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Intro

Kate Grandbois: [00:00:00] Welcome to SLP Nerd Cast. I'm Kate. And I'm Amy. And we appreciate you tuning in. In our podcast, we will review and provide commentary on resources, literature, and discussed issues related to the field of speech language pathology. 

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Amy Wonkka: Just a quick disclaimer, the contents of this episode are not meant to replace clinical advice.

SLP Nerd Cast. Its hosts and its guests do not represent or endorse specific products or procedures mentioned during our episodes, unless otherwise stated, we are not PhDs, but we do research our material. We do our best to provide a thorough review and fair representation of each topic that we tackle.

That being said, it is always likely that there is an article we've missed or another perspective that isn't shared. If you have something to add to the conversation, please email us. We would love to hear from you. 

Kate Grandbois: Before we get started in today's episodes, 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 [00:02:00] SLP Nerd Cast. Uh, we're both members of ASHA's State 12 and both serve on the a a C advisory group from 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.

I'm not gonna say hazah, it's, it's so hard. I am in such a habit of saying either Hooray or Hazah. After we do that little intro, for those of you who may be new to the podcast, and, um, someone made fun of me, Amy, and I'm not gonna say it anymore. Um, so today's episode is the second part of a a c basics, uh, yes in our, for those of you who are just joining us, um, our first episode on a a c basics was related to terminology and personnel, and today we are going to discuss barriers to a a c, um, knowledge and implementation as well [00:03:00] as strategies to overcome those barriers.

Um, we chose this topic because as two, working a a c specialists, we feel pretty strongly that speech and language pathologists should be empowered to have the knowledge, have, should have the knowledge to, um, treat clients with a, a c, and should be empowered with the, uh, competence to do so. We have structured today's episode a little bit differently than, um, our previous episodes.

Um, our learning objectives today are identify barriers for successful implementation across different environments and identify successful strategies across different environments and profiles. So instead of going through those two learning objectives one by one, we are going to discuss the different roles that are within a a c implementation.

Um, we'll define what those roles are pretty briefly, and we are going to identify barriers within each of those roles and then [00:04:00] discuss strategies to overcome those barriers within each of those roles. So instead of going through our learning objectives, boom, boom. One, two. Um, we're gonna sort of discuss barriers and strategies collectively together as we discuss the episode.

Yes. Ha ha.

Thanks. That makes me feel better. I know. Um, so Amy, do you wanna kick us off to give a little bit of background in terms of what the a a c roles are? 

Amy Wonkka: Sure. In our earlier episode, we discussed the idea that, you know, a a c is something that in most environments is owned by many, many people, and that includes the person with complex communication needs, um, and then lots of other people who interact with that person.

But each person, um, who's involved has sort of different roles and responsibilities. And sometimes what happens is we'll see, you know, folks kind of [00:05:00] back away from any role or responsibility in the context of a a c because they feel like they maybe don't know enough or it's not their role. And so part of what we're gonna talk about, we now.

It's just a bit about those different roles and how it is really important that everybody sort of plays their part in the implementation of a a c. So, as we know, people with complex communication needs who use augmentative and alternative communication are a really heterogeneous group. So you can't, you know, if you've met one person who uses a a c, you've met one person who uses a a c.

That's such a good expression. I've heard it used for 

Kate Grandbois: autism before, but not a, a c and I think it's perfect. 

Amy Wonkka: I think it's applicable, you know, across all domains. Um, in particular, um, there's a lot of heterogeneity. When we think about people with complex communication needs who use a a C, and that can be uncomfortable for communication partners because you can't really say, well then you do this.

If the person checks x, y, Z [00:06:00] boxes, then this is your prescription for what you're supposed to do. Um, so that level of ambiguity and breadth can be, can be hard for communication partners. Um, so we're gonna reference the work of Kathy Banger et al. And this, this article is up on our website. They introduced a personnel framework to help clarify professional roles within the context of an A a C assessment process.

In reading this article, I feel like these roles are also helpful to think about in terms of implementation. And for those of you who listened 

Kate Grandbois: to our first episode, we did go through this article in the first episode, and we're just gonna do a review for the context of discussing barriers and strategies within each of these roles as defined in that article.

Amy Wonkka: Correct. And we're only actually gonna talk about a few of the roles from that article because what we're focusing on today is clinical problem solving, identifying barriers, and then thinking about some solutions around those barriers. So we're going to sort of use these personnel roles as a way to think about those [00:07:00] different barriers in different environments.

Uh, so there are a number of roles described in the article that we're not covering today. So the first rule that we're going to start with, um, actually I'm gonna back up for a second. As we go through these roles, I want you as a listener to try and figure out which of these hats you wear, because chances are you wear at least one of them, so perhaps multiple.

So listen and try and place yourself as we go through these roles. Okay, the first one is the a a C finder. And to quote, binger, etal, the primary and essential roles of the a a C finder are to identify individuals who might benefit from a, a C and make referrals to professionals with a a c assessment expertise.

A a c finders may include an array of individuals, including the person with complex communication needs, their family members, their friends or peers, medical personnel and educational personnel. So they make the point that a lot of these finders don't make the referral, and that [00:08:00] has really negative implications for the people who use a a C, right?

So when you're referred late for your a a C assessment, that's a deferred time before you get access to an A a C system that can help you. And that's learning time lost and probably. A greater number of frustrating experiences they make. Another couple of other points, just that a lot of these finders may not have training or instruction in the area of a EC.

Uh, so when we move forward in the barriers, we'll talk a little bit more about that. So in our next, our next role, and this is a big important role, this is the general practice, SLP. So in their article, they describe the role of many SLPs working with people who use a, a C as people who are providing a range of services, but they're not specialists in a, a c.

So their definition for general practice, SLPs would be these professionals provide direct service, speech language services, and include SLPs who working in schools, hospitals, private practices, and long-term care facilities often serve as the primary [00:09:00] SLPs For individuals who use a a c, currently it's common for general practice SLPs to service a a c finders making those referrals.

Okay, so there are a lot of general practice SLPs. Um, I would say for myself, I am probably, I am no longer a general practice SLP, neither me, neither. These are people, neither like, to make this analogy to healthcare, I think of the general practice. SLP as like my general. Practitioner physician. So that's the person I go to if I have a problem and I'm like, oh, I have this right, I've got a sore throat, I'm gonna go to my doctor.

