143: Get Set: How To Conduct Dynamic AAC Assessments

TRANSCRIPT

[00:01:00] 

Venita Litvack: Hi everyone. Thank you so much for coming to this session. I am super pumped to have the AAC coach here today. I've been dreaming about getting her on the podcast for a while and it's finally happening. So I've asked her to come on and talk about conducting dynamic AAC assessments.

And I can't wait to hear what you have to say, Kate. So really quickly, we are going to do some brief introductions and backgrounds. Then we're going to talk about the universal requirements for emerging AAC learners. Then we'll jump into the different models of AAC assessment and talk about the important [00:02:00] decision makers that need to be involved in the process.

And we'll wrap up with a description of dynamic assessment. So really quickly, if you're not familiar with me, my name is Spinney to look back and I have a passion for AEC assistive technology and literacy as well. I have been able to deliver a couple of poster presentations on AAC at Asher. I used to be a consultant for device company and a school district assistive technology specialist here in Florida.

Now I am a part-time tele therapist, AAC consultant, and host of the speechy situp podcast, as well as a mom to a little over one year old. And all of a sudden at the beginning of the year, I just said, I'm going to do a try out. But I'm doing a sprint triathlon to be very clear. It's like the easiest version of a triathlon.

So we'll see if it happens by the end of the year, but Kate, I can't wait to learn more about you. Can you go ahead and introduce 

Kate McLaughlin: you? 

Sure thanks. My name is Kate McLaughlin and I am a speech language pathologist, specializing in AAC [00:03:00] for kids with complex communication needs. Uh, my focus of my practice is really on autonomous communication and helping kids and their families on their journey to achieve autonomous communication.

I am a. Ashes certified speech language pathologist, and I hold licensure in the state of Connecticut. I'm here in Connecticut. I'm in private practice. I, um, provide direct therapy services as well as consultative services, um, to individuals as well as school districts. And I've also created an online course that's available through learn, play thrive, and that course is called authentic AAC, implementing communication systems for autonomy and connecting.

Venita Litvack: Yeah, that course looks amazing. How many credits 

Kate McLaughlin: is that worth? So it's registered with Ashoka for, um, 1.2 CEU. So it's 12 credit hours. Contact hours. 

Venita Litvack: Yeah, that's incredible. [00:04:00] I love her courses. She has like a few, but they're very in depth and just highly specialized. So I look forward to looking at that one, um, in the future.

So our hope by the end of this podcast today is that you'll be able to identify two universal requirements for all emergent AAC users described two models of AAC assessment. Identify three key stakeholders in AAC assessment. And finally describe the dynamic process of AAC assessment. And I think we skipped our financial disclosure.

That was my fault. Um, Kate, I'll let you go ahead and share yours and then I'll share mine afterwards. 

Kate McLaughlin: Sure. So in terms of financial disclosures, I am the owner of AAC services of Connecticut, and I receive a salary in that position. I'm also the owner of the AAC coach, and I receive a compensation for speaking and coaching services.

And I, as I mentioned, Of course creator [00:05:00] for learn, play to thrive. And I receive a commission for the sale of that course in terms of, uh, non-financial disclosures. I serve as the unpaid ch AAC chair for the therapists and our diversity collective. 

Venita Litvack: Awesome. And I should have put it in here, but you're also receiving a state.

Or this pod course. Um, and then in terms of my relevant financial relationships, I have ownership interest in speechie situp LLC and tassel learning, LLC. And I receive royalties from the bluenose what to do book series. And I am a member of Pascha special interest group 12. We already talked about our learning outcomes.

Now let's dive into the interview. So Kate, what are some important considerations from your perspective and the evidence to keep in mind when considering AAC 

Kate McLaughlin: assessment? So when I, when we start out on an AA, uh, for an AAC, Assessment. I think we need to recognize some universal needs of all AAC users. So often we jump into [00:06:00] thinking about what does this individual need, but we need also to recognize what do all AAC users need.

And when we think about this and, and my practice here, Is largely informed by Gail Porter's work. Uh, and she identifies, um, and the resource for that is, is listed, um, at the end of these slides. Um, but she identifies accessibility, uh, specificity efficiency, intelligibility, and social value as universal needs for AAC.

And what that really means is. All AAC learners need, um, an accessible system and that system needs to be robust. Um, and I'm sure that's something that you've probably talked about in the past, but if I'm happy to talk about what that means in terms of rural bus system, but they need to have access to that system.

And they also need partners who are knowledgeable about AAC and. Who have habits to support [00:07:00] AAC, accessibility. So it's not enough just to have the system. You need to have people around you who understand AAC and understand how to make it truly accessible across the person's day. Um, you need a system that allows you to be really specific in your communication.

That that means, and that speaks to that robust language system. You need a system that has lots and lots of vocabulary that allows you to communicate for lots and lots of different reasons. The, when we have our own thoughts that we want to communicate, we need to be able to have really specific vocabulary that allows us to share those thoughts and to express our personality, right?

