Tag Archives: AAC

Unspoken voices: Gathering perspectives from people who use Alternative and Augmentative Communication (AAC)

This blog post is from Katherine Broomfield – Speech and Language Therapist, Gloucestershire Care Services NHS Trust. Kath has recently been successful in achieving an NIHR Doctoral Research Fellowship, will start her PhD with Prof Karen Sage of Sheffield Hallam in 2017 and will be working with our team as part of this.

I lead the local AAC service in Gloucestershire; part of the adult speech and language therapy service. We assess and provide basic communication aids such as low-tech, paper-based systems and direct-access, high-tech devices. In a quest to improve our service, I was interested in how to reinforce the quality of the assessment and support that we provide to people in need of communication aids. I also wanted to understand how to improve people’s experience of using them. In 2014, I secured funding from Health Education England South West to carry out a clinical academic internship at the Bristol Speech and Language Therapy Research Unit, under the supervision of Professor Karen Sage.  The objectives of the internship were to: a) search for research literature about how to best support the implementation of communication aids, b) carry out interviews with service users and c) consider areas for further research.

The literature search uncovered limited information about why some people use communication aids effectively and others do not; nor what ‘successful communication’ means to people who rely on communication aids and what they feel best supports them to achieve this. The services users I interviewed reported very different views on successful communication aid use. They also provided some interesting insights into how to improve the support that NHS services provide when issuing AAC equipment. The number of participants in the interviews was small however and they were all adult users of one particular device. By the end of the internship, I had generated more questions than I had answered.

I chose to apply to the National Institute for Health Research (NIHR) for funding to carry out further research into the perspectives of users of communication aids. In February 2016 Prof Karen Sage relocated from Bristol to a post at Sheffield Hallam University (SHU) Centre for Health and Social Care Research. This provided me with the opportunity to establish a team to help me with my research project from the vibrant health research community in Sheffield and, more specifically, to approach Simon Judge at the Barnsley Assistive Technology Team. Simon agreed to join Prof Karen Sage, Prof Karen Collins (SHU) and Prof Georgina Jones (Leeds Beckett University) in supporting me to develop my research proposal, complete the funding application and, if successful, to supervise me while carrying out the research.

At the end of last year I was awarded NIHR funding. My project aims to develop a greater understanding about why people do and do not use communication aids and how they view success with using them. I plan to carry out a more extensive and specific literature review focusing on user perspectives and outcomes for communication aids. I will then complete a series of interviews with young people and adults who use communication aids at different points across the AAC pathway – from assessment and provision of equipment to the use of communication aids in people’s homes, schools and communities. The ultimate aim of the project is to develop a patient reported outcome measure (PROM). The PROM will be made available for use by NHS services to gather the perspectives of people who use communication aids about the equipment and the support they receive.

The project is one aspect of my PhD training programme (the Clinical Doctoral Research Fellowship, or CDRF) targeted at developing practicing NHS clinicians into academic researchers. This scheme is part of the current drive to improve the use of research evidence within NHS services.

I am really looking forward to working closely with people who use communication aids and their friends, families and carers throughout this project. I am also excited about the opportunity of working closely with the team at Barnsley Assistive Technology whose clinical work and research I have admired for some time. I will be setting up my own blog imminently to keep people informed about the project – but in the meantime, I am contactable via Simon and the team. I am passionate about good communication and I still have a lot to learn about AAC, so please get in touch!

 – Katherine Broomfield, Speech and Language Therapist, Gloucestershire Care Services NHS Trust.





Means, Reasons and Opportunities

In 2010  Barnsley Assistive Technology Team in conjunction with Devices for Dignity undertook research to look at communication aid users views of communication aids and their priorities (report | paper ).

Example page from Barnsley MRO resource.

Example page from Barnsley MRO resource.

As part of this work a symbol based questionnaire and symbol based resources for qualitative interviews were developed. The symbolised interview prompt sheets enabled particpants with speech and language disorders to fully participate in the interviews and hence enabled the project to get true input from these participants, rather than via a communication partner.

Recently within our team we have been exploring the more formal examination of Means, Reasons and Opportunities (Della Money and Sue Thurman, 2002) during our assessments. Money and Thurman’s work states that, without the means of communication you cannot express yourself, without reasons for communication, there is no point or need to communicate and without the opportunities, there cannot be any communication. We are all aware that however amazing or high-tech a piece of equipment  is, or however right it may be for the person, if they do not have the reasons or opportunities for communication the introduction of the technology will be unsuccessful.

We have always discussed these three aspects during our assessments but are looking at more formal discussion and tools with which to do this. We identified that the symbol based resources which had been used for the qualitative interviews in the previous D4D work could be used when considering the reasons and opportunities and that the other parts of the original resources would still be useful if discussions of means, reasons and opportunities lead to further discussion of the features of a communication aid required.

In the original work the sheets of symbols were used as a series of sheets that people pointed to, or indicated selections on via the most appropriate method. For this application we cut out the symbols and laminated them so that they could be moved around and so that they could be transferred to a ‘reasons’ or ‘opportunities’ sheet or area.

We used this successfully with a Stroke Survivor. He had been referred to our team for assessment for a communication aid after previously rejecting a communication aid. We decided to use these resources to look in detail at the means, reasons and opportunities to identify potential reasons why a communication aid had been previously rejected and to fully explore with the person where he felt a communication aid would be of benefit. He was keen to interact with the resources and the symbol support aided the understanding within the discussion.

Having developed these resources we are keen to share them and have made them freely avaliable below. If you do use them it would be great if you could contact us with case studies or examples of how you have used the resources.

AT Training – 2014 dates and update on service commissioning

We have now published the dates for our 2014 training courses. The courses will take place in the week beginning 22nd September and the week beginning 17th November.

The courses are designed as either an introduction, refresher or update for staff who work with people with disabilities who may benefit from either Environmental Controls, Communication Aids, computer access or specialised wheelchair controls.  The courses are available to staff working in our current ‘patch’ of Barnsley, Rotherham and Doncaster.

NHS England is in the process of taking over responsibility for commissioning these specialised services and these sessions will include an update on this and provision within the region.  In addition the courses will cover how the care pathway will work – for example criteria for referrals, information required and expectations around local service provision.

The training page on our website has a PDF flyer with detail of our 2014 courses.