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SLP Insights: Understanding the Power of High-Tech AAC Devices | FREE ABA CEU — Transcript

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0:00all right everyone welcome back to the
0:01blossoming together podcast today we
0:04have a guest speaker on her name is
0:06Kelly we're going to be talking about
0:08AAC so the first objective is identify
0:11and apply interdisciplinary
0:13collaboration strategies between bcbas
0:16and slps to effectively integrate AAC
0:19devices into everyday communication
0:21routines and our second objective today
0:24is demonstrate how to implement modeling
0:26strategies and understand the importance
0:28of modeling all right so it's a special
0:31month right it is it's October it's AAC
0:34awareness fun oo and that's how we have
0:36you on we really wanted to get into it
0:39but before we do that we kind of want to
0:40get to know you a little bit how long
0:43have you been in the field how long have
0:44you been in SLP tell us a little bit
0:46more about yourself yes so my name is
0:48Kelly Hamilton I'm a pediatric speech
0:50linguage
0:51pathologist um I'm licensed in the state
0:53of Michigan and I have my certificate of
0:56clinical competence with the American
0:57speech and hearing Association I've been
1:00practicing for about 3 and 1/2 years all
1:02within multi-disciplinary pediatric
1:05centers um I love working with kiddos
1:09and a lot of my practice is done through
1:12play and sensory based activities I
1:14really like to work with other
1:15disciplines like OT is bcba and getting
1:18experience with the parents yeah it's
1:20really nice it's amazing and I feel like
1:21we really like that too so that's why
1:23we're excited to have you on yes it's so
1:25nice we talk about I feel like almost in
1:26every episode we refer to like speech
1:28language pathologist we're like please
1:30reach out to your SLP so we get to see
1:32you on a daily basis and it's really
1:33nice yeah thanks for having me no
1:35problem so Kelly this competency
1:38certificate yeah we were like we've
1:40never heard of that can you tell us
1:42about that cuz we we you know we're
1:44always like oh we have to be competent
1:45in this area and we've never heard of
1:47anyone else mention it I mean I'm sure
1:49it exists or people have it but we've
1:51never heard anyone mention it before
1:53okay yeah so it's pretty common for
1:55speech pathologists to have their CCC
1:57SLP certificate
2:00your yes you get your SE so we know what
2:03it is yes it's just we only know the
2:05acronym yes um so that just means you've
2:08um done all your schooling you've taken
2:10your test and you're licensed it's like
2:13the fancy name oh I like it so it's
2:15pretty much like bcba yes you're
2:18competent in your field certified okay
2:20cool that's really fun good to
2:22know um so let's get into it today we're
2:24going to be talking about AAC since it
2:26is AAC awareness month we really just
2:28want to get into what is AAC AC yes um
2:32so AAC stands for augmentative and
2:35alternative
2:36communication um and it describes
2:38different ways to communicate other than
2:41verbal speech so let's kind of break
2:44that down augmentative and alternative
2:46they sound like big words so
2:49augmentative just means anything that
2:52might help support verbal speech um so
2:55it augments it and then alternative
2:58would be in replace of verbal speech so
3:01instead of using verbal speech you would
3:03augment it using something different
3:05okay that makes sense yes so when we
3:07talk about a that's that's what we're
3:09that's kind of what you're referring to
3:10yes and I know we've kind of heard about
3:12it in our field a little bit there's
3:13high-tech versus low Tech I think that
3:16when we think of AAC we only think of
3:18iPads and tablets can you talk about the
3:20difference between high-tech versus low
3:22Tech AAC yes so AC those are the two
3:25main kinds Hightech and lowte um when we
3:29think about high te a lot of times we
3:30think about a speech generating device
3:33that's our iPads that have an app on
3:35them that is speaking for for the child
3:39um a lot of the different apps that we
3:41use are um symbol based and the child
3:44might push a button and then it says a
3:46word so that's our Hightech probably
3:48what we think about most of the time yes
3:51then we have our low Tech this might be
3:53something like a core board uh maybe a
3:57communication board or even a a pack
4:00um that's something that's more static
4:02it's more the child pushing uh not
4:05pushing selecting yeah pointing to a
4:08picture to make a choice to communicate
4:11interesting why are AAC so important yes
4:15so AC is really important and it's it's
4:19all around us we everybody uses a and a
4:23lot of times we think oh it's just you
4:25know a kid using an iPad we're using AC
4:27right now noard oh I never thought about
4:31it like that I like um you know think
4:33you might make a list to go to the
4:35grocery store that's using AAC sending a
4:38text message think about it we said it's
4:40augmenting or alternative alternative a
4:43different way to communicate sending a
4:45message there so many different ways to
4:47communicate yeah leaving a note so
4:50everyone is using AAC all the time MH um
4:54and it can be really helpful when it's
4:58hard for us to express ourselves so
5:01that's where we think about that
5:02Hightech AAC um anytime somebody is
5:06having a hard time expressing their
5:08wants and needs that's when we can use a
5:11high-tech aec system to support their
5:13verbal speech it's like when I'm really
5:15mad at my husband and I can't like talk
5:17to him about it but then like after he
5:18leaves the room I text him like I didn't
5:20like how you did this yes yes you gave
5:22him that message through AAC I'm
5:26like yes all right and then how do you
5:30decide how do you decide on which AAC a
5:33learner might use or when you're
5:36starting out how do you like decide that
5:39yes um so I'm going to talk about my
5:42experience it might be different um some
5:45kids get AC through their
5:47school um or through different Outlets
5:50but um I work in an Outpatient Center so
5:53that's I can talk about how I get kids
5:55devices um so it really is based on the
5:58kids needs okay and what we could do is
6:02we can look at different high-tech
6:04systems or apps that have different
6:07features that would match with the
6:09child's needs so um maybe they need
6:13bigger buttons or smaller buttons we can
6:16look at different apps that match the
6:18kiddo's needs and then um from there
6:22tryal those apps in in different
6:24sessions okay so I like to trial maybe
6:28you know like three to four different
6:30apps see how the child does and then
6:32from there um ultimately make a decision
6:35on which application would be the best
6:37for the kid yeah is there like an
6:39evaluation that you do with those like
6:41different um apps like is it like a
6:44stand more like like we would call maybe
6:46like like your free operant like you
6:48know you got a bunch of them out not
6:51like bunch of them out like after you
6:52try like how do you know that's the one
6:54like are you collecting data on it or is
6:55it something you just are observing yeah
6:58so I is um like subjective and objective
7:02some of it is just that clinical
7:03observation oh they really use the
7:05device a lot more when I was using this
7:09application um other times we are taking
7:12that hard data when I use this app I am
7:15seeing accuracy with 60% of Trials yeah
7:18that makes sense um so it's a mix of
7:20both we also have to consider different
7:23factors like I was going to ask like can
7:25they like scanning arrays is that
7:26something you would consider yes um how
7:28many buttons do we think they can look
7:30at how old is the child an older child
7:33might need a bigger display versus are
7:36we looking at a 2-year-old they might
7:37need a little bit smaller display this
7:39is why we see different size like
7:40tablets walking through this on yes cuz
7:43every child has um has different needs
7:46and when we're thinking about apps too
7:48um most of the times I am able to Bill
7:50insurance so a child is able to I'm able
7:54to order it through an insurance and a
7:56lot of times insurance is paying for
7:58that now
8:00yes thank goodness but that's not always
8:02the case so if the family is going to
8:05have to private pay for the device we
8:07also have to think about the cost of the
8:09apps some of these applications are
8:11really
8:12expensive do you have like a ball park
8:14like ball range they can be three four
8:17$500 my god um just for the app just for
8:20the application and then we also are
8:22talking about purchasing an iPad
8:24purchasing a case a strap I and you want
8:27the device to be quality so it's going
8:28to be those more expensive
8:30iPads and things yes um so we have to
8:33consider those factors too um in you
8:37know in a perfect world we can get a
8:39Kido whatever whatever app is yes is uh
8:42best for them but definitely price can
8:44be a factor um but majority of the time
8:47I'm trialing different apps in my
8:49sessions looking at the data that I have
8:52and then seeing which app the child
8:54interacted with the best okay um and
8:56then from there I'm going through
8:57Insurance to get the the device have a
9:00question so is it normal where you if
9:03after you recommend an app to Insurance
9:05you say like I think lamp lamp's coming
9:08lamp is the best one for this kiddo has
9:10are there instances where Insurance
9:11might say we don't think so so not
9:14necessarily that they don't think the
9:16app they might say will only cover 80%
9:20of a device so they don't really like
9:22care maybe about which app you use but
9:24it's more about the fact that they're
9:25getting a device yes um they don't
9:28necessarily care about the the data with
9:30the different apps okay interesting
9:32curious yeah no that's that's a good
9:34question I want to pause really quick
9:36for our first code word for the bcb's
9:38receiving their cus our code word one is
9:42AAC all right so I know I just mentioned
9:44lamb are there can you talk about some
9:46of the other apps that you use quite
9:48often especially with our early learner
9:50like early learner kiddos yeah yeah so
9:53um I there's lots of different apps out
9:55there these days I feel like there's
9:57just more and more all the time
10:00um a lot of the I use in the early
10:03interv um I like to go snap lamp words
10:08for Life grid touch chat Touch chat with
10:11word power all of those apps are symbol
10:14based so meaning there is a button or a
10:17symbol picture that the child is then
10:20going to push and it's going to provide
10:22the child with auditory feedback and
10:24they're going to be able to hear the
10:25word nice and then I've seen where some
10:27speech pads change the voice right right
10:29sometimes match what they like if they
10:32have like a sample that maybe they could
10:33match it to or if it's a boy or a girl
10:36The Voice there's lots of different
10:38voices and we try to match you know
10:39gender or even if there's a cultural
10:42background um there's different accents
10:44on the app cool the tricky thing is the
10:46voice is synthetic so it's not sometimes
10:50words come out sounding funny yeah every
10:52time someone puts my name on one of
10:53their kids
10:54devices really yeah doesn't come out
10:57really good we can play around with that
11:00but that is the tricky thing is that
11:01they are it's not uh necessarily a human
11:04voice right okay inde that's nice I
11:06wanted to ask a little bit before we
11:08move on um about coreboard and like how
11:10you decide so if the if we're not using
11:13a high-tech device and you use a
11:14coreboard to support your learner how do
11:16you decide what is on that coreboard and
11:18what that coreboard should look like
11:20yeah so coreboard are made up of core
11:23words or high frequency words that a
11:26child might use to make requests okay a
11:29lot of times it's words you know like I
11:31want open more in on go go yes go I'll
11:37done um so the coreboard sometimes
11:41they're pre-made and they're they're
11:42preset and you're asking about like a uh
11:46static like not Hightech not Hightech
11:48just a coreboard like sometimes you know
11:50when you go to the park you'll see like
11:52adaptive Parks like you'll see bunch of
11:53core Boards out on there are you asking
11:55about like those kinds I'm thinking like
11:58um cuz soci men mentioned with low te
12:00like we're looking at like those static
12:02coreboard so like if a learner may not
12:04have access to a tablet or their tablet
12:06might be broken we have like a core
12:08picture board it's like a little
12:09laminated sheet typically that I see yes
12:12and so that might be a picture from
12:14maybe their high-tech device like the
12:15home screen um or maybe their speech
12:18therapist has found words that are
12:20really important to them highly
12:22preferred items that they can then point
12:25to to make a selection um anytime we're
12:28thinking about different buttons on a
12:29device we want to be thinking about what
12:32is going to be motivating and meaningful
12:34for the child yeah socially significant
12:36we would say yeah yes yes so every
12:39kiddos would be a little bit different
12:40okay that's good to know nice so we want
12:43to get into some myths that you know we
12:46hear we hear you guys address things
12:49we've read
12:51online good stuff yes let's dive into so
12:55did you want to start yes our the first
12:57myth that we wanted to address is our
13:02it's Halloween it's almost Halloween
13:04let's do it very important so our AAC
13:06devices only for nonvocal
13:09communicators yes so that is a myth I
13:12thought you said yes like I was like
13:14like you like no so that is a myth um
13:18AAC devices are for more than just
13:21children who are I like to say
13:23non-speaking okay um because when we
13:26think about vocal a lot of our kids do
13:28make vocal sounds they might vocally
13:30stem make different um maybe letter
13:34sounds vowel sounds so they're just not
13:36speaking yet the sounds they're making
13:38are not um are not functional so a lot
13:42of our um AC is for more than just
13:44nonspeaking kiddos if you think about it
13:47everybody uses a different different
13:49forms of AC right we talked about
13:50leaving notes we talked about how it can
13:52be leaving messages writing different
13:55things out um anytime a kiddo is having
13:58a hard time just expressing their wants
14:00and needs or maybe communicating for a
14:03different variety of requests so maybe
14:05kiddos can are speaking but they're only
14:07labeling and I'm only labeling colors
14:10I'm only labeling letters or singing
14:12songs that's not really functional for
14:15everyday communication there's gaps in
14:17areas that they want to communicate and
14:20so a high-tech a device might benefit
14:22them so that they can communicate a
14:24wider variety of things M I know you sir
14:27and I we work together with a um a kiddo
14:30who he had another diagnosis going on
14:33that was impacting his ability to
14:36communicate um a praia right yes so he
14:39was a praic but um maybe your kiddo is a
14:42just got language processor or has a
14:44praxia and while they can speak it just
14:47might be difficult and I know with a lot
14:48of the distal language processors now
14:50I've been seeing a lot of the speech PS
14:52adding folders called gals right yeah my
14:55phrases I see a lot yeah um so a kiddo
15:00might have something else going on
15:01that's impacting their ability to
15:03communicate and they might just need
15:05some more support so or they might be
15:08communicating and it's not easy for The
