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Sally Boa and Lois Cameron


Quality Indicators for AAC Sally Boa and Lois Cameron Funded by NHS Education Scotland Conducted by Talking Mats Limited and Capability Scotland – PowerPoint PPT presentation

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Title: Sally Boa and Lois Cameron

Quality Indicators for AAC
  • Sally Boa and Lois Cameron
  • Funded by NHS Education Scotland
  • Conducted by Talking Mats Limited and Capability

Overview of Quality Indicators
  • To develop, in partnership with individuals who
    use AAC, a set of quality statements relating to
    the AAC service in Scotland

  • On-line survey (27 responses)
  • 4 Focus groups (2 with adults, 2 with children)
  • 12 Individual interviews
  • Range of areas (all NHS Scotland areas
    represented apart from Dumfries and Galloway,
    Grampian, Highland and Orkney)
  • All data analysed using Framework Analysis

Adapted the quality statements from
Communication report (CM 2012)
  • Translated into user friendly questions under
    three headings
  • People who work with me
  • Information
  • How AAC services work
  • (Structured conversation for individual and focus
    group using Talking Mat framework)

1. People who work with me 2. Information provided Process
1a. Know about me 2a. Outcomes of assessment and plan for implementation 3a. Stick to a care pathway
1b. Keep up to date with AAC and have access to training 2b. In a way that I can understand 3b. Gaining funding
1c. Know about AAC 2c. Who is who and contact details 3c. Local services
1d. Work as part of an AAC team 2d. named person/keyworker 3d. National services
1e. Talk about me to other members of the team 2e. Timescales 3e. Provide long-term support
1f. Take my preferences into account 2f. Funding 3f. Access to a second opinion
1g. Have time for me 2g. My care pathway 3g. Clear about when to refer on
1h. Put me in touch with other AAC users   3h. Work with Health, Education and Social work
1i. Involve me in decisions   3i. Provide trial equipment
1j. Involve me in target/goal setting   3j. Access to a range of equipment
1k. Look at my needs regularly   3k. Early introduction to AAC
1l. Provide training for me   3l. Clarity about who is keyworker
1m. Provide training for my family   3m. AAC is adapted to suit my needs
1n. Provide training in my wider environment   3n. Equal access to Assessment and intervention
1o. Check they have my consent to work with me    
1p. Work on their own    
Individual and focus group interviews
  • Capability Scotlands Disability Equality
  • Different perspective
  • Shared values

  • 10 Quality indicators for AAC services in
    Scotland were identified

  • All participants felt that the people who worked
    with them should provide them training
  • If a person does not know how to work their AAC
    aid then the speech therapist isnt doing their
    job (interview 8)
  • Training should be provided for family and
  • Its really important that my sons and the
    nurses who come in to look after me understand my
  • Not everyone agreed that this was as important as
    individual training
  • someone has to learn and then they are the
    person that tells the others - family user is
    less important than the main user (interview 1)

  • All participants agreed that it was important for
    AAC professionals to listen to their views and to
    really know you as a person
  • They cant provide for your needs if they dont
    know you (Survey)
  • Its important that the people I work with can
    understand what I'm saying and this takes a while
    to develop (interview 10)
  • One participant commented that AAC professionals
    should be flexible and, as part of valuing
    individuals, should have the scope to work
    flexibly them
  • We found that SLTs can get locked into a way of
    doing things. This is done here. (interview 1)

3. AAC Keyworker
  • Participants agreed that
  • they should have a clear point of contact in
    relation to AAC
  • Roles and responsibilities should be defined and
  • Really need to know about roles and
    responsibilities who does what what does the
    teacher do, what does the SLT do and what does
    the parent do (interview 1)

4. 4. Involvement in decision making
somebody has to have awareness of what is
realistic in time scales and help you set
realistic targets (survey respondent) That you
should know how long things will take. People who
are disabled have to plan, therefore it is really
important to know how long things will take.
(Interview 8)
  • Participants believed they should be
  • involved in decisions
  • kept informed
  • Given information in a accessible form
  • And that services should work together to achieve
    defined goals.

