creating communication environments an overview developed by judi cumley and mary wirkus wisconsin...

Creating Communication Environments

An OverviewDeveloped by

Judi Cumley and Mary WirkusWisconsin Assistive Technology Initiative

Learner Outcomes Understand the foundations of functional and

interactive communication Identify target activities and strategies for

eliciting active participation by student(s) Select communication opportunities that are

natural and appropriate Arrange the environment to promote

communication Identify the steps in a “least to most” prompt

hierarchy

Agenda

• Background of “Creating Communication Environments” (CCE)

• Purposes of Communication• The Three Main Ingredients of Creating a

Communication Environment• Activity• Environment• Partner

• The Prompt Hierarchy• How Can This Be Useful for YOU?

Background Information CCE is based on ECT (Environmental

Communication Teaching) - developed by Dr. George Karlan at Purdue University

Developed for a classroom TEAM Emphasis on eliciting communication within

natural environments Originally developed as a 5-day training program

for school-age children who use or need AAC Replicated throughout the country for children

and students of all ages & disabilities (CCE in Wisconsin since 1999)

Everyone Communicates…

Crying Eye contact Sounds Words Pointing Falling asleep Screaming

Communication boards

Picture exchange system

Voice output systems Gestures/signing Hair-pulling

Silence

Communication Purposes Expressing Wants and Needs

*Once desired action or object is achieved, communication ends

Social Interactions including Social Etiquette*Social vocabulary is difficult to provide, but vital

for social acceptance* Greetings, Conclusions, “manners”, etc

.

Exchanging Information * Starts as “joint attention” then develops into more

complex interchanges with content or topic specific vocabulary

Janice Light 1988, 1997, 2005

Changing Purposes of Communication

WANTS

&

NEEDS

Social Interactions

& etiquette

Sharing Information Sharing

InformationSharing Information

Social

Interactions

& etiquette

The importance of different communication purposes changes over our lifetimeJ. Cumley, 2001

Based on J. Light, 1988, 1997, 2005

Social

Interactions

& etiq

uette

WANTS

&

NEEDS

WANTS & NEEDS

If we only have to think about encouraging our students to

communicate for three different purposes, why is it so

HARD…..what can make it easier?

AAC Augmentative/Alternative Communication

*refers to the ways (other than speech) that are used to send a message from one person to another (ASHA, 2005)

Examples• Communication boards/books/picture symbols• Speech Generating Devices (SGDs)• Picture Exchange Communication System (PECS)• Morse Code• Eye Gaze• Picture Schedules

AAC can be a vehicle for developing:

expressive languagereceptive languageliteracycontrol over the environmentcommunication initiation

AAC is not….

A last resort“Giving up” on speechOnly for those of a certain IQ or AgeOnly the job of the speech-language pathologist

Myths and Misconceptions: Young Children with CCN

(Complex Communication Needs)

Myth and Misconceptions

AAC hinders or stops further speech development

The Evidence

AAC approaches (signs, picture symbols, VOCAs*) do NOT

hinder speech development. In fact, speech often increases

during AAC treatment approaches

From: Augmentative Communication News, Volume 18, Number 2, June, 2006

*VOCA= Voice Output Communication Aid




There is a representational hierarchy of symbols from objects to written words

The Evidence

Children can learn to understand and use a variety of symbols at a

very young age (e.g., sign language) through repeated

exposure to the symbol and its referent in natural contexts





Children must have certain skills to benefit from

AAC (e.g., be at a certain age, have a particular cognitive or linguistic

level, etc.)

The Evidence

There are NO prerequisites for communication. AAC focuses

on all aspects of communication and communication begins at birth. AAC is an appropriate

intervention approach for anyone with CCN.





AAC is a last resort and means professionals are “giving up”

on speech

The Evidence

The “Wait and See approach” is not an effective way for teams

(e.g., speech-language pathologists, teachers,

paraprofessionals, parents to develop communicative

competence)


Using AAC effectively Communication partners must model AAC use

• Use of a penlight or finger on paper displays (aided language stimulation)• Sit next to individual with device to facilitate modeling• Use it as both a receptive and expressive tool• Be natural-focus on communication, not the device/board

AAC must be engineered into the environment• Displays mounted around the room/school/home• ACCESS to communication wherever student “is”

– Pool – Playground– Home– Out shopping– Bathtub– School or instructional settings

When designing AAC overlays, be sure to include...

Vocabulary that reflects all 4 categories Wants & Needs Exchanging Information Social Closeness Social Etiquette

Use a communication board to talk to each other. Does it contain the 4 purposes of communication?

