Kate Grandbois: [00:00:00] Welcome to SLP Nerd Cast. I'm Kate. And I'm Amy, and we appreciate you tuning in. Whether you're an SLPA teacher, an EI provider, an allied health professional, or a parent or guardian of somebody with speech and language needs, we hope this podcast will give you some valuable information and keep you at least a little bit entertained.

In our podcast, we'll review resources, literature, and discuss ideas related to the field of speech language pathology. 

You can use this podcast for ASHA Professional Development. For more information about us and certification, maintenance hours, and all the other stuff we do, go to our website, www.slpnerdcast.com.

If you would like to use this episode for Asha Cmhs, you can purchase your CEUs on our website. I guess technically they're [00:01:00] cmhs, not C, but all the same. Yes. 

Amy Wonkka: Ours, our cm. 

Kate Grandbois: Yes. Yeah. Before we get started in today's episode's, financial and Non-financial disclosures, um, I am the owner and founder of Grand Wa Therapy and Consulting, LLC and co-founder of SLP Nerd Cast.

Amy Wonka is an employee of a public school system and co-founder of SLP Nerd Cast. Uh, we're both members of SIG 12 and both serve on the a a C advisory group for Massachusetts Advocates for Children. I am a member of the Berkshire Association for Behavior Analysis and Therapy, mass a BA, the Association for Behavior Analysis International and the corresponding Speech Language Pathology and Applied Behavior analysis special interest group.

So what are we talking about today? 

Amy Wonkka: Today we are covering some of my favorite area of the field, um, and we're gonna talk about basics in the area of a EC. So we are going to do sort of a deep dive into the terminology and then we're [00:02:00] gonna talk, um, quite a bit about just the personnel who are involved.

There's a lot of people who are involved in a EC intervention. Um, and then we'll have some resources where listeners can learn more. And why did we choose this topic 

Kate Grandbois: other than it being super fun? 

Amy Wonkka: Super fun. It's like the best area of the field. Um, 

Kate Grandbois: well, we're not biased at all working for a A A C specialists, quote, a, a c specialists for the last how many years?

Amy Wonkka: Long time between 

Kate Grandbois: the two of us. 20. Mm-hmm. Almost 20. 

Amy Wonkka: Long time. Long time. Long time. Yep. Years. It's good stuff. Um, I think one big piece is that many, many people use some form of a a c and it's really likely that speech language pathologists, teachers, e providers, BCBAs, other people in related fields are going to have somebody on their caseload at some point in time who uses a, a C.

Kate Grandbois: And it's more and more prevalent now in, um, non-specialty areas. I think at one point in time, [00:03:00] non-speaking individuals or individuals with limited speech got placed in substantially separate, separate classrooms or got placed out of district or, you know, there were fewer specialists. And now it's become, I wouldn't use necessarily use the word mainstream, but it's become much more commonplace in a variety of different settings.

Wouldn't you agree? 

Amy Wonkka: I totally agree. And I think with that, um, in 2012, like 20. A pivotal year in the field. 2012 was when, you know, iPads came out. The speech generating applications were being developed for iPads in 2012. Prologo was one of the first ones that came out. Uh, and then a lot of the major manufacturers kind of followed suit.

Um, and it was a, it was a pivotal point I think in, in the field of a a c particularly, you know, here where we are in the United States. Um, I think with that change, a lot of people got access to high tech tools who hadn't previously [00:04:00] had access, so it opened a lot of doors for people. It also sort of flipped upside down the traditional paradigm around, you know, having a specialist driven assessment model.

Uh, it, it, you know, changed things for funding. So I think. In addition to more people being served in more inclusive settings, I think we also see more people providing, just having access to high tech tools that weren't commonplace before. I mean, there was a day not that long ago that we, you know, I had a, you know, a flip phone and then before that I had, had, you had flip phone 

Kate Grandbois: forever.

Amy Wonkka: I did 

Kate Grandbois: the technology specialist who refused to transition to touchscreen technology for 

Amy Wonkka: so long, for so long. I am wary of the robots. But, um, but you know, I mean, I think our, our culture has shifted a lot in terms of how, how consumers have access to technology and that has had a ripple effect in a a c.

It 

Kate Grandbois: also had a really [00:05:00] big impact on the field at large, just from a product standpoint. I mean, you know, prior to 2011, you chose your hardware from a vendor. You chose the hardware and the software together as a package, and there was, you know, less competition. You know, these companies, they were established.

Um, and then when the iPad came along for the first time, you had a variety of different softwares available on the same hardware. So it became more of a software marketplace instead of this bundled software and hardware together. And the, the companies have totally changed the landscape of who you, you know, the options that you have as a prescribing clinician have totally changed.

So I'm just seconding the, the piece of history that 2011, 2012, those, those were some wild and crazy times. 

Amy Wonkka: Lot of crazy times. Well, crazy times. Yeah. I mean it's, it really has changed things a lot. Um, and I think. When we look at the literature, something that keeps coming up is, you know, [00:06:00] regardless of the time, um, most professionals, many professionals exit their graduate programs not feeling adequately prepared to work with people who use a a C.

And that's true. There's research, you know, certainly in the field of speech language pathology. I think one heartening piece of research is. You know, they've done some surveys, I think it was Lloyd et all in maybe 1994 that could be incorrect. Um, but did some surveys of graduate programs and then redid kind of that same approach in maybe 2008.

Um, we can get the correct references and dates. We, we will put 

Kate Grandbois: the correct reference on the website. Um, 

Amy Wonkka: but you know, they, they looked at graduate programs and the number of people who even just offered a course in a a c, um, it did increase between 94 or whenever in the nineties. That first one was in 2008 or where, whenever in the two thousands.

The subsequent one was. Uh, but it's still not, it's, it's not at a point where [00:07:00] most folks are reporting like, yes, these students who are coming out are very equipped to provide assessments and intervention 

Kate Grandbois: regardless of where you go to graduate school. If your graduate school offers a course, there are also varying degrees of experiences that you can get.

So for my graduate school as an example, we had a required course in the a a C, and there was one really competitive clinical placement for a a C, and it was, you know, two, two students out of our whole class would be accepted every year into that program. And there were no other clinical placements for a a c.

So, and as we all know now, you know, as we know as experienced clinicians, you cut your teeth on the job. You learn so much from getting your hands dirty, working with other experienced clinicians, getting critical feedback. So. A, a c is one of those areas where you may or may not get that experience in graduate school because it is so specialized.[00:08:00] 

Amy Wonkka: Well, and in the 2008 ish paper, uh, they made that point as well that they, you know, in looking at the faculty and the clinical staff at these different universities, not, not a majority of their staff are, are well versed in a a c necessarily. And again, that was a while ago, and I think that things are moving in the right direction.