5.Suitability and adaptability of AAC
  • Participants believed that AAC equipment should
    be suitable and adapted to meet their individual
  • Including developmental growth
  • Future life changes
  • Future technology changes
  • Opportunities to access and trial a range of
    equipment was also seen as vital, as was a
    holistic approach

In our particular case AAC support is lifelong.
It has to be able to change according to the
challenges and continuum of life. Also the
quickly changing world of AAC in a modern
technological age. (Survey)
Janets story
  • Janet was formerly a very effective LLL (Language
    Living and Learning, a Minspeak-based programme)
    user on her Delta Talker.
  • She then moved on to a Vantage system
  • occupational therapist thought having a smaller
    device would give her a better range of movement.
    The new system had fewer keys than Janet was used
  • Since getting her new device, Janet has found it
    extremely difficult to learn to use. It is
    particularly difficult for her to re-learn the
    placement of the buttons and how to access the
    correct layers on the new system.
  • As a result, Janet prefers to use her
    communication book or to spell words out on her
    hi-tech device. (Focus group 3)

6. Equal access to funding and
  • we had to fund our sons own AAC as the one
    provided by our local NHS trust was unreliable
  • we were lucky we had a really great SLT who saw
    the underspend and got it but not everybody is
    that lucky. (interview 1)
  • it shouldnt matter where you live or how much
    money you have there should still be the same
    access to services. (interview 5)
  • Being in a remote location it might be
    unrealistic to have a local service, but strong
    local knowledge is brilliant, with the support of
    national service Survey
  • Access to equipment and services should not
    depend on geographical location or whether they
    had a particularly good Therapists
  • Opinion varied about whether services should be
    provided at a local or national level
  • some preferred local but recognition that not all
    staff could be specialist and therefore a
    national service that could support the local was
    seen as important.

7. The importance of support in the
event of breakdown
  • Joe has no other means of communication when his
    Lightwriter isnt working. He doesnt even use an
    alphabet board to communicate. (Focus group 3)
  • You kind of assume that everything will take a
    long time (interview 1)
  • Several individuals were unable to fully
    participate in this project because their devices
    were either broken or inadequately maintained.
  • Others explained that they had waited months or
    even years for their High-tech AAC machines to be
    fixed leaving them unable to communicate

8. Transitional support (between AAC
  • Participants highlighted that their programming
    and stored information can be lost when they make
    a transition from using one AAC device to
    another. Trialling new equipment can also be
    meaningless if the trial is too short and does
    not allow time for the machine to be properly
    programmed and for the individual to get used to
  • David told the group that he had his new
    Pathfinder in the house for three months before
    he really knew how to use it properly. He felt
    there should be enhanced support when new
    machines are introduced losing all his short
    cuts was a real problem

9. Suitability of design of equipment
  • Particularly an issue for school age participants
    the cool factor
  • colour
  • weight
  • Karen said that it was really important to her
    that her Talker was purple, because that is her
    favourite colour. Focus group 2

10. AAC in the wider community
  • One young focus group participant expressed
    anxiety at the idea of going to a respite service
    because she was worried that staff and other
    children would not be able to understand what she
    was saying.
  • Im going to respite this weekend and Im
    worried people wont understand me (Focus group
  • A sense of confusion for some of the younger
    participants about why AAC works in some settings
    and with some people but not others
  • I can use my machine with nice people and
    Its easier with my Mum and Dad. She then went
    on to say, When Im out people dont understand
    me (Focus group 2)
  • Other participants highlighted the need for the
    wider community (for example shop workers) to be
    aware of AAC and how to communicate with people
    who use it.

Observations potential Risks
  • Adults living in residential care appear to have
    less communication support and less access to
    high tech equipment than those living with their
    family or independently in the community.
  • There appears to be disparity between the high
    standard of communication support enjoyed by
    children in specialist schools and the lack of
    such support at adult residential services

Rural Isolation
  • AAC users living in rural areas appear to be at
    risk of feeling isolated.
  • Sarah is the only person in her day centre or
    area with AAC needs and she is very isolated.
    Although meeting other AAC users is one of the
    highest importance this isnt happening for Sarah
    as she is the only person in the area using AAC
    and therefore is very isolated and shunned by
    others at her learning disability day centre.
    Interview 12
  • We live on a remote island with few AAC users.
    Opportunities to attend conferences and parent
    groups provided essential networking and learning
    and friendship (survey)

  • Value of getting the views of people with
    communication disabilities
  • Importance of really listening to the views of
    AAC service users
  • Needs to be on-going
  • Could it be woven into AAC services so that these
    are evaluated from a user perspective?
  • How to do this genuinely?
  • Use these indicators as a measure of service
  • Link with the Scottish AAC Education framework