AAC: Establishes a means of communication Provides opportunity for social interaction Promotes receptive communication Encourages expressive communication Decreases frustration Provides opportunity for initiation

Think about YOUR students who are struggling to

communicate effectively…

What are some characteristics of their

communication?

Common Characteristics of Students Using AAC

Rarely initiate interactions Usual form of communication is NOT

using a communication device Gestural responses (head nods) to yes/no

questions main form of communicating May use “challenging” behaviors to

communicate

Common Characteristics of Students Using AAC

Most vocalizations are unintelligible Rarely interact with peers Communication system may not be

available when needed Necessary vocabulary is not

programmed or correct symbol is not available

Supporting AAC users….Create a Communication Environment

Expect all students to communicate Recognize and respond to the student’s

communication initiations Arrange the environment to increase the

likelihood for communication Identify communication opportunities within

natural routines and activities

Addressing Communication Challenges AND Creating a

Communication Environment…

Requires changes in the… Activities Environment Partner

Communication

Act

i vi t

i es

Env

iron

men

t

Par

tner

Dr. George Karlan

“Incidental teaching episodes are brief, positive, and oriented toward communication rather than

language teaching.”

Selecting a Target Activity to Elicit Communication Should be brief in nature, but occur 3-4 times per

week Requires communication (initiations) by the

student Activity should be process - not product oriented Activity represents a class of activities

Art activities, cooking, reading books, snack Variation in content from episode to episode, but same “core” vocabulary

Choices are offered during the activity COMMUNICATION is the goal of the Target Activity!

Selecting Target Activities Start by identifying a “target” activity

Student must have a reason to perform the activity Activity must provide opportunities for success Must be motivating Must be functional and interactive Must be age-appropriate Must reflect family wishes/team consensus

Describe your Target Activity on the

Target Activity Form

The Target Activity Form- Sample

Cumley, J & Pallaske, M. 2002

Target Activity Description

Communication Turns Communication Considerations Prompt Hierarchy

What does student have tosay to begin the activity? Environmental Cue…

Open Questions…

What does student have tosay to continue the activity?

Prompt or Request Communication…

Environmental Modifications

Full Model

What does student have tosay to end the activity?

Descriptive Feedback

Students come to table at snack time. Snack materials are on counter. Materials: food, placemats, napkins, straws, milk (white & chocolate), communication overlays for requesting snack items & standard vocabulary-more, all done, uh oh, help, etc.

How is vocabulary represented:

Activity Vocabulary:

Wants/Needs:

Social Interactions & Etiquette:

Sharing Information:

Does your Target Activity have at least THREE

opportunities for the student to initiate?

What does the student have to say to BEGIN the activity?

What does the student to have to say to CONTINUE the activity?

What does the student have to say to END the activity?

If you can’t think of 3 statements the student needs to say to be engaged in the activity….

pick a different activity!

Communication Turns-exampleSnack

Beginning: Student asks for snack items.(e.g., milk, cracker, napkin, straw, placemat)

“I want….” “Can I have ….” “milk”, etc.

Middle: Student asks for “more”, “help”, makes social, informational or etiquette comments to peers and adults“I want more ….”, “more ….”, “good …..” “I like …” “You want…”

End: Student indicates when finished(asks to be excused, says “all done”, asks for clean-up materials, asks to

go to transitional activity)“all done”, “clean up”, “no more”, “bye-bye”

The Target Activity Form- Sample


Target Activity Description Communication Turns Communication Considerations Prompt Hierarchy What does student have to say to begin the activity? Environmental Cue…

Open Questions… What does student have to say to continue the activity? Prompt or Request Communication… Environmental Modifications

Full Model What does student have to say to end the activity?



Student asks for snack items (e.g.,Milk, cracker, napkin, straw, placemat) “I want …”“Can I have….”“milk”

Student asks for “help”Student asks for “more…”Makes comments to peers and adults “I want more…”“I like ….”“good …”“You want …..?”

Student says “all done” when finished“clean-up”“go play”“bye-bye”

How is vocabulary represented:

Activity Vocabulary:

Wants/Needs:

Social Interactions & Etiquette:

Sharing Information:

Communication Considerations

How will the vocabulary be represented (e.g., objects, tangible symbols, photos, symbols, etc.)

