Help Me Help You: Effective Training for Communication Partners of Adults with a Disability who use AAC. AAC EBP Group 2012

The Alternative and Augmentative Communication (AAC) EBP Group  Began about 4 years ago with 5 people  Has now grown to 25 Speech Pathologists  Members are from various organisations supporting adults and children with disability.  This year Dr Andy Smidt was invited as our academic consultant and attended several meetings.

Evolution of the Clinical Question  Voted to explore AAC with adults  A group member had been asked by her manager  The clinical question evolved from this. How much time do you need to train support staff to use an AAC system with a person with complex communication needs?

The Clinical Question In Adults with Disability, What Forms of Communication Partner Training are effective in facilitating communication using an AAC System?

Selection Criteria for Papers Papers were excluded if:  Focused on training strategies for communication partners of children  Training was for the client rather than for the communication partner  Outcome of the training had not been measured  Subjects of the study with communication needs were at a non symbolic level of communication  Paper was older than 1990

Background Question What Forms of Training are there for People who Support Adults with Disability? Approx 20 papers were read, summarised and discussed in the group…

Main Points from Background Reading… Positive outcomes to training are more likely when:  Training is delivered in a naturalistic setting  Trainees learning is supported with coaching and feedback from supervisor /trainer,  Managers are trained too (Jahr,E 1998)

Background Reading: Training strategies which resulted in changes in trainee behaviour and client –trainee interaction included:  Interdisciplinary training (Dobson et al 2001)  Direct SP in put as well as workshop (Chatterton 1999)  Train the trainer (peer to peer/ pyramidal training) (Haberlin et al 2012)  Video training (Macurik 2008)  Focus on individual clients (Bloomberg and West 2003)  Modules delivered over 6 months (Chatterton 1999, Bloomberg and West 2003)

CAPs for the Clinical Question  14 articles were appraised by the group  5 included in CAT  Kirkpatrick’s Ratings were used to evaluate the training

The Kirkpatrick Model Donald Kirkpatrick 1996 Four Level Model Evaluating the Impact of Training 1- Trainees Reaction 2- Trainees Learning 3- Changes in Trainees Behaviour 4- Results (Impact of Training)

Papers included in CAT Chadwick D & Joliffe J (2009), ‘A pilot investigation into the efficacy of a signing training strategy for staff working with adults with intellectual disabilities’ British Journal of Learning Disabilities 37:1 pp Smidt, S. Baladin, V.Reed and J. Sigafoos (2007) “ A Communication Training Programme for Residential Staff working with adults with challenging behaviour: Pilot Data on Intervention Effects”, Journal of Applied Research in Intellectual Disabilities 2007, Vol 20, pp Light, Janice, Dattilio, John English, Jane Guiterrez, Lisa; et al; (1992) “Instructing facilitators’ to support the communication of people who use AAC”, Journal of Speech and Hearing Research, vol 35(4), Aug, 1992 C.Torrison, E.Jung, K. Baker, C.Beliveau and A.Cook, (2007)“The impact of staff training in Alternative/Augmentative Communication (AAC) on the communication abilities of adults with developmental disabilities”, Developmental Disabilities Bulletin,2007, Vol 35,No 1 & 2, pp Wood, Luiselli & Harchik (2007), Training instructional skills with paraprofessional service providers at a community-based habilitation setting, Behavior Modification 31(6),

D.Chadwick and J.Joliffe (2009)  Formal sign training to staff can improve the recall and use of sign in communicative exchanges with adults with intellectual disability. Level of Evidence (NH&MRC): III-2- control group used Kirkpatrick Rating: level 2-knowledge tests level 3-changes in trainees behaviour

A.Smidt, S.Baladin, V.Reed and J.Sigafoos (2007)  MOSAIC training to residential support workers resulted in increase in staff use of AAC over a 3 month period.  This was not sustained in the long term (apart from in 1 out of 3 groups trained) Level of Evidence (NH&MRC): IV –Single Case Design Kirkpatrick Rating: Level 4 –Client outcomes measured

J.Light, J.Dattilio, J.English, and L. Guiterrez et al; (1992)  Client focused training delivered 1:1 to support staff in a naturalistic setting can increase conversation participation and control for people who use AAC. Level of Evidence (NH&MRC): III 2 - evidence obtained with a case control study Kirkpatrick Rating: Level 4

C.Torrison, E.Jung, K. Baker, C.Beliveau and A.Cook (2007)  Client focused training in communication and AAC, combined with 1:1 support from trainer to staff can result in small changes in client AAC use  A range of success among the 4 clients, but impact was seen in both clients and trainees. Level of Evidence (NH&MRC): IV Kirkpatrick Rating: Level 4 -outcomes for clients measured

Wood, Luiselli and Harchik (2007)  A combination of instructions, demonstrations, behavioural rehearsal and performance feedback can be combined to produce rapid and significant training outcomes. Level of Evidence (NH&MRC): IV Kirkpatrick Rating: Level 4

The Clinical Question In Adults with Disability, What Forms of Communication Partner Training are effective in facilitating communication using an AAC System?

Clinical Bottom Line: Strategies that show evidence of training communication partners to facilitate communication in AAC Users include  A series of half day direct training sessions  Use of video illustrating using AAC  Use of video feedback to communication partners  Analysis of videoed interaction by trainees  Visual aids (e.g. cards showing KWS)  Person Centred training  Action Planning/ Goal Setting  Training on making AAC resources  Instruction within the Natural Environment  Coaching methods-e.g.. demonstration and feedback  Individual and small group training

The outcomes evaluated included:  Observations and video recording of interactions in the natural environment  Knowledge/ Skills tests of trainees pre and post training.  Self ratings on behaviour changes of trainees.

What Next?....E3BP Integrate the external evidence we appraised this year and Look at the best available evidence internal to our clinical practise.  What training are we delivering?  How are the outcomes for our clients evaluated?  How can this be improved?  How can we integrate the external evidence?

2013 Venue for our meetings to be confirmed! Contact Clinical Group Leader: Bettina Bacall Arenstein E: PH: