Facilitated Communication Kasa-Hendrickson, C. & Hanson, D., 2008 Cardinal, D., 2006 Facilitated Communication Standards and Best Practice Christi Kasa-Hendrickson Darlene Hanson Don Cardinal Facilitated Communication Training Standards 2000

Kasa-Hendrickson, C. & Hanson, D., 2008 Cardinal, D., 2006 Attitude Structure Best Practice Elements of Facilitated Communication fall into three categories Practice Cardinal, D., 2006 Facilitated Communication Training Standards 2000 Facilitated Communication Training Standards 2000

Kasa-Hendrickson, C. & Hanson, D., 2008 Cardinal, D., 2006 Elements of FC Structure Attitude Practice FC USER Practice Attitude Structure Cardinal, D., 2006 Facilitated Communication Training Standards 2000 Facilitated Communication Training Standards 2000

Kasa-Hendrickson, C. & Hanson, D., 2008 Cardinal, D., 2006 Attitude Elements Citizenship Presumption of Competence The Right to Communicate Empowering the Facilitated Communication User Total Communication How would you work with a team who is not presuming competence? How do you make sure a team is empowering the communication user Cardinal, D., 2006 Facilitated Communication Training Standards 2000 Facilitated Communication Training Standards 2000

Principles & Best Practice: Attitude Kasa-Hendrickson, C. & Hanson, D., 2008 Cardinal, D., 2006 Principles & Best Practice: Attitude Citizenship and Presuming Competence Citizenship is membership in a community Citizenship carries with it a presumption that a person's interests and those of her or his community are somehow intimately linked with each other. Cardinal, D., 2006 Facilitated Communication Training Standards 2000 Facilitated Communication Training Standards 2000

Kasa-Hendrickson, C. & Hanson, D., 2008 Cardinal, D., 2006 Principles & Best Practice: Attitude Right to communicate That all people have a means of communication which allows their fullest participation in the wider world That people can communicate using their chosen method and that their communication is heeded by others. Cardinal, D., 2006 Facilitated Communication Training Standards 2000 Facilitated Communication Training Standards 2000

Principles & Best Practice: Attitude Kasa-Hendrickson, C. & Hanson, D., 2008 Cardinal, D., 2006 Principles & Best Practice: Attitude Empowering FC user -- Questions to ask: "Am I determining the pace or am I allowing the facilitated communication user to determine the pace?", "Am I getting a third person's attention or am I teaching the facilitated communication user how to do that?” "Am I determining who reads or hears what the facilitated communication user has typed, or am I letting the facilitated communication user determine who receives his or her communication?" Cardinal, D., 2006 Facilitated Communication Training Standards 2000 Facilitated Communication Training Standards 2000

Principles & Best Practice: Attitude Kasa-Hendrickson, C. & Hanson, D., 2008 Cardinal, D., 2006 Principles & Best Practice: Attitude Total communication approach Not meant to replace current successful communication methods Meant to enhance and expand current communication opportunities Many people who type also use some speech, sign, prepared communication boards Cardinal, D., 2006 Facilitated Communication Training Standards 2000 Facilitated Communication Training Standards 2000

Kasa-Hendrickson, C. & Hanson, D., 2008 Cardinal, D., 2006 Practice Elements Pointing Ergonomic Setup Communication Partner Establish a regular schedule Physical Support Use challenging material Prompts and Cues Activities to Maximize Success Encouragement and Emotional Support Varied and open ended activities Monitoring Treat the person as a competent Saying each letter as it is indicated Avoid interrupting verbal and typed echoes Device correction strategies Control difficult behavior Reliability Check Patient, positive, and persistent attitude These are the easiest it is nuts and bolt, more easily controlled and implemented. Choices when to fade when to get a different piece of equipment. How to use the independent communication… what should we do now. How do you make decisions and problem solve on the spot. How do you teach others to do this… Cardinal, D., 2006 Facilitated Communication Training Standards 2000 Facilitated Communication Training Standards 2000

Kasa-Hendrickson, C. & Hanson, D., 2008 Cardinal, D., 2006 Elements of Facilitated Communication Training Created by Cardinal 2006 Monitoring (look at keyboard) Emotional Support Control Difficult Behavior Physical Support Ergonomics Comm. Partner Some elements of FC can be easily viewed, yet, some, like emotional support need another “view.” Others, like physical support are viewable, but unable to show its multi-dimensional characteristics. Device Correction Strategy Structured Activities Pointing Cardinal, D., 2006 Facilitated Communication Training Standards 2000 Facilitated Communication Training Standards 2000

Principles & Best Practice: Practice Kasa-Hendrickson, C. & Hanson, D., 2008 Cardinal, D., 2006 Principles & Best Practice: Practice Elements of FC Training: Physical Support Physical support may include the following: Assistance in isolating the index finger; Stabilizing the arm to overcome tremor; Backward resistance on the arm to slow the pace of pointing or to overcome impulsiveness; A touch of the forearm, elbow, or shoulder to help the person initiate typing; or pulling back on the arm or wrist to help the person not strike a target repetitively. Cardinal, D., 2006 Facilitated Communication Training Standards 2000 Facilitated Communication Training Standards 2000

Principles & Best Practice: Practice Kasa-Hendrickson, C. & Hanson, D., 2008 Cardinal, D., 2006 Principles & Best Practice: Practice Elements of FC Training: Emotional Support Emotional support involves providing encouragement, but not direction, as the person points to communicate. Elements of FC Training: Communicative Support Various forms of prompts and cues to assist the FC user to stay focused in the communication interaction, to provide feedback to the FC user on the content of their message, and to assist the FC user in clarifying unclear messages. Cardinal, D., 2006 Facilitated Communication Training Standards 2000 Facilitated Communication Training Standards 2000

Principles & Best Practice: Practice Kasa-Hendrickson, C. & Hanson, D., 2008 Cardinal, D., 2006 Principles & Best Practice: Practice Introducing the Technique Follow the recommendations of the assessment regarding choice of hand, type of support, and seating. Plan in advance the choice and position of device(s), and appropriate activities for getting started. Establish a regular schedule by which the practice of pointing through facilitation can develop. Clearly explain to the communicator what is being done and why, and have the use of the technique demonstrated either by an experienced facilitated communication user, or through use of a video. Cardinal, D., 2006 Facilitated Communication Training Standards 2000 Facilitated Communication Training Standards 2000

Principles & Best Practice: Practice Kasa-Hendrickson, C. & Hanson, D., 2008 Cardinal, D., 2006 Principles & Best Practice: Practice Introducing the Technique Use challenging material that is meaningful to the communicator. Structure activities to maximize the success of the communicator.･Provide varied and open ended activities, allowing for the opportunity for complex communication. Treat the person as a competent communicator, one who has ideas and feelings to share. Support the communicator in avoiding or interrupting verbal and typed echoes when they interfere with communication which accurately expresses the communicator's intent. Support the communicator in controlling difficult behavior. Work with a patient, positive, and persistent attitude. Cardinal, D., 2006 Facilitated Communication Training Standards 2000 Facilitated Communication Training Standards 2000

Kasa-Hendrickson, C. & Hanson, D., 2008 Cardinal, D., 2006 Structure Elements Assessment Independence Competency-based Facilitator Training Multiple Facilitators Technical Assistance Documentation Portfolio Approach Validation, Authorship and Authenticity Sensitive Information Job responsibility of the trainer… make sure that the assessment is complete, making sure that people are documenting.. How can they best carry out their job responsibility… How can you best carry out this process. Where Darlene is now and where she is going… In other areas of your job how do you make sure people are doing their job… Cardinal, D., 2006 Facilitated Communication Training Standards 2000 Facilitated Communication Training Standards 2000

Principles & Best Practice: Structure Kasa-Hendrickson, C. & Hanson, D., 2008 Cardinal, D., 2006 Principles & Best Practice: Structure Assessment An individual needs to be identified as a candidate Those who support that individual need to show commitment to the training process. Both of these elements begin with the assessment. Cardinal, D., 2006 Facilitated Communication Training Standards 2000 Facilitated Communication Training Standards 2000

Principles & Best Practice: Structure Kasa-Hendrickson, C. & Hanson, D., 2008 Cardinal, D., 2006 Principles & Best Practice: Structure Questions that drive the Assessment What are the current communication strategies? (candidacy) How have people developed the communication to this point? (environment) How does this person interact with the printed word? (starting point for the exploration) Does support make a difference? (benefit) Cardinal, D., 2006 Facilitated Communication Training Standards 2000 Facilitated Communication Training Standards 2000

Principles & Best Practice: Structure Kasa-Hendrickson, C. & Hanson, D., 2008 Cardinal, D., 2006 Principles & Best Practice: Structure Determining Candidacy? Facilitated communication is a type of Augmentative/Alternative Communication (AAC) for people who do not speak or whose speech is highly limited and disordered, and who cannot point reliably The method has been used by people with autism, Down syndrome, cerebral palsy, pervasive developmental disorders, and other developmental disabilities Cardinal, D., 2006 Facilitated Communication Training Standards 2000 Facilitated Communication Training Standards 2000

Principles & Best Practice: Structure Kasa-Hendrickson, C. & Hanson, D., 2008 Cardinal, D., 2006 Principles & Best Practice: Structure Collaborative Team Approach Support and commitment from an aid user's team (program planning team, circle of support, etc.) is critical to long term success with augmentative/alternative communication (AAC) and facilitated communication training. Cardinal, D., 2006 Facilitated Communication Training Standards 2000 Facilitated Communication Training Standards 2000

Principles & Best Practice: Structure Kasa-Hendrickson, C. & Hanson, D., 2008 Cardinal, D., 2006 Principles & Best Practice: Structure Independence A primary, long-term goal of facilitated communication training is independent communication. This goal involves･being able to access communication aids without physical support; being able to initiate the process of communication with others; and･exercising control over the content of one's communication.The fading of physical support should begin at the outset of the training process, with both facilitators and facilitated communication users aware of the importance of this goal. Cardinal, D., 2006 Facilitated Communication Training Standards 2000 Facilitated Communication Training Standards 2000

Principles & Best Practice: Structure Kasa-Hendrickson, C. & Hanson, D., 2008 Cardinal, D., 2006 Principles & Best Practice: Structure Competency Based Facilitator Training All facilitators should participate in on-going training and support Multiple Facilitators--Each FC user should have several facilitators to reduce dependence on a particular facilitator, to increase independent communication, and for there to be sufficient examples of valid and authentic communication to document in a portfolio. Technical Assistance Team problem solving with experienced facilitators Cardinal, D., 2006 Facilitated Communication Training Standards 2000 Facilitated Communication Training Standards 2000

Principles & Best Practice: Structure Kasa-Hendrickson, C. & Hanson, D., 2008 Cardinal, D., 2006 Principles & Best Practice: Structure Documentation Portfolio Approach The portfolio documents over time instances of novel communication. It is important to note that validation represents a set of skills to be learned in the process of becoming a competent, responsible communicator; it is not a test of the user's abilities. In addition to the facilitated communication user's portfolio, a portfolio of the facilitators' training, skills, and abilities should be kept, documenting each facilitator's progress through competency training. This documentation should be used to determine the facilitator's level, and which supports he or she is prepared to provide for the facilitated communication user. Cardinal, D., 2006 Facilitated Communication Training Standards 2000 Facilitated Communication Training Standards 2000

Principles & Best Practice: Structure Kasa-Hendrickson, C. & Hanson, D., 2008 Cardinal, D., 2006 Principles & Best Practice: Structure Validation, Authorship If the use of more formal validity testing is pursued, careful consideration needs to be given to such factors as the types of tasks used, the familiarity and naturalness of the test environment, the experience level of the facilitator, and both the facilitator and facilitated communication user's feelings about doing the test. Cardinal, D., 2006 Facilitated Communication Training Standards 2000 Facilitated Communication Training Standards 2000

Principles & Best Practice: Structure Kasa-Hendrickson, C. & Hanson, D., 2008 Cardinal, D., 2006 Principles & Best Practice: Structure Sensitive Information Any sensitive information should be verified through clarification across multiple facilitators. Sensitive information should be discussed carefully with a team of skilled facilitators. It is important that the FC user develop an independent strategy for yes/no as quickly in the training process as possible. Cardinal, D., 2006 Facilitated Communication Training Standards 2000 Facilitated Communication Training Standards 2000

Best Practice: Concluding Thoughts Kasa-Hendrickson, C. & Hanson, D., 2008 Cardinal, D., 2006 Best Practice: Concluding Thoughts Learning to type and to use all of the best practice elements is complex. Remember the following: Set goals Work and problem solve with a team Stay focused and positive Create games and strategies that can be successful each time your practice Set aside time to practice as well as remembering to use typing in the thousand opportunities that come up throughout the day. Cardinal, D., 2006 Facilitated Communication Training Standards 2000 Facilitated Communication Training Standards 2000