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by Judy Seligman-Wine
In Israel augmentative and alternative communication (AAC) implementation is widespread for children with both physical and cognitive disabilities. Adult AAC services still require development.
The Ministries of both Health and Social Welfare are just beginning to develop programs to train professional personnel to implement AAC programs in school and residential settings. However, the government does not fund either AAC services or acquisition of AAC equipment. The Ministry of Education provides training for people working in their employ at no charge. AAC services are available through special education settings. Payment is necessary, however, outside of special education or for families wishing to augment services their child receives.
In most cases, a family must pay privately for an AAC assessment or consultation from a specialty clinic. One Health Fund will cover this expense on the basis of an unwritten rather than formal agreement. AAC equipment must be purchased privately, most often with the support of private funding agencies. The Ministry of Health is required to fund everything included in what is referred to as "the basket of services." As yet, AAC services and equipment are not included in this basket, despite repeated efforts.
All three communication disorders/speech-language pathology training programs offer courses in AAC. One program offers a full year, the second is a full semester, and the third offers a half-semester.
For most people (children and adults) who communicate using AAC, the primary communication tool is a chart. Voice output, primarily in the form of digitized speech, is frequently used in conjunction with the communication chart. Speech-generating devices (SGDs) are rarely used as the primary communication tool in Israel—they are expensive devices that must be imported and for which there is no public funding. Replacement in the event of breakdown is problematic. In addition, many people within the community do not use technology on the Sabbath and religious holidays, thus reinforcing the use of a paper chart as a primary tool.
Yet the use of computer technology for communication is growing. Hebrew voice synthesis software is now available, enabling speech output through computer usage. The Boardmaker® program, which creates printed symbol-based communication materials, is available in both Hebrew and Arabic. Several writing programs—"Writing with Symbols" and "Clicker 4"—have been translated into Hebrew. An SGD loan library, run by a service organization, lends out a wide range of SGDs and computers with communication software to children and adults from throughout the country for up to six months. However, the many access devices that enable AAC usage through technology, particularly for adults, are not available in Israel, primarily due to expense. Even if funds are available, families are hesitant to acquire these devices, because they have difficulty obtaining devices to try out before purchase.
Israel is a small country, making it possible to plan AAC events on a national scale. The Israeli chapter of the International Society for Augmentative and Alternative Communication (ISAAC) is very active, holding events such as a two-day annual conference with accompanying post-conference workshops, half-day workshops throughout the year, and an annual gathering (free of charge) for persons who communicate using AAC from throughout the country. For many individuals, this annual meeting is the highlight of their social calendar.
ISAAC-Israel also publishes an annual journal comprising original articles, translations of major works from other languages, and the Hebrew translation of the abstracts from the English-language AAC Journal from the previous year. ISAAC-Israel is actively working together with government agencies to develop regulations for the rights of persons who communicate with AAC.
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