic assessment tools. Really take those into account. And so many of them are free online, which is amazing because that makes it really quick and easy to do. You can print them easily, save them on your computer. You can even forward it to other caregivers. And. Communication partners to get their input.
[00:36:09] So some of the ones that I personally recommend and use frequently include the DAG 3. So that stands for the Dynamic AAC Goals Grid, and it's on its 3rd edition. It was created by Toby Dynabox and basically, They go through all of the core competency areas looking at different skills and you can check off.
[00:36:34] If they've met that goal, if it's, you know, they're still making progress toward it, or, you know, they haven't even started to get. You can even check off what types of prompts they need for different skills. And it also goes by emergent, emergent transitional, context dependent, all the way up to independent.
[00:36:53] So there are five different levels within each competence area. And what I love about this is you can do it as many times during the year as you want. And also it's so great for helping develop goals because You can just use, it's helpful for the wording. And then when, if somebody asks, you know, why did you think of that goal?
[00:37:14] I can go back and show them, you know, this is, you know, research based. We're looking at all the competencies and this is one of the areas that we need to work on. So that one is free and you can find it online. So I'll...
[00:37:27] Carolyn Dolby: ...just, and that was, oh, sorry. And I wanna say that was dag, DAG three, 
[00:37:31] Kathryn: DAGG 3 
[00:37:32] Carolyn Dolby: 0 2 Gs. 
[00:37:33] Kathryn: Two Gs. And I can also type that in the chat, too. 
[00:37:37] Carolyn Dolby: D A G G 3. Mm hmm. Oh, thanks. Yes, the DAGG 3. Oh, I love it. Do you mind going over those competencies? And then I will type those into the chat, too. 
[00:37:51] Kathryn: So, one competency is the social competency. So, how you are using language are you using it to request?
[00:37:59] Are you using it to protest? Are you using it in a turn taking situation? That type of thing. Linguistic looks more at, you know, what vocabulary you're using, any morphemes you're using, semantic relations, things like that. The operational context competence is where, how are you using the system?
[00:38:21] Are you able to adjust the volume? Do you know to take it from area to area? Do you know how to charge it if it is broken or something like that? And then strategic is looking more at, will you switch communication methods if you're not understood? How would you prepare communication breakdown? You know, these are all things that, when they come together make you a very strong communicator.
[00:38:44] So that's why we're looking at those areas. And then, like I said, the psycho social competence is a newer one that they've added in, in recent years. So it's not always included on the, these, these Dynamic assessment tools, but you do want to think about how the person using AC views their AC use.
[00:39:04] Like, do they love using it? Are they indifferent? Does it make them upset that they have to use it and trying to support, you know, positive relationship with their AC use and communication partners? 
[00:39:17] Carolyn Dolby: Perfect. Thank you. I'm going to get those in there. 
[00:39:20] Kathryn: Sure. Is it okay if I talk about some other dynamic assessments?
[00:39:24] Yes. Absolutely. So, the next one that I like to use, especially, I really recommend this for people who work with older students or adults is also from Tobii Dynavox. It's called the Tobii Dynavox Augmentative and Alternative Communication Needs Assessment. So I'm going to take that in our chat right now.
[00:39:44] I
[00:39:47] Carolyn Dolby: think I got it 
[00:39:48] Kathryn: so this 1 is. You really want to fill this out with either the person and I. My auto correct, just change the name. Okay, there we go. You want to fill this out with the person who uses or some really close communication partners because basically you're looking at where do they need support?
[00:40:09] You know, is it in the community? Is it at home? Is it in specific therapy areas and then looking at, you know, how often do you feel like you're able to. Efficiently communicate in X, Y, Z environment. How often do you think you're able to communicate requests sufficiently? That type of thing and you can develop some goal area.
[00:40:32] So you're looking at you know. All the time, some of the time, rarely that type of rating scale. And then again, that can help you choose your goal areas. And I personally think that this is great for some older students because it's a really looking at community participation. So not that younger students don't participate in the community, but really looking at, you know, how can they be more independent 
[00:40:58] Carolyn Dolby: and for those that are listening Not live.
[00:41:01] I just want to say that this one is the Dynabox Augmentative and Alternative Communication Needs Assessment. Okay. 
[00:41:08] Kathryn: Yes. 
[00:41:08] And I don't have a handout, but if you, Carolyn, do you share the reference list with people? Oh, we can absolutely we can go if you if you ended up sharing the reference list, all of these are in the references and then you'll also be able to see some of the articles that I constantly go back to just for, you know, some.
[00:41:28] Refreshers on the social, the different competences or things like that. 
[00:41:33] Carolyn Dolby: Great. Another question was, do you use the communication matrix? 
[00:41:38] Kathryn: That was going to be one of my next ones. So the communication matrix is also online. It used to be free, but it is still very low cost. And basically it is a list of questions that you answer, you know, is, The child, do you feel that the individual is able to get their needs met, you know, with whatever type of.
[00:42:03] Communication modality, and then it'll go through how do they request are more something? Is it moving their body? Is it nodding? Yes. Things like that. And after all is said and done, you get this beautiful little graph that is colored in. White, yellow, orange and gray based on if things are not seen emerging mastered or completely surpassed.
[00:42:28] And you're looking at communication from 7 levels from preintentional communication. All the way up to language when you're starting to combine and it makes such a great visual for different people on your team because you can say, hey, look you know, they're really solid using unconventional communication methods.
[00:42:46] So, body movements, things like that. Let's try and get them. Up to the next level, or, hey, I see that they're doing a lot of independent requesting, but I would like to see them protesting. So let's work on protesting and refusing. And this is great to do year after year. I love to show parents, you know, look what they did last year.
[00:43:06] And let me look how many colored boxes we have. Now, like I said, it's pretty low cost. You do get a certain amount of free. Evaluation, so sometimes you can recommend a family make their own login and then they get like, I think, 5 free assessments. So you could. Log into their thing and help them fill it out.
[00:43:28] What I do with my coworkers is we all just split the cost. So, we pay, I think it's like, 25 dollars for. A year, and then you get a certain amount of assessments, and then you just buy credits for more assessments. So, 1 of us goes on and notices. Hey, you know, we're out of assessments. They'll be like, hey, I'm just going to add 20 dollars and assessments left on it.
[00:43:50] And that works for us. Depending on your facility, you might be able to ask them to pay for it for you, but it is such a great tool. It is worth every penny and it's pretty low cost considering things. 
[00:44:03] Carolyn Dolby: Yeah, sorry. Julia asked a question and I gave her the, I was silly and I put in the wrong what she was asking for.
[00:44:09] She was asking, I know, I know. Sorry. That was silly. She was that, so you were just going over the communication matrix. I would make sure. Yeah. 
[00:44:18] Kathryn: Yes. Yes. Two other ones that you, or three other ones you should think about too. Another free one, the Quad Profile. This is a free tool that will look at your morphology, semantics, syntax and basically just a checklist.
[00:44:32] Hey they use these words they use these types of semantic relationships. You know, they're using agent plus action type of sentences. Super easy. Great way to Look back and say, okay, you know, in this period of time, they've learned this much because they have like, 5 different check areas on it.
[00:44:51] And it's super simple. So that's Q. U. A. D. profile quad profile. I'd also look into the out for AAC. so that I'm going to type it into the chat the out for AAC. so that means that stands for the assessment. Of learning process. For AAC, and this is really great. If you are working with people who are using different access methods, because it's helping you separate the communication task from the motor task, say, using eye gaze or switch scanning, and it really looks at, you know, what is their attention to the task?
[00:45:31] Were they excited by it? Interested? Just not interested at all. Are they starting to fine tune the movements? Are they thinking of it as a tool? So that's a really great thing to look at. That is free. It's really just a rubric to kind of think about, but I do sometimes include it in reports.
[00:45:48] You know, when we first introduced it, they were at a level 1, and from there on, and then my last dynamic assessment tool that I like to use is the profile that was developed by Tracy Kovac. And this is an assessment that you do have to buy. And it has, you know, the little manual and the grading sheet, but you're able to do 3 assessments on 1 manual for 1 person.
[00:46:15] And again, it looks at all of the different. Competence areas, and you kind of get a score from 1 to 3, you give them a score 1 to 3. Are they doing something rarely sometimes all the time and then getting an idea of if they're an emergent communicator, a transitional. Context dependent that type of thing.
[00:46:36] And that's again, really great to go back on. That one gets a little bit technical. So I think that's one that you would keep in the file just for you and other SLPs to kind of look back on. Of course, you can show it to people, but I do think that's a little bit more technical of one. You don't get like a pretty graph.
[00:46:53] It's not as easy on the eyes and that sort of one . 
[00:46:58] Carolyn Dolby: So for those, oh, sorry. I was just gonna go back. For those that are just, that are gonna be listening to, that's not live. I wanted just to say the last two that you mentioned was out a LP for a a mm-Hmm. Assessment of learning process for a a C. And then the last one would be a C profile.
[00:47:13] Just wanna make sure everybody's got Yes. Mm-Hmm. . Perfect. 
