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Knowledge and Skills

American Speech-Language-Hearing Association (ASHA) Practice Policy

Augmentative and Alternative Communication: Knowledge and Skills for Service Delivery

Special Interest Division 12, Augmentative and Alternative Communication


About this Document

This Knowledge and Skills document is an official statement of the American Speech-Language-Hearing Association (ASHA) and is one of several documents that outlines the responsibilities, knowledge, and skills necessary for6 speech-language pathologists in the area of augmentative and alternative communication (AAC). According to the ASHA Scope of Practice for Speech-Language Pathologists (SLPs), which defines universally applicable characteristics of practice, speech-language pathologists are responsible for “establishing augmentative and alternative communication techniques and strategies including developing, selecting, and prescribing of such systems and devices” (ASHA Scope of Practice for Speech-Language Pathologists, 2001).

The knowledge and skills described within the current document build on the information from the ASHA Scope of Practice and fulfill the need for more specific procedures and protocols for serving individuals for whom speech and/or writing is precluded as a primary means of communication. SLPs who practice in this area are required to hold the Certificate of Clinical Competence in Speech-Language Pathology and to abide by the ASHA Code of Ethics. This includes Principle of Ethics II Rule B that states: “individuals shall engage in only those aspects of the profession that are within their competence, considering their level of education, training, and experience” (ASHA, 1994).

This Knowledge and Skills document was developed by a working group from ASHA Special Interest Division 12, Augmentative and Alternative Communication. Steering Committee members were Stephen Calculator (chair, document revisions committee, 2001), Amy Finch, Tracy Kovach, Ralf Schlosser, and Rose Sevcik. Michelle Ferketic and Susan Karr (ex officios) and Alex Johnson, 2000–2002 Vice President for Professional Practices in Speech-Language Pathology, provided support from the ASHA National Office. Lyle Lloyd, Anne McGann, and Doreen Blischak contributed to an earlier draft of the document.



Background

What follows are knowledge and skills associated with the provision of AAC services by speech-language pathologists. The stated knowledge and skills should be regarded as minimal, necessary standards that may or may not be sufficient depending on the special needs presented by individuals who may need to, or already do, rely on AAC. The knowledge and skills suggested in this document are not presented in hierarchical order. They are also not mutually exclusive; there is considerable overlap across them.

AAC is a multidisciplinary field that requires skills that transcend the typical discipline-specific training received by speech-language pathologists, physical therapists, occupational therapists, educators, and other professionals who may serve on an AAC team. (Note: the term multidisciplinary is used throughout this document to denote involvement by two or more team members. These team members often collaborate in an interdisciplinary or transdisciplinary manner of service delivery.)

Not all SLPs are expected to engage in all areas of AAC practice. However, all SLPs are expected to recognize situations in which mentoring, consultation, and/or referral to another professional are necessary to provide quality services to individuals who may benefit from AAC.

AAC services should be consumer driven; individuals who use AAC, and their families, should play key roles as members of a team. In most cases the service delivery model of choice is the transdisciplinary approach, encouraging extensive collaboration between team members, role release of skills to and from one another, and maximizing each team member's skills and contributions to the team.

Still, each team member is expected to possess skills specific to his or her discipline. For example, SLPs are rarely called on to do seating and positioning assessment. Instead, they are more likely to refer to 6the appropriate team member, often a physical therapist, to carry out such an assessment. Results have great bearing on the nature of the subsequent AAC program, as do other professionals' findings with respect to individuals' motor skills (and possible means of accessing an AAC device), sensory skills (and implications for size, location, and spacing of items on a communication display), and so on. AAC assessment and intervention requires input from a team, not only an SLP.

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Definitions

Some terminology in AAC has changed since the previously published competencies document (ASHA, 1988). Much of the information pertaining to the terms and definitions that follow is drawn from three currently prominent texts in the field of AAC (Beukelman & Mirenda, 1998; Glennen & DeCoste, 1997; Lloyd, Fuller, & Arvidson, 1997).