But, uh, studies have shown that in the field of education as well. And when you think about how many a, a c users are included in, you know, educational settings and have teachers and are of school age, um, and as we'll talk about much more in this podcast today, there are a lot of people who. Are not the person who's, you know, conducting the assessment.

You guys can't see my air quotes, but who are really important to be part of the assessment process And even more so the implementation process. A a c is something that should be infused throughout somebody's school experience if they're a school aged person. And it's not enough to make that the sole responsibility of the [00:09:00] speech language pathologist.

Kate Grandbois: And just to set the tone for the talk today, we recognize that this is a specialty area, you know, it's a hyper-focused, um, we're not gonna use the word certification, specialty, specialty certification as a hot button topic. We are not gonna talk about that today, but we do acknowledge that there is a, there people devote their entire.

Courses of, you know, their entire professional lives to learning and studying a, a c. There is so much to learn in the field of a, a c. And the purposes of today's episode are to help a clinician who is new to a, a, c or a new grad understand the lay of the land, um, to transition into embracing a, a c more in your scope of competence.

Amy Wonkka: And, and to echo that, I think that what we're talking about today in the plan is for this to be a two part podcast. So today we're gonna cover a lot of the relevant [00:10:00] terminology and personnel. And then in a future podcast, we're going to give more actual clinical examples. 

Kate Grandbois: Yes, and I just sort of exactly how we approached the behavior management.

Um, this is a two-parter. We, there was just so much we could say, we can't possibly squeeze all of a a c basics into one episode. So this is a two-parter. Um, the two parter is the two episodes are going to cover two objectives each. Each episode is worth one Asha, CMH. Um, you could listen to both episodes for two Asha Cmhs, which is equal to 0.2 CEUs.

This conversion and terminology just drives me nuts. One in the same two hours of continuing education for both, for listening to both episodes. The learning objectives for today's episode, part one include, number one, identify key terms used in a a C and what they mean. Learning objective number two, [00:11:00] identify some of the different personnel roles and responsibilities involved with a a c assessment and intervention.

Uh, our next episode, part two is going to cover two different learning objectives. So learning objective number three, identify barriers for successful implementation across environments and learning. Objective number four, identify successful strategies across different environments and profiles. And that will be highlighted.

We'll be highlighting a lot of different case examples, um, and clinical examples, um, throughout the second episode to highlight and give examples. I just keep using the word examples to, to highlight some of those barriers and strategies 

Amy Wonkka: and the content that we're gonna cover in both of these while geared towards speech language pathologists as we'll.

Talk more through the podcast. It's also relevant for all of these other people who are key people in a a c intervention. So if you are an early [00:12:00] childhood educator or you know, a K through 12 educator, you're a vocational coordinator, like all of these things can be very relevant and applicable to you as well if you're somebody who supports a, a c users.

Kate Grandbois: Uh, so that's a sort of a nice segue into learning objective number one, identify some key terms used in a a C and what they mean. Take it away, 

Amy Wonkka: Amy. So, so today, you know, we are gonna spend a fair amount of time talking about terminology in the area of a a C and we've talked about jargon on this show before and how we use it, but sometimes it leaves people out of the conversation or makes them feel like they don't know enough things like that.

Um, I think as somebody who, who's currently in sort of a specialist role, I think that this is. Kind of a commonplace that makes if people feel like they don't know enough or they're not, they, they're not qualified to help support people who [00:13:00] use a a c. I think a lot of times it is things like jargon, like, oh, I don't even, I don't know what that means.

I feel uncomfortable, I wanna do my best job. Perhaps I'm not the right person for this. Um, so I think that that's a downside to jargon, but jargon isn't all bad, right? I mean, jargon comes from a place where, you know, people have developed these terms because they describe something really specific that takes a lot of words to describe without the jargon, right?

Like jargon is shorthand for a reason. Um, and most of these jargon term kind of decoded versions that we're gonna talk about today comes from ASHA's website. So Asha has some really nice consumer friendly overviews on their website in the area of a, a c and will reference things that will all be, um, up on the website.

But there are a lot of different places where you can find some very consumer friendly information from Asha regarding a UC 

Kate Grandbois: Asha is has a wealth of information up there. I'm just gonna second that I know. High [00:14:00] fives sometimes to Asha. Good job, Asha, but only sometimes. Thanks guys. Um, anybody from ashe's listening?

Amy Wonkka: Probably not,

but if you are, thanks. I'm glad we're recording 

Kate Grandbois: this on a Friday. It's just been a long week. Anyway, moving on. So what's our first jargony jargon word? 

Amy Wonkka: First jargony jargon word. You guys probably already know this one. What is a a c. A a c stands for augmentative and alternative Communication. So Ash's definition, um, is all the ways we share our ideas and feelings without talking.

And I liked that. That's their, like, it's 

Kate Grandbois: nice, 

Amy Wonkka: right? Like 

Kate Grandbois: I jumped right into a way more technical, boring snoozy definition. I like that so much more. 

Amy Wonkka: Yeah, they have a couple, they have like three different pages that were super, like family friendly, like, and, and that I actually hadn't looked at prior to kind of [00:15:00] preparing for this episode.

So it was nice to see them and they went on my list of things that I would share, that I would share with families in the future. That's so great. Um, so I like that one a lot. There's also the International Society for Augmentative and Alternative Communication. Uh, shorthand is Isaac. They put on a pretty sweet conference every couple of years.

I 

Kate Grandbois: think the next one's in Rome. 

Amy Wonkka: I know I'm so afraid of planes, but now nobody's, 

Kate Grandbois: nobody's going anywhere, so forget about it. 

Amy Wonkka: Um, but yeah, they do. I, I'm, I'm there every time it's drivable or a short flight. Um, they, uh, their definition is a, a c is a set of tools and strategies that an individual uses to solve everyday communicative challenges.

Communication can take many forms such as speech, a shared glance, text, gestures, facial expressions, touch, sign, language, symbols, pictures, speech generating devices, et cetera. Everyone uses multiple forms of communication based [00:16:00] upon the context and our communication partner. Effective communication occurs when the intent and meaning of one individual is understood by another person.

The form is less important than the successful understanding of the message. I love that. I really like that one too. 

Kate Grandbois: It's so good. That last sentence, the form is less important than the successful understanding of the message. I think, and this is maybe an idea to unpack later on in a, in an episode for a more intermediate learning level, but that gets so lost sometimes.

The message is really why we're using a a C, and I think that that's so, it's such an important focus. It's so important to not lose sight of that. 