Our language choices, um, reflect who we are and share that with them. Uh, ACE users need a system that allows them to be as efficient as possible so that they can keep up in conversation, um, and that they can communicate effectively and as quickly as [00:08:00] possible, um, at all times. So we need to address. In there for fatigue or positioning, um, so that we make sure that, um, that their AAC isn't only, um, accessible and efficient for them when they're in an optimal, uh, state or optimal positioning.

But truly that is as efficient as possible. All of the time, um, AAC users need language systems and AAC supports that allow the. Give them intelligibility of communication. So as many people as possible understanding what they're trying to communicate. And when we think about AAC, um, in general, we want to think about it in the context of multimodal communication.

So we're not just talking about expressing yourself through an AAC system alone, but looking at a toolbox of communication skills. And how can this individual express themselves as intelligibly as possible, so that as [00:09:00] many people as possible understand them, and that may look different, um, with different partners, right?

You may need a formal AAC system to communicate broadly with a wide community, but for people who, you know, really well and tell the build communication may be, uh, vocalizations and gestures. People who know. And then Gail Porter talks about having as socially valued an AAC system as possible. And that what that she's basically saying there is, we want a system that other people look on and respect and interact with that individual.

With respect, whenever we're talking about. Social value. I think it's really, really important that we keep in mind, um, an awareness that we do have, uh, a range of, um, diversity and social intelligence. So we have different type neuro types. We have, um, neuro-typical people and we have, um, neurodivergent [00:10:00] individuals and we want to really be aware.

Of the double empathy problem or we're thinking about social value and what the double empathy problem really talks about is neuro-typical people. And, um, our divergent people, um, do really well interacting with, uh, the same neuro type. But when. Neuro-typical individuals interact with, um, nor divergent individuals.

Uh, there's a lot of miscommunication and misunderstanding that happens on both sides. So whenever I'm talking about social value of an AAC system, I want to keep in mind that we're not trying to hold. Julie, our neuro divergent clients, our autistic clients. We're not trying to hold them to neuro-typical standards, but we're trying to make them successful in the social interactions and the life that they want to have.

So when we're thinking about what's socially valued, what's socially valued for neurotypicals is going to be different than what's valued for autistic people for [00:11:00] type. So, um, we want to keep that in mind whenever we're considering social bad. And then in addition to all of that, that, uh, Gail Porter has talked about, then we also have, um, our AAC competencies that have been described by Janice light.

And those are linguistic competencies, social competencies, operational, how to use the device and strategic. What kind of strategies do you know that allow you to communicate, um, and make up for some of the, the things we know about AAC that. Uh, by nature, less efficient than speech. So we want to be thinking about when we're doing an AAC evaluation, all of the skills that our learners are gonna need to have, and the supports are gonna need to have in place, um, to, um, be able to communicate and to do that autonomously, to be able to say what they want to say when they want to say it, how would I want to say it?

And to whomever. So all [00:12:00] of those are universal needs regardless of the learner that you have in front of you, um, that those needs need to be accounted for and thought about whenever we do an AC evaluation. Um, so it's not as simple as just considering a device, uh, right. What we're considering is a language system.

Is it going to meet all of those needs we're considering access needs? So, um, what are the, our learners, individual sensory, uh, sensory motor and vision, uh, needs. And then we need to consider the learner in the context of their community, right? It's not as simple as an individual with an AAC system. They exist in, in the community, um, that needs to understand them and support them.

But we also have to make sure that the AAC system reflects their language, their race and ethnicity and their gender identity. So there's a lot to take into account when we're doing an ACSS. [00:13:00] And again that, um, all of those things, um, are, uh, in the context of multimodal communication. So even though there's a lot for us to think about here, when we're doing an AAC assessment, it's just one piece of the puzzle, right?

It's about kind of helping, uh, an AAC learner, um, use all the communication school, uh, skills at their disposal to interact with other people and to, um, share themselves with the. And then when we're thinking about a C assessment, we're also need to recognize that we're not just talking about this moment in time and making sure that the learners communication needs are met for the current moment, but that we're, we're laying a foundation.

That will support them long into the future, um, so that they can be growing skills that will support, um, support them. And, and this is where that dynamic assessment piece comes in because we do grow and change as we age. And, and we need to make sure [00:14:00] that the AAC meets their needs. Um, across that, that lifespan.

The one thing that I didn't mention that falls really under the partner piece is the understanding of co-construction as a universal need. And when I say co-construction, I mean, Um, it's not as simple as an individual. Creating a message on an AAC system and playing that message. And, um, it's really a back and forth between the partner and the AAC user and that the understanding and the shared meaning that comes out of that interaction is truly co-constructed.

Um, all of our conversations are, um, but sometimes when we sit down to, uh, Pick an AAC system and teach it to a student. We get so focused on their use of the system that we forget that it exists in conversation. And when, um, AAC learners are. Developing their skills often that co-construction is incredibly important for them [00:15:00] to be expressing themselves and being understood by others.

So there's a, in terms of that, those partners being knowledgeable and how to, how to support, um, AAC learners. I think, um, we need to think about co-construction a lot more than we, we often do. That makes sense. So that it's a lot of information. Um, but basically we need to be aware that, um, AAC needs don't vary as much from individual to individual, as we might think.

