Services for Children and Young People with Disabilities/Special Educational Needs

Advisory Teaching Service

Augmentative and Alternative Communication (AAC)

Nicki Grey

AAC Specialist

Tel: 01452 426955

E-mail: gloucester.ats@gloucestershire.gov.uk

Guidelines

Augmentative and Alternative Communication with particular reference to

Communication Aids

For Children and Young People

0-25 years

Original June 2006

Reviewed: June 2018

Nicki Grey, AAC Specialist

INDEX

1.0 Introduction

1.1 What is Communication? 1.2 Aim of the Policy

2.0 What is Augmentative and Alternative Communication?

2.1 Unaided Communication

2.2 Aided Communication 2.3 Low Tech Communication Aids 2.4 High Tech Communication Aids

3.0 Eligibility Criteria

4.0 Assessment of Need

5.0 The School’s Commitment

6.0 Timescale for Assessment for a high tech aid

7.0 Multi-Agency Commitment

8.0 Identification of need and the referral process for high tech aids

8.1 Identification of need 8.2 Referral Process

9.0 Transitions

10.0 Purchase, insurance and maintenance of aids

10.1 Purchase 10.2 Insurance 10.3 Maintenance

11.0 Monitoring and Evaluation of this Policy

Appendix 1

Protocol for Requesting a Communication Aid

Appendix 2

Referral Form - Request for Assessment/Reassessment for Communication Aid

Appendix 3

Student Information - Request for Communication Aid

Appendix 4

Communication Aid - Request for Individualised Equipment and/or Associated Peripherals

1.0 Introduction

1.1 What is Communication? Communication has been described as ‘the essence of human life’. (International Society for Augmentative and Alternative Communication). It is the means by which we give and receive information about ourselves, and the world we live in. A difficulty with communication impinges on all areas of life and can have adverse effects on social, emotional, cognitive and language development and well - being. People communicate using a range of different methods. Some people may require additional aids to enable them to communicate. 1.2 Aim of the Policy These guidelines lie within a larger framework encompassing all methods of communication. AAC is part of Total Communication, which aims to ensure that all pupils with communication difficulties have a consistent and coherent approach to meeting their communication needs throughout their lives in school and in the wider community. Some children with severe communication difficulties will need to use other methods to assist them. These methods are known as Augmentative and Alternative Communication (AAC).

2.0 What is Augmentative and Alternative Communication?

Augmentative and Alternative Communication (AAC) adds and complements spoken communication. Most AAC users combine aided and unaided methods. Augmentative and Alternative Communication (AAC) is the term used to describe various methods of communication that are used to get around problems with ordinary speech. AAC includes simple systems such as pictures, gestures and pointing, as well as more complex techniques involving powerful computer technology. Some kinds of AAC are actually part of everyday communication for everyone. For example, waving goodbye or giving a ‘thumbs up’ instead of speaking. Or pointing to a picture or gesturing, in a foreign country. However, some people have to rely on AAC most of the time. www.communicationmatters.org.uk/page/focus-on-leaflets

2.1 Unaided Communication

Requires no additional equipment e.g.: - • Body language, facial expression, eye pointing • Sign language (e.g. British Sign language, American Sign Language) • Signing systems (e.g. Paget-Gorman Signed Speech, finger spelling) • Signed vocabularies (e.g. Sign Supported English, Makaton vocabulary,

Signalong) • Verbal/gestural strategies (e.g. cued articulation, cued speech) 2.2 Aided Communication Aided communication is a subset of AAC which refers to those methods of communication which involve using additional equipment, such as picture, symbol, letter or word boards or books and technology-based systems such as voice output communication aids. This may be used alongside speech and unaided communication, (Communication Matters, 2013). 2.3 Low Tech Communication Aids Low Tech Communication Aids are a form of aided communication. These communication systems may take many forms and consist of systems such as pen and paper, objects of reference, alphabet charts and books with photographs, pictures or symbols. 2.4 High Tech Communication Aids High tech communication systems are a form of aided communication. These are devices that require at least a battery to operate. They range from simple single message devices to the sophisticated computer based devices. A reliable method of access is needed for communication systems. Access methods may be direct or indirect. Direct access includes:- • Finger pointing • Keyboard • Infra red or light pointers • Eye gaze Indirect access includes: - • Scanning with an input device e.g. a switch • Head switch / foot switch • Listener-mediated scanning communication (partner assists user to make

vocabulary selections)