Um, for a lot of things, my doctor is able to just take care of those things for me. But if it's something else that requires specialized support and help, like I've got a funny mole or something, you know, she's gonna send me to the dermatologist who is somebody who with a mole, who is just like, you know, an expert in all things skin related and that's who you wanna go see for your funny mole.

Um, 

Kate Grandbois: so, so in our field, a general practice, SLP, this was, this [00:10:00] article was the first time I had heard this term and it made me feel better because I also no longer feel like a general practice SLP, and I can't treat, I used to be able to have, you know, I used to have knowledge about fluency and, uh, dysphagia.

Or dysphagia. I'm probably saying it wrong. I don't even know how to say it. That's how little I know about updated information because I've been doing nothing with a, a C for so long and I think. You know, the general practice SL play, SLP plays a such a massive role in a, a c intervention. And we'll talk about that more as we go through and identify barriers, um, and strategies.

But the, the general practice SLP is just the most important, one of the most important players. There are many important players, but I really app, I guess my point is that in this article, I really appreciated that they called out and, and gave a whole bucket, um, to the general practice. SLPI really appreciated them.[00:11:00] 

Amy Wonkka: Well, and I think similar to the, the general practitioner, you know, in, in my Jazzy mole example, um, you know, I don't wanna go to the dermatologist for my strep throat, right? So the general practice SLP serves such an important function, um, and they have so.

People at home listening, oh, who are these people in their body Parts go on. Dermatologists are our friends and they help us wear such. They true. Um, no. So I, I feel as though when we think about general practice SLPs, they have all of this knowledge about a broad range of, um, client needs. And so they're, they're also a huge resource if you're not the general practice.

SLP, the general practice SLP is a huge and important resource if you are the general practice. SLP. Well, thank you. 'cause you're a huge and important resource. [00:12:00] Seriously. Um, and, you know, you have a lot of knowledge and skills, but within that. Is, is a responsibility for people who use a, a C if they're on your caseload.

Um, the next role that we'll talk about is the a a c clinical specialist. This is sort of the role that Kate and I are both currently employed in. Uh, these are professionals typically who are SLPs who have particular expertise in a, a c our skilled at conducting a a c assessments and take a leading role in securing funding for s STDs.

They're referred to as a a c intervention specialist in the article 2008 by Kelman et al. Um, and they're described as professionals who typically spend at least 50% of their working day. On a, a c related activities. Uh, so compared with general practice SLPs, people who are in this sort of clinical specialist role are receiving, you know, lots of professional development.

They're digging deep on all of these topics, reading their research, going to conferences, doing all of these things really specific to a a c. So people in the a a [00:13:00] c clinical specialist role have a lot of information about a narrow range of content. And so the intersection between somebody who's a clinical specialist and somebody who's a generalist really provides this amazing, robust continuum of information for the client with complex communication needs.

Kate Grandbois: Totally agreed. Um, and I, I'm not sure if we mentioned this in a previous episode, but, um, the a a C clinical specialist is somebody who, if you are a general practice SLP, seeking more information about A-A-C-A-A-C implementation, or you're clinically interested in moving into an a, a c clinical specialist role at some point in your career.

Um, we might talk about this a little bit more later, but mentorship is one of the most amazing experiences I've ever had. My mentor was this lady named Amy. I don't know if anybody has ever heard of her. She's sitting across from me. I can see her face, but this is, and I'm very passionate about mentorship and I know Amy can talk about her [00:14:00] mentorship experience and mentoring experience.

Um, if you do have an interest in, in be, you know, moving more into a specialist role or really embracing a a c as part of your practice, I cannot say enough about, um. How, what a great learning experience that can be. Um, and Asha has tons to say about mentoring. It's documented well in the literature.

We're gonna do an episode on it more in the future. Um, but anyway, soapbox over moving on. 

Amy Wonkka: No, I, I agree with that sentiment. I mean, I, I, I say all the time that all of my best ideas for somebody else's idea that I just absorbed, put inside a file folder somewhere in my brain. And I do think, you know, that's probably true for most of us with any, with any of our clinical skills, we learn those skills through interacting with our clients and with other clinicians.

Uh, so to, to work with somebody who has a focused interest in, in study in one areas, a wonderful way to learn more. Um, one more thing about this. A a c [00:15:00] clinical specialist, you don't have to have that job title. That is, that is more. A category that they're using to describe somebody who is predominantly involved in a a c activities as the bulk of their clinical practice.

It's, it doesn't need to be what you're called. Um, and the structure of a a c teams is going to vary a lot depending on where you are located and what type of work environment that you're in. Um, so just to know, these are categories that are not specific job titles. They're just descriptions of the type of work that these different people are doing and sort of what their roles are within the a a C assessment process.

Kate Grandbois: So a so next on the list, um, a a c clinical specialist is the A a C facilitator and communication partner. What can you tell us about that role? 

Amy Wonkka: So these folks are super important and. They are, the authors make the distinction between the two roles. And so I'm [00:16:00] again, just gonna pull words from their article.

Uh, they say that the role of facilitator, broadly speaking, is to assist with the client's day-to-day. A, a c needs, which may include device maintenance, like charging and programming, interacting with manufacturers, and providing instruction for communication partners. Um, so a, a c facilitators can include family members, friends, general practice, SLPs, a, a c, clinical specialists, lots of lots and lots of different people.

So they sort of separate out the. Operational tasks is how I read this. Like, so the operational tasks of like maintaining and dealing with the actual, you know, aided tool. And then communication partners, they're describing as folks who typically have relationships with clients using a, a c that are either social, like family members and friends, or educational and caring in nature.

So like teachers, PCAs, um, these people who are in the partner role are assisting the communication exchange at a level that is typically not expected of a less involved listener. So, so partners are working together, [00:17:00] they're doing some co-construction of messages, they're resolving communication breakdowns, so a communication partner.

Is different from a facilitator in terms of the, the jobs that that person is doing. Facilitators troubleshooting all of these equipment things. The communication partner is having this relational experience with the person who's using a a C, and they're doing that in a way that's different from somebody in the general public.

So they're making the distinction, you know, between a communication partner who has a more active role in the interaction compared with somebody, um, who's, who's not communicating with the ACS or at that same level. Okay. That seems pretty succinct. 

Kate Grandbois: And 

Amy Wonkka: then, and I think. Oh, sorry. I, I think that, you know, another important point to raise there is just that a lot of the people are, are in both of those roles together, right?

So there's a lot, you know, you, you are very likely to be multiple roles that we've already talked about. 