[00:47:17] Kathryn: And like I said, I love all of these because you're always going back to that communicative competence model, and it's really easy to develop. What goal areas you want to target and create a solid toolbox where are the people we're supporting are able to communicate whatever they want, whenever they want, however they want.
[00:47:36] Carolyn Dolby: Right. I love it. Well, I know that we are all on on the edge of our seats knowing we want to know how you incorporate AAC into your therapy sessions. 
[00:47:46] Kathryn: Sure. So, like I said, I always have AAC supports available. In my therapy area, I have posters and I, like, you can get them from all of the device companies.
[00:47:58] Your reps are happy to send them. So I put them back to back so I can flip them easily when a student comes in based on what they need. They're trialing or what they're using. I have like tech boards, you know, I have my iPad if they have their own iPad. It's out to, like, we just have so much so that we can use whatever and then I love to follow my students interests.
[00:48:22] We all know that's like the hot topic now is connection over compliance and connection is where you get that spontaneous communication. So, I try to do a lot of play based therapy because I do work with younger students when I'm, you know, doing an assessment with older students. I'm trying to find.
[00:48:40] whatever topic or hip thing they want to talk about. They are all more hip than I am. I don't know the slang. I don't know all the things that they, so I'm always like, what's, what's up? Like, but they're excited to teach me about it. So that's something that we can do during our sessions. And then I love, love, love to get into the classroom as much as I can and either co treat with another profession.
[00:49:03] Or do a lesson together. Something that has been really fun that we've been doing at my school for the past 2 years is we pick a book that is going to be the basis of our lessons and every SLP in our building does it. We all serve different classes, but once a week we go into that class. We read the book with everybody.
[00:49:25] Everybody is modeling. We pick out 4 words that are the words that we're focusing on. And then we do an associated activity as like a little extension where they get to practice a little bit more naturally. And we developed this after looking at PRC literacy planner. So they have one, they usually make one every year.
[00:49:50] I'm going to type it in the chat. So PRC Saltillo is one of the device companies. They make accents unity vocabulary lamb vocabulary. Touch chat, Nova chats, things like that. And they made this literacy planner which is amazing. So they have a month every month, they pick a book, they have your core words for you, exactly what you should model.
[00:50:12] And it's free. Wow. So you can share it with your teachers, you can share it with parents, like sometimes we'll print out little pieces of it and say, you know, this is what we're doing, but we were really inspired by it. And so now we just can choose our own books and kind of think of what craft goes with it, what cooking activity, a science project.
[00:50:34] And everybody in the class loves it. The kids love it and the staff love it. Because it's such a low pressure way for them to get involved with modeling. You know, we build in everybody today. Here are four words. This is the words we're going to practice. All right, everybody. This is how you're going to find the device.
[00:50:50] The word on this type of device. This is how you're going to find out on this type of device. All right, everybody wants to want all the adults to practice. Now we want all the students to practice. And when the students are practicing, it's a chance for our staff to practice modeling. 
[00:51:05] And then because I'm in there.
[00:51:07] I can show them how I model, how I provide wait time, you know, how I'm phrasing questions to the students, which are more open ended so that it's a little bit more spontaneous communication. So that is a tool that I love. The PRC Saltillo also makes a calendar. That has a theme for the year. So they've done a science one that I shared with one of my teachers who loves to do science experiments with the kids.
[00:51:32] So she got so into it and did all of the science experiments, followed the script exactly. And she was like, this makes using AAC so easy. And I was like, exactly like, this is what, and so that's another free tool. You can also look into assistive where AssistantWare's Core Word Classroom that gives you some ideas of how to use different core words and again, free, you can share it with different communication partners.
[00:51:58] So, all this to say, my therapy sessions look like a mix of child led therapy where we're doing fun things and then also some preplanned activities, especially when I'm in the classroom that I can show off how we're using different core words. And. different techniques that I can then send the activity home to the families.
[00:52:24] Awesome. And you know what? The internet's your friend. I'm sure if you type in, I need an idea for this random topic that we're doing at school. I'm sure that you can find it either on a blog or somebody's Instagram and things like that. There are just so many exciting ways to get people. But if you are excited about it, you go into that therapy session.
[00:52:46] You are hyped up. I'm sure whoever you are with is going to get so excited too. And you'll get so much buy in. You'll get spontaneous communication. Just keep. Smiling, keep trying, you know, Dory from Finding Nemo says, just keep swimming. Just keep going. Okay. If you are met with dead silence and you're the only one using the AAC, I promise within time, everyone will be doing it.
[00:53:12] Carolyn Dolby: I love it. I love, I think when you're, I think there is a lot of Need on really trying to get the staff and the caregivers all on board and the buy in. I think the resources that you've been giving us. Are fantastic. Especially all the free ones. I'm really, I'm really excited to, I'm going to go type into the PRC Saltillo Literacy Planner.
[00:53:32] That's intriguing to me. And I love the fact that 
[00:53:35] Kathryn: they actually have one for middle school students too. The Literacy Planner does have one here. For literate for middle school students. I've never used that 1 because I'm my kids are a little bit too young, but they have a little chapter books like Anna Green Gables is on there and they even explain, you know, like, how you can read it with your older students.
[00:53:53] It's like a book club type of vibe for them. So there is an option for older students with the literacy planner, but that's like, my number 1 thing I can always find something to do. 
[00:54:03] Carolyn Dolby: Oh, that's great. Oh, we do have a question. It's a little long. I'm going to, I might I'm going to paraphrase it just a little bit.
[00:54:09] But he was indicating that he's got students that are cognitively performing very young, maybe 1 to 6 months and he's seen SLPs and team members have kind of disagreed whether a student is using language in intentional versus just a pattern of behavior. Can you share any thoughts on how you interpret and share language performance?
[00:54:36] Kathryn: So, definitely I feel like this comes up frequently like, oh, they didn't really mean that stuff like that. And, you know, who's to say that they didn't really mean that unless they tell you that, you know, that's the thing is that we don't know what's in their brain. No one knows what's in anyone else's brain.
[00:54:52] So I do like to, you know, explain to people who say that, you know, I'm always attributing meaning. I am always assuming that what someone said is what they meant to say, unless they show me otherwise. And I'm acknowledging all different communication methods that they're doing and also thinking back to language development.
[00:55:12] Traditional language development for people who are typically developing, you know, they're babbling. They're making all sorts of sounds. They're saying words. So I have a two year old the amount of times he says choo choo, even though there's not a choo choo around or he's talking about trucks, just over and over trucks, trucks, trucks, there's no trucks, like, but he means it.
[00:55:34] And. You know, we all just assume, oh, you know, he wants to talk about drugs. So thinking about that with our students who, you know, have cognitive impairments who have different disabilities. They might really mean what they say. They're also every time they're doing things that we might think are not intentional, you know, that's them developing their motor plan, learning where words are learning how to use their bodies and they're learning from our reaction.
[00:56:04] So they know, okay, if I keep saying milk, someone's eventually going to get me milk. And maybe they said it a hundred times even though milk is not around because they just want to drink. And so sometimes you have to, you know, put. You're thinking cap on and think, you know, why are they saying milk a million times?
[00:56:21] Or, you know, it's their students getting really tired. They've done a lot of really high intensity work. They did great. And then they just keep saying, you know, paw patrol and, you know, maybe they're just telling you they need a break and they're ready for something a little bit more fun. So. I know that's a such a tough mentality to fit, like, to shift.
[00:56:41] But I really just try to give an, like, use myself as an example. So when my students are saying something like that, I always acknowledge it. Maybe I'll say to them, I know you're really talking about that right now. I keep hearing you say that word. Right now, I'm not thinking about that. So if you're thinking about that, that's fine.
[00:56:59] But every time you say it, I don't have much. That was to say to you, like, I'm going to be talking about this with everybody, or I'm trying to talk about this, or can we try and figure out a way that we can talk about that? You know, that's the whole reason we communicate is because we want to talk about something together.
[00:57:16] So maybe they just are looking for something to talk about with you and like all kids, especially if they're. You know, younger kids or, you know, developmentally wise, we think that they might be performing younger. They just want to talk about what they want to talk about. And to be quite honest, I'm an adult and you know what?
[00:57:34] I want to talk about ABC 99 percent of the time. So, you know, you just got to let them do it. 
[00:57:41] Carolyn Dolby: Hey let's we got one more question. So here we go. Anonymous says, even after long term trials, many of their students are not responsive to robust high devices. What factors would influence your decision to recommend light or mid tech over a dynamic display high tech device?
[00:57:59] Great question. 
[00:58:00] Kathryn: Sure, certainly if it is the student's preference you know, in those situations, I would definitely be taking data whether it's, you know, paper and pen or just in your brain how are they doing with some of the light tech supports, like a paper based system? There are certainly, I've certainly worked with kids who are just like So amazing at using the paper base, and they're just like, I don't want this.
[00:58:25] Like, I'm good here. If it's their personal preference and they feel confident, definitely go with that. We always, always want to honor the person's choice in how they want to communicate what they want to use. The other thing is, you know, if they're just also very independent. If everybody you can also even say, you know, at this time, I really want us to focus on using X, Y, Z system but still giving opportunities for high tech.