3.0 Eligibility Criteria Inclusion Criteria: The Guidelines relate the arrangements for children and young people/ young adults (CYP) up to age 25 who are the commissioning responsibility of Gloucestershire County Council (GCC) and NHS Gloucestershire Clinical Commissioning Group (CCG). Exclusion criteria: CYP up to the age of 25 who are not the commissioning responsibility of GCC or Gloucestershire CCG are not covered by these arrangements. This exclusion applies to those CYP placed in Gloucestershire by other Local Authorities. Also excluded are people over 25.

4.0 Assessment of Need Initial assessment of need is to be carried out by teachers, parents/carers, Speech and Language Therapist (SLT), AAC Specialist, Advisory Teacher as appropriate, to establish the methods and strategies to be used by or with pupils. If initial assessment determines that the CYP requires further assessment for a communication aid the Gloucestershire AAC pathway will be followed. It will not be appropriate for all CYP with communication difficulties to be in receipt of a high tech communication aid. Assessment will determine whether or not a high technology solution is appropriate to their communication needs. This policy assumes that the CYP will already have in place a communication system, such as a book or chart or a system of signing, and that every measure has been taken to use these effectively. There will need to be evidence of the resources that have been introduced, used and reviewed with the CYP. This evidence should include reports of reviews, target setting and outcomes and will form part of the assessment process.

5.0 Commitment of school and/or setting:- • Value and respect every possible method of communication that a CYP may

need to use. • Ensure that all individual communication strategies are supported, by

developing a shared knowledge, skills and attitudes base essential for an effective Total Communication environment.

• Raise awareness and develop a communication inclusive setting. • Ensure all communication support materials are provided for a CYP in all

environments. • Ensure adequate resources to support CYPs’ methods of communication are

provided and maintained. • Offer initial training to staff, parents/carers, peers and other relevant individuals

involved with the CYP in collaboration with relevant professionals.

6.0 Assessment for a communication aid Recommendation for assessment for a communication aid does not necessarily mean that provision of such an aid will be the outcome of the assessment. Assessment and provision of a communication aid should be a natural development from the provision already in place. For example, it will become clear that current communication system is not meeting the CYP’s needs and the possibility of assessment should be agreed by the CYP’s parents, and professionals involved.

7.0 Multi-Agency Commitment There is a firm commitment to involve the CYP and their parents/carers and families at all levels of the process. The AAC Specialist has a key role in co-ordinating AAC referrals. The various disciplines and agencies, which will become involved with these CYP and their families, are likely to include many of the following: - • Teachers • Teaching Assistants • Speech and language therapists • Physiotherapists • Occupational therapists • Clinical/educational psychologists • Specialists in hearing and vision from health • Advisory teachers • Paediatricians • Social services

8.0 Identification of need and the referral process for High-Tech aids 8.1 Evidence of a desire to communicate e.g. a) body language

b) gesture/facial expression c) eye-pointing d) hand pointing e) vocalisation (possibly including some speech) f) objects of reference g) communication boards/books/pictures/symbols h) signing i) able to use an eye transfer (e’tran) frame

• Ability to understand cause and effect • Evidence of turn-taking skills • Some form of reliable intentional movement, e.g. yes/no

• Commitment from parents to use the systems at home/with extended family/ socially

• Commitment from school to support communication systems by offering an

inclusive curriculum 8.2 Referral Process All referrals requesting AAC intervention are considered by the local AAC team. The school/setting must send the referral request to the AAC Specialist. The AAC Specialist will:-

• Check to ensure all evidence is present. • Discuss with Local AAC Team; this includes Lead Advisory Teacher, Speech

and Language Therapist. • Ensure all criteria for referral have been met. The assessment may be undertaken by the regional Specialised AAC Services also known as the HUB, or the Local AAC Team. The Hub This relates to the official document, Guidance for Commissioning AAC Services and Equipment, NHS-England, (March 2016). An individual accessing a specialised AAC service would have the following:

a severe or complex communication difficulty associated with a range of physical, cognitive, learning or sensory deficits;

a clear discrepancy between their level of understanding and ability to speak.