Kate Grandbois: Right? The last identified role per this article is collaborating professionals. [00:18:00] And as Amy already mentioned, um, you know, depending on your work environment, depending on a variety of things, the team of individuals working with the client is really gonna vary.

And there are so many collaborating professionals that should have input and participate in any assessment or implementation. We're not really talking about assessment today, but any component where a a C is involved, and that could include teachers, paraprofessionals, occupational therapists, physical therapists, BCBAs, um, you know, these individuals are really going to, like I said, they're gonna need information about a a C, but they're also going to have input.

Based on what stage you are in the a a C process? Precisely. Uh, precisely. Precisely, precisely. So we're gonna cut that out, right? Totally not, nope. That stays. [00:19:00] Sorry, am moving on. So are those 

Amy Wonkka: all of our defined roles? Yes, tho. I mean, those are not all of the roles that are defined in the binger et all article, but those are all of the roles that we're gonna talk about moving forward.

Kate Grandbois: Okay. So now that we have a little bit of background or we've reviewed the roles, we are going to, instead of, like I said, instead of moving through with our two separate learning objectives, we are going to discuss each of these roles, barriers for each of those roles, and then strategies to overcome each of those roles.

So we assume that the bulk of our audience are SLPs. That may not be the case. Um, if you are an SLP, I think. Learning about the barriers and challenges for each of these separate roles is still really clinically important because it's information that you can give to the a a c facilitator. It's information you can, or identify with a collaborating professional to facilitate improved relationships or, um, interactions with a a c.

Um, you can [00:20:00] facilitate improved imple a a c, implement implementation in the different settings. So I do think that understanding barriers and strategies for each of these separate roles is, is very important. I would agree, and I think I love it when you agree with me. It makes me have all that, 

Amy Wonkka: I feel very validated.

It's nice. So I think that part of, um, what will come out of these ongoing conversations is that the helpfulness of clarity of roles. So you don't need to go onto, go with, go to your team members and say, you, you are a finder and you are the a, a c clinical specialist. I am the generalist. SLP. It's not, it's not really about assigning roles.

It's more about thinking of the different tasks that are involved in supporting somebody who is learning to use augmentative communication and then. Making sure that everybody who, who should be responsible for a portion of those roles understands that they should be responsible, agrees that they should be responsible, um, and that everybody's on board with their different [00:21:00] place in the process.

Kate Grandbois: I totally agree, and I think if anything, delineating specific roles or titles can be more divisive than helpful. Be, and it, it creates a barrier. Um, I know Amy and I have both experienced this as the quote, a, a c specialist, that's our job titles. That's what we're hired to do. Um, and if you, you know, go into a setting where you don't have relationships with the employees there, you're new on the scene, there can be this barrier of, well, this lady came in and, or this man, you know, who, if it's there's an a, a C specialist who's a man out there, I'm sure you're out there.

Hello. Um, you know, coming in, being like, oh, this lady thinks she knows everything. I think. Giving titles to these team members can be, um, can really sort of instigate territorialism and egoism, which are absolute barriers across the board to almost everything. So. Mm-hmm. Um, I think if you think of, in thinking about these roles quietly in your mind, and then thinking about the tasks, um, that the a [00:22:00] a c user needs to accomplish with each of these different individuals is, is the more collaborative and facilitates more work being done in a positive way?

Amy Wonkka: That's, that's such a good segue into our first barrier. Excellent. Which is, look at that. I did that. It was magic. I didn't even plan it. Delayed or missed referrals. So this is happening if your finders aren't finding. But no, you don't wanna go to your finders and say, you're a finder. Why did you find what terrible finder you baptized?

You're a terrible finder. Did you even know that? You're the finder, right? So I, I mean, you can see how that could pose some problems that you, that you don't wanna create for yourself. Um, but I think that this is actually something that occurs relatively frequently In the Binger etal article, they actually talk about, they cite some other studies.

You know, just giving examples about delayed access. They had a study they cited, um, where late referral by finders was cited as a problem in 93% of individuals with [00:23:00] a LS, who were eventually referred to an a a C assessment. And they found similar delays in a different study. Uh, similar delays in referral, observed in a study of children with cerebral palsy.

So again, these are people who aren't getting access to the supports that they need in a timely manner. So, finder not finding is a problem. It's a barrier for the people who have complex communication needs. 

Kate Grandbois: And so, just as, as a reminder, the finder, I guess for me, the first thing that comes to mind is a parent or a communication partner.

That's not always the case. It could be a teacher, it could be the gym teacher, it could be, you know, uh, another specialist on the team. It could the general practice, SLP or the primary SLP, um. The difference is that. Primary SLPs general practice, SLPs, we have knowledge of a a c. We went to school, most of us had a class on it.

We are aware that it exists [00:24:00] and the majority, but the majority of finers might not have that information. They might have seen as an, an episode on 60 minutes about pro quo to go in 2011 or whenever that aired, you know, and they might have some knowledge, but they don't necessarily have the deeper knowledge for that.

A a C could be used for augmenting speech. It could be used for people with limited speech. It doesn't necessarily have to be a more emergent communicator who has zero functional speech. Um, so, and I guess I'm so good with segues today. That's a good segue into the solution for delayed referral. Um. Take it away, 

Amy Wonkka: Amy.

Well, you make, you make great points, right? I think identifying that really, depending on your environment, and I would say in the work environments, um, in all of the work environments where I've been employed, you kind of want everybody to be a potential finder. You want anybody to be a potential finder, and most of those people did not go [00:25:00] to school for speech language pathology.

Um, so one of the important solutions is just to give people access to that information and to give them access to information about a, a c in a way that is easily digestible, not overwhelming, but just something they can put in the back of their brain and remember. Um, and I think that's information.

About what a a C is in general, but it's also information about the process and procedure in your own particular work environment. So, so what do you do if you think somebody might benefit from a a c? 

Kate Grandbois: You had mentioned to me, uh, previously some good ideas about. Again, all my best ideas are someone else's ideas.

This is so that you said not me. Um, but distributing permanent product or handouts like pamphlets, um, putting flyers up in your school setting or in your clinic. Um, a lot of places have bulletin boards. Like did you know, you know, with like graphics Yeah. Or pictures or something that's easily digestible [00:26:00] just to get the information out there so that someone in your work setting, just walking by sees the reminder that a, a c is a thing and it's not just for, you know, X part, you know, X profile person.