15:10Listener to understand right maybe their
15:12speech is unintelligible that's the case
15:13with our friend he could put two three
15:15words together but we just were unsure
15:18what he was saying um so we can use AAC
15:22to support verbal speech it's not just
15:24for kids that are just non-p speaking
15:26right going right into that I know a big
15:29with and something that comes up a lot
15:30with parents is once we introduce a
15:32device or an A that they're not going to
15:34focally communicate with us or if they
15:36have any like verbal communication
15:39they're going to stop it stuff of that
15:41sort what would you say yeah what would
15:42you say to that yes that's another myth
15:45that's a big one you get it all the time
15:46I feel like it's always I hear that
15:48every kiddo that I get a device the
15:50first question is parents are well are
15:53they not going to talk then and I get it
15:55you're scared and I mean especially when
15:57they have these hules and you know this
15:59is something they've been like you know
16:01they've been going to speech therapy and
16:02I sometimes I feel like they think
16:04speech therapy means that they're talk
16:07you're verbally speak to me and it's
16:09just that's myth too sometimes right
16:11yeah that's a myth too it's it's not
16:13always the case I like to tell parents I
16:16can't promise that verbal speech um but
16:19I can promise language and I can promise
16:21that your child can communicate with you
16:24um so jumping back to that myth that it
16:27AAC is going to hinder verbal speech one
16:30way of communicating does not diminish
16:33another so if the child is already
16:36speaking and maybe like we talked about
16:38they just need AAC for more support if
16:41they can say more verbally and they can
16:44push the button more on the AAC and use
16:46the sign that doesn't diminish the other
16:49forms it just kind of shows us
16:51generalization across different um
16:54different ways to communicate um the
16:56other thing I like to think about is we
16:58really want to build kids confidence in
17:01communicating if we're thinking about a
17:02kiddo who maybe has been in speech
17:04therapy for a year focusing on verbal
17:07speech still has no words minimal words
17:10they haven't had a lot of success right
17:12their needs are not being met and so if
17:15we can provide them with a way to have
17:17success with communicating and their
17:20confidence is going to build and once we
17:22build that confidence in communicating
17:23they're going to communicate more right
17:25that's amazing I feel I don't know have
17:28you ever into this where a parent might
17:31want a low Tech AC versus a high tech AC
17:35for this reason I know it's a myth but
17:38say that's what they're telling you yes
17:40I hear that a lot parents are like okay
17:44we'll try it but I'm not sold on a
17:46high-tech device let's just try a
17:48coreboard something they can point to
17:51and I feel like some providers will say
17:52okay let's let's try it it's something
17:55but that is really doing a disservice to
17:57the kiddo boards are static they don't
18:00change it really limits the things a
18:02kiddo can say and a lot of our autistic
18:05Learners have really specific interests
18:07that they want to say you know be able
18:09to navigate to those and give them that
18:11option yes or we might not know what
18:13those interests are right you know
18:15they're on the they can get to them on
18:17their AC or sometimes even spell them
18:18out I've had that happen so many times
18:21where starts spelling out words yeah or
18:24different characters um and if they
18:27don't have access to a keyboard or
18:29access to aiet of animals oric how can
18:32they tell us their interest um so for
18:36parents who are more like oh let's just
18:38try the coreboard I really like to
18:40recommend let let's not do that I know
18:42you're scared I know that this is it's
18:44different you know using AC it's not
18:46what we expect but as providers we can
18:49really try to make it um not as scary
18:52for parents that comes a lot from the
18:54confidence you have in yourself as a
18:56clinician too in the belief system you
18:58have cuz talk about this all the timee
19:00new BCBS when a parent's asking for
19:02something or they're pushing for
19:03something putting your foot down also
19:06and being like well it's not in the best
19:07interest for our kid and having
19:09confidence in the research and being
19:11able to present that to parents in like
19:13a you know a meaningful way to them like
19:15I hear your concerns and I value that
19:18however this is why it'll promote
19:19communication I feel like this happens a
19:20lot where they'll come to the speech
19:22path and say well same thing or then
19:24come to us and be like well what do you
19:26think about the situation would you do
19:30yeah and my thing is it's only scary if
19:32we make it scary you know if you as a
19:34therapist are afraid of the device and
19:36afraid to implement it that's going to
19:37come off on the parent and and the other
19:40um people on the team but as therapists
19:43we really have to believe in our kiddos
19:45and presume that confidence that they I
19:47love that piece yeah they they can use
19:49the device and that they know their
19:51animals they know their letters their
19:53shapes presume that they can do it and
19:55try something that might we have to
19:57teach every word at one time yes we
19:59don't have to do that um and so as a
20:02care team you know if you're working
20:03with the SLP OT bcba it's really
20:06important that everyone's on that page
20:08and just supporting the parent saying
20:10yes we need this we need a communication
20:11system and if the child is minimally
20:14speaking or non-speaking it needs to be
20:16a high-tech system right yeah nice I
20:20have another myth that I've heard so
20:23often especially like I feel like in the
20:24field of ABA so if a kid is in on the
20:29AAC device do we need to block it yes
20:32another myth that is not true um I am a
20:37big supporter of stemming a big
20:39supporter of Regulation so everybody
20:42stems on language so I want you to think
20:45in your head a lot of us have inner
20:47monologues yeah right what am I thinking
20:51what am I thinking like in my brain are
20:53so
20:54white thank you um you know like my
20:57inner monologue lot of times it's like
20:59Taylor Swift lyrics and I'm just singing
21:00that part of that song over and over
21:02again yeah I'm stemming and I'm stemming
21:05on language I'm just not doing it out
21:07loud yes and like overt way yes and
21:10that's regulating for me I'm stemming on
21:13it to calm myself down because maybe I
21:15don't want to think about the work
21:16that's in front of me right too often
21:18yes too often so that's helping me calm
21:21down now a lot of times with our AAC
21:23users it's not that internal language
21:26stemming it is pushing you know goldfish
21:2910 times and then yes listening back and
21:32it's it's almost like a little dj
21:33goldfish goldfish open open more more
21:35and you're like I live for I have a
21:37learner who they go between two
21:38different animals and then like and it's
21:40very specific it's always like the goat
21:42and the horse and they go goat horse
21:43goat horse goat horse and then they go
21:44play it back for themselves and I'm
21:48like pad right on the top on the top
21:50there's like a little
21:52yeah sentence bar yeah and um you know
21:55we we kids stem on things that are
21:57regulating and things that like so a
22:00kiddo stemming on an AAC device means
22:02one they like it hey they like to
22:04communicate they like to communicate and
22:06I want to use that to calm myself down
22:09um I feel like too we have to think
22:11about a kid gets this device we expect
22:13them to be able to use it to be able to
22:15navigate find the different folders use
22:18the back button use the clear button if
22:20we don't let them explore it how are
22:22they going to learn how are they going
22:23to learn it yeah so sometimes kids learn
22:26how to navigate those pages use the
22:28clear buttons through the simming and
22:31the expiration on the device my favorite
22:33example has been well we wouldn't take
22:35if a kid was vocal and we wouldn't be
22:37able to take that away so why should we
22:39take the AC away yeah yeah like if a kid
22:43was scripting you know scripting a song
22:45or something we would not put our hand
22:47over our mouth and say shut up stop stop
22:49saying that we would just say like okay
22:51yeah yeah same situation it's the same
22:54situation we have to give our AC users
22:57that same Grace and that that same level
22:59of confidence that we give our our vocal
23:01kiddos I feel especially coming back to
23:03parents this is like a situation that
23:05happens a lot where they'll Cal and be
23:06like well they're just playing on it
23:08they're not using it like would you what
23:11would you tell them in that specific
23:12situation um I tell them that that's
23:15good they're interested they're
23:16exploring and a lot of times we'll see a
23:19high increase in stemming when a kiddo
23:20first gets a device because it's novel
23:22it's new maybe they've only had it for a
23:25couple sessions with the speech
23:26therapist now they have it all the time
23:28so it's fun to explore um in my practice
23:32I have found that if a child stems on
23:34their device they're also more likely to
23:36use it functionally down the line so we
23:38just kind of have to trust the process
23:40um and let them work through it I like
23:42that I heard something recently um about
23:44a learner who was getting a new device
23:46and their parent was concerned about the
23:47same they're like well they're only
23:48pressing the buttons they're not
23:49functionally using it they're just
23:50pressing and pressing over and over
23:51again and that speech therapist
23:53mentioned she's like I don't think
23:54they're stemming on it they're
23:56navigating and learning all these new
23:57words don't know they can't read
23:59necessarily and some of the pictures
24:01don't indicate what it's saying so this
24:03learner is just pressing the different
24:04buttons to get to know what that device
24:06is saying so that he can use it in the
24:08future yeah and it like I don't know it
24:10like brought a little Clarity to me I
24:11was like oh that does so much more sense
24:14yeah maybe they don't know especially on
24:16the device sometimes there's a million
24:17things some things they might not have
24:19ever been exposed to maybe yet yes words
24:21yes I have um a friend I'm working with
24:23and he's stemming a lot on the device
24:25and I was trying to figure out is there
24:27like a pattern and is finding the words
24:29that are the same so is is in like three
24:31different folders he's going is go to
24:33different folder is different folder and
24:35then like yeah he found it in like the
24:38breakfast foods then his Foods I'm like
24:40oh you're just showing me that you know
24:41these words are the same and I know what
24:43this word means yes I know what it means
24:45and if we wouldn't have let him stem and
24:47explore it we wouldn't know that he
24:49knows that those two different pictures
24:50of an egg mean the same thing exactly
24:53thank you for yeah bringing Clarity on
24:54that I think it's one of the biggest
24:55misconceptions that I I think I feel
24:57like I deal with basis or even sometimes
25:00it happens a lot with my techn or I had
25:01it happening a lot with my technicians
25:03where they're like well they're not
25:04using it to communicate yet they're just
25:07hitting all these divice like these
25:08words and I feel like just telling them
25:11how you explained it is really helpful
25:13yeah thank you we have a second code
25:16word for our bcbas your code word too is
25:19myth how do you spell that M YT H
25:23nice so another myth or another
25:26situation when teaching a learn to use
25:28an AAC what is the first goal that we
25:31need to Target or hit on um yes so it's
25:36just more of a situation it's not really
25:37a myth yeah this is not a myth this is
25:40not a myth not a myth okay um so the
25:44first thing we look for is really some
25:46kind of buyin or interest in the device
25:50so for kids different kids it looks
25:52different ways that might mean them
25:55imitating a model that might mean them
25:58stimming on the device it might just
26:00mean that they're looking at it yeah
26:02that they attended to my model we're
26:05just trying to get some type of of buyin
26:08with the kiddo that shows us that
26:10they're they're interested and that they
26:12want to explore it so if I'm the bcba
26:15and you're the speech path on the case
26:16and you've introduced the AC what are
26:18some tips you have for me to show my
26:21technicians or for me to try out on the
26:23floor yes so um I I want to read a quote
26:29that I found that kind of goes with this
26:31um so I think she'll look right into the
26:33camera when you say it okay yes so um if
26:38a kiddo um only sees a symbols a symbols
26:42for two times per week for 30 minutes it
26:45will take them 84 years for them to have
26:48the same exposure to AED language as an
26:5018-month-old verbal
26:53child yeah 84 years um so it that's a
26:59lot a long time so we think a lot of our
27:02kiddos get get devices they might have
27:04Tri it in a session for maybe 10 weeks
27:08for 30 minute sessions that's not a lot
27:11of time and so as um as bcbas I think
27:15sometimes we expect that we they get the
27:17device and they're going to be able to
27:19use it perfectly and they're not they
27:21really need more support they need um
27:23those models and they also need um all
27:27of us collaborating together to make
27:29sure that we're on the same page with
27:30how we're going to implement the device
27:32and creating goals I think this is a big
27:34thing like my goal as a bcba cannot be
27:37five steps ahead of where you are with
27:39the Learner in your sessions so as bcbas
27:42we need to really really ensure to
27:44collaborate to decide those goals and I
27:46feel like this happens a lot or I've
27:48seen it happen a lot with new BCBS
27:50they're like okay cool now they have a a
27:51device now I can work on tacting which
27:53is like labeling now let's ta 25 it with
27:56the a but we may not be there cuz you
27:59just introduced this they're still not
28:01even like in your sessions they're not
28:03even expected to use you're still at the
28:05point where you're modeling you're
28:07showing them you're still trying to get
28:08that buy in yes we're still trying to
28:09get that buy in they're still exploring
28:11it and so well it might be a great Goa
28:14to tack 25 things or label 25 things
28:17that might be 6 months from now let's
28:19just start with maybe them imitating a
28:21model or them independently using their
28:25device two times in your session and
28:27that's a really like I feel like that's
28:28great that you gave some like helpful
28:30goals those are really good and I feel
28:32like that's where sometimes we get stuck
28:34you know we're stuck we're like we have
28:36to write a goal yeah to be able to use
28:38this in our sessions what should we
28:40do it's tough too cuz you guys you know
28:43you aren't always trained in AAC and I
28:46really think that's where if your child
28:48has a AAC device you really should lean
28:51on the SLP to make those targets I think
28:54like BCB you guys make the B and in my
28:57sessions I'm found that bit to make sure
28:59that my kiddo is staying safe it's the
29:01same thing I can make those targets for
29:03communication so that you guys can
29:04follow them and it's all about
29:06collaborating like okay you have already
29:09created these targets how can I put them
29:11into my session now where it makes sense
29:13for me yeah expanding it once it's
29:15mastered yes
29:18yeah next yes all right so we've talked
29:22to did we touch on modeling without
29:23expectation yet I don't think we have y
29:25can you like tell me about that cuz
29:27that's like Kiki yes yes um so we like
29:32to use the phrase modeling without
29:34expectation and this just means that we
29:36are modeling without expecting the child
29:39to imitate or to push a button after us
29:42um this is really important because one
29:45we we don't want communication to feel
29:46like a task that if we're modeling
29:49showing them how to use the device that
29:51they have to then they should be doing
29:54it but then they have to try and do it
29:56um we also really want to make sure that
29:59when we're
29:59modeling it's it's to show them how to
30:02use different words so they can we're
30:04modeling lots of different things in
30:06different environments and they're not
30:08always going to push the button right
30:09after us yeah and and that's okay and
30:12you don't you don't need to expect them
30:14too like this not every um opportunity
30:17throughout the day needs to be a trial
30:19or an opportunity and I think that's
30:20something that bcbas could really take
30:21away like it doesn't always have to
30:23count towards your data some things can
30:25just be to learn yes without expectation
30:28yeah and if we don't show a kiddo how
30:30are they going to know to use it so they
30:33need those models all the time and um we
30:36can't be forcing them to to push a
30:37button after us yeah perfect I agree
30:39with that I also think it goes back to
30:41making sure that we are modeling
30:43throughout our session that's a big
30:45thing too it's not just there for the
30:47kiddo we can also show them how to use
30:50it I think that's something I always
30:52struggled with as a technician
30:53especially yeah I mean think about like
30:55a verbal child if we want a verbal child
30:58to um like you said maybe maybe tax
31:00something or label it we might say it
31:02first maybe they're labeling animals
31:04might say cow pig course with the a user
31:08would we just hold the device in front
31:09of them and say okay tell me the animals
31:12no we would do the same thing we do the
31:13same thing yeah so we have to treat it
31:15the same way and give them those models
31:17and I think also realize okay we're also
31:20going to have to learn how to use this a
31:21little bit cuz that's where gets a
31:24little scary too like okay well I don't
31:25know where the cow is right yeah so now
31:27I got to go on the device and look for
31:29it with the kiddo I mean that's helpful
31:31too though that's how kiddos learn to
31:33navigate pages and we can show them how
31:35how to use their device I I don't know
31:38where everything is on all my kids
31:39devices I'm learning too so I might say
31:41okay let's let's find that cow oh where
31:44is it oh it's not here let's go back and
31:46showing them how we use the device um
31:49you know if we want a kid to learn
31:50language we have to show them and with
31:53our AC users that means we have to show
31:54them how to use it on their device yeah
31:56nice it creates a language Rich
31:58environment you know like all this
31:59labeling and modeling it teaches them
32:02that great yeah why is this so important
32:07um it it's really important because we
32:09don't want communication to feel like a
32:11task and we really want the child to
32:14feel motivated to communicate
32:16communication is intrinsically motivated
32:19we can't we can't force anyone to
32:21communicate even our verbal kiddos we
32:23can't make them speak
32:25Noe no nope they um they talk because
32:29cuz they want to so or they're ready to
32:33they're ready yes so we um we have to
32:36just provide those models if they if
32:38they aren't ready to push the button yet
32:40yeah that makes sense I know we didn't I
32:41don't think we had a planned in the
32:43section but why we shouldn't go into
32:45that like hand overhand prompt jump yeah
32:49jumping into that a little bit like
32:50right now yeah let's let's dive into
32:53that um so I know as a field um in
32:58Speech Pathology we are really shifting
32:59away from so are we yeah I feel like
33:02it's a it's a collective it's crossed
33:04all disciplines um it definitely was
33:06used in the past and there are
33:08definitely still speech therapists that
33:10that use hand overhand prompting um when
33:13it comes to teaching a child an a device
33:16we should not be using hand overand
33:17prompting no it really like it it's
33:20their autonomy this is their this
33:22person's body where we shouldn't be
33:24manipulating it in order to force them
33:26to communicate with the device that they
33:28may not want like we're forcing them to
33:29say something that they may not want to
33:30say right yes or we we that that's not
33:33my it might not be what they even wanted
33:35exactly you know like if I saying like
33:37say more water like how do I know they
33:39want water exactly that might not be
33:41what they want and then we've created
33:43Communications now a task they are going
33:45to take my hand I have to do this we've
33:48made it a task which is we don't want
33:49communication to be a task it has to be
33:51intrinsically motivated um so now we
33:53we've made communication of task we've
33:55violated their body autonomy and we're
33:57them to do something that they don't
33:59want to do we just probably created a
34:00behavior
34:02right yes yeah um so that hand overhand
34:06prompting it really violates kids
34:08autonomy um it also though can really
34:11make kids feel promp dependent so um in
34:16sometimes in cases where hand overand is
34:17used then when the child wants to
34:19communicate they're reaching over to
34:22grabbing your hand and um trying to have
34:24have you use it yeah um so and when
34:28we're trying to teach a Kido hand uh a
34:30AAC device we should not be using hand
34:32overand it's it's a thing of the past we
34:34just know it doesn't support um them
34:36learning their device and if you like so
34:39if you were in a meeting say you were
34:40like meeting with me as a bcba or
34:41another bcba who may they have a learner
34:44who kind of is struggling to use their
34:46AAC device maybe it's newer maybe
34:48they've had it for a few months but they
34:50just really aren't in that bcba's
34:52perspective communicating effectively
34:54with the device how would you help that
34:56bcba proceed with the communication
34:59those person might be feeling stuck yeah
35:01they might be feeling stuck like okay
35:03we've had it for 3 months it's not
35:04working and they might think like maybe
35:05we need more more prompting to use that
35:08hand overand um I would say the Kido
35:10probably needs more models they need
35:12more of that modeling without
35:14expectation kids need lots and lots of
35:17models to be able to use their device um
35:20I also think about is are we trying to
35:23use it during motivating times right
35:25communication has to be intrinsically
35:28so are we using toys that are meaningful
35:30for them activities where they might
35:32want to communicate and I think this
35:34falls under two when it communication
35:36isn't request like requested upon them
35:39or always asked followed by a question
35:41like it we how can we model language
35:43without asking like say this what do you
35:46want yes tell me what you want use your
35:49words yeah use your words tell me what
35:51you want and instead of using phrases
35:53like you know tell me on your talker we
35:56could just model go okay and just go
35:58right into modeling that um instead of
36:01saying things like
36:03say you know say car and offering their
36:07just model car car car yes taking that
36:11that prompt away because if we continue
36:14to prompt the kid we're going to make
36:15them prompt dependent and then when the
36:17kiddo starts wants to use the device
36:19more independently they are going to
36:21rely on you prompting them to use it
36:24right yeah so it just creates more um
36:27more difficult down line right so I have
36:29a few more phrases that I wanted to go
36:31over with you and you tell us the
36:32alternative yeah so you ready we already
36:35talked about you use your words to tell
36:38me yes something right so let's do say
36:43uh yeah so we might say like say more
36:46say go instead let's just model go mhm
36:50more it's easy is that yeah on our end
36:53too yeah all right what about for what
36:57you want instead of asking a question
37:00just model what they want might want oh
37:02cars cars animals whatever it may be or
37:06if you give them a little bit of time
37:07you could see what they're going towards
37:09and then just model that yeah see what
37:10they're looking at something like want
37:12to play with cars want to play cars
37:14sorry yeah I want to play cars um so
37:16just eliminating those those prompts and
37:18stricking right with the word that the
37:20child might use to request yeah and in
37:22the beginning would you stick to like
37:23one or two words versus a whole like
37:26sentence yeah yeah maybe um depends on
37:28the kiddo a lot of our AAC AAC users
37:31might start with just using a single
37:33button so maybe you're just modeling one
37:35button or um maybe depending on um where
37:38the kiddo's at and what the SLP
37:40recommends you might be modeling two
37:42words like want more cool sure do you
37:44have any other ones that you wanted to
37:45go over or I think the biggest one is
37:47like I just want to I don't know I guess
37:49this is like a disclaimer but don't use
37:51like use your words that's I feel like
37:53that's such a rude phrase to say go get
37:56your words tell me with your words I
37:58feel like if like if someone's on the
38:00floor crying they're already telling you
38:02something's wrong yeah communicating in
38:04a way or even if they're not like even
38:06if they do want to go and they're
38:07indicating that they want to go in some
38:09form of communication that's probably by
38:10Body Language or gesturing at that time
38:13may not be the time to be like use your
38:14words model it yeah just model go we're
38:17all done and I think back like if it was
38:19a verbal Communicator we wouldn't be
38:22preg tell me what you want we might be
38:24like you're I'm mad I'm frustrated I'm
38:26all done comes from those well
38:28intentioned clinicians where they're
38:30trying to create like a learning
38:32opportunity but it's might be causing
38:34more harm than good yes I think so with
38:36that too yeah um with like you talked
38:40about having like the device accessible
38:42and I guess this kind of goes back to
38:43like go find your words to tell me how
38:45can we position a learner's AAC device
38:48to promote learning and to promote them
38:49using it more yeah so positioning is a
38:52big factor um the kiddo has to have
38:55access to the device to use it and and a
38:57lot of times when they're first learning
38:59how to use their device that access has
39:01to come from us as the communication
39:03partner we have to be providing that
39:05device and that might mean us offering
39:07it to them when we're modeling um I have
39:09a controversial question oh should we be
39:11carrying it um so I I don't mind if the
39:16communication partner carries the device
39:17maybe the child's not ready right it's a
39:20it's a new thing um some kids don't have
39:22ownership of it yet so they might not be
39:25ready to carry it around I also think
39:27some of these kiddos are like 2 years
39:29old or 18 months and they have ha around
39:31this big eyad yeah um so I think it's
39:35definitely dependent on the kiddo and um
39:38maybe what even like the parents schools
39:40are if they want them to be carrying it
39:41around versus that's a goal I've worked
39:42on with the speech path later down the
39:44line we want our learner to start
39:46seeking out their AAC so let's not pick
39:49it up for them you know like add some
39:51distance what are some good ways to like
39:54I don't know maybe prompt or remind them
39:56that we forgot it or just go into the
39:57next room and see if they need it yeah
40:00or I feel like as communication Partners
40:03if we want the child to communicate we
40:05have to have that device available for
40:07them we have to provide that access so
40:10if you're tuck and let's say you're
40:11leaving a room and um the device got
40:14left behind that's really on the T to go
40:16back and get it I would rather not
40:18prompt the kiddo like let's go get yours
40:20yeah like I me oh we forgot it let's all
40:22go back and get it you stay here I'll be
40:23right back I'll go get it for you yes um
40:26because we don't want again we don't
40:27want it to feel like a chore and you
40:30know maybe the kiddo's older they can do
40:31it but instead providing that access is
40:34really on the communication partner
40:36would there ever be a situation maybe
40:37like later down the line where you want
40:39to work on that though is what I'm kind
40:40of trying to ask oh yeah there there
40:42might be um maybe the kiddo's older
40:45they're more in the school AED years and
40:47um we want them to carry their they're
40:49going to school and want them to be able
40:50to have their device on them yeah and
40:53maybe then we are having everyone model
40:55like oh we're leaving let's put the
40:56strap on your body you Pi it and put
40:58your fing through the loop that the
41:01handle oh you picked it up oh you don't
41:03want to carry it I'll carry it for you
41:05yes and just kind of modeling and
41:07showing them how they can move their
41:08words around that's nice like that yeah
41:11and when guiding our technicians do you
41:12have any other guidance on how they can
41:14help like keep it in close proximity or
41:17to position it so that the let's talk
41:19about like the crazy place the places we
41:20know it's not get like gets left like in
41:23the gym yeah yes yeah that is tough and
41:26that's when I like to see a strap on a
41:28device if um maybe the kid was running
41:31around the gym in a circle the
41:32technician can strap it on their body
41:35and then um the device is there for them
41:37anytime it's being worn on a strap I
41:39like to see the screen facing outwards
41:41because maybe the kid is running by the
41:43technician they can you know swing by
41:45and and make a U make a request or when
41:48it's facing outwards then the technician
41:50can model while the kid is playing I had
41:52a learner like in the gym they were
41:55brand new to their AAC and it took a
41:56while and like the First Independent um
41:59like button that they pressed was run
42:01they were playing in the gym and their
42:02favorite activity is running so they're
42:04running in the gym and then they stopped
42:05and they like it was on their front page
42:07and he would click run that is amazing
42:10yeah yeah it was one of my favorite
42:11things so like having it accessible
42:12during those moments that you don't
42:14think that the learner is going to look
42:15at it or be attended to it yeah um I an
42:18ideal situation that device is staying
42:20within an Arms Reach of the child and
42:22that's that's the kiddo's arm so that
42:24they can make it uh a request so that's
42:26that's close
42:27and a lot of times it's on us as a
42:29communication partner to position that
42:31device so maybe we've moved from the
42:32table to the floor we're going to bring
42:34that device down to meet where the
42:36child's at level I like the word
42:38communication partner I don't know if I
42:39mentioned that talked about that as the
42:42communication partner yeah yeah um I
42:45also like to think too the device if
42:47it's laying flat if you think like a
42:48screen it might get a glare so I a lot
42:51of devices have a backstand or maybe the