Um, all AAC learners need. Um, really robust systems. They need partners who understand them and understand AAC, and they need time to work on lots of skills and develop those skills, um, far into the future so that they can be successful communicators and live autonomously, live the life they want to. 

Venita Litvack: Yeah, thank you for that summary.

I feel like that was a good, um, brief summary of everything that you just [00:16:00] explained. Is there an assessment protocol or checklist that includes these areas that you like to use? 

Kate McLaughlin: It's a good question. I'm not, that's going to be that straightforward, unfortunately. Um, there are some great, uh, assessments out there that I think.

Take these pieces into consideration more than others. I really, really like the AAC, the pragmatic profile for AAC learners or AC users. Um, it's a really great, uh, assessment of communication skills that looks at communication, not just. Um, in the context of AAC, but looks at the whole learner, um, and it looks at them across their, their life.

So are you going to find a checklist? That's going to go through this step-by-step for you. Unfortunately not, it'd be great if, if somebody created something like that for us, I think that there's so much variation when it comes to, uh, culture and context and all of [00:17:00] that, that. It would be a challenge to create something like that.

But I think as practitioners, if we are keeping these things in mind and we are, we're checking back in with these things, how are we doing in these areas? Um, we can, we can do well by our, our learners for sure. 

Venita Litvack: And then another question I had is. How does the funding source play into this or does it not in your eyes?

Well, 

Kate McLaughlin: of course it does. Right? In reality, funding source does play into this. I think that, um, the way I look at it is we have to have, as, as clinicians, we have to have a really good understanding of what is actually needed to create competent AAC users. And. And then look to our, uh, funding sources and our procedures to see how we can get.

Meet those needs with what's available to us. Right? So, uh, unfortunately the funding systems don't look to are [00:18:00] these universal needs always, they look to their bottom line. And so I think that as clinicians, if we have a really good sense of what's needed, and we have a firm understanding of why it's needed, then we can make selections within the funding systems and structures that we have available to us that are going to best position our learners.

That makes sense. 

Venita Litvack: Awesome. Is there anything else that you wanted to share about the considerations before 

Kate McLaughlin: we move on? No, I don't think so. I think that was, and we can always come back to share. Yeah. So now can 

Venita Litvack: we talk about the different models of ACFS. 

Kate McLaughlin: Yeah. So my work is, is largely, um, informed by the participation model, which, um, Fuelman and Miranda have written about.

And really what that model does is it looks at participation patterns and communication needs across a, an individual's life and across settings. And when we do that, we look to identify [00:19:00] barriers and supports for the learner in terms of access to AAC. We want to be thinking about, um, and I'm sorry, this slide's a little confusing here, but the opportunity and capability access fall under that, um, access, uh, barriers and support.

What we want to be doing is determining what barriers are there in terms of opportunity and what supports are in place in terms of opportunity. And then what barriers. Place in terms of skill and access and what supports are in place, um, so that we can make a plan for what the learner needs for today and then what they need for the longterm.

As we, as we talked about, and what's really nice about the participation model, especially in this conversation around dynamic assessment is we make that plan and we implement it. And then we come back to assess, how is that working for us? Right? Is, is, uh, The system and the choices we've made are they meeting those needs and if they are great and we continue on and if they're not, then we [00:20:00] need to reassess the barriers and supports and figure out how can we problem solve and make that better.

So the, and the participation model is really a continuous process. It's not a one and done it really recognizes that, um, AAC assessment is really an ongoing process. Um, yeah, sorry, go ahead. No, no, no, no. It was going 

Venita Litvack: to say yes, I can definitely see that. And I liked that it accounts for the environmental factors as well.

Can you give some examples of some types of barriers or some types of supports that you might see with? 

Kate McLaughlin: Sure. So, I mean, barriers can be a partner knowledge, right? Partner beliefs about a learner. Um, it can be access various, so it may be access to an AAC system, or it may be access to an appropriate AAC system in terms of, is the learner able to actually use it.

If you have a learner in more, a complex body and they have an AAC system that doesn't [00:21:00] allow them to access that in some alternative means other than direct selection. Well, that's. Access barrier. So there's a lot of different, um, barriers that may come in terms of access. 

Venita Litvack: Thank you. And then for support, I'm guessing would be like the opposite 

Kate McLaughlin: of a lot of things.

Yeah. The opposite of that, having partners that understand Daisy, having partners who understand how to support the individual, having partners who create space for the individual to communicate and, and. Help them gain access to interactions and experiences, academic or vocational or otherwise where they can communicate and they can work on building their skills and interacting with other people.

Um, so, uh, and again, supports having good systems that are well well-matched to the learner. Um, yeah, 

Venita Litvack: and I think I cut you off. Was there anything else that you wanted to share about. Oh, 

Kate McLaughlin: well, in terms of different models of assessment, I think, and I think there's another, [00:22:00] um, on this slide. Yeah, there you go.

Um, if there are different procedures and I think this goes to the funding source question a little bit, um, different procedures that we tend to follow. When we do an AAC assessment, there's more of a medical model and part of this. Has largely been informed by, um, the insurance funding system of doing three historically three extended trials of different AAC systems, collecting data on that, making a, you know, proceeding that would be a feature match of figure.

What system works for the learner. And that's a part of all of this, but picking three systems to trial, collecting data, and then making your choice. Um, and, and that is certainly necessary when you're doing a, um, insurance-based funding. Of an AAC system, but what I tend to be more of a fan of is the specific language system, first approach that crispy gay has talked about.

Um, and that really [00:23:00] looks at having a system that is really well designed to meet the needs of many, many learners. And I think for school systems, this makes a lot of sense to have a system that is likely to work for many, many learners. And have that be the first system you trial. When we do the three extended trials, what often happens is in that say it's a month long trial.

The learner is just getting up to speed without one system. And then we change the game on them a hundred percent and ask them to learn another system. And then we do it again. And then we try and compare those things. Well, the problem with that is there's a lot more value in the learner having one system and sticking with it and taking that time to learn and build their skills, um, rather than us.

Keeping them in this place of changing the game on them. So if we start with one system first that meets the needs of lots of learners, um, then they can have the time they need. And if we then as part of our [00:24:00] evaluation and dynamic assessment, say, Hey, this is not working for some reason. Um, it particularly around access that this system doesn't meet, this individual learners needs, then we can look to another.

Um, but that works really well when you have, um, uh, like in a school district where you ha you can build a community of, um, individuals who are using the same system, because one of the other struggles that a lot of teachers have when they have classrooms, where everybody has a different system, they're, they're juggling to try and create these rich language environments that our learners need to develop their skills.

And if we follow a specific. Uh, language system first, then many of those learners are likely to be on the same language system so everybody can be learning together because one of the things we know about language development is it assumes a community of language users. Um, The learner can learn [00:25:00] from, um, like your daughter at a year, she's in a, an environment where everybody's communicating around her using the language system that she's going to develop.

Right. And we want to create that same type of experience for AAC learners. So following that specific language system, first approach, we're more likely to be able to provide them with that. That 

Venita Litvack: makes sense. So when you're picking the specific language system, us, and we've actually had Chris Fu gay on, and he did bring this up in his pod course, but, uh, I'd like to talk about it a little bit more when you're picking a specific language system.

First, are you picking one that accounts for maybe more access methods? 

Kate McLaughlin: I personally, yes, personally, I'm looking for as robust a system as possible a system that will support learners now and into the future. So a system that's accounted for language development over time and meet those changing language needs.

However, that system does it, I'm looking for a system that offers [00:26:00] as many access methods as possible. Right. So I you're likely have learners who are direct selectors and can use a standard iPad. Right. Um, or a communication book where they can touch. Um, but you're also going to have learners who aren't going to be able to direct select that way.

And they may need a scanning system, or they may need eye-gaze or, you know, they may need to use different methods of access. And I want a system that accounts for that, because there are. Systems for direct selectors, um, where the language system is organized to make everything equally accessible.

Meaning if you're a direct selector, you're touching a touch screen, everything on that screen is equally accessible to you. It's one hit two hits. However many, if you're a scanner and you have to scan through not everything is equally accessible, but things that are earlier in this. Aren't going to be faster, easier for you to access.

So [00:27:00] ideally we want a system, a language system that has options that will. Uh, communication efficient for our alternative access users. So a system that, um, has designed, uh, options that prioritize important messages for scanners so that they're not having to scam through lots and lots of things to get to, uh, basic needs or, or, or, you know, um, things that are more frequent and conversation than others.

So, yes, I want to be able to look for a system that is. As robust as possible, but we'll also meet as many, uh, learners needs as well. That makes 

Venita Litvack: sense. And you had mentioned having a system, maybe for someone who is switch scanning that gives them access to quick phrases. And now we're hearing more about gestalt language processing.

I actually had Alex on yesterday. And it seems like that would be, there's not a good system [00:28:00] out there right now for these type of learners. So if we're implementing like a specific language system first, it might not even be the best type of system, but it sounds like if you kind of treat. Like ours individuals who switched scan, where they have access to phrases, that might be the way to go until we get better systems 

Kate McLaughlin: for this population.

Yeah. I think, I think, and that's a big conversation right now. How do we meet the needs of our gestalt language processors? And, um, and Alex is doing great work there. Um, I think that I just want to go back to the switch scanners for a second to say it's not just that they need access to phrases. They need access to language.

That's organized in a way where the most frequent stuff. The most F uh, provided to them in the scan as early as possible. But yes, they also need phrases as all AC learners do. Um, and particularly for our gestalt language processors, they are going to absolutely need gestalts available to them in their, in their device as well as language, um, that helps [00:29:00] them mitigate those gestalt.

So break up those gestalts and combine those. Um, with other chunks and other words to support their language learning over time. So yeah, there isn't. So when we think about what is the system right to pick as a specific language system, first, that's one area that we need to grow as a field. We need to think about how are we meeting the needs of our gestalt language processors.

And we're, we're really lucky that that conversation is happening now. And certainly. That comes into play when we're considering what system to use. And at this point in time, I think we're thinking about I'm an Alex and I've done some work together on this thinking about what, um, what those modifications might be to current language systems.

And then also, how, how do those modifications get, uh, W become more part of those language systems so that they can meet as the needs of as many learners as possible, or, um, over time we might learn that language processors need something more specific, and that might be a reason [00:30:00] why we move on to a different system.