In addition, an individual must:

be able to understand the purpose of a communication aid

have developed beyond cause and effect understanding, and may:

have experience of using low tech AAC which is insufficient to enable them to realise their communication potential.

Local AAC Team (also known as the Spoke) A graduated assessment may also be undertaken by the Local AAC Team in consultation with parents/ carers, and staff working in the school/setting including professionals involved with the CYP.

The protocol for requesting a communication aid is given in Appendix 1. Appendix 2 contains the referral form to be completed by the school/setting. Appendix 3 gives the Student Information Form to be completed for the local team assessment. Appendix 4 gives the specific request form to be completed after assessment and consultation.

9.0 Transitions

If a CYP moves to a non-maintained setting, with a communication aid, owned by the LA the LA will continue to loan existing equipment for a period of two terms. The receiving setting will need to re-assess the CYP’s needs. Post 16 transitions The Local Team will support the transition if the communication aid has been commissioned through the Hub/NHS England.

10.0 Purchase, insurance and maintenance of aids

10.1 Purchase (Local AAC team) Where there is evidence to support the recommendation for a communication aid the LA will loan the equipment. Schools will have a commitment to provide the first £300 of the cost of the equipment. All schools will have a commitment to purchase and update software as required. 10.1b Purchase (The Hub) For those that meet the Hub criteria: AAC systems will be provided by the Hub following the assessment period if identified as appropriate. The Hub will issue, monitor, maintain, recall and refurbish equipment as required. 10.2 Insurance, (Local AAC Team)

AAC systems are no longer covered by Gloucestershire County Council ‘All Risks’ Policy. Schools, setting and families should take care of the property and take reasonable steps to prevent loss and damage.

Any loss or damage to the equipment should be documented and reported to the AAC Specialist. Any repairs and replacement will be considered on an individual basis.

All claims involving theft must be notified to the Police immediately.

10.2a Insurance, (The Hub)

The Hub will not insure AAC systems. Insurance will be the responsibility of the school / setting and family/ carers.

10.3 Maintenance 10.3a Local AAC Team Great care should be taken of equipment by all concerned parties. At the time of purchase a warranty will be taken out on the equipment to cover for at least the first year. Such warranties do not cover inappropriate use or management of the equipment. 10.3b The Hub The Hub will maintain equipment that is purchased by them.

11.0 Monitoring and Evaluation of this Policy. The document will be reviewed and agreed by the Local AAC Team and Head of the Advisory Teaching Service in consultation with Gloucestershire CCG’s and a representative from the Regional Specialised Services for AAC.

Appendix 1

Augmentative and Alternative Communication (AAC) Care Pathway. There are nationally agreed protocols for AAC assessment and funding of equipment.

Gloucestershire follows these protocols which are summarised below.

Referrals made to the AAC Specialist following consultation between CYP; parent/carers; and

professionals from health, education and social care. All referral are passed to the local team for

ongoing assessment of complexity.

The referral will then take one of the two routes outlined below.

Local team has resources to assess

the CYP.

Local team assess

Local team does not have

resources to assess the CYP.

Referral is made to the Hub.

Referral meets

criteria for

specialised AAC

funding

Assessment

recommendations

are provided by

local AAC

commissioning

arrangements

Costs are met as follows;-

1/3 health

1/3 education

1/3 social care

Hub carries out

assessment and

commissions

equipment

Advisory Teaching Service Augmentative and Alternative Communication (AAC)

Appendix 2

Request for Assessment/Reassessment for Communication Aid

Referral Form

1. Who should be considered as the key person with responsibility for this referral?

Name

School

Address

Email address Phone No.

Role Signature

2. The Pupil

Name Date of Birth

Setting/School Year Group

Home Address:

Name of parent(s) / guardian(s) / carer(s)

Please give details of the pupil’s difficulties, including any medical diagnosis.

At what stage of the SEND Code of Practice is the pupil?

3. Basis of Referral

Is the communication need mainly for:

Understanding language

Communicating verbally

Using written communication

What equipment / resources have been provided for the pupil to date?

Type of equipment/resource Please specify

Low-tech communication system, e.g. symbol book

Access device(s), e.g. switches, alternative keyboard, rollerball

Supportive software

Portable writing aid

Computer

Voice output communication aid, e.g. Big Mack, MessageMate, Pathfinder

Other

If resources have been available are these now inadequate? If so, in what way?