42:53case can be propped up that's really
42:55nice if the devices l flat um so that
42:58there's not a glare and the Kido can see
43:00the models that you are um that you're
43:02providing uh I have a question I don't
43:03know if we discussed it yeah or if we're
43:06planning to or might come up later but
43:08especially when we're having it out in
43:09moments like this other kids coming up
43:11to the AC device and also trying to use
43:13it and I feel like it's like a I feel
43:16like I hear so many different viewpoints
43:18on it we like okay no like we tell them
43:20no this is our friend's words and then
43:22some speech Pats have told me like okay
43:25let let them use it or let's ask ask the
43:28person that it is and see if they'll
43:29tell us yes or no yeah I'm a big
43:32supporter of letting kids explore other
43:34kids' words um so if your kiddo wants to
43:37run over and touch another friend's
43:39boards and see what's on there I'm
43:41thinking there's a kiddo who loves to
43:43check out the letters and the and the
43:44numbers the numbers and the shapes and
43:47he wants to see every every device and
43:50what shapes they have um now there gets
43:52to a point you know maybe it's
43:53disruptive maybe the other kiddo has a
43:56lot of ownership of their device and
43:57they don't want other kids touching it
43:59that's okay maybe we might let our
44:01friend touch it one time um I think if
44:04we try to deny that access to other kids
44:07words how are we supporting them using
44:09their own words yeah yeah Fair true you
44:11know um so I think a little bit of
44:13exploration is okay and um maybe just
44:16kind of depends on the situation but we
44:18want to create this environment where
44:21everyone's using all different kinds of
44:22communication and and we're um you know
44:25supporting all different use of it and I
44:27don't know I just think if we deny it
44:28it's just kind of like denying kids
44:30exploring their own device right creat
44:32more accessibility too like you know in
44:34that one cool thing I've seen you guys
44:36have started doing here did it before is
44:38the groups the AC groups where all the
44:40kiddos with the same devices kind of
44:42hang out together and they might get the
44:44chance to look at other devices yeah so
44:46one more thing with the device something
44:49that I kind of run into sometimes um
44:51like in my sessions is like the volume
44:53might be too low or like how do we
44:55control the volume and what is like
44:57optimal volume control I guess for the
44:59session yeah that's a big piece because
45:02we want to make sure the kiddo can hear
45:04the auditory feedback that is provided
45:06when they push the button so that might
45:08mean if you're in a space that is a
45:10little bit louder like the gym you need
45:12to turn the volume up and each app has
45:15their has different settings you can
45:16work with your kids speech therapist to
45:18learn how to turn the volume up but we
45:20want to make sure that volume is turned
45:22up enough where they can hear it if they
45:24can't hear the device um yeah it's
45:27meaningless right yeah yeah um so making
45:30sure that they can hear it is really
45:31important I think something with that
45:32too is like sometimes it'll be in guided
45:34access a lot of times we have guided
45:35access on so just so you know there is a
45:38way to turn the volume up like with it
45:40and guided access most of the apps or
45:42all of the apps should have a volume
45:44control like within a settings page that
45:45you can find with your SLP yes correct
45:48yes all right so jumping back into it
45:52again cuz it's so important want just
45:55reiterate yes why hand overhand
45:58prompting is not good especially when
46:01teaching AAC I know as like you said as
46:04a field in yourself as like speech pets
46:06you guys are shifting away from it too
46:08same thing with us bcbas we are trying
46:10to learn from you guys shift our
46:13thinking as well and move away from it
46:15yeah we're promoting more autonomy in
46:16our field and understanding like the
46:18rights of our Learners right yeah and we
46:21should not be using hand overhand
46:23prompting with AAC users and we talked a
46:25lot earlier about um just protecting
46:28their autonomy but we also want to think
46:30about to their authentic personality so
46:33if we are making a choice for them you
46:35know making them push car or bird
46:39whatever it might be that might not be
46:41really what they want to say and we're
46:43not letting them Express themselves in a
46:46meaningful way it's it's us doing for
46:49for them yeah um so making sure we're
46:52respecting their personality and what
46:54they want to say is important right
46:56makes sense I also like to think about
46:58um when we're teaching a kid to use a
46:59device we like to teach them a motor
47:02plan that just means that they know how
47:05to navigate the device and if we are
47:08taking their hand to the button they're
47:10not learning how to get to that button
47:12by themselves let's say that button's
47:14embedded within a couple different
47:15folders they're not learning how to push
47:18those different folders and get to that
47:19button they're just letting you do it
47:22for them so we really want to make sure
47:24we're helping them learn a motor plan by
47:26them doing it
47:27right so one thing I've learned from
47:29speech paths or suggestions I've been
47:31given is especially when we get stuck on
47:33the motor planning piece is how can I
47:35help them learn where that button is so
47:37sometimes I've been given the suggestion
47:39of get like open up the folder for them
47:41but don't click the word they're looking
47:43for in the folder as a prompt what would
47:45you say to that yeah I think that that
47:47that's okay like maybe you want them to
47:50like we talked about like labeling an
47:52animal um you might open the animal
47:54folder something I really like to do is
47:56um um verbally narrate how to get there
47:59so okay I'm going to go over here and
48:01I'm going to push things then I'm going
48:03to go to animals and now I'm in the
48:06animal page and we're just narrating how
48:08to get there and then one thing you
48:10could do is like maybe once you're there
48:11and they're still having trouble
48:12scanning through all of that maybe just
48:13pointing to where would you point to the
48:16icon or um I might just give them the
48:18model push it I want you to push bird
48:20bird um and maybe you model it once they
48:24don't imitate maybe model again and
48:26third is usually we kind of Y yeah and
48:28move on or hold your finger or just okay
48:30yeah it's a bird cool I like that a lot
48:33yeah um so with prompting are there any
48:36other strategies that bcbas can be like
48:38aware of to use for prompting other than
48:41modeling or would you just stick with
48:43like that modeling and labeling for them
48:45like narrating I would really stick with
48:47that modeling without
48:49expectation and um narrating how to get
48:52to different folders those are our our
48:54best tools to yeah help our kiddos learn
48:57their device and really making sure that
49:00when we are modeling We are following
49:02the targets that the speech therapist is
49:04recommending sometimes it's like okay
49:06let's model every word on the device and
49:09now that that's too General the kiddo
49:11maybe can't pick up on it so working
49:13with the speech therapist maybe we're
49:15working on five core words and preferred
49:17items and I'm modeling those in my
49:20sessions so that the kid can have
49:21success with certain buttons I think
49:23this is a really good point especially
49:25for bcbas to consider when like helping
49:27families and like we do a lot of parent
49:29training it's part of um like our
49:31therapy um and I've had a lot of parents
49:33say like we're overwhelmed with the