Um, another thing that, um, Amy and I had talked about a while ago, um, and this is more at a much larger institutional level, but here in Massachusetts we have, um, in order to get your teacher licensure, you have to have a certain number of hours. I can't remember what the exact specification is. Uh, 10. But you need, huh?

10. You need to have 10 hours. Yeah. I should know that. For, for a variety of reasons. But, but anyway, um, so teachers, in order to get a teacher licensure, have to have 10 hours of either, is it observation or continuing education? I think a variety of activities participate, point being by the time they become teachers and they're in the classroom, they know a little bit about what a a C is.

So depending on where you are in your country, if you have [00:27:00] access to, you know, lobbyists or, you know, feel like writing your congress, man or woman, um, your, your state representative, that is something that I feel has been really helpful in our geographical area to get information to the finders who are teachers.

Amy Wonkka: Yeah, I agree with that, Kate. I think that what it does is it's kind of set the stage for a whole new group of finders to have basic information about what a a C is and who could benefit. And I think when you're providing information to finders or people who are potential finders, it can also be helpful just to remind people that, you know, A, a c doesn't reduce somebody's likelihood of developing or using oral speech.

It's not an either or. And I think that this comes back to people who would benefit from augmenting their communication. I think sometimes when I've experienced later referrals, it is often complex communicators who would fall into that [00:28:00] category of being somebody who it could really help to augment their communication.

Um, and sometimes what happens too is. If you're somebody who might use it to augment your communication in different environments, and we'll talk a lot more about this a little bit later in the podcast, just considering different environments and tasks. But when you have very familiar communication partners who understand your oral speech, they might not identify that it is a potential barrier for you moving into a broader environment or with more communication partners.

So that's also something that generalist SLPs or a a c clinical specialists can help to, um, make sure that finders better understand that communication efficacy is really a, a bigger thing than just in this one moment, at this one time. And we need to kind of think about supporting our communicators across their entire life and their communication needs across the day.

Kate Grandbois: I agree completely. Um, is that a reasonable segue into our second [00:29:00] bucket? Oh yeah. I believe it's second barrier. So, um, the second barrier that. That is related to the next role is having unclear roles. So someone saying it's not my job or a, a c is something that someone else does. 

Amy Wonkka: Yeah. And I feel like, I mean, Kate, you touched on this a little bit.

I, I don't love the term specialist. I, I don't love the idea of pulling out a whole section of SLPs as being 

Kate Grandbois: specialists if we are not going to open Pandora's box and discuss the SLP certification for a c specialties a, the AAC c specialty certification. But yeah, I suppose as a, as a current events news announcement that anyone who is listening, um, the a a c specialty certification is going to be a thing.

Um, they, it takes a while. It will be a couple of years. Um, people have strong feelings about it. We are not going to discuss those strong feelings. Um, [00:30:00] but it is, it is happening. So, so I suppose stay on the lookout for news related to that. Um, but in terms of how that relates to this barrier, so we, in discussing that, you know, the, one of the barriers is people thinking that a, a c is something that someone else does and it's not their responsibility.

That barrier can go in reverse in terms of someone thinking, well, I am the one that does the A a C and no one else does it. So effective a, a c implementation really does need to be a, I was gonna say a two-way street, but you know, a collaborative effort where it's a shared responsibility and the a, a c quote specialist, quote, certified specialist, whoever is empowering everyone on the team to take ownership of and embrace the tool.

Yes. I, I say the opposite of 

Amy Wonkka: haah to, to that, the opposite of, of, I 

Kate Grandbois: dunno, 

Amy Wonkka: poo poo. I dunno. [00:31:00] That could be it, but it's not nearly as fun of a word. Poo poo. Um, poo poo. Okay. We'll think of it. If anyone has any 

Kate Grandbois: ideas of what the opposite of Hiza is, we would love to hear from you. Yes, 

Amy Wonkka: yes, we would. But no, I mean, I think, I think right there, there shouldn't be, whether you are a certified specialist or not, there shouldn't be one person driving the a a c bus.

Um, and if there is one person it. It, you're, you're probably not driving the right bus. Um, so in reading to prepare for this podcast, we came across an article from Hunt et al, and we will post this up on our website as well. It is titled, collaborative Teaming to Support Students with Augmentative and Alternative Communication Needs in General Education Classrooms.

I thought this article was awesome. Um, they have a lot of it. It's definitely worth checking out, especially if you work in a school [00:32:00] or other team-based environment. Um, they define collaborative teaming as a group of individuals with diverse experience working together to achieve mutually defined goals.

Um, and according to experts in the field of collaborative teaming, an effective collaborative teaming process involves regular positive face-to-face interactions, a structure for addressing issues, performance and monitoring, and clear individual accountability for agreed upon responsibilities. So I love that quote.

Yeah, it, it, this is great and I think it connects, I resonated. I think this article resonated a lot with me because it connects to a lot of what I do in my work with implementation plans and using the set framework, um, which are both strategies for collaborative 

Kate Grandbois: team-based approaches to a a c. Um, and I think it extends behind a, a c in general.

I mean, you know, you could apply this amazing quote that maybe we will put on our website with a [00:33:00] reference to any team collaboration, especially where you might have some prickly pairs. 

Amy Wonkka: Yeah, I mean, I, this article is great. They, they make the point that, you know, you have a lot of different team members, those team members can have over overlapping functions.

So sort of back to the Bing. Article where we talk about the different roles. A lot of people who are participating in a a c supports have a lot of different roles. They have a lot of different functions, and all of those people are important. All of those roles are important. Um, and when we think about working collaboratively with other people in this hunt, in this hunt paper, they reference an earlier study, uh, by Soto and colleagues in 2001, where they, you know, go through some interviews with people who have worked on collaborative teams for at least three years.

And, you know, people really felt like, so you can't really do that without collaborative teaming. It's, it's, it's. It's really necessary in order to have successful inclusion. So collaborative [00:34:00] teaming, when we think back to that definition we just said, that involves a lot of components, it involves a lot of time, it involves a lot of parts.

Uh, training was another thing that came up as important in that Soto article. Uh, and then finally they felt that the regular team meetings with all members contributing toward achieving shared and mutually defined goals was reported to be very important. So, back to, I love that 

Kate Grandbois: shared and mutually defined goals.

Right? And I think that is so important, especially if you are employed or acting as an a a C specialist. And this will be incredibly important for any quote certified people in the future. Yes, you do not own it. You don't own it, it doesn't belong to you. Your job is to take the input from other people and collaborate and not show up on the scene and tell everybody what to do, not how 

Amy Wonkka: it works.

Kate Grandbois: Just right. Just a little bit passionate about that. I will, I will step off my soapbox again. 

Amy Wonkka: Yes. So I would, we're not gonna get deep into it today in this podcast, but I would point you if you're [00:35:00] interested in learning more about collaborative teaming, if you're interested in learning more about implementation plans, we have a podcast for both of those.

Um, so I would encourage you to check those out. Uh, the last thing that I wanna talk about with the hunt at all paper, and the reason why you should look this paper up and you should print it out, is their idea of a unified plan of support or a UPS. So this to me, is essentially a version of what I'm doing when I do implementation plans.

It's basically, uh, it's, it's a documentation that looks at the curriculum, the communication, and the social supports. So when I was reading it, it's, it's like an implementation plan for assistive technology and an implementation plan for augmentative communication, like integrated in together, because this article was about inclusion, so using a a c in an inclusion setting in general education.

Um, what's awesome about this paper and why you should print it out is that they have examples. So you can look in the paper and they print examples of what this actually looks like. So it can [00:36:00] really help you if you're somebody who's in a generalist SLP position or you're the a a c clinical specialist.

If you take a look at this paper, you can get a, get a feel for examples of what their, what their UPS looked like, and that might help you shape some of your own. I would say, you know, start small. Don't try and write this big huge document for everybody. Um, but really consider if this is something that you can use in your practice.

And again, that's probably most applicable when we think back to those roles for people who are either in a generalist or an a a c specialist position. Um, I think I love these articles. These are such good lines. No, they're so good. So, you know, if you listen to this podcast, you know, there's like typically one or two articles that we're like, oh man, you should really print this out.

This is one of them. Um, because you wanna see their example. And I thought the one for people who are in an a, a c clinical specialist role and are already doing implementation plans. Something that was super cool in this article that I wanna find [00:37:00] a way to integrate into my work is that the authors use a rating scale for each of the, each of the items on their implementation plan.

Essentially they use a rating scale so that when the team meets monthly, they go through each section of the implementation plan and determine as a group how much success they had implementing these different things. And their, their metrics were, you know, not at all, somewhat, moderately, well, and fully.

And so what they found was that by going, by having, assigning these ratings together as a group and going through. Through each area of the implementation plan and determining their ratings as a group, it allowed them to emphasize strategies that they rated as somewhat, right? So perhaps for a a c it might be modeling, maybe it's modeling during shared storybook reading, and people are like, uh, we're doing that somewhat.

Then they decide as a group, like, okay, we're really gonna emphasize this for the next month. And then they can revise and eliminate strategies that the group scored as not [00:38:00] at all implemented. Right. Love that. So they might say, oh, shared, you know. Modeling during shared reading. We're not implementing that at all because we find that, you know, it's, it's not necessary and it's cumbersome and the student is engaged and doing fine with the, with the supports that are in place for everybody else in the classroom.

So we're not doing this too much. So then they just pull that off the plan so it's clear to everybody what their goals are. This is great article. 

Kate Grandbois: So this is basic just to sort of wrap that back into our learning objectives, having a written implementation plan, having some of these metrics is a great strategy for overcoming the barrier of team collaboration, getting other people involved, a classroom teacher or another professional who thinks that it's not really their responsibility.

This is something that happens only in the speech room down the hall, or only in the outpatient clinic. Um, and having some of these meetings and some of these strategies, not only are they evidence-based right here in the literature, but they're effective. 

Amy Wonkka: [00:39:00] Yes, and so, so for the barrier of, it's not my job or it's somebody else's job, the solution for that is to have a clear and ideally written down and discussed on an ongoing basis guideline for it.

Whose job it is and what the expectation is. And 

Kate Grandbois: this barrier of it's not my job, a, a c is something that someone else does is related to several roles identified in that original, that first article. Right. So I can imagine that it would be relevant possibly to the a a C finder if they're still in the picture.

It would be relevant still to probably not the general practice SLP or the a a c clinical specialist. But the A a C facilitators, that's a really wide role, the communication partners and the collaborating professionals. Right? So based on that first article from Binger, the Binger et all article, there is such a wide variety of roles and having better effect, more effective [00:40:00] collaboration to decrease the feelings that it's not their responsibility is really, really important For sure.

Amy Wonkka: And for barrier number three. Who segue, right? Like you might be the general practice. SLP, who up until this point has thought, it's not my job. We have somebody in my office who has specialist after their name, pretty sure it's their job, not my job. 

Kate Grandbois: Or you are maybe a new grad, or maybe you're not a new grad, but this is your first experience with SLP and secretly and quietly in your thinking bubble, you're going, I'm gonna fake it till I make it.

Which is okay, everybody starts somewhere. Um, and if you don't know where to start, or you're just on, you know, in the beginning of your journey, or maybe you're a classroom teacher who is also having those same feelings mm-hmm. Um, that is, it's okay. Um, but there are things that you can do to facilitate your knowledge, right?

So 

Amy Wonkka: barrier number three. [00:41:00] I don't know where to start. Right. That's your barrier. I can't even get started. This is completely overwhelming. It's not a matter of organizational, you know, delineating roles. I don't even know what the roles are. I don't know what we're supposed to be doing. 

Kate Grandbois: Right. And to be fair, I've been working as an a, a c quote specialist, but basically be doing nothing.

A, nothing but a, a c in my practice since I was for eight or nine years. And my first technology conference, my first a a c conference, I literally walked through the vendor hall and was like, I'm not using that. I'm never gonna use that. That looks stupid. I was totally intimidated. It's what happens. It is a natural part of the learning process.

Accept it, move on. It's gonna, it's gonna be okay. 

Amy Wonkka: We're gonna, we're gonna take you into our time machine now, and we're gonna bring you back to 1989. In, in 1989, a speech language pathologist named Janice Light wrote a paper where she defined communicative competence for a a c users as the [00:42:00] development and integration of skills from four different domains.

And those domains are operational competence, linguistic competence, social competence, and strategic competence. 

Kate Grandbois: Is this, are you bringing up this article because this is where people should start this? Yes. Yes. So this is like the basic fundamental start here. This is like the, this is the strategy for overcoming that barrier.

I can, 

Amy Wonkka: yes. So this is like, this is the foundation. I'm actually gonna direct people to a 2014 article that she wrote. She co-wrote with David McNaughton. This will be on our website. Uh, and I was actually, sometimes these articles, you know, you're only able to get access to them if you're an ASHA member or you're only able to get access to them if you are, you know, in, in school actively and have access to, you know, an online database.

This one I was able to find for free online. Um, it's, it's a really great article, but it, it's a response to her work in 1989. And [00:43:00] then in 2003, she expanded that initial idea to include psychosocial factors like motivation, attitude, confidence and resilience, as well as barriers and supports within a communicators environments as all of these things that come together, um, to result in communicative competence for people who have complex communication needs and are utilizing a, a, c.

So I'm so fortunate to have this wonderful job where I'm able to dig really deep in this one topic area and learn so, so much about this clinical area that's so interesting and meaningful for me. And even with that, I don't, I don't know all the things, right? So I have this privilege to be able to learn all of these things.

Uh, I still don't know everything. I'm learning new things all the time. And so when you step back and think back to those roles, if you're a finder or a partner or a general practice, SLP, how overwhelming must it feel? Because a, a c is big. It's, it's not just learning, uh, how to use the system and [00:44:00] navigate the system.

It's not just learning the receptive and expressive language skills. It really is the integration of all of these components. So if you're feeling like you don't know where to start, please print out this 2014 Janice Light and David McNaughton article, and we're gonna talk, we'll talk you through the highlights of it, but it's, it's really good.

And it kind of covers all of these big areas. 

Kate Grandbois: We will have a, well, we will have it on our web, on our website as a reference. Is it possible because it's free, can we put a link? That's a good question for you because you're the webmaster. Can we put a link? I dunno. No, but I mean, it's not a violation of any copyright.

If we put a link so people can click on it and just get the article. 

Amy Wonkka: Now, I mean, I guess if they stopped letting it be free, the link would be dead. And then hopefully someone would email us, let us 

Kate Grandbois: know, and we would take it down. We will figure this out. People, we will have an easy way for you to get this article off of our website.

Amy Wonkka: That's right. 

Kate Grandbois: Hey, dude, check. That's right. 

Amy Wonkka: That's right. Um, so [00:45:00] in this 2014 article, which is just super good, um, you know, she, the authors are reflecting back on their work from 25 years ago, right? So they're, they're looking back on this 1989 article, um, and making the point that in that time so many things have changed for people who use a, a C, right?

So 25 years ago, a lot of the people who are using a a c are living in these large residential institutions. They have very limited educational, vocational opportunities. Now, thankfully, folks with complex communication needs are doing all sorts of amazing, you know, people are going to work, they're going to school, they're participating in their communities, um, to a greater degree.

And what's happened is those changes have also resulted in increased communication demands that really we do need to address. We need to think about all these things as clinicians who are supporting people who are using a, a, C, we need to think about the now, we need to think about the future, and we need to think about how all of these different components intersect.

And [00:46:00] if that feels overwhelming, I think it's because it is. But this article really helps walk you through and kind of compartmentalize all the different things that you wanna be thinking about. Uh, so we're just, we're gonna go through the four core key areas from Dr. Light's 1989 article, and we're gonna start with those because those are a really helpful starting point.

Kate Grandbois: So just to review, those four areas are linguistic, operational, social, and strategic. Correct. Okay. Yes. Take it away. And 

Amy Wonkka: we're gonna start with linguistic. So linguistic I think is one of the pieces that feels most comfortable to those of us who are the generalist SLPs, because this is getting at a lot of the, the training that we've received that is not connected with a, a, C, right?

So this is receptive language skills, this is expressive language skills, semantics, syntax, all of these things. Um, so it's [00:47:00] complicated by the fact that many aided a, a c systems aren't necessarily true language systems, right? So they may not have inherent syntax, they might not have morphology or grammar.

So part of what you need to tease out is thinking about. What your, what your person, who, who, what your client, who has complex communication needs is working on in terms of their expressive and receptive language skills. So if you, you know, regardless of your setting, you're probably doing assessments. So if you've done a formal or informal language assessment, look at where that, look at where that communicator is currently.

Um, if there is some, you know, you may see a gap between expressive and receptive language skills. You may not, you may see expressive and receptive language skills that are clustering kind of the same and use your clinical decision making just like you would if you weren't factoring in a, a c into your clinical decision making to make choices about what's an appropriate next step.

If your person is [00:48:00] primarily a single word communicator, you know, think about things like brown stages. Think about. You know, acquiring around 50 single words before you're working on two word combinations. Once you're doing some two word combinations. Also think about the early morphology, like present progressive and things that we tend to see around that same, um, language acquisition phase.

Think about having a balanced corpus of types of vocabulary that you're using. You'll hear a lot corpus about 

Kate Grandbois: corpus, such a big word, a balanced corpus. It's fun though. It's a fun word. It is a fun word, but a balanced word bank. A balanced body 

Amy Wonkka: translates, right? So a balanced body. And that's important because when we think about linguistic skills, we don't want our communicator just to be using nouns.

And we talked about this a little bit in the first chunk of this podcast, the the part one. Um, but sometimes that's a trick that we get. We get tricked by with aided a, a c because a lot of types of. [00:49:00] Words are not good picture producers, right? So sometimes we have a tendency to do nouns, nouns, nouns. But when we look at just good language intervention, good expressive language intervention, it's not all nouns.

And so just being mindful of those components, so those would all fall into this linguistic skills bucket. 

Kate Grandbois: Um, for me, the takeaway, very general, very general takeaway from this linguistic, the article of this linguistic category is that as an SLP, you don't need, you're not using totally different skills.

You're still using your SLP skills, you're still making decisions about language. It's almost not different at all. You just have this extra tool. It's like learning to go from writing with a pen to typing. It's still language. It's still right. You know, a lot of it is still the same. Um, you just have this extra thing that you have to take into consideration.

Amy Wonkka: And I think with that, taking into consideration other components of [00:50:00] language exclusive, like separate from the thing. So we talked in the first phase of this podcast about aided versus unaided. Well, if you have a, somebody who's learning to use single word symbolic communication, you're probably also working on unaided methods using gestures.

Just, just like you would, just like typical language intervention for anybody who is working on that. You know, one to two word level. I think another big piece to consider in this linguistic competence bucket is it's not just expressive. And I think that's another place where, where we get a little tricked sometimes as clinicians, because we're so focused on a a c, we're so, so focused on the expressive component.

