I-ASC: Identifying Appropriate Symbol Communication

Ways of working

ways of working
ways of working

Ways of working define a range of service structures and team processes that potentially influence the way decisions are made.

Balancing decisions

This refers to the process of debating the important elements of the AAC system and set up for the individual child. Where necessary making explicit trade-offs to reach the final decision. Findings suggest that contextual factors influence decisions within the communication aid recommendations process, e.g., service structures, team composition, service delivery and team knowledge.

Implications
  • Ensure family needs are adequately accommodated within the decision making process.
  • To support learning and skill development, plan for access to appropriate quality communication opportunities.
  • Be aware of the trade-off between the knowledge and skills of those available to support learning the system, and choosing the language system that best suits the child’s abilities (i.e. the most appropriate symbol language may be unfamiliar to those around the child).
  • Plan ahead for changes in staff support or the child’s circumstances to ensure adequate ongoing support for system maintenance, editing, and AAC-mediated language modelling. Ensure the reason for referral to any type of AAC service is clearly understood at the assessment planning stage. For example, assessing for an updated system due to technology obsolescence is likely to require a different process to an assessment of a child with no AAC experience for their first AAC supports.
I-ASC Resources
Other Resources

Please email i-asc@mmu.ac.uk if you know of resources that should be included here

Learn more

Lynch, Y., Murray, J., Moulam, L., Meredith, S., Goldbart, J., Smith, M., Batorowicz, B., Randall, N., and Judge, S. (2019) Decision making in communication aid recommendations in the UK: Cultural and contextual influencers Augmentative and Alternative Communication

Webb, E.J.D., Meads, D., Lynch, Y., Randall, N., Judge, S., Goldbart, J., Meredith, S., Moulam, L., Hess, S., and Murray, J. (2019) What’s important in AAC decision making for children? Evidence from a best-worst scaling survey, Augmentative and Alternative Communication, doi: 10.1080/07434618.2018.1561750

Basis for the referral

This refers to the reason why a referral for a communication aid assessment is instigated and the influence of referral information received on the recommendation process.

Implications
  • Ensure the reason for referral to any type of AAC service is clearly understood at the assessment planning stage. For example, assessing for an updated system due to technology obsolescence is likely to require a different process to an assessment of a child with no AAC experience for their first AAC supports.
  • Ensure all relevant information is captured in the referral process to support appropriate assessment planning.
  • Where children need to demonstrate skills to access specialised AAC services, alternative clinical pathways need to be in place to support skill development for children not able to meet the referral criteria.
I-ASC Resources
  • for detailed information on capturing a comprehensive language and cognitive profile see link to language and cognition section
Other Resources

Service specifications for complex disability equipment: Communication aids https://www.england.nhs.uk/commissioning/spec-services/npc-crg/group-d/d01/

Please email i-asc@mmu.ac.uk if you know of resources that should be included here

Learn more

Lynch, Y., Murray, J., Moulam, L., Meredith, S., Goldbart, J., Smith, M., Batorowicz, B., Randall, N., and Judge, S. (2019) Decision making in communication aid recommendations in the UK: Cultural and contextual influencers Augmentative and Alternative Communication

Extraneous factors

This describes factors outside the immediate situation that influence the decision making course of action. This may include access to services, awareness of rights, the impact of chance. Findings highlighted the influence of unpredicted and unconnected extraneous factors within the decision making context.

Implications
  • Be explicit in identifying the influence extraneous factors may have on decision making.  For example, the influence of the child’s school placement or the service delivery model used. Consider addressing these factors where they have undue influence (for example, for children who live further away from assessment centres, consider telehealth to allow equitable access to services).
  • Consider whether the available resources are overly influencing the decisions within the recommendation process. If so, consider altering the recommendation process to closer align with child need rather than available resources.
I-ASC Resources
Learn more

Lynch, Y., Murray, J., Moulam, L., Meredith, S., Goldbart, J., Smith, M., Batorowicz, B., Randall, N., and Judge, S. (2019) Decision making in communication aid recommendations in the UK: Cultural and contextual influencers Augmentative and Alternative Communication

Lynch, Y., Goldbart, J., Dada, S., Moulam, L., Randall, N., Judge, S. Meredith, S., & Murray, J. (2018). A literature review on the language abilities of children and young adults who use aided AAC during language development. Communication Matters Journal, 32(3), 16-20.

How decisions are made

This describes how decisions are made and considers the processes used to make decisions within AAC system recommendation. Findings suggest that the way services are organised, and the work methods used may have a considerable impact on recommendation processes.

Implications
  • Be mindful of not proceeding to make recommendations in the absence of core information (particularly the language and communication profile of the child) and be creative to problem solve gaps arising from service structures and delivery methods.
  • Be explicit with each other in how decisions have been reached. This supports participation and understanding of the decision making process by all team members including the family and child.
  • Communication aid trial plans should be developed from an evidence-based rationale.
I-ASC Resources
Other Resources

Please email i-asc@mmu.ac.uk if you know of resources that should be included here

Learn more

Lynch, Y., Murray, J., Moulam, L., Meredith, S., Goldbart, J., Smith, M., Batorowicz, B., Randall, N., and Judge, S. (2019) Decision making in communication aid recommendations in the UK: Cultural and contextual influencers Augmentative and Alternative Communication

Webb, E.J.D., Meads, D., Lynch, Y., Randall, N., Judge, S., Goldbart, J., Meredith, S., Moulam, L., Hess, S., and Murray, J. (2019) What’s important in AAC decision making for children? Evidence from a best-worst scaling survey, Augmentative and Alternative Communication, doi: 10.1080/07434618.2018.1561750

Information brokering

This refers to the access to, and movement of, information across parties or people within the decision making process. Findings suggest that service constraints in cross-sector (e.g., health and education) collaboration can make accessing all desired information challenging. This constraint results in decision making based on the available information, rather than desired information, which may affect outcomes.