49:34device well the kids's just not into it
49:36we've used that like strategy like okay
49:38the speech therapist is working on these
49:40five words how about you target this one
49:41word today um like we're going to Target
49:44like snack like during snack we know
49:46that this Kido love strawberry so like
49:47labeling and modeling strawberry during
49:49that time yes I love that I know what
49:52gets really tricky and something BCB
49:54really struggle with is when we're told
49:57like okay now all we need to do is model
49:59we're stuck like okay well what do we we
50:01need data we need to be collecting some
50:03kind of data so we wanted to help some
50:05of our bcba listeners on how you can
50:08collect data in these situations one
50:10thing you can do is just collect the
50:12data on the frequency of modeling
50:14opportunities you're presenting so
50:17really like if we were working on go say
50:19that's the goal we're working on how
50:20many times as we like the technicians or
50:23the communication partner are we
50:25modeling go so if that's 10 times that
50:28session we would just collect data for
50:30those 10 opportun it happened 10 times
50:32and then we can compare that too yes and
50:34I would also have it if I have that as
50:36an option I'm also going to have how
50:37many times this learner is spontaneously
50:39emitting that same communication so we
50:42said go how many times did the learner
50:44say go on their device or verbally
50:46throughout their session um and then you
50:48can track like say they said it three
50:50times hey three out like three
50:51opportunities they did it on their own
50:53out of like the 10 that were modeled yep
50:55yeah that's great that's how I like
50:57breaking it down yeah yeah another thing
51:00uh I wanted to talk about is giving the
51:04learner some time in between the models
51:07as well or after like you've modeled the
51:10opportunity like taking a pause like see
51:13what they do after that doesn't need to
51:15be right away I know we've talked about
51:17this in last episode the manding episode
51:19sometimes our Learners need a few
51:21moments to process something yeah give
51:23that model give them a couple seconds to
51:24process the model and give them a second
51:26to pull their hand up and come over and
51:28and try it yeah if something with this
51:31that I like kind of want to ask you in
51:33your opinion if the learner like looks
51:34away from the device or maybe is not
51:37showing like explicit interest do we
51:40like still continue like um allowing
51:43that time before we like represent the
51:44model like what would kind of indicate
51:47to you that maybe like we maybe that's
51:49not the opportunity we're going to
51:50Target for learning or okay it's time to
51:52like move on to something different yeah
51:54I think if the child is not interested
51:56anymore has is maybe looking away maybe
51:58you model again and model again and give
52:01that weit time one more time we don't a
52:03child doesn't have to be looking at the
52:05device for the model to be effective cuz
52:06they are going to hear it which is good
52:09um but if you're really trying to get
52:11data for your trials um maybe then you
52:13just model again and and move on and try
52:15again a different time that's a good
52:17point yeah something you could also do
52:19is when you're working on that data
52:21collection is collect the latency
52:24between when you've gave a model to when
52:26they started responding if that's
52:27something they're doing that can this
52:30can also help you in situations where
52:32maybe you're training parents and
52:33technicians on when to how long to wait
52:37right you know after that time delay
52:39you've taken data and you've seen oh it
52:41takes them maybe 10 seconds to respond
52:43to that model okay make sure you're like
52:46consistently presenting 10 seconds in
52:48between a model for them to have that
52:50time to process lot yeah and it gives I
52:54think this gives the technician like
52:55with like an expectation of exactly what
52:58that's going to look like like that I
52:59know it's really easy for us I feel like
53:01when we've been in the field a lot
53:03longer and we've been doing this a lot
53:05longer it feels natural to model all
53:07these opportunities whereas parents and
53:09technicians might struggle a little bit
53:11with it or it feels really awkward right
53:15feels really awkward you know waiting
53:17like if you talked to me and I sat here
53:18and I waited for time I might feel
53:20really awkward and personally me I will
53:21like start filling it was like filling
53:24in some like things or giggling where
53:27sometimes if you have just like concrete
53:28data it makes it a little bit okay like
53:30now I need to give them 10 seconds and
53:32then we can move into another flow yeah
53:35yeah that weight time it can be awkward
53:36but sometimes our kids need it to
53:37process yeah and I think something else
53:40to consider with like Learners becoming
53:41distracted maybe or like not really
53:43focusing is like taking the environment
53:45into consideration so can you speak on
53:47like how to promote language like
53:49considering the environment yeah so we
53:52um want to make sure that we're always
53:55modeling but if maybe we're not modeling
53:57in the right environment like if we're
53:58in the gym and it's really loud and our
53:59kiddo is like running around like crazy
54:02maybe that's not the best time to try
54:04and get your trials in and um the
54:07environment is just too crazy for them
54:09we um always want to make sure they're
54:11regulated and it's doing a activity
54:14that's really motivating for them so um
54:16maybe that's motivating operations yes
54:19in the Ava World okay yeah something
54:21that's motivating for the kiddo um that
54:23they're interested in an activity a
54:25sensory based activity
54:27and making sure that we are um providing
54:30them with all the correct tools to be
54:32successful the device they have access
54:33to the device that's close to them the
54:34volume's up and um it's in a space that
54:37they want to communicate yeah that's key
54:40all right so one last thing I wanted to
54:42kind of touch on is I've noticed many
54:45speech influencers suggesting that bcba
54:48shouldn't be working on these
54:49communication goals in their sessions
54:52but I feel like it's really important
54:53for bcbas and speech BS to really
54:55collaborate
54:57as one unit to start working on some of
54:59these goals yeah it is really important
55:02for everyone on the child's care team to
55:04be on the same page and I think for a
55:07provider to say the bcba should not be
55:09working on AAC well they spend 30 hours
55:12a week in ABA what do you mean they
55:13shouldn't be using their device um but I
55:16also feel like it's really on the speech
55:18therapist to provide the bcba with what
55:20those targets are and what's appropriate
55:22for the child and if a child has a
55:24device that's currently in therapy the
55:26speech therapist should be providing the
55:27bcba with with what we're going to work
55:29on yep and what we're going to work on
55:31and then the bcba can implement it um
55:34and we need everyone on the same page
55:36yeah for the kiddo to be success for the
55:38learner sake yeah we need consistency
55:41yep I feel like this gets tricky too
55:43sometimes I know like as bcbas like
55:46sometimes we come off as like we don't
55:47want to go and seek like the advice or
55:50we don't know how to or when we do it
55:52comes off I I know it doesn't happen
55:55here a lot but say someone's coming to
55:56you and they're also being like no no
55:58you can't do this what tips do you have
56:00for that person like if we were the bcba
56:02coming to someone and they were being
56:04like no you can't work on this yeah I
56:07think um it's important for all of us to
56:09just just be flexible and maybe you know
56:11you