Where is the Opportunity for Control with AAC? Communicating in Group Homes.

I recently had a mom whose adult child is living in a group home ask me to provide some guidelines for staff to help them with using AAC.

For more than 20 years I have provided consultation to an agency that runs a few dozen group homes for adolescents with autism and adults with a variety of developmental disabilities and dual diagnoses.

Many adults with intellectual or developmental disabilities do not develop sufficient speech to meet their communication needs.  And once outside the school system, they are often unlikely to receive any direct services for speech-language therapy.  

Many do not have any speech. Many of those who do have speech lack adequate speech in many contexts.  And for all of these clients, we need to consider how to provide them with improved communication.

Adults with developmental disabilities are vulnerable for an inability to get their needs met.  They have the least access to sufficient communication systems or skill-building.  And even those who have had some alternative system when they were in school have frequently lost access to a system as they transition to adult services.

What we have is a system with

• Unique clients: who may have had no prior language interventions. (This is particularly true for older clients who were in school when there were fewer options and services.)  These clients may have developed ways to communicate that are not universally understood but have been established over a long period of time.
• Unique environments: where life is highly routinized, needs are all met, opportunities to exert control may be very limited, and there are frequently few opportunities for communication interactions.
• Unique partners: Staff in adult programs may have minimal education and training, often do not understand communication needs, have difficulty with consistency in the face of having to provide services to several clients at once, and who need strategies to use that give them step-by-step directions.

Our goal is to increase communicative intent, to increase communication in a way that we understand intent, and to improve quality of life by reducing frustration and anxiety.

The biggest bottom line is that communication needs to be motivating.  This can be difficult in group homes where needs are met routinely and opportunities for a single individual to exert control over what happens are limited by staffing ratios and other clients’ wishes.

I urged staff to consider what their clients - including this young man - want or like, what the environment allows them to have unique to themselves, what alternative response they can use to tell staff and how staff can consistently require that they use that response to indicate what they want.

I remind the staff to think of communication as power.  It is about having control over the environment.  Our clients need to learn that they can have this power.  Staff needs to consider ways and times when this is possible within the structured environment of a group home situation.

Until next time.... Keep on talking!