List the vocabulary that must be available. Try to have vocabulary that represents

• Wants/Needs• Social Interactions & Social Etiquette• Sharing Information

The Target Activity Form - Sample










How is vocabulary represented? Communication board with PCS symbols. Vocabulary for expansion & labeling. Student points w/some vocalizations. Teacher models & expandsActivity Vocabulary: milk, straw, napkin, cracker, placemat…

Wants/Needs:I, want, more, help, specific snack items

Social Interaction & Etiquette:sit here, want some?, please, thank you

Sharing Information:good, yucky, uh oh, all done

Video…..


Communication Environment…

Requires changes in the… Activities Environment Partner

Communication

Act

ivit

ies

En

viro

nm

ent

Par

tner

Arrange the Environment to Increase the Likelihood of Communication

Common Strategies….

Use motivating materials and activities Materials should be in view but not accessible Student should need assistance with some materials Provide small or inadequate amounts of materials Sabotage Provide something the student doesn’t like/want Use communication boards/devices & visual tools

Your Environment Are there any environmental changes you

could make to increase communication?

Activity-based environmental changes• Material location, amount, type

Communication-based environmental changes

• Picture symbols, communication boards, device placement

Video-

Note Environmental Arrangements












, Wants/Needs: I want, more, help, specific snack items

Social Interaction & Etiquette: sit here, want some?, please, thank you

Sharing Information: good, yucky, uh oh, all done

All students have snack placemat with specific snack vocabulary velcroed on top & core vocab. permanently on sides.

Single small pieces of snack Straw on table, but out of reachMilk carton not openWrong flavor of milk (sabotage)


Communication Environment… Requires changes in the…

Activities Environment Partner

(And that means YOU!)

Communication

Act

ivit

ies

En

viro

nm

ent

Par

tner

What are some common characteristics of communication

partners?

As a Communication Partner…

What Can DISCOURAGE a student from

communicating…

--test, bombard, or demand responses (e.g., “what is this called” “what do we use a knife for?” “what do we call this?”)

--use rhetorical questions (e.g., “you don’t want milk, do you?”)

--use YES/NO questions --anticipate their needs so they don’t have to ask

As a Communication Partner…

What else Can DISCOURAGE a student from

communicating…

--don’t give them regular access to their communication system(s) --when they make a choice, ask them again --use only teacher-directed activities so the student doesn’t HAVE to

communicate --”GOOD TALKING!” as a reinforcer --use figurative language (“take your seat” vs. “sit”) --”rush” the student’s communication

Strategies to Promote Communication

Adapted from Original ECT, Hodgdon, 1999

Engage (get at their level, eye contact)

Establish attentionProximity to child

Be in their line of vision

Watch for student to orient to you (attention shift)

Use visuals (present visual first)

Use meaningful gesturesExaggerate movements to attract attention

Hold gestures (point long enough to mutual referent)

Less may be better!Match student’s verbal output?

Expand by one

Strategies to Promote Communication

Adapted from Original ECT, Hodgdon, 1999

Wait for responsesCount to 5, 10 after a command/question

Stay engaged

Increase opportunities for initiation

Be consistent with labels (why?)

Modify the environment to create active participation, communication

Make sure the student has access to communication at ALL TIMES!

The most language learning will occur when your response is

related to the student’s focus of interest or to what he has

communicated.

YOU are part of the environment …

When you use a prompt hierarchy you can:

Provide consistency across partners because of framework

Give students processing time Be individualized Provide only as much prompting as is

needed

Prompt Hierarchy Environmental Cue

PAUSE

Open Question PAUSE

Prompt OR Request for Communication PAUSE

Full Model PAUSE

Incorporate descriptive feedback into each step

Descriptive Feedback Use after the student has produced a

communicative response (at any point within the hierarchy)

Descriptive feedback is specific to the student’s communication

“Oh, you asked for more juice, here’s your juice.” “You want paint. Here’s some blue paint.” “You asked to be all done. We need to do just one more, then we’re all done.” “You looked at the cheese, here’s some cheese for your

sandwich”.


Serves Three Functions Acknowledges

• Immediately acknowledges that the partner “heard” the student’s communication attempt

Confirms• Confirms that the message sent by the student is

the same as the message understood by the partner.

Models• Can be used to model an expanded version of the

communication message.

Prompt Hierarchy Step #1Environmental Cue

Set up the environment to signal to the student that an activity is about to begin.

Lining up at the door Getting everything ready for an activity & then

waiting…….. Art materials prepared but out of reach Desired items visible but inaccessible Cutting the pizza up and waiting

If student responds, provide... Descriptive Feedback

Prompt Hierarchy--PausingPause after every step to give the

student time to respond to the cue. Focus your attention on the student

(expect communication!) A N

PAUSE D

If the student responds, provide... Descriptive Feedback

Prompt Hierarchy Step #2Open Question

If the student does not respond to the pause by making a response:

Ask a WHAT, WHY, WHO, WHEN, WHERE, OR HOW Question ONE time

• “What do you want?”• “Whose turn is it?”• “Where does that go?”