Remember to step back a little bit and do a thorough inventory of your clients current. Skills and their gap areas. So if you have somebody who has receptive language skills that are, you know, within normal limits and are not a concern, um, and not, are [00:51:00] not a limiting factor for them in any way, then yes, go, go super hard and heavy on the expressive component.

But if you step back and, you know, you find that there are still receptive gaps, even if those gaps are syntax, morphology gaps, make sure that you're working on those still receptively. Um, we don't necessarily, again, we know the a c users are a very heterogeneous group. So just because you acquire a skill expressively doesn't necessarily mean that's gonna transfer to a receptive skill.

And we need to make sure that we have equal emphasis if that's what the person's needs warrant. So just in the linguistic bucket, think about typical language development, acquisition, 

Kate Grandbois: all. Forget about morphology. Yep, yep. All the skills you already have as an SLP, all the training you already did. 

Amy Wonkka: Yep.

Don't forget about morphology, and don't forget about receptive skills and making judgements about the person's linguistic skills as a whole, 

Kate Grandbois: very well summarized operational, [00:52:00] operational 

Amy Wonkka: competency. This is where it gets a little scary for people, I think a little bit. I think when I first started, uh, this is what was scary for me.

I, for, I did start in the advent, like before iPads and all of those things. I was working in a c before that. And so I like some of the things that I, that I knew about my, my client's, a, a c devices were that they were very expensive and I did not wanna do anything to break them. I did not wanna be the person to break the device.

So I think that operational skills are. Where it can get scary for people. Um, when I first started with a a c it was, it was before iPads, it was before, you know, cell phone. I don't think I had a cell phone. Um, but it was, it was before, you know, this kind of consumer electronics was ubiquitous. And so what I knew was that my client's devices were very expensive, very complicated, and I did not wanna be the person who broke them, 

Kate Grandbois: right?

And every, they were huge. They were clunky. Every operating [00:53:00] system had a different system. I mean, none of, there wasn't uniform. It's very different now. Um, I always think of operational competencies as the technical, non-linguistic, how you use it, how you charge it, how you program it. Um, what the a a c user's independence is across those things.

Do they carry it from place to place? It's the un. Fun, non-communicative nuts and bolts. 

Amy Wonkka: I, I think, yes, 

Kate Grandbois: you've 

Amy Wonkka: co generally speaking, captured it. I mean, this article does a 

Kate Grandbois: very good job of describing this in a much more science rooted language, but generally speaking, the takeaway is that it's important to make sure that you're focusing not only on the linguistic components of a a C and those linguistic a a c skills, but also the ownership and maintenance and [00:54:00] techie nuts and bolts kind of stuff.

Amy Wonkka: Yes. And I think these are the pieces that can be intimidating for, for people who maybe don't have a huge comfort level with electronics. And even though, you know, the dynamic is a little bit different now, I think you still know that this is important. You don't wanna mess it up. And I'm thinking of people, particularly who are in that facilitator and partner role, you might not know as much about the tool.

You might not know or feel as comfortable navigating it or doing basic programming, kind of those finder tasks, or excuse me, the facilitator tasks. Um, and I think it's important for people to get some level of comfort, and there's a lot of different ways to do that. A lot of the manufacturers have trainings and, and different resources online.

Uh, you can also check in with your, you know, look at your implementation plan, see if your generalist SLP or your a a c clinical specialist can help you out with this. 

Kate Grandbois: This is also a great thing to do. Um, we have [00:55:00] previously encouraged people to attend a handful of conferences to get additional information.

A TIA Closing the Gap, Isaac? Mm-hmm. Which is I-S-A-A-C. Mm-hmm. Um, it's an international conference. The vendor halls take an hour or two and cruise the vendor halls and play with the stuff. Get your hands dirty, ask the vendors information. That's a really, and I mean this field changes every year, every, you know, handful of years.

I don't go to one of these conferences. I feel like I'm a fraud because the technology has changed so much and the software has changed so much and the light tech systems have changed as well. So, um, getting fa more familiar. Conferences are a great way to get more information, become more familiar with operational competency kind of stuff.

'cause you can play with the toys that you're teaching someone how to use. 

Amy Wonkka: Right. And I will say, you know, I have gone many, many times to a TIA, which is the Assistive Technology Industry Association Conference. And what is [00:56:00] particularly great about that conference is that it is put on by the assistive technology industry.

So they have a really robust vendor hall. There's a lot of access to the vendor hall. Um, and so you really have a lot of the people there all in one space, and you can go in and, and that is the vendor hall as opposed to some, like, Asha, the vendor hall is a bit overwhelming for me. It, it's so huge.

There's so many people. So everybody has sort of different preferences. If you, if you prefer to go, I mean, obviously I prefer to go very deep and narrow in one area. So that's, I guess, not surprising. Um. Right, right, right. But I agree. So, operational skills. We've talked a lot about operational skills in terms of the generalist SLP facilitator or partner.

And the reason that that's important is because operational skills on the part of the A a C user are very essential. So in the light and McNaughton article, they talk about how, with respect to the communicator, these are the skills that they need to produce. The hand or body positions, shapes, [00:57:00] orientations, movements for gestures, signs, other modes of communication, being able to utilize different selection techniques.

So are they somebody who's using direct selection? If so, what part of your body are they using? Indirect selection, some type of scanning. Um, how do they navigate? Do they have the skills to navigate and operate aided a EC systems accurately and efficiently? Um, can the communicator program their system themselves?

Are they able to add, identify vocabulary that should be added? And are they able to add those words themselves? Uh. So these are really important skills. You have to have the linguistic, the operational, and social competencies. And I think that this is a really important thing for people who are working with complex communicators who are using AC to be aware of, you know, you, you need to have the linguistic skills, you need to have the operational skills, but you also have to learn the pragmatic component.

You need to figure out like when and when shouldn't I? And where and with whom and how do I [00:58:00] communicate with different people in different places. Um, you know, these are all of the things that we're working on when we're working on pragmatics. We're thinking about like, how do I enter into a communication interaction with you?

How do I take turns and not talk over you? Um, how do I maintain a topic? How do I shift a topic? 

Kate Grandbois: And I have always found that this is a very tricky thing to get into because the nature of a a C, you know, communication rates are much slower. Communication partners don't tend to wanna wait as long. They wanna finish the sentence or the, they wanna jump into the communication exchange.