Amy Wonkka: Well, and I think, I didn't, I didn't like quote their website, but the a A C Institute also has, or at least used to have a really nice definition on theirs too.

That was basically like the goal is the highest communication possible, right? You wanna be able to communicate what you wanna say, when you wanna say it. And I think, you know, all of that together is what a C is. And I [00:17:00] think. You know, you can distill it down to that simple one, but the complexities are nice too.

Kate Grandbois: And I'm not sure who originally said this, but another nice acronym, um, for clinicians starting out with a, a c that I think is a really great takeaway is snug. Do you have a reference for that? So, snug, spontaneous, novel, utterance generation, um, is really your ideal. Um, it's what your, it's what your ideal practice is.

It's what your ideal goal is for the a a c user to be, to be able to produce snug, spontaneous, novel, utterance generation. And if there is a reference for that, we will put it on our website. Off the top of my head, it's just so casually thrown around in my work environment. I'm not sure if it comes from literature, but 

Amy Wonkka: Oh, it, yeah.

No, it does. And it's, yes, that's, that's exactly, um, that is the ultimate goal. And we have a reference up on our website that is actually an Asher reference. Um, and it is under the heading core vocabulary, making sense of symbols. And in there [00:18:00] they talk about different symbol representation, but they talk specifically about snug.

So. 

Kate Grandbois: Perfect. Thanks again. Asha. Two points 

Amy Wonkka: for you. I have such a mixed, mixed experience because like the dues are due with the holidays. There are a lot of money and so there are days where I'm like, my money did good things. They've made all these, today's one of those days. 

Kate Grandbois: Oh good. I'm, yeah, I like to, I like when I pay my bajillion dollars in dues and continuing education because they have a monopoly on that entire situation that we won't go into.

But it's good when they, when, when ASHA brings the party home. That's so nice. 

Amy Wonkka: Yeah. This is one of those times. So a a 

Kate Grandbois: c We know what, there's a, a handful of different governing bodies who have different, more technic, different definitions ranging from technical to more feel good. Um, what is the difference between augmentative and alternative?

Amy Wonkka: Right. So there is a difference. There is a difference and both are important, and that's why they have their own standing [00:19:00] in the acronym, right? So when we think about alternatives, I think that that's what more people think of when they think of a, a c. So an alternative really is a substitution four. So that would be American sign language for individuals who are deaf, um, and choose to be signing.

And in that culture, um, it could be a high tech speech generating device for somebody who has little or no functional speech. These methods of a a C are serving as that individual's primary mode of communication, uh, as an alternative 

Kate Grandbois: to, to communicating with speech. 

Amy Wonkka: Yep. And that can be temporary or permanently.

Um, so in some cases you may, you know, begin using a high tech tool. As your primary mode of speech as an alternative. And then perhaps, especially this is especially true for younger individuals, right? So you may provide people access to a a c at a very young age at that point in time, it is an alternative.

And over time it may morph into [00:20:00] something that augments their speech. 

Kate Grandbois: Or I'm also seeing some stuff in the news these days about people who have been intubated. Mm-hmm. Um, and have suffered vocal fold injury or, you know, something, some other, I'm, this is really not my area, but some other issue related to intubation that, or being actually intubated that prevents you from communicating verbally.

So there's a lot of different reasons, I think why a, a C might be temporary. 

Amy Wonkka: Yes, for sure. And actually, um, this is also not my practice area either, but I do know that John Costello and the work at a children's hospital in Boston, they, they do a lot with this. They do a lot, um, with temporary CAC. And a, a c in intensive care settings.

Mm-hmm. So if you're looking for more information about that, they're a great place to start. Um, so, so that's 

Kate Grandbois: alternative. What's augmentative? 

Amy Wonkka: So augmentative could be the exact same thing. Right. So the examples that we gave as an alternative were [00:21:00] American Sign Language and a speech generating device.

Those exact same, a, a c methods could be used to augment speech, but the function is different. So in the case of augmentative communication, the A a C is adding to the person's oral speech. And usually for these folks, the oral speech is effective. In some environments or for some tasks or with some communication partners, but not all, so it's not meeting all of their needs in all of their environments with all communication partners.

And so the a a C is really serving as a supplementary support at those times when it's needed. Again, to go back to that definition that I didn't quite quote from the a a C institute where the, the goal is the highest communication possible, right? Mm-hmm. We want, we want people to communicate at their absolute best, not just in some environments, not just with people who know you well, but.

Everywhere. We want your world to be as big as you want your world to be. Um, 

Kate Grandbois: and I think that this, this component of [00:22:00] I, um, a, a c this augmentative piece is sometimes the most difficult to explain. Um, or sometimes depending on your stakeholders, sometimes it's the harder to get buy-in because the person has verbal speech to some degree.

Um, so there can be a lot of questions around augmentative, um, augmentative communication related to, I don't know, he doesn't need the iPad. He, I understand everything he says at home, or, you know, this is, this is stigmatizing. I don't really want this. I they can't, we just make their speech better. It's, it opens up a lot more questions, I think in my personal experience.

I a thousand percent agree with you. Uh, and I think thanks for that validation. I got nervous. Agreed. Um, I, I think you need to start holding up green cards. Like good job, keep talking 

Amy Wonkka: red cards with like shark teeth on them or something. If we are really in disagreements. [00:23:00] Um, you know, I think for anybody who's listening who's not, you know, a, a c is not your comfortable wheelhouse area in the field, um, or, you know, perhaps you are an educator or somebody who didn't have a whole lot of background in this, in school, I think it can be really confusing.

And, and for you guys, what I would, what I would say is that it really is a balancing act and I think. When we are making a plan together, because hopefully you're making a plan kind of together as a group. I'm gonna frame this in an educational context, but this would be clue would be true in any other, you know, context as well with multiple, uh, providers.

I think you wanna think about what your ultimate goals are. I know, you know, sometimes when we see folks with speech that is minimally intelligible, but becomes better for familiar listeners over time. Um, particularly for kids who are like younger, right? Like, let's say like you're thinking about elementary school.

Some [00:24:00] folks who are like, perhaps the student's SLP is thinking about, okay, but I know, you know. In eighth grade, they're gonna transition to a different school and have all of these new communication partners and they're really gonna need to have the skills necessary so that they can be understood in this new place with these new people.

So that provider might want the team to focus to some degree on A a, C. And that might be confusing for team members who say, this is silly, I can understand all the things that this person is saying to me. Um, so sometimes just having a conversation around what your goals are and understanding that sometimes for people who are using it to augment their speech, it's not the top priority but it, but we do still need to work on it a little bit because we want the person to have the skills solidly in place so that when they need to use them, they have them there to use them.