AND then…...PAUSE If student responds now, provide...


Prompt Hierarchy Step #3 Prompt or Request Communication

If the student does not respond to the open question & pause……

Provide a prompt to students (ONE time)• Choices, carrier phrase, initial sound, visual cue

OR Request Communication (ONE time)

• “Tell me what you need.”• “Tell me what goes next.”

AND then……PAUSE

If student responds now, provide... Descriptive Feedback

Prompt Hierarchy Step # 4Full Model

If the student does not respond to the partial prompt and pause….. Provide a full model for student

• Use student’s AAC device• Use developmentally appropriate model

AND then…...PAUSE If student responds now, provide...


PAUSEPause Pause Pause Pause Pause PausePause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause Pause!

In other words…PAUSE!

Prompt Hierarchy

Gives student the necessary time to process information and to formulate a message to communicate

Provides a structure for adults that encourages communication

Can be customized for individual students Organized as least to most

Prompt Hierarchy












, Wants/Needs: I want, more, help, specific snack items

Social Interaction & Etiquette: sit here, want some?, please, thank you

Sharing Information: good, yucky, uh oh, all done

Snack materials set out, but out of reach of students.Adult waits expectantly.

What do you want?What do you need now?Who do you want to pass that to?

Do you want apple or crackers?I want ……..Mmmmmmm (for milk)

I want milk.Apples pleaseI want more crackers please

You asked for milk…here’s more milk.Crackers…..here’s 3 more crackers.Milk is good! Are crackers good too?

All students have snack placemat with specific snack vocabulary velcroed on top & core vocab. permanently on sides.

Single small pieces of snack

Straw on table, but out of reach

Milk carton not open

Wrong flavor of milk (sabotage)

CCE is a paradigm shift…

• From sole focus on the student’s AAC device to communication

• From focusing on the student’s communication limitations to creating a communication environment

• From a single player to team ownership for communication opportunities

• From product-oriented activities to consciously designed communication-based activities

Where do I go from here?

Some Possibilities… Identify one specific student (do not select your most “challenging” student!) Encourage other teams in the district to join you & form a

“study group” where you…. Use videotaping to help you analyze your activities, partner

behaviors & environment Critically analyze the activities for student communication

opportunities (minimum of 3) Set up your environment to maximize communication (one

activity a day) Post prompt hierarchy & start to use Provide feedback to team members & ask for same Others?

ReferencesAmerican Speech-Language-Hearing Association website: www.asha.org

Burkhart, L. 1993, Total Augmentative Communication in the Early Childhood Classroom, p.38

Binger, C. & Kent-Walsh, J. (2005). Evidence-Based Language Supports for Children Using AAC: Increasing Expressive Communication. Closing the Gap conference, Oct. 2005, Minneapolis, MN.

Blackstone, S. (2006). Young children. False beliefs, widely held. ACN:Augmentative Communication News, June 2006, 18 (2).

Casey, K. & Kornfeld S. (2004). Developing language-rich light tech AAC systems

for young children. Closing the Gap, October/November 2004, 23 (4).

Hodgdon, L.A. (1999). Solving behavior problems in Autism: improving communication with visual strategies. Troy, Michigan: QuirkRoberts Publishing.

Karlan, George. Environmental Communication Teaching Training. Field-Initiated Research Grant Award No. H023C9005 from the Office of Special Education, U.S. Department of Education. Lafayette, Indiana: Purdue University.

Light, J. (1996) Communication is the essence of human life: Reflections on communicative competence. AAC Augmentative and Alternative Communication, June 1997 (13), 61-70. Light, J.C. (2005, May). AAC interventions to maximize language development for young children. State College, PA: AAC-RERC. Retrieved June 10, 2008 from http://aac-rerc.psu.edu/index-16147.php.html

Skotko, B., Koppenhaver, D., & Erickson, K. (2004). Parent Reading Behaviors and Communication Outcomes in Girls with Rett Syndrome. Exceptional Children, 70 (2), 145-166.

Quill, K. (2000) Do-Watch-Listen-Say: Social and communication intervention for children with autism. Baltimore: Brookes Publishing.

WATI (2009). Assessing student’s Needs for assistive technology. www.wati.org

Thank you for coming….

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