Like tier two as Chris 

Venita Litvack: explained. Oh, wow. Well, it's an exciting time, you know, we're learning we know better now. So I'm excited to see where the field goes in that direction. Anything else that you want to talk about in terms of the models of AAC assessment? 

Kate McLaughlin: No, I don't think so. No. Okay. Awesome. 

Venita Litvack: All right.

So let's talk about the key stakeholders that we need to consider when conducting AAC assess. 

Kate McLaughlin: Sure. So an ESE assessment has to be a team-based approach. And I say has to, as, um, that if it is at all possible, it needs to be a team-based approach. Um, so it needs to include the learner themselves needs to be a primary person in that.

Um, decision-making team and their family needs to be a primary participant whenever possible in that decision making team. But of course, we [00:31:00] also need SLPs, OTs, PTs, um, teachers of the visually impaired. Orientation and mobility specialists, whenever you can get them, that's wonderful. Other 80 professionals and really anybody else in the learners life who is a stakeholder and seeing them be successful with AAC.

I really, when I say to families and what I say to team. I really look to the individual and their family to be, um, decision makers. So, um, I think that our role as professionals is to provide them with information, to make good choices about their AAC, um, system, because the family is really going to be.

The people around the learner for the long run, right. Speech pathologists and other therapists come and go out of a learner's life. The family is really there for the long haul, so they better know why they're choosing what they're choosing and know [00:32:00] that it's a good fit for their family. Um, so thinking about that, um, more of a medical model versus a specific language system first.

If in that medical model, I'm making decisions with the family about what systems we're going to try and I'm explaining and helping them understand why we're selecting the systems we're selecting and, and really making, helping them become informed consumers. The the, uh, the information and, uh, the AAC systems and making them primary decision-makers.

And when I think about the specific language system, first, uh, method, I'm bringing them in really early and explaining that to them. This is why we're doing it this way. It's not that we are trying to fit your child into this box. But, you know, we have selected this system to meet the needs of as many learners as possible.

And this is the community of language users that we're building, because that will support your child in terms of their learning. And then let's talk through that system. And, and if we then [00:33:00] look to another system or if the family feels very strongly, that that system doesn't meet their learners needs.

Language reasons maybe, um, then, then looking on, but they need to be, um, uh, a primary participant in the whole process. Absolutely. 

Venita Litvack: I didn't. I know you work in private practice. Do you do assessments 

Kate McLaughlin: for schools as 

Venita Litvack: well? Or is it primarily? Okay, so this'll be a relevant question then. What is the best way for school-based therapists to get the family involved in the assessment process?

Kate McLaughlin: What are your suggestions? Well, I think. I think we want to be looping them in as early as possible. Right. And having them be part, part of all of the conversations and be meeting with them. The truth of the matter is we're doing an AAC assessment because we have a really complex kid in front of us, you know, some more complex than others, but the more complex, the profile of kid, the more, uh, of our time and attention they're going to [00:34:00] need.

And the more collaboration across team members are, is going to just be essential. So. Bringing the family into those conversations as early as possible. And again, providing that, um, information as, as much as possible to them pointing them in resources where they can learn more, um, and bringing them into the evaluation.

So often I see a. People do evaluations where the family hears about the results afterward. And ideally I don't, I don't like that model. I think they need to be in there. They need to be seeing it for themselves. They need to be understanding and hands on a system so that they have a sense of the, again, what we're doing and why and where that fits in the longterm for their child.

Um, the other thing that I talk about a lot, when I think about AAC is this long-term vision. Learning AAC. Takes a long time and it requires a really long-term vision to [00:35:00] keep you on the path that will get you to the place you want to go. And often if we don't include parents in that, um, it's frequent that team members change and then, oh, somebody has something they like better, or they want to try something.

And the poor learner is just. The game is changing on them all the time. And what we know about language learning and AAC learning is it takes a long time. So again, going back to that, those three trials, if we're changing the game on the learner a lot, that's a problem. So bringing the family in to the process as early as possible and helping them be as informed a member of the team as possible is really going to pay off in the long-term and it's worth the time to do it.

Um, it's worth the. Um, because it really is about setting the learner on a journey towards autonomous communication. I know not all families are, um, in a place where they can devote the time and the resources to that. And that that's, that is a [00:36:00] reality. Um, I think as professionals, we want to do our best to include them in whatever way is, uh, possible for them.

Not everybody has the time to come in and, and do all that. And, and I think we need to work with families as much as possible to, to work around. Their individual needs are. So I don't say all this to, to, um, be naive to the barriers there, there are, you know, uh, families really do struggle with a lot of things in life.

And so we want to be mindful of that. But, um, again, knowing if we have a sense of knowing what are, um, what's needed for all learners, what's our ideal situation. Then we can, um, try and create as close to that as possible for. 

Venita Litvack: That makes sense. Thanks for sharing that. Um, were there any other points on this, this 

Kate McLaughlin: part?

No, I think my, my big takeaway is who the decision-makers are and yeah. Awesome. 