AAC is, foremost, a set of procedures and processes by which an individual's communication skills (i.e., production as well as comprehension) can be maximized for functional and effective communication. It involves supplementing or replacing natural speech and/or writing with aided (e.g., picture communication symbols, line drawings, Blissymbols, and tangible objects) and/or unaided symbols (e.g., manual signs, gestures, and finger spelling). Whereas aided symbols require some type of transmission device, unaided symbols require only the body to produce. Many individuals with severe communication and cognitive impairments can benefit from nonsymbolic forms of AAC such as gestures (reaching for a desired object) and vocalizations that convey different emotions.

AAC also refers to the field or area of clinical, educational, and research practice to improve, temporarily or permanently, the communication skills of individuals with little or no functional speech and/or writing. Regardless of the mode(s) selected, AAC involves the utilization of symbols (e.g., single meaning pictures, alphabet-based methods, and semantic compaction) to represent individuals' communication intents.

Various types of symbols may be used alone or in combination with one another. Regardless of their particular form, all symbols are used to represent other things, concepts, and ideas.

Symbols can be aided or unaided, as described above. They can be acoustic (e.g., digitized speech and tones), graphic (e.g., photographs and writing), manual (e.g., signs and gestures), and/or tactile (e.g., tangible symbols such as those found on an object communication board). Symbols are referred to as static when they do not require movement or change to understand meaning and dynamic when they do (e.g., gestures and animated graphic symbols). Finally, symbols can be classified by their relative iconicity, or the degree to which they visually resemble that to which they refer. Conversely, opaqueness describes the lack of resemblance between symbols and that which they represent.

As indicated above, symbols and modes of communication can be classified as aided and unaided. The term “aid” also refers to a type of assistive device that supplements or replaces natural speech and/or writing. Aids may be electronic (e.g., a voice output communication aid) or nonelectronic (e.g., a communication board).

Individuals' uses of AAC may be enhanced by the application of different strategies. A strategy is a process or plan of action that is used to improve (e.g., accelerate) one's performance. Examples of strategies include topic setting and letter and word prediction.

Technique refers to an approach or method. This includes ways in which individuals who use AAC select or identify messages (e.g., direct selection or scanning). It also refers to types of displays, either fixed (i.e., the display remains the same before and after a symbol is activated) or dynamic (i.e., the visual display changes upon selection of a symbol, as when touching a symbol for ice cream prompts a new array of symbols depicting different flavors).

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Knowledge and Skills

Following are the roles, knowledge base, and skills deemed necessary for SLPs to provide a continuum of services to individuals with limited natural speech and/or writing.

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References

American Speech-Language-Hearing Association. (1988). Competencies for speech-language pathologists providing services in augmentative communication. Asha, 30, 55–58.

American Speech-Language-Hearing Association. (1999). Code of ethics. Rockville, MD: Author.

American Speech-Language-Hearing Association. (2001a). Competencies for speech-language pathologists providing services in augmentative communication. Asha, 31(3), 107–110.

American Speech-Language-Hearing Association. (2001b). Scope of practice in speech-language pathology. Rockville, MD: Author.

American Speech-Language-Hearing Association. (in press). Role and responsibilities of speech-language pathologists with respect to augmentative and alternative communication. Rockville, MD: Author.

Beukelman, B., & Mirenda, P. (1998). Augmentative and alternative communication (2nd ed.). Baltimore: Paul H. Brookes.

Glennen, S., & Decoste, D. (1997). Handbook of augmentative and alternative communication. San Diego: Singular Publishing.

Lloyd, L., Fuller, D., & Arvidson, H. (1997). Augmentative and alternative communication. Needham Heights, MA: Allyn & Bacon.

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Index terms: augmentative and alternative communication, service delivery models

Reference this material as: American Speech-Language-Hearing Association. (2002). Augmentative and Alternative Communication: Knowledge and Skills for Service Delivery [Knowledge and Skills]. Available from www.asha.org/policy.

© Copyright 2002 American Speech-Language-Hearing Association. All rights reserved.

Disclaimer: The American Speech-Language-Hearing Association disclaims any liability to any party for the accuracy, completeness, or availability of these documents, or for any damages arising out of the use of the documents and any information they contain.

DOI: 10.1044/policy.KS2002-00067