Yes. They're not trying to scramble and catch up. 

Kate Grandbois: Yes. Um, and. Having that conversation can be difficult, and I think if you're just starting out and you're having some uncomfortable feelings about that [00:25:00] conversation, you are not alone. It's, it is a, it's a gray area for a lot of people. Um, but it is important.

I mean, just, just like you said, we want their world to be as big as they want their world to be. We want them to be communicating with the guy at Dunkin Donuts or, you know, ordering something at the deli counter in, you know, interacting with unfamiliar listeners in their environment. 

Amy Wonkka: Similarly, sometimes your intelligibility, right?

So your ability to accurately form sounds and sequence those sounds together into words and phrases and sentences is impacted as your utterance length gets longer. Right? So there are some speech disorders that result in intelligibility breakdowns with length of utterance increasing. So another time where you might see a a c used is for.

Again, you know, thinking about a school environment, having somebody be able to show what they know. So you may be fine with your oral speech [00:26:00] to answer some questions, but if you're asked a complex question and the expectation is that you'd be able to answer it, you don't want your oral speech to be the limiting factor in demonstrating that you understand the content or you can answer the questions.

Um, so it may also come into play as sort of an educational tool that could also be true on a work site. Um, you know, when you're doing a job interview, you're meeting with a potential employer. You wanna make it clear to that employer and the person who's interviewing you that you are able to answer their questions and follow their directions, and you understand what they're saying.

Um, whereas like on the fly, you're fine with your oral speech. So it just gives people more flexibility 

Kate Grandbois: and no matter how old you are, making personal connections, I mean personal connections and relationships are rooted in communication. Um, you never want speech to be a limiting factor in sharing a moment, sharing a thought, sharing a story, making a joke.

Laughing at, you know, responding to the joke, telling someone that their joke was inappropriate or [00:27:00] telling someone to buzz off. I mean, there are so many components to interpersonal relationships rooted, um, in communication that you never want speech to, to be, um, a limiting factor there. Um, and in a previous episode we had talked a little bit about aided versus unaided mm-hmm.

Communication strategies. Do you wanna give a quick overview about the difference between those two things? 

Amy Wonkka: Sure. So I think, you know, just to recap, A a C isn't only a replacement for oral speech, so don't be confused if you see someone who's using an a, a C system and you thought perhaps they didn't need it.

Um, aided is what we are talking about. And I think what a lot of people are thinking about when they're thinking about a a CA lot of times, so these are just require an a, a C system that's aided, requires a tool external to your body. So that could be a device, that could be a piece of paper. Um, any, anything that you have to bring with you and carry with you [00:28:00] that's aided.

Um, unaided is just your body, so gestures, body language, facial expression, sign language, these are all unaided, just your body. All you need is your body. You're good to go. 

Kate Grandbois: And in terms of the aided communication, I know that there is a lot that we had talked there is so much to say about symbolic communication and how sim different kinds of symbols play a role in aided communication and the spectrum of symbolic communication.

Um. There are some fancy words that go along with discussing which kind of symbol set you use. There are acronyms related to the companies that make the symbols. There are acronym or big fancy words related to the kind of symbol that you use. And, um, you know, I've been working, I've been doing nothing but a, a C for 10 years and sometimes I say them backwards.

Uh, so what can you tell us about the symbol [00:29:00] type in aa, in aided A, a C? 

Amy Wonkka: So I think a lot of people give a lot of thought to symbol type. Um, and I think where I see it happening often is if the symbols don't make sense to me, the communication partner, I'm more likely as the communication partner to have trouble with the symbol set and perhaps think that maybe this is a bad fit if I don't understand the symbol.

So yes, when we think about symbols, I think that. Where symbols come up often are for communication partners, and often people who have a little less experience with a a C may have a few more challenges around symbols because if the symbol doesn't make sense to me as a communication partner, I might feel like how on earth is the symbol gonna make sense to the person who I'm trying to support in building their communication skills?

Right? So when we think about aided symbols, those are the ones that are external to our [00:30:00] body, and that can include so many things that can be objects, partial objects, textures, photographs, line drawings, printed words, written words. I mean, there. There's a whole number of supports that fall under that aided category.

Um, and 

Kate Grandbois: the feature matching process comes into play a little bit here because you wouldn't necessarily, and then this is more in the assessment piece, but in thinking in terms of the importance of the symbol in the aided strategy. For example, you wouldn't use text for someone who isn't literate, right?

So, you know, there are a lot of things to cons. There are so many things to say about symbols, and I know we're really just talking about the definitions of some of these terms and how they play a role. Um, but there, there are specific pieces of the symbol that are matched specifically to the a, a C user based on a whole host of factors, any sensory related, you know, ocular motor [00:31:00] issues, you know, positioning issues, um, cognitive issues, things like that.

What about the word iconicity? That's a big fancy one. 

Amy Wonkka: Iconicity is super, is is very fancy. Um, I think Iconicity talks about, so just just to back up for a second, a symbol is just something that represents something else. Mm-hmm. So what it represents, we're gonna henceforth refer to that as the reference.

So the thing that is represented by the symbol is the reference. So the English language is, is symbolic. It's simple. Well, 

Kate Grandbois: language, I mean just language in general is a sequence of rule governed symbols. 

Amy Wonkka: Correct. So, you know, in, in the English language, this like arbitrary strand of phoniums, like at, right, that is arbitrary group of sounds that clustered together.

Cat represents this idea of cat. The reference is cat. So Cat you say cat, it gives me this picture in my head. Four legs, [00:32:00] fluffy, descended from tigers. Terrifying. Thank you. When you die, all these things. Um, and when we think about aided symbols, it's no different. The big difference is that some aided symbols are super abstract.

Like those phs at super abstract, those, that sequence of phs has no clues in it to tell you what it refers to. But when we think about aided symbols, sometimes they do have all sorts of clues in it that kind of help you guess what it's referring to. Right. So iconicity is that, is is the term that kind of refers to how closely that symbol connects with the reference.

Um, um, so Iconicity is best thought of as just a continuum. So on one end you have these symbols that are pretty similar or very similar to the reference. And then, you know, kind of gradually you move across the continuum. And on the other side you have like oral speech at that tells me. Nothing inherent to that symbol that explains cat to me.

Um, we have a [00:33:00] link to an awesome presentation, um, an Asher presentation from 2007 by Mary Joan McClure and Libby Rush. As I was prepping for this podcast, um, I kept searching for things and, and like repeatedly downloading it. 'cause I would get like hits in Google where I was like, oh yeah, that's exactly what I want.