[00:58:55] So, maybe when you're in a group setting, the high tech is available for them to explore, but then they have their own, like, dedicated light tech system that can be with them throughout the day. So, they're still getting exposure in case they changed our minds. And, you know, you can always do a light tech option that looks a lot like a high tech option because you could print out boards, you know, you could print out every page from one of the boards and, you know, You know, put them in a binder.
[00:59:24] So that's 1 way that you can do it. And I hope that answered that question. But it's very, you know, depending on the person, you know, and again, it sounds like you just really want them to have access to something. And if that's what they're using right now, you do sometimes have to meet them where they're at.
[00:59:39] You want them to be motivated to use it and if they're just. Not motivated to use something high tech. They're not using it. They don't feel confident. It seems difficult for them. Meet them where they're at. And then you're developing that language. They're getting so much vocabulary. They're able to practice interacting.
[00:59:56] Maybe they'll have more opportunities to use it. And then eventually you can revisit high tech. 
[01:00:03] Carolyn Dolby: Wait, I think I went, I think on the flip side of, I think maybe how to support your recommendation. Oh, okay. Or mid over a high, cause I think, you know, I don't blame a parent saying, no, I want the fancy.
[01:00:16] Kathryn: Right. 
[01:00:17] Carolyn Dolby: Most expensive because, you know, 
[01:00:19] Kathryn: I want. Of course, of course, everybody wants the best for their child or the person they're supporting. Okay. Okay. I think you're just going to go back to that data saying, like, look how spontaneous they are with this. Look how independent they are. This is their autonomous communication.
[01:00:35] Whereas with the other program, and, you know, this goes for whether you're comparing high tech and high tech or high tech and light tech whereas with the other program, it is every single utterance is specifically From a direct model, every single utterance is with so much wait time, or they're pushing it away.
[01:00:56] You know, those types of things you can write in a report or use as justification and something I wanted to mention as much as you can getting caregivers or other team members to attend your evaluation sessions or your therapy sessions. So they can see AAC in action, how you are. interacting with AAC and modeling and providing wait time and using open ended questions in action and then they'll also see, oh, okay, wait you know, they did so much in this area.
[01:01:35] They wanted to talk about this. I should really be talking about this more or, oh, wow, I see that program number one is really such a better fit because I see what they're doing. Like they can make a Sentence much faster or communicate a short message to me very quickly. 
[01:01:51] Carolyn Dolby: Right. So I mean, I think you're right.
[01:01:52] You're saying is you're recommending if you are recommending mid or light. It is because that is their, their mode right now. But I think also to say that that might not be where they stay. 
[01:02:04] Kathryn: Of course. Yes. You always want to say, and even if they are using high tech. I always let families know this is a dy it's dynamic.
[01:02:12] We can be changing so many things all the time, you know. There are times that you're going to go up a grid size because it's just, it's what you want to do. Maybe you have to shift to a program that has a keyboard right on the homepage because they're getting so good at spelling and they're using spelling all the time to support their communication.
[01:02:32] It's we're always looking. How can we make it better? So right now, they might be using that light tech system. And you're constantly looking. How can we make this better? How can we make this better? And it might be, you know, after a year, what's making it better? Is that shift to high tech? But for some students, it might take a little bit longer of time.
[01:02:52] You're, you're just constantly assessing what is meeting their strengths and supporting their needs. 
[01:02:58] Carolyn Dolby: Right. Data, data, data.
[01:02:59] Kathryn: I know. 
[01:03:02] Carolyn Dolby: Well, I can't believe that it's coming to an end. 
[01:03:07] Kathryn: I know, I could talk about it forever. 
[01:03:08] Carolyn Dolby: I know. I want you to keep going. But Kate, you have been an amazing guest. Thank you so much. I really hope that you will come back.
[01:03:18] And again, I mean, you, I, I love your resources. I'll make sure that the references are available too. 
[01:03:26] I think that's powerful, but you know, everybody wants those free, you know, we Great resources were wonderful. 
[01:03:33] So thank you so much. 
[01:03:34] Kathryn: You guys were so amazing. Thank you so much for letting me talk your ears off about ABC.
[01:03:41] I love doing it and I hope you're all just as excited. And if you ever have any questions or want to learn a little bit more, you can follow me on Instagram at AAC with Kate. So I'm going to drop that in the chat. AAC with Kate. 
[01:03:56] Carolyn Dolby: I love it. Thank you. All right. We look forward to seeing you again. Thank you.
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