Implications
  • Avoid information gaps in the assessment process through creative, collaborative working. Where gaps are unavoidable, document the known gaps within the process only then can service constraints be transparent to all involved.
  • Where the responsibility for assessment and information collation is split, either between services or professional groups, develop collaborative work practices to ensure optimal information flow.
I-ASC Resources
Other Resources

Please email i-asc@mmu.ac.uk if you know of resources that should be included here

Learn more
  • Lynch, Y., Murray, J., Moulam, L., Meredith, S., Goldbart, J., Smith, M., Batorowicz, B., Randall, N., and Judge, S. (2019) Decision making in communication aid recommendations in the UK: Cultural and contextual influencers Augmentative and Alternative Communication

Inheriting decisions

This describes how current actions are influenced by previous decisions. Findings suggest that the type of first aid chosen influences recommendation processes for second or subsequent communication aids. Consequently, extra care is needed in these early decisions, as they will have ramifications for the future.

Implications
  • When making recommendations, aim to retain child and family’s existing learning already invested in one type of graphic representation and/or communication unless there are strong reasons to change.  
I-ASC Resources
Other Resources

Please email i-asc@mmu.ac.uk if you know of resources that should be included here

Learn more

Lynch, Y., Murray, J., Moulam, L., Meredith, S., Goldbart, J., Smith, M., Batorowicz, B., Randall, N., and Judge, S. (2019) Decision making in communication aid recommendations in the UK: Cultural and contextual influencers Augmentative and Alternative Communicatio

Policy

This refers to any policies that influence access to AAC service support and funding. The findings suggest considerable variability in local interpretation of national policy and guidance.

Implications
  • Consider the influence of any local, regional and national policy that may influence the recommendation process.
  • Be mindful of policy-compliant decisions that are not in the child’s best interest and avoid if possible.
I-ASC Resources
Other Resources

Please email i-asc@mmu.ac.uk if you know of resources that should be included here

Learn more
  • Lynch, Y., Murray, J., Moulam, L., Meredith, S., Goldbart, J., Smith, M., Batorowicz, B., Randall, N., and Judge, S. (2019) Decision making in communication aid recommendations in the UK: Cultural and contextual influencers Augmentative and Alternative Communication
  • See Policy and legislation for summary of UK policy

Roles and responsibilities

This considers information about who does what in the communication aid recommendation process, and to what extent (including discord and unhelpful expectations of each other). Findings suggest that role clarity may be lacking in some communication aid recommendation processes.

Implications
  • Where barriers to team working, or information gaps are identified, there is a need to problem solve to develop more collaborative working that supports a child-centered process.
  • Creative problem solving may be needed where team members cannot come together for decision making (for example, the use of telehealth).
  • Clear mutual understanding of all team member roles and responsibilities including families is core to effective decision making.
I-ASC Resources
Other Resources

Please email i-asc@mmu.ac.uk if you know of resources that should be included here

Learn more
  • Lynch, Y., Murray, J., Moulam, L., Meredith, S., Goldbart, J., Smith, M., Batorowicz, B., Randall, N., and Judge, S. (2019) Decision making in communication aid recommendations in the UK: Cultural and contextual influencers Augmentative and Alternative Communication

Service delivery model

This considers the way a service is delivered which affects resources and services made available to the child. This includes service delivery models, team structures and communication aid recommendation processes. AAC services are delivered using lots of different service models. The findings indicate that different service delivery models had a considerable influence on the recommendation process.

Implications
  • Consider the setting used for the recommendation. Can some or all of the process be undertaken in the child’s everyday settings?
  • Be mindful of the timeframe available. This may be prescribed by the service delivery model (e.g. a set number of appointments). Shorter timeframes may warrant more comprehensive information gathering processes in advance of any decision making appointment.
  • System trials can fundamentally influence decision making. Ensure trials are formally set up and supported and given an adequate timeframe. This enables the child to optimally engage with the trial. It also provides the best available data to inform final decision making.
I-ASC Resources
  • I-ASC communication log – still in development
Other Resources

Please email i-asc@mmu.ac.uk if you know of resources that should be included here

Learn more
  • Lynch, Y., Murray, J., Moulam, L., Meredith, S., Goldbart, J., Smith, M., Batorowicz, B., Randall, N., and Judge, S. (2019) Decision making in communication aid recommendations in the UK: Cultural and contextual influencers Augmentative and Alternative Communication

Team theory

This describes AAC theory that may have influenced decisions. Findings suggest that many professionals use implicit theoretical frameworks to underpin their decision making. These related AAC and assistive technology models, professional education and clinical/teaching experience.

Implications
  • Team working will be enhanced by developing a shared understanding of the models and philosophies individuals draw on to support their decision making.
  • Having time to be a team and for a team to form and develop effective team dynamics can enhance role clarity and team working processes.
  • Be mindful that implicit theoretical frameworks may support the management of multiple competing factors however it may exclude people from decision making. Explicit detailing of the decision making process may support collaborative discussion.
I-ASC Resources
Other Resources

Please email i-asc@mmu.ac.uk if you know of resources that should be included here

Learn more
  • Lynch, Y., Murray, J., Moulam, L., Meredith, S., Goldbart, J., Smith, M., Batorowicz, B., Randall, N., and Judge, S. (2019) Decision making in communication aid recommendations in the UK: Cultural and contextual influencers Augmentative and Alternative Communication