Venita Litvack: Perfect. [00:37:00] All right. So how long does the AAC assessment process take? You've alluded to this, I think throughout. So let's 

Kate McLaughlin: talk about it a little bit more. Yeah. Um, it takes a long time. It really doesn't stop. Right. So. R. And as we said before, this is really built into that participation model.

That it's a constant process. Um, it is truly dynamic assessment. We are always kind of watching what's working well, what barriers are and problem-solving those and that it's that process of dynamic assessment. And I talked about that long-term vision, it's that active engagement and. Process that actually gets you to that longterm outcome because learner's skills change as they grow and develop, they may be developing motor skills that give them more access opera options, right.

They may be developing motor skills that make them more efficient and they're. Um, hopefully they're growing their language and literacy skills so [00:38:00] that they may decide that, oh, I, you know, I used to communicate primarily with symbols and want text-based communication become more primary in my city. So we have to account for those changes as the learner grows, additionally, their needs change in terms of what language they need, access to what language is important to them as a teenager is very different than language when they're, you know, preschool, elementary age, um, and the settings they're in are going to change.

Um, if we're doing a good job in terms of inclusion, We're thinking more about peer relationships and, and, uh, eventually vocational settings. And so their, their language needs are gonna shift and grow, um, over time. And so we need to be thinking about those on an ongoing basis. Um, and additionally, as they kind of get a sense of who they are and where they, you know, what they like, what they don't like.

Um, That will evolve in terms of what [00:39:00] a system needs to do to reflect, reflect them as the individual. So, um, the, all of those things change. The other really cool thing that happens that I've had the benefit of following, um, some really complex learners over extended periods of time. The longer we work with a learner or, and this, I think this speaks to the family, being there through all of it, we get a much deeper understanding of our learners, strengths and personalities of their needs.

And then that. Makes us that much more equipped to do the dynamic assessment and make the tweaks that are going to make the system as, um, effective for them as possible. So short and long answer short, but short of it is really, it never really ends. It's a, it's a learning process and a process of, um, assessment and modification for as long as you're working with an agency.[00:40:00] 

Venita Litvack: So I know this is going to be a, not straightforward question, sir, but let's say you encounter a team and, um, you know, they say, okay, the device is not working. This client had it maybe like over a year, even longer. What is your. Consideration in that type of case, 

Kate McLaughlin: first consideration is what's happening now.

Right. So what does, um, what does the AAC teaching look like? What does the implementation look like? Um, does it match up with what we know is best practice for AAC implementation? Is there a lot of modeling of that AAC system across. Um, across settings across people, are people modeling without expecting the learner to respond exactly in that moment are, you know, not requiring them to [00:41:00] imitate or not prompting them to, to use the system when the learner doesn't want to, when the learner doesn't honestly have something to say, I, you know, are people making the device feel like work, right?

Because often, uh, learners will, you know, we want. Think about their system as a system that helps that opens up possibilities for them, helps them express what's on their mind, not something that they do, um, to meet other people's needs or to do academics or, you know, it, it has to be something that grows their life, not something that feels like work.

So I really first and foremost, look to what's implementation. Looking like, again, I also, part of that is how well selected is the system for the learner? Is it a robust language system, um, which is necessary for a, um, a learner for aided language or modeling to be happening in a, in a real authentic way.

Um, and is it truly physically accessible to the learner? So. [00:42:00] It may be, and I've, I've met learners who have what looks like good, fine motor skills. Um, but they're not accessing their device and come to find out there's some underlying vision issue. Um, like cortical visual impairment, that's getting in the way of their system, accessing their system.

Right. Or it may be something like a gestalt language processing we talked about earlier. It may be that they're not using the system because this is not how they, how they develop language. And so we need to make some modifications to make sure. Um, so it's, it's really. The answer to the question is it's this dynamic assessment process it's really looking and seeing what's happening now.

What are the barriers? What are the supports, you know, and what needs to shift. And what I often say to people is it's never the learner, that's the problem. They're never, the reason that AEC is not working. What we need to do is, um, sometimes it's the AAC system, as I [00:43:00] mentioned, in terms of. If it's not robust, if it doesn't honestly meet their access needs or their language needs or their physical access needs, um, more often than not.

Um, when a good AC, uh, match has been made, it's the implementation where things fall apart. Um, it's, it's, that's the, we're not creating a context with the learners experience is either seeing their ASE used so learning so that they can learn how to do it themselves. Um, or they're not seeing, they're not seeing it use for reasons that are authentically important to them.

And. Uh, see it used in a way that feels really safe and supported and interesting to them. And so more often than not, it's a shift in implementation that has to happen. Sometimes it's Fitz have been going on a really long time and the implementation has felt negative to the learner. Then we need to kind of look to a different system sometimes, so that we're just shifting the whole, whole game for the learner.

And really clearly communicating that we're making a [00:44:00] shift, but honestly, Um, often we're also able to make that shift just by drastically changing the implementation. 

Venita Litvack: That makes sense. You said something that I loved and I wanted to repeat it. You said the learner is never the reason AAC isn't working.

And I think that's an awesome quote and takeaway from this. Um, one other thing I wanted to ask is how are you choosing grid size? Are you. Is that something that you consider the access piece in AA? 

