Best Practices in Communication Support

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At all times, please remember to utilize and promote the standards of best practice in communication support and encourage others to do the same. In particular, support for looking at the keyboard and fading physical support needs to happen all the time in order to foster the person being in control of his or her communication.

Attitude

When working to support a person to learn to point to communicate it is central to focus on approaching the FC user as an equal. Be sure to interact with the FC user just as you would a person without a disability.

Citizenship and the Presumption of Competence

People with disabilities, who struggle to communicate, should be approached as equals. Facilitators should practice the following:

  • Never talk down or use a childish or unusually loud voice when speaking to someone. Talk to the FC user as you would a person without a disability.
  • Be careful to use language, materials and topics that are age-appropriate and should represent interests of people without disabilities of the same age group.
  • Presume Competence! Remember that people who struggle to communicate cannot always show what they know or are thinking. It is vital that you assume that the person is a complex, thinking, feeling equal and then go about working to teach the person with a disability to be able to communicate their thoughts.

Empowering the Facilitated Communication User

The goal of facilitated communication is to allow facilitated communication users to use language to accomplish all of the typical communication functions that are useful in daily life. To do this, facilitated communication users need to be provided with opportunities be heard. Facilitators should ask themselves:

  • “Am I determining the pace or am I allowing the facilitated communication user to determine the pace?”
  • “Am I getting a third person’s attention or am I teaching the facilitated communication user how to do that?”
  • “Am I determining who reads or hears what the facilitated communication user has typed, or am I letting the facilitated communication user determine who receives his or her communication?”

Practice

Elements of FC Training: Physical Support

Physical support may include the following:

  • Assistance in isolating the index finger (only until the person can do this themselves)
  • Stabilizing the arm to overcome tremor
  • Backward resistance on the arm to slow the pace of pointing or to overcome impulsiveness
  • Facilitator resetting the FC user to the neutral position (pulling the FC users arm back to the center of the board)
  • A touch of the forearm, elbow, or shoulder to help the person initiate typing; or pulling back on the arm or wrist to help the person not strike a target repetitively
  • Support to maintain good posture and body position while typing
  • Coaching to ensure that the FC user slows their movement to develop a controlled rhythm to typing
  • Coaching so that the FC user continues to look at the board.
  • Facilitator reading each letter as typed. This helps the FC user to know that there message is understood and also assists in providing a rhythm for typing
  • Reminders to use correction strategies, especially delete and back space
  • Facilitator teaching strategies to correct errors; the facilitated communication user should be given the confidence (through encouragement) to correct his or her communication partners’ (i.e., facilitators’) errors if they miscall letters
  • Facilitator checking with the facilitated communication user both during the writing of the message and once the message is complete to ensure accuracy
  • FC user and facilitator should practice and achieve an independent yes/no response as quickly as possible

Elements of FC Training: Emotional Support

Emotional support involves providing encouragement, but not direction, as the person points to communicate. In their role of providing emotional support, the facilitator acts like that of a coach. When providing support the facilitator might say:

  • Keep going.
  • You can do it.
  • Tell me more.
  • Do you have more to say?
  • What’s next?
  • You’re doing great.
  • I know this is difficult, keep trying.

It is important to let the FC user know that you understand that this is difficult, but that you also know they can achieve this goal.

Elements of FC Training: Communicative Support

Various forms of prompts and cues to assist the FC user to stay focused in the communication interaction, to provide feedback to the FC user on the content of their message, and to assist the FC user in clarifying unclear messages. Again in providing communicative support the facilitator is taking on the role of a coach. When providing communicative support the facilitator is helping the FC user to focus their attention and completed the message.

Strategies for providing communicative support:

  • Make a schedule outlining the typing session
  • Make sure the content is interesting and meaningful
  • Decide ahead of time, with the FC user, about topic and content
  • Use set work as a warm up to get started

When providing communicative support the facilitator might say:

  • Here is what you typed so far, what is next
  • Do you have more to say?
  • Do you need to correct that?
  • Let’s finish this thought first.
  • Keep going.
  • We were talking about, ___ you can finish.

Structure

Total Communication Approach

Facilitated communication training is not meant to replace established, effective strategies currently being used by a person; rather, it is meant to provide a means whereby that person can expand current strategies and develop a more comprehensive means of expression.

Many people who type to communicate also use the following communication strategies:

  • Sign language
  • Prepared communication boards with pictures or words or a combination of both
  • Speech
  • Communication devices with pre-recorded messages or choices

Collaborative Team Approach

FC users must have the support of a team of people committed to continued successful use of the method. This team may include family members, teachers, therapists and friends. Support and commitment from an FC user’s team is critical to long-term success with augmentative/alternative communication (AAC) and facilitated communication training. In order to be empowered and personally invested in any communication evaluation, planning, and teaching/learning, the FC user must always be included and involved in decisions which relate to the following:

  1. The types and levels of support that person needs for successful communication
  2. Activities, therapy and training to be undertaken
  3. Communication aids and devices to be used
  4. Plans for dealing with specific concerns

In addition to the facilitated communication user, parents, other family members, and others who know the person well will usually play a vital role in obtaining and providing this information, in initiating action, and in other aspects of the decision-making process.

Assessment

In order for facilitated communication training to be considered and successfully implemented, two things must occur: an individual needs to be identified as a candidate and those who support that individual need to show commitment to the training process. Both of these elements begin with the assessment. In determining the benefit of facilitated communication training for an individual, the following should be considered:

  1. Current communication strategies
  2. Current and past use of AAC strategies
  3. Independent pointing skills
  4. History and current description of movement problems
  5. Current and past use of support strategies across the person’s range of social contexts

Independence

A primary, long-term goal of facilitated communication training is independent communication. This involves:

  1. Being able to access communication aids without physical support;
  2. Being able to initiate the process of communication with others; and
  3. Exercising control over the content of one’s communication.

The fading of physical support should begin at the outset of the training process, with both facilitators and facilitated communication users working toward this goal. There should be regular training sessions focused specifically on independence, which may involve going back to set work and trying some routine responses and exercises without support. Always provide the support needed for open communication during this process, but continue with the set work exercises while the FC user is working on typing without physical touch.

Multiple Facilitators

Facilitated communication training must involve ongoing, active widening of the number of people prepared to support an individual’s communication for the following reasons:

  1. To reduce dependence on a particular facilitator
  2. To increase independent communication
  3. For there to be sufficient examples of valid and authentic communication to document in a portfolio

Facilitation with an inexperienced facilitator, or with one who has not worked previously with a particular facilitated communication user, is likely to be more challenging and frustrating than facilitation with someone with whom the facilitated communication user has an ongoing relationship. Therefore, the contact time of facilitators should be arranged so that experienced facilitators are positioned to support the development of expertise and comfort within the new dyad. Inexperienced facilitators should not be expected to provide support beyond their skill level (e.g., in test situations).

Kasa, C. (2008). Adapted from the ICI training standards (ICI, Syracuse University, 2000).