And then it'd be like, you, this is the fifth time you downloaded this weirdo. Um, so it's, it's a great, 

Kate Grandbois: at least it was reliable 

Amy Wonkka: talking about Yeah. Right. They, they do a great job talking about all sorts of things connected with thinking about symbols and they have a whole piece that connects to the point Kate made earlier about all the different considerations when you're picking, um, symbols as part of an assessment.

But they check that out. That'll be up on our website. But on one end of this continuum, you have a very transparent symbol. So that would be the term. That goes along with, you know, the, these symbols really look a lot like they're reference as a result, it's pretty easy to guess what they are. So if you had, you know, back to the cat example, a photograph of like [00:34:00] that classic cat, right, like a gray striped tabby cat, maybe he's just like on a white background.

That would be a pretty transparent symbol. There's clues in there that tell you what, what reference it connects to. Uh, sort of in the middle of that continuum are what would be referred to as translucent symbols. So these aren't as easy to guess as transparent symbols. You need like some extra clues, but once you figure it out, it makes sense.

Um, for me, these are things, if you have anybody who's using a semantic compaction system, which we'll talk a little bit about later. That's, that's where these fit for me. Like the icons. I don't really understand it, but then I understand somebody explains to me the story behind it. It makes sense. I understand it.

Um, and then on the far other side, 

Kate Grandbois: is it, are bliss symbols an example of tr of translucent symbols? 

Amy Wonkka: I mean, for me, they're not, I feel like they're, they're, I mean, they're, I feel like they're more, they're more opaque, like opaque [00:35:00] symbols. Mm-hmm. Because opaque symbols are things like written text. Right.

And bliss symbols are hieroglyph key. So I think for me, yeah, it's more like a written, I, I don't really know. But for me, that's where I would place them. And I think that the McClure and Rush presentation also makes the point that, you know, these, this continuum of transparency is not a hard and fast rule.

I think especially when you're thinking beyond that more transparent symbol. Some things that like, make a lot of sense to me might not make sense to Kate because they're also relative to our life experiences and learning. And so, you know, something that I think Boardmaker symbols are a good example.

Like, uh, to me the symbol for want, which is like the little dude's hands, like moving toward a red box, that has become a, a translucent symbol because I, I know what it means, but I think if I were to show that to my husband, he would probably, 

Kate Grandbois: or the green arrow for [00:36:00] go. I always thought that was a, another good example of that because Oh yeah, go, there's an arrow.

It's implying motion. It's implying movement. But if I showed it to a lay person, they'd be like, what? 

Amy Wonkka: Okay, so excellent segue, um, into the next point, which is you also could hear people talking about concrete compared to abstract symbols. This is a similar continuum, right? So you have very concrete symbols on one end, very abstract symbols on the other end.

Um, it's, it's not a hierarchy. So that's something that I think confuses a lot of people. And I would like to say that the literature. And the McCluen Rush presentation talks about this a bit as well. You know, it's not like you don't have to like move through concrete transparent before you've mastered it and you're able to move on to abstract or translucent symbols.

That's, that's not how it is. It's, it's really when you're making decisions about symbols, it should be informed by the actual [00:37:00] client data. So their preferences, what works best for them. There's no one perfect symbol set. There's no one universal symbol set overall, or, or like for people with certain diagnoses or sensory needs.

Just because you tried something with one person who had a similar profile doesn't mean it's the right fit for another person. 

Kate Grandbois: And to sort of loop that back to what we were saying before about making. You want the symbol set, you want the a c tools to set them up for the most spontaneous and novel communication as possible.

So if you have an a, a C user who is using different symbol sets, or you're trying to figure out which symbol set, you know, through the feature matching process, perhaps they're demonstrating some success with different, you know, with opaque symbols and with transparent symbols. But maybe one is slightly better than the other.

Um, it really should be just to hammer that home again, data-driven based [00:38:00] on their best performance. Um, in terms of, you know, if you are choosing a symbol or trying to, you know, think about what symbols to put in different environments, that really needs to go back to, um, a data-driven decision. 

Amy Wonkka: A thousand percent.

And I very in sync today, we're very in sync. But I think, you know, when you, when you think about it too, it's, it's also a continuum. A a c is a system. Most people are combining aided and unaided methods. A lot of people who are using aided methods are using a number of different types of aided methods.

You very easily could be using some opaque abstract symbols and also have some really concrete, you might be also working on making a choice of two objects when you're feeling stressed out or, you know, you're in a very noisy environment or so. It's also not like people aren't stuck into one type of symbol.

Um, I think also bears [00:39:00] mentioning that we've talked a lot about symbols, but this is true for words also. I mean, some words. Words are 

Kate Grandbois: symbols. 

Amy Wonkka: Truth preach. Words are symbols. Words are symbols. So. Um, words are symbols and words are both concrete and abstract. So, you know, in the earlier example of cat, that's a specific noun.

It's a much more concrete concept. It's a better picture producer. Um, how about that? Or interesting or fabulous? What picture if, if I say cat to you and you close your eyes, you can probably conjure up some idea around 

Kate Grandbois: what fear claws eating, things that pounce on you in the night, those kinds of things because cats are horribly terrifying.

Sorry, do you cat lovers out there? I'm so afraid of cats. 

Amy Wonkka: Just alienated like half the people who are sitting, listening to 

Kate Grandbois: the cats. I'm just afraid of them. Like I'm [00:40:00] afraid of bees. 

Amy Wonkka: It's fun. They hurt my 

Kate Grandbois: body and I don't like them. Now you alienated 

Amy Wonkka: all the people sitting at home with their bees listening.

Kate Grandbois: Some people keep bees. I like the beekeepers and the cat people. 

Amy Wonkka: Yeah, I just don't want 

Kate Grandbois: them in my house. 

Amy Wonkka: But you can picture what a cat looks like when you close it. I can. 

Kate Grandbois: And to be 

Amy Wonkka: cat is concrete and it 

Kate Grandbois: evokes feelings of fear. 

Amy Wonkka: Correct. 

Kate Grandbois: Moving on for you, 

Amy Wonkka: for you the word 

Kate Grandbois: interesting or the word fabulous, I don't know that I get images as much as I have connotations or associations or feelings around those words.

Amy Wonkka: And I think this is helpful for people to be aware of because sometimes what it means for folks who are supporting, um, individuals who are using ac, especially earlier communicators, is there might be a tendency on the part of the partner or the people providing the augmented communication to overemphasize nouns.

Nouns are very important. Nouns are, you know, approximately 50% of, uh, [00:41:00] somebody's first 50 words, you know, in, in, in America anyway, I think in English speaking countries. Um, and that does shift culturally. So those are other things to be aware. Um, but here we use, you know, nouns. Nouns are a big piece of early, uh, vocabulary corpus for people.