Kate McLaughlin: Yeah. I mean it all, again, it, it will vary based on the system that's being implemented. Um, I looked too, so.

It's a, it's a complicated question because it, um, if you're working with a core plus content system, um, by that, I mean that core plus categories, uh, or, or, uh, core plus fringe system or a, uh, a motor plan based system where you [00:45:00] have direct selectors and people, so good, fine motor goodness. Then really you want to provide them as much in an array as they can handle.

Um, and when I assess that I'm not looking to see, can they find things I want them to find, can they use it? Can they, um, isolate a point to select things they want to select? I don't so much care whether or not they know what they're selecting yet, because that's something that develops over time, but can they, can they select small target?

Right. If they can, then I'm going to try and give them as much on a page as possible, um, because, um, that's going to decrease their navigating needs and, and, um, make communication more efficient. Um, but, um, if you're looking at a system that is, um, pragmatically organized, like. Then I'm really looking at what's their language level.

What are, you know, what are they expressing? Are they expressing a range of [00:46:00] communicative and tense? Are they combining words? And then I'll make a decision based on that individual system. Um, and certainly, um, if it's an access need issue, then we're really having to assess, uh, scanning, for example, what, um, Uh, what are their access needs?

What, what can they physically access? What can we give them and how are we going to grow that over time? Um, I have learners who have started, um, scanning with a relatively small number, but they're also partner assisted scanning a more robust system and they're developing their access needs, um, as we go.

Um, and then, uh, I, and I've lost my train of thought here a little bit, but, um, in terms of how do we decide, um, the, the array, um, when we think about alternative access, it's coming back to me. When I think about alternative access, I think a lot of clinicians are. Uh, scared to go to alternative access it's it [00:47:00] does require a skillset to teach, but we never want to, um, limit a learner's communication, uh, because of motor needs.

Right. So I don't ever want to give. Uh, learner or a system that won't meet all their language needs now and into the future, just because of their motor needs. So in those situations, it's better to look to an alternative means of access so that they can have, um, they can express all of their thoughts then limit.

Uh, with something that meets their motor needs. And it doesn't mean that, um, you can't be doing more than one support. One that gives them, as I mentioned with some scanners doesn't mean that you're not giving them maybe a more simplified support that they can physically access efficiently and then giving them an additional support that allows them to meet all their communication needs.

But it may be slower if that makes sense. Yeah. No, that 

Venita Litvack: makes sense. And you kind of alluded to my next [00:48:00] question where you have like AAC, the assessment process, there's so many parts. And then if you bring in like the alternative access piece, where can clinicians who, you know, went into this, doing an AAC assessment, they thought it was for direct selection.

How can they get support for that alternative access piece? Do we go back to the key stakeholders that you mentioned? Like the occupational therapist, the physical 

Kate McLaughlin: therapist, certainly. So, um, I think, yes, you have to go to the motor professionals that are going to help you think about positioning, um, healthy motor movement.

Right. Um, where does the learner have volitional movement? Um, I often look to head movements, either switches or, um, head nods, um, because, uh, a lot of individuals can develop those with practice. So we have to [00:49:00] be kind of using that team wide approach. And then as individual clinicians, we really need to be growing our awareness of what is out there what's available in terms of systems.

Um, what's needed to teach those systems when it comes to switch scanning, Linda Burkhart's work and. Stepping stones to switch access, which is available on her website is excellent and really gives teams step-by-step approaches to teach alternative access. So we have to kind of look to our team and also, um, look to build our skillset and awareness of what's what's out there.

Venita Litvack: What about the. I know that that's still like fairly new. I think that, um, Dr. Zynga, he actually shared about it on the practical AAC bot blog. Um, is that something that, 

Kate McLaughlin: you know, you're utilizing, I'm not, I am not super, super familiar with it quite honestly. Um, so yeah, that's something that I have to look more into.

Venita Litvack: Yeah, and [00:50:00] it might not even be necessary for that alternative access piece. It's just like some type of protocol that can be used. Um, awesome. The last thing that I wanted to ask, which is probably a question that you hear very frequently, if you're doing any type of. Presentation, like outside of where you're doing your current assessment is how do I get access to AC systems?

You know, where I currently live? Um, if this is not something that they do like on a regular basis. 

Kate McLaughlin: Yeah. So I think these days, lots of clinicians have access to iPad. I think that, um, and a lot of companies will provide, um, in terms of language organizations, a lot of companies will provide, uh, speech, language pathologists with, um, access to those systems to do those kinds of evaluations.

Vendors are often very, um, willing to, um, Provide trial [00:51:00] devices or to come out and trial them with you. Um, so that you can, you can do that work. You don't have to own it, all your, your, your, um, your school system doesn't need to own it all, but it, it is about kind of finding access so that you can do, do the trials that you need to do.

And there, there are, there are ways to do that. Um, if you, if you look to the companies and see what they're already providing speech pathologists in terms of licensed. To systems. And then, um, in terms of technology, if you're looking beyond something like an iPad, um, contexting those vendors there it's, um, they're incentivized to share that with you because that's how they, um, sell their system.

Right. So, um, connecting with them and looking for trial options through them is often. 