So I, in my personal experience, this can be a very tricky, not impossible, but it takes a little bit of maybe finesse or open and honest conversation about the nature of A a C and how it is so different than natural communication. Have you had that experience also? I think 

Amy Wonkka: that for all of these areas, but particularly social and strategic, the next one that we'll talk about, [00:59:00] it really includes the partner a lot.

It includes the partner, like the partner needs to. Take a role, an active role in being a supportive communication partner. So I think that under the social and strategic domain, we think more about things we can do to help support the communication partner. And so those may be strategies like, wait, silently.

Don't read over the communicator's shoulder. Don't try and finish their sentence for them. And I think all of these things are also individualized. You know, the, the person who is the AAC user needs to be, have an important, very, the important voice in, in deciding, you know, what is appropriate for them. I think all of these things are variable based upon you know, who you are and your, you know, your culture, your sociolinguistic skills are not a universal in some cultures and in some circles of relationships, [01:00:00] things are gonna be appropriate and inappropriate.

You know, we think about, like right now I'm in my like pseudo professional mode, right? I'm like professional slash podcasty. So casual, professional, but you know, when I am. Not, not serving as a professional and I'm out casually with my friends. I have different ways that I would enter a conversation, right?

And I code switch depending upon the environment and the people. So there's the sociolinguistic skill of understanding the pragmatic difference in those different environments and with those different relationships. They also group under social competence in the 2003 article, socio relational skills.

So this would be, you know, these are kind of pieces that also further, uh. Add to somebody's pragmatic skills. So, you know, do you, are you an active participant in interactions? Do you seem interested in your communication partner? Do you project a positive self-image? You know, these, these socio relations skill, relational skills, [01:01:00] light makes the point in the 2003 article light at all.

You know, that, that these are really important for people who might have significant barriers to their interpersonal relationships. 

Kate Grandbois: Super, super important. And I think SLPs in general, depending on, again, going back to those roles, I think SLPs were very aware of the need. So first social skills. We get a lot of training on it, but this is another way that the general practice SLP can, um, help other people on the team overcome this barrier.

Um, in terms of educating them about the social impact and the, the relationship between pragmatic skills, um, and an a a C user and society and expectations and all of those kinds of things, how does that tie into the strategic component? 

Amy Wonkka: So the strategic component is the last of those four key competency areas that were identified by light way back in 1989 and have been subsequently revised by her.

Um, you know, the strategic component is really [01:02:00] being able to identify the barriers in your environment, identify the barriers in your society, identify the barriers inherent to the use of your a a c system, and then pick different strategies that helps you to bypass those limitations and make the best choice for what's gonna optimize your communication in these different environments given these different barriers.

So this is a, a really pretty sophisticated, um, skill that needs to be explicitly taught for a lot of people, like troubleshoot it together, troubleshoot, you know. Okay. So in particular for people who have, um. Oral speech or gestures or vocalizations that are well understood by their familiar communication partners, having a frank conversation where you break down different situations, uh, that they may find themselves in and help come up with a plan again together about what might be some strategies they might use.

Okay, so you're gonna go to the coffee shop and you're [01:03:00] gonna order, you know, the usual, and maybe there's a coffee shop. You go to a lot. And if this one guy, Jim is working, he totally knows your vocalizations and gestures, and he's gonna get you what you want. Um, and that's gonna be the quickest and most efficient way to have that communication exchange if Jim's working.

But if Jim's not working and there's somebody new, what's, what's, what are you gonna do? Do you wanna try? You know, and, and having, it's, it's having the critical thinking around identifying those barriers in your environment, and then how are you gonna troubleshoot it based upon all the tools that you have in your toolbox.

Kate Grandbois: One of the things that I love the most about, about. Uh, the notes you have here, but also this article is being strategic about overcoming social constraints. Um, and you have written here about, you know, an example would be talking to someone about using humor to put a communication partner at ease, an unfamiliar communication partner.

Um, and I think having these, having these conversations is [01:04:00] so important. Um, and also might make people uncomfortable at first, but I think it's a, it's a, it's such a com it's such a crucial component of human connection, you know, to, to help people who are a, a c users have that human connection and use their a a c tools to establish and maintain those human connections.

Amy Wonkka: Yeah. Yeah. I, I totally agree. I mean, I, I would definitely point people to this article if you see yourself at all in that third barrier. Like, where do I start? Print this out and read through it and kind of think about different goals and objectives that might be appropriate for the person who's using a a c who is on your caseload or in your classroom or in your family.

Um, and kind of think about is there some skill kind of from each of these big domain areas that could be helpful. And where am I going to start? What's an appropriate starting place? [01:05:00] Um, and where do I take my next steps? We're not, we're not gonna get into, um, the, the additional psychosocial factors, but I would definitely encourage you to read the article.

I think, you know, the psychosocial factors that she identified in this 2003 article and that they're talking about throughout this 2014 article are motivation. Attitude, confidence and resilience. Um, you know, a while back there was a lot, you know, like the catchphrase was grit and like, how do we, can we, can you teach somebody to have grit and all these things?

Um, I think what's, what's really important and was really meaningful for me in, in rereading this article was. That all of these things aren't, aren't related to speech and language goals, but they're related to how we interact and include other people in our lives and how, you know, we're, we are supporting different environments for communicators.

And I think just being aware in the back of your mind [01:06:00] about, you know, is my interaction with this person promoting their motivation? Um, you know, am I approaching them with a positive attitude? Am I helping them to have a positive attitude about their a EC system? Am I helping to build their competent, their confidence?

Am I helping to build their resilience? And just being aware that, you know, these factors are not things that you get from the standard scores on the self, but they're really important. Um, and together all of these different components integrate. To form the foundation of skills that help somebody to be a competent communicator with a, a c.

Uh, it's a great article. You should check it out. 

Kate Grandbois: We hope that everybody is feeling a little bit more secure in some of these a, a c basics and, and underpinnings. Um, this, the literature that we reviewed today is really a springboard, I think, into asking so many more questions, learning so much more. Um, if you're still with us [01:07:00] and you have questions, please, please, please send us an email.

Um, if you are, we wanna learn more about mentorship, you wanna learn more about the certificate, the upcoming certification process, which we don't know very much about, but if you have any questions whatsoever, um, please don't hesitate to reach out. We love hearing from you. Um, is there anything else? No, I think that's it.

We do still want someone to tell us if they have the opposite for Hazah. You have to, if anybody has any ideas, you could just send us an email that says nothing but poo and I will be happy. Oh, it should not say Koo. All right. Well thanks for joining us, [01:08:00] everyone.