Um, but nouns alone aren't enough to generate any multi symbol utterance. So if you're just going for things that seem like solid picture producers and they're concrete and they fit into these nice boxes of this symbol visually makes sense to me. You're really leaving out essential building blocks of language.

So don't let that bias toward things that are better picture producers skew your intervention. Um, if you're somebody who provides language intervention, think about what you would do with somebody if they were using oral speech. Those same targets should generally apply broadly to somebody who's using a a C.

Um, you [00:42:00] know, verbs, for instance. Verbs are super important. They don't really translate that well to pictures, uh, determiners that this, those are. Frequently used words in a lot of frequently used word studies, uh, don't translate well to images. So be aware of that. 

Kate Grandbois: And you have a, um, you have a list here, I mean a link here in our notes, um, about a great blog post that goes into this a little bit more about how you shouldn't limit the symbol set for someone with intellectual disabilities.

Amy Wonkka: Would you like to read the quote? 'cause it's a good one. 

Kate Grandbois: Sure. So we are gonna have a link, um, in our handout and on our website to a blog post that is posted on the fabulous, fabulous blog practical, A a c, um, that's for all. For those of you who don't know it. Practical is P-R-A-A-C-T-I-C-A-L. So it's a little, it's a little fun acronym there.

Um, so this is a quote from that blog post. Don't assume that because the symbols [00:43:00] are abstract, that people with intellectual disabilities can't learn them. They can, they do. You don't have to take our word for it. Read the longitudinal research done in the 1990s and beyond by Maryanne Roski and Rose Sev Sevick.

I'm gonna guess that Subick Sevick. For starters, they intentionally selected abstract symbols for their A a C intervention and demonstrated that people with significant learning challenges can use abstract symbols successfully. That is huge. 

Amy Wonkka: Yeah. 

Kate Grandbois: End quote. Yeah, that is huge part with me. Yeah. The quote, the quote ended with the word successfully.

But that is, that is my interpretation is that is super important and, and that research is amazing. Everyone should know that. 

Amy Wonkka: Mm-hmm. And they, it in that same blog post, they have some really nice tips about how to structure intervention for people who are using to use learning, to use symbols such as, you know, keeping your keywords in a consistent location.

This is the same [00:44:00] idea as, you know, learning to touch type, right? Like if I, if somebody came in and moved the A around on my keyboard every night, I would, I would be an even less effective typer than I am right now. Um, using emotional like context for teaching vocabulary with the idea that, you know, we have an emotional attachment to something and if it's like particularly funny or enjoyable, you're more likely to learn things.

Um. Providing repeated practice and then actually just talking about the symbols. So they have some really nice tips on there. 

Kate Grandbois: That's awesome. Can you talk to us a little bit about, um, terminology related to access? So what is access for those, for those individuals out there who are brand new to a a c, can you give us a brief description of what access is and then do an overview of some of the terminology related to access?

Amy Wonkka: So you may hear the term access methods, and that's really just talking about how the person interacts with the aided a, a c tool. And they're, you know, [00:45:00] just like aided and unaided. There are two big categories here. There's direct selection and in direct selection. The communicator is doing something to select the particular word or words they want directly, such as pointing, touching with a finger, using eye gaze, things like that.

Um, indirect selection, the communicator does something to select from offered choices. And this is also called scanning. You might hear it called scanning. Low tech scanning systems typically involve a communication partner presenting pictures in a specified sequence, and then the communicator does something to indicate when the symbol they want to use is presented high tech scanning systems.

And to present these options, uh, usually by highlighting different quadrants or some other. Visual or auditory queue. Um, so they might, you know, highlight quadrants of the screen, screen rows or columns. And then that may also, you know, progressively narrow down. So you might start off, uh, highlighting quadrants.

And the communicator selects the quadrant [00:46:00] that the word they want is in. And then, you know, the system will go through the rows and then they select the row that they want, and then it will go across the column, and then they can select the word that way. Um, as, as you can guess, usually direct selection is fastest, but there are exceptions.

And identifying the access method or methods should certainly be part of your a a C assessment. And again, a a c assessments should be multidisciplinary. So this is not something that one person should be determining on their own. Um, and it should, there should be something in the implementation plan that, that, in which it's evaluated on an ongoing basis.

And just like symbol sets people, often people may use multiple, uh, access methods as well. 

Kate Grandbois: Shameless plug to our previous episode on implementation plans. If anyone would like to learn more about implementation plans, we did an episode on that a few weeks ago. Um, and we've already talked a little bit about, um, symbolic representation.

Is there anything else that you wanted to say about access? [00:47:00] 

Amy Wonkka: No, I mean, I think access is, access is usually, if you're somebody who's not conducting the assessment, access is something, the key points for you to take away from that are that multiple providers should be involved if you're, particularly if you're looking at more complex access, um, than direct selection using your finger, uh, or people with complex bodies sensory systems, you need to make sure you're wrapping in all of the important personnel, um, and know as a practitioner, even if you're not the person conducting the assessment.

These are things that are good things to be on your radar because if you, you should, you should be constantly bringing questions back to other members of the team. You know, what it looks like. So and so is getting fatigued. Is there any way that we could look at maybe switching access methods or if there's a different place where we could position the device?

Um, so just be aware that those are things that can be modified over time. Some people might use a combination of eye gaze and scanning, right? So you can have shifting and relaxing, give [00:48:00] your, give those different parts of your body a break. So just know that those are, those are things that can be changed over time, if need be.

Um, 

Kate Grandbois: before we move on to our second learning objective, do you wanna talk at all about symbolic representation and how that is related to iconicity? 

Amy Wonkka: Yeah. You know, I do, I do. I know you do. Uh, when we look at single meanings, there are basically three big types of aided symbol language representation methods.

Asha has a really nice post on their website, uh, titled Augmentative and Alternative Communication, uh, decisions, and that goes more in depth into this and snug, which Kate had referenced earlier. So really, there are single meeting pictures. One picture means one idea you don't have to be literate for, for this type of system.

Um, however, a potential con is that the symbol set can become really overwhelming and slow to navigate because you end up having thousands and thousands and thousands of pictures and even on a high tech tool [00:49:00] that can take a lot of effort to navigate through, um, alphabet based systems. That would be spelling, that would be spelling plus word prediction.

Um, whole word text only systems. Literacy is obviously required and literacy may be a limiting factor. So you may have early emergent literacy skills and be able to do some things via an alphabet based system, but it might limit your access in other ways. And then multi meaning pictures, which are also called semantic.