Venita Litvack: Yeah. And one thing I always share with the vendors as well is that they're going to have the newest technology and they're going to be the most knowledgeable in that system. So even if you get [00:52:00] access to a device, let's say it like a loan library, it might not be what you would be getting through insurance because it's not like the most recent model or, or whatnot.

So sometimes it is better to just go through the vendors and they typically have vendors like all over the country and in your area. So, but also 

Kate McLaughlin: remember that you're, you're trying to get a sense of your learners needs and their abilities, and you can learn a lot on an outdated device in terms of their access methods and their, their abilities.

Um, but. Th the caution that I give people in terms of vendors is remember, you're not just there for the device. You're really making a decision about language organization and we can't let vendors, uh, tip the scales towards their product and make, you know, we need to really, um, and I know. We practice ethically, but we can, you know, you have to know what's out there to be able to assess it and your vendors are not going to be your unbiased sources.

So educating yourself [00:53:00] about what, what systems are out there, um, and understanding the difference between the technology and the language organization, right? The technology. Often can take up a lot of our, um, attention because it's brand new and it's interesting, and there's a lot to learn there, but really the technology is just, uh, the means with which the learner is going to access their language system.

And that language system is really the long-term, uh, learning, um, focus, if that makes. 

Venita Litvack: Yeah. Yeah. And well, and that's where that device trial comes into play too. That way you're considering different types of devices, hopefully different types of device, you know, systems that belong to different companies.

But, um, yeah. I trust everyone here is making

Kate McLaughlin: Uh, no, and I don't, I don't mean to suggest otherwise, I guess what I'm saying is that. There are a lot of really well developed language systems that [00:54:00] exist separate from the technology that houses them. And so being aware of what those language systems are be the, you know, be it pod, unity, um, word power, you know, all of those different language systems and understanding you're making really two decisions.

You're making a decision about the physical technology and you're making a decision about the language. Uh, clinicians, you know, are making a decision about the technology and thinking kind of the language system comes with it, if that makes sense. Um, but, but there, there are two, two decisions and sometimes like in the case of unity, it does.

Right. Um, but, um, but, but really we want to be, um, looking at both things. 

Venita Litvack: Yeah. Well, and sometimes it does too. If it's like a more. Like specialized alternative access. I gave her head pointing because unfortunately not all of the robust language systems accommodate for those types of access methods too.

So it's hard. Right? 

Kate McLaughlin: It's hard. Yeah. And th there's, there's a lot [00:55:00] to know, but I, you know, Um, clinicians who aren't quote unquote, AAC specialists can do this. I mean, it is, it is very achievable. Um, but it does take, like I said, in that universal needs, we have to have a sense of what, what is needed, um, so that we can make those choices for the individual learner.

Yeah, absolutely. 

Venita Litvack: So we talked a lot about assessment today. Do you feel like your other course goes into like implementation and 

Kate McLaughlin: treatment? So the, um, the course is, uh, Hey covers some of what we talked about today in terms of assessment and, and has a lot of information on implementation, um, teaching communication partners, uh, writing goals for school settings.

Um, so it, it really, it is covers both. Um, it's a, it's a course that is really focused on communication, autonomy and making decisions again, because I'm going to talking about that longterm making decisions that lead you to [00:56:00] that ultimate longterm. Through assessment and through implementation. 

Venita Litvack: Okay.

Awesome. So it's like a deep dive. This is 

Kate McLaughlin: just ours. It's a deep dive to say the least. 

Venita Litvack: Yes. Awesome. All right. Anything else that you wanted to share about AEC assessment before we wrap up? No, I think that's it. So these are all of the references that you included, and this will be in the handout or someone can take us, you know, you can take a screenshot of this.

If you like to look at these references now, otherwise they will be in the handout. And where can everybody find and connect with you? 

Kate McLaughlin: So, yes, I'm on Instagram and Facebook as the AAC coach. So you can find me there. I'm also at my website, www dot the AAC coach. Oh, my 

Venita Litvack: gosh, you just reminded me that I just found your treasure trove of free resources on your website and includes all of the visuals you've ever posted on social media.

And then some, and I love that you had [00:57:00] visuals for like different activities. So it was like potato head or, you know, just common things and the type of core words that you could use in those activities. That was amazing. It's such a valuable resource and. So many in there, like, do you know if 

Kate McLaughlin: there's a touch?

No, I don't. I've lost. I've lost, but yeah, there's um, there's a lot of informational handouts and then activity-based kind of ideas to get people thinking about all the different types of messages that you can be more. Yeah, 

Venita Litvack: it's incredible. Actually shared it with some of my clients like the parents, just to give them ideas of what to work on in between sessions not work on, but what they could do modeling in between sessions.

Kate McLaughlin: Yeah. That's awesome. That's great to hear. Thanks 

Venita Litvack: again for that. Well, thank you so much for coming on today and talking about AAC assessment. I feel like this is a very complex. Topic, but he broke it down where I feel like it's a little bit less intimidating and people know that there's, you know, additional resources out there that they can go and check out if they need to.

Yes, absolutely. [00:58:00] Thanks again, Kate. And 

Kate McLaughlin: thanks for having me.