What steps have been made to address this situation? (Include, where appropriate, details of equipment/resources trailed etc)

Please specify, as precisely as you are able, the equipment/resources you feel the pupil needs that is not/are not currently available

4. Please give details of those people/professions who play a part in meeting the needs of the pupil and indicate whether their support for this referral has been sought

Role Name and Email Address Contact number Support? ()

Parents/carer

Head teacher

Teacher

SENCO

Speech and Language Therapist

Occupational Therapist

Physiotherapist

SEN Support Services (please specify)

Other

Other

5. Please give any further information which you feel would be helpful when considering this pupil’s referral

6. Please give details of any on-going support available

Classroom support? Yes No

If yes, please give details:

Technical support? Yes No

If ‘yes’, please give details:

Other? (please specify)

7. Will an interpreter be needed for the purpose of the assessment?

Yes No

8. Signatures and Consent

I give permission for the following:

Photographs of the child can be taken to support his/her referral Yes No

Video film of the child to be taken to support his/her referral Yes No

Signature of parent/guardian/carer:

Date:

Please note that we cannot proceed with the referral without a signature of consent from the above I understand that this document is the first step in the application process and that it will be used to judge the pupil’s suitability for AAC.

Signature of staff responsible for referral:

Date:

Thank you for taking the time to fill in this form. Please return it to:

AAC Specialist, Advisory Teaching Service, 4-6 Commercial Road, Gloucester. GL1 2AE

Email: nicki.grey@gloucestershire.gov.uk

PLEASE ATTACH ALL COPIES OF RELEVANT INFORMATION IN SUPPORT OF THIS

REFERRAL

Appendix 3

Advisory Teaching Service Augmentative and Alternative Communication (AAC)

Student Information

The Advisory Teaching Service has received a request to see the young person named below. In order to plan the best way forward, it would be very helpful if some background information could be provided. Ideally, all people currently working with the young person, including the parents, will be involved in the completion of this form.

Name

Date of Birth

Home Address

School

Please fill in who was involved in the completion of this form

Parents

SENCo

Class Teacher

Teaching Assistant

Occuapational Therapist

Speech & Language Therapist

Physiotherapist

Other

Date the form was completed

Interests

What does the young person enjoy?

Please tick which best describes the young person’s level of attention when they are engaged in one of the enjoyable activities mentioned above

1. Attends only briefly

2. Attends for 5 minutes or more

3. Is generally attentive

4. Can retain attention to the task despite distractions

What does the young person not like/enjoy?

Hearing Abilities

How would you describe the young person’s hearing? (please )

Good Adequate Poor

Is a hearing aid worn?

Yes No If yes, which ear or both?

Please give details of any tests carried out, or attach copies of audiology reports, if applicable

Vision

Are glasses worn? Yes No

Does the young person have any known visual difficulties? Yes No

If ‘yes’, please fill in the following:

Can the young person… Yes No Don’t know

make their eyes work together?

follow a moving object up and down with their eyes?

follow a moving object left and right with their eyes?

maintain gaze on a fixed target?

Does the young person have a limited visual field?

If yes, please explain…

Does the young person have any known visual perceptual difficulties?

If yes, please explain…

Please give details of visual/perceptual test results and/or attach copies of the relevant reports, as applicable.

Generally, how would you describe the young person’s vision in day-to-day situations? ()

Good Adequate Poor

Do you have any concerns about the young person’s hearing and/or vision which have not yet been addressed? ()

Yes No

If yes, please explain…

Communication

Please describe the young person’s level of understanding…

Formal Test Results:

Date Test Score Age Equivalent

Does the young person have difficulties in expressing them self? ()

Yes No

If ‘No’, please go to the next section (Seating and Positioning) If ‘Yes’…

Please tick if the young person has a clear way of…

Communicating ‘yes’ and ‘no’

Providing information

Asking questions

Directing others

Providing clarification

Requesting clarification

Please tick which methods of communication the young person uses, giving examples of how these methods are used, where applicable

Facial expression and how used…

Eye-gaze and how used…

Gesture and how used…

Vocalisation (sounds) and how used…

Speech and how used…

Signs and how used…

Which sign vocabulary/language is used?

Approximately how many signs are used?

How many signs are put together in an utterance? (e.g. ‘daddy car’, daddy wash car’, etc.)

Approximately how many signs are understood?

Graphic symbols and how used…

What type of symbols are used?

In a typical school day, how often are symbols used?

Approximately how many symbols are used?

How are the symbols presented? (e.g. charts, communication book)

Please enclose a photocopy of a typical page and/or chart.

Speech output device and how used…

Which device(s) is/are used?

What (if any) standard vocabulary package is used with it?

What does the young person usually do if you don’t understand them? (explain if necessary)

Give up

Repeat

Give more information

Change their message

Try another way of communicating their message

Become frustrated

Something else…

If the young person is already using communication equipment, who funded it?

If the young person is already using communication equipment, what training and support is provided and by whom?

Seating and Positioning

Does the young person use special seating at school and at home?

Yes No If yes, please give details…

Is the young person’s current seating meeting their needs well?

Yes No If no, please explain…

Is any other positioning equipment used (e.g. standing frame, wedges, etc.)

Yes No If yes, please give details…

What is the young person’s preferred position at school?

Which position appears to enable greatest physical control?

When is the young person’s seating due to be reviewed?

Who is responsible for he young person’s seating?

Mobility

How does the young person move around?

Inside…

Outside…

Is a powered wheelchair used at school or at home?

Yes independently Yes just learning No

If yes, how is it controlled?

If no, please give reasons for this…

Education

At what National Curriculum or ‘P’ Level is the young person working at in:

English Numeracy Science

Reading Test Results

Date Test Score Age Equivalent

* If no recent test results are available, please give some idea of the young person’s current reading and spelling abilities, e.g. does the young person recognise any words? How many? Does the young person know initial letter sounds?

How does the young person record his/her work? Please send some examples of English and Maths, where applicable

Use of Information and Communication Technology (ICT)

Does the young person use a computer at school/in therapy sessions and/or at home? ()

Yes No

If yes, please indicate below what method of control us used and how successful it is (more than one method may be used).

Method of control Good Just about functional

Poor

If a computer is not used, what are the reasons for this?

What type of computer is used in school and at home?

Does the young person have his/her own computer at school?

Yes No If yes, please give details…

If the young person has his/her own computer at school, who funded it?

If the young person has his/her own computer at school, what training and support is provided and by whom?

What computer software does the young person use and what is it used for?

Software used Used for

What other software is regularly used by other children in the class?

Software used Used for

Does the young person use any other technical equipment (e.g. toys, speech output device, etc.)

Yes No If yes, please give details below

Method of control Good Just about functional

Poor

Medication

Does your child take any on-going medication which you feel affects their abilities:

Yes No If yes, please give details…

Is there anything else you wish to add which would help us to get a full picture of the young person’s abilities?

Please list any attached documents, e.g. SLT report, examples of work, etc.

Document attached Date of document

Thank you for taking the time to fill in this form. Please return it to:

AAC Specialist Advisory Teaching Service, 4-6 Commercial Road, Gloucester. GL1 2AE

Email to: nicki.grey@gloucestershire.gov.uk

Advisory Teaching Service Augmentative and Alternative Communication

(AAC)

Appendix 4

Communication Aid

Request for individualised equipment and/or associated peripherals

1. Who should be considered as the key person with responsibility for this request?

Name Role: Date:

School

Address

Email address Phone No.

2. The Pupil

Name Date of Birth

Pupil ID Year Group

School Key Stage

Home Address

Details of the pupil’s disability or limiting condition.

3. Nature of Request

Type of communication aid or specific associated equipment:

Supplier/Catalogue details:

Product Code:

Email:

Name:

Address:

Telephone Number:

Cost of equipment:

Cost of warranty:

Include any other additional costs (e.g. mounting, software, switch)

Item Cost Supplier

School

The school agrees to pay first £300.00.

School is aware of commitment to purchase and update software as required. Reference

Gloucestershire AAC Guidelines.

Headteacher Date:

Advisory Teaching Service

Approved by Head of Service

Date:

Approved by Lead Advisory Teacher

Date:

. Please return completed form to: AAC Specialist

Advisory Teaching Service, 4-6 Commercial Road, Gloucester. GL1 2AE

Email: nicki.grey@gloucestershire.gov.uk