Compaction literacy, again, is not required. The meaning is derived from combinations of specific pictures and, excuse me, the symbol set remains smaller and the navigation might be faster. 

Kate Grandbois: That sounds great. 

Amy Wonkka: Sorry. I think similar to iconicity and transparency and opacity and concrete versus abstract, a potential barrier here is with the multi meaning pictures, which I sometimes get [00:50:00] feedback from communication partners that they don't really make sense because they're not super transparent.

Um, so sometimes you'll see folks have a preference for single meaning pictures, and I think that that's. A good thing to be aware of as somebody who's interacting with the a a C user that one of the reasons your individual might not have all syndrome, meaning pictures, is for efficacy and speed of communication.

And by combining multiple methods, they may be able to combine, to have much more robust and complex utterances, uh, than they would with single meaning only. I 

Kate Grandbois: think that's so true. I, um, just as like a, a personal anecdote, I use multi meaning pictures and semantic compaction systems in my practice all the time.

When I first was starting out and I went to a conference and I was in the vendor hall and I saw one, the words, these words came out of my mouth. That is so stupid. That [00:51:00] is, makes no sense. I will never use it. I, I, I passed judgment and I put it on the shelf in my mind. And only years later did I revisit it and realize that so much of it is absolute genius.

And now it's a tool that I regularly use and recommend. Um, but that is a huge drawback, and it's, it's a, it's a reaction that not, it's not just, it's not just communication partners that have this reaction, it's other professionals also that have this reaction. Um, we were texting yesterday just about this exact situation.

So I think, um, that's something to keep in mind. It's, um, a real drawback to using multi meaning pictures, but multi meaning pictures are awesome. And don't let that stop you. If you, if you feel like there is room to educate or get buy-in from someone who is not on board with using them, um, it's something that you could consider working on.

Amy Wonkka: Well, and I think if you are the person who feels like, I [00:52:00] don't like this because it feels confusing and if it's confusing for me, I'm sure it's confusing for the person with complex communication needs. Like, if that's your response, also maybe frame it in along that continuum of, you know what, these are really just translucent symbols that don't make sense to me right now, but will make sense to me just like at, um, wouldn't make sense to, uh, somebody who doesn't speak English.

If 

Kate Grandbois: you told me what the word cat was in Japanese, I would look at you with a blank face. You could have said the word salami. I don't know. Those are not symbols that make any sense to me. I do not have that learning history. 

Amy Wonkka: Correct, correct. But it's, but it's actually a robust language system, you know, similar to semantic compaction in the sense that it is something that can be learned.

So also be aware that if you're feeling those feelings, that's okay. And that's understandable and that's a great time to reach out for us. Support from other people on the team. I will say too, all of the major vendors who pro, who produce [00:53:00] a a c systems a a C software, um, have a pretty robust amount of supports available online.

And so if you have somebody who's on your caseload who uses a certain, you know, communication device or communication app, just start off by trying to Google it. Just google it, see if you can get to the website of the person who created it and see what, what resources they have available there for free.

Um, because they also want the people who are using their products to be successful. So there's a lot of information out there that you can just access on your own. Uh, so we definitely recommend that people do that. That's it. We should probably move along to our secondary. That's awesome. 

Kate Grandbois: Well, I think that's a lot of, I think there's a lot of resources out there, so that's great.

Um, okay, so learning objective number two, identify some of the different personnel roles and responsibilities involved with a a C assessment and intervention. 

Amy Wonkka: So we are gonna talk really in this next section. It's going to connect with this article up on our website from [00:54:00] 2012 by Binger et al. And what they did is they looked at a framework for defining roles in the a a C assessment process.

We are not looking at that, their article to help guide us in assessment for the purpose of this podcast. But what I think is great about that article, um, is that they make the point that in order to conduct a successful a a C assessment, you have to have collaboration between multiple people. One person really can't do it in a vacuum, and that's also true for intervention.

Kate Grandbois: You shouldn't do it in a vacuum. If you are experiencing a, so, you know, a situation where someone did an a, a C evaluation in a vacuum and did not consider the environment stakeholders, communication partners. That is not, that's not ideal. It should always be some com right? Some, I'm looking for a lot of validation today.

Amy Wonkka: So we, I mean, we are talking about assessment because assessment [00:55:00] is, is what, what drives your a, a C tool and strategy, you know, selection, hopefully, and hopefully it wasn't done in a vacuum. Um, so they outline in their article kind of these six typical steps in an a, a C assessment. They make the point that the steps might overlap.

Um, they're not necessarily completely linear, but step one referral. So I think what we're gonna do here is just go through these steps and kind of connect it to all the other people who may be in the person's life referral. You may be somebody who, you are a referral source. That's who you are. Your, your job is just not to know what the person should use, not to know how they should use it, not to know.

How to train people, how to use it, but just to know, you know, what this person maybe, maybe could benefit from a a C, right? So just that awareness, making the referral. Next comes the case history. The case history is built from, you know, reading [00:56:00] previous reports, but really there's a lot of interview that happens there in the case history.

And so knowing people who know the person, the, the better everybody knows the communicator, the more valuable that case history is going to be. So this, the third step is really forming the question, forming the diagnostic question. And, you know, in our implementation plan podcast, we talked a lot about, like this, this idea that, you know, a, a c is, is.

They're to solve a problem. Um, so what are the goals? Like what do we hope that the a a c system is going to do for the person? How do we think it's going to benefit them? What, what things can we automatically rule out because it's just not a good fit? Um, so kind of refining that diagnostic question.

Step four is the evaluation procedures. So, you know, that is actually trying some things, understanding what your testing procedures are gonna look like. Um, trying a variety of tools. Step five, identifying [00:57:00] and recommending your AC interventions, strategies, techniques, devices. Step six, secure the funding.

Step seven, repeat steps two through six as you need to. Um, and I think at this point, can't be stated enough. A, a c is an ongoing, should, should be a circle a, a C service. You should conceptualize it like a circle. Just because a kid had an Evel three years ago doesn't mean that same thing that was the best fit three years ago is the best fit today.

Kate Grandbois: And just to sort of do a shameless plug for this article, I love this article. Um, I think that it does a really nice job of describing not only the roles, but how your institution should view a a c. I have had a lot of success talking with administrators referencing this article. If you are in an, in a school or a clinic and you have a handful of a, a c users, but there isn't any in-house a, a c specialist or in-house a, a c policy and procedure, [00:58:00] and you are feeling like you would like to develop one or you would like to, you know, start that conversation about how your institution can use a a c, I find I think that this article is a really great place to start, um, in terms of defining roles and also.

Showing administrators a piece of literature that says there is a lot to learn about a, a c. Just because it's in my scope of practice doesn't mean that I'm the only person who is qualified or should be involved in implementing a a C in this setting. Uh, 

Amy Wonkka: yeah. And like, you shouldn't be, you know, I, I think when I think about this article, um, it's page two 80.

On page two 80. There's a table. Table one. 

Kate Grandbois: I love this table. 

Amy Wonkka: Yeah. It's so good. It's, I think that for the remainder of this, of our time, we're just gonna talk through some of the, I think the first four, they outline a number of different personnel roles and kind of where [00:59:00] those people come into play in, in the evaluation process and what their responsibility is.

And some of those, you know, like Kate mentioned, are more administrative. Um, so, you know, we're talking about. People at the more administrative level. I think most of the people who are listening to this podcast are in the first five kind of buckets that they, that they separate out in this table. And we're gonna talk about those a little bit.

Um, the first one we already mentioned, which was the a a C Finder. So the person who's serving in the finder role is really involved in the, in those first stages, right in the referral and in the case history. This person's job really is to identify people who could benefit from a, a C and make that referral.

Um, that seems like a small thing, but it's a huge thing because you need to know enough to know that somebody could benefit from this and make that referral. So, so a team can come out and, and take a look and see if it could help them. [01:00:00] Um, I think the folks who are. More likely to be missed in the referral process?

Are those folks who could potentially benefit from a, a C to augment their oral speech. I think we tend to see more immediate referrals for people who are candidates for using a, a c as an alternative to speech. So as you are out there, you know, kind of have your finder hat on all the time and ask yourself, huh, I wonder, you know, if you're working with this person, you feel like if you use visual supports, it's super duper helpful.

Um, maybe when they're upset, if you have a visual, they're better able to tell you what they need. Those are people who could be appropriate referrals for an assessment to see if they could benefit from some augmentation. Right. So a, a C finder. Um, the next role is the general practice. SLP. So the general practice.

SLP, you know. In some places, general practice. SLP is also the person doing the A EC assessment, and they're both, but in their example, the general practice SLP is involved [01:01:00] in a lot of the steps. They're involved in the referral, they're involved in the case history, they're helping frame the diagnostic questions.

They're helping with the evaluation. They're identifying and recommending the options. They might even help with the funding. This person is serving kind of for case management. They've probably done the speech and language evaluation. They're helping in the decision making process with funding. They have a big role, but as we can see, by going through the table, they don't have the only seat at the table.

Kate Grandbois: And I think the general practice, SLP usually will have so much information about other stakeholders who may be. Have a seat at the table, but aren't at the table at that given moment. So, you know, if you have an external person coming in to do the eval, the general practice a a c, I mean the general practice speech pathologist has collaborated with the teacher and the PT and the OT and the BCBA and knows the administration.

That is a huge, it's, uh, to me that is a tremendously [01:02:00] important role. 

Amy Wonkka: Being the liaison Yes. On a multidisciplinary team is so vital liaison. 

Kate Grandbois: That's such a great word. 

Amy Wonkka: And it's helpful for people to un know and understand their role in the process too. I mean, I think part of what this table helps is it can help you have a conversation with all the stakeholders and identify like, okay, I'm gonna, I'm gonna be on this, you can be on this.

Um, they identify an a, a c clinical specialist, which is sort of the role that Kate and I both are, are currently working in. Um, which would be, you know, the person who's kind of completing the evaluation, helping with the device and strategy selection, completing the funding reports, doing some technical support around a, a c support around clinical implementation support around troubleshooting.

Um, but this person, you know, is, is not the only person. This person is just one of many people. Um, and so moving along, there's also the a c facilitator slash communication partner. This person is involved again, in the referral. They might be making the referral. They're [01:03:00] an important part of the case history.

They're an important part of framing the diagnostic question and the, and the evaluation. Um, and this person is, I mean, in, in my mind when I'm reading it, it's it's parent, it's a guardian. It might be, you know, the. Paraprofessional at school if the person has a paraprofessional assigned to them. Um, but these are people who are super important.

Their input is really, really important. Um, and then, you know, the other piece that I think is relevant for folks who, who aren't, who maybe see themselves as outside the a, a C process would be the collaborating professional. These, these people are also super important. The ot, the pt, the vision or hearing specialist.

Um, these folks should be an active part of the assessment process. They should be an active part of the referral case history, diagnostic questions, evaluation. Um, so I think from reading this article, looking at this table, [01:04:00] I think one big takeaway is that a lot of people who maybe previously felt like they didn't have the necessary knowledge, um, or it wasn't really their responsibility.

To have an active role in a a c intervention actually do have a super important part, and you don't have to, the expectation is not that everybody act as the a, a c clinical specialist, right? The expectation is that everybody has all these different, equally important roles to play. And by identifying what those roles are and identifying when you need support and who might be the best person to go to for that support, um, you're going to have a really nice cohesive unit supporting the AC user.

Kate Grandbois: Agreed, and this is a really great article, um, to have in your desk or to have in your back pocket to review when you're con no matter what role you play, and, um, no matter who your conversation partner is, if it's talking with administration, if it's talking with the rest of the team, when you're referring [01:05:00] for an a, a C evaluation or when you're talking to an a, a c clinical specialist who's coming in from somewhere else to do the eval.

Um, I think understanding all of those roles and having a reference to this article can be a really powerful way to have a conversation and really start to collaborate. And I think that pretty much wraps us up, 

Amy Wonkka: I think. So our, our second section, we're gonna take all of these fancy words that you've learned and we are going to help you guys unpack a couple of examples where if you get a new client on your caseload who went somewhere outpatient, maybe got an assessment, help you understand how to unpack that assessment.

Understand what the recommendations are and translate those into meaningful ways that you could implement that in your practice. 

Kate Grandbois: Yes. So, uh, just to review, stay tuned, part two, a a c Basics where we will learn how to identify barriers for successful implementation across different environments and identify successful strategies [01:06:00] across different environments and profiles, um, while we discuss different clinical cases and examples.

So, thank you for joining us. We hoped everybody learned something. If you're interested in using this episode for, um, credit for professional development, Asha, CM Hs, et cetera, et cetera, uh, please go to our website to learn more. You can find information about purchasing CEUs on the episode page. Um, please reach out to us anytime with questions or concerns.

We love hearing from our listeners. You can follow us on Instagram and Facebook for regular, uh, regularly posted announcements and tips. And we have a comment for us on our website. I don't think I'm forgetting anything That's about it. 

Amy Wonkka: Such a great job. 

Kate Grandbois: All right, we will see everybody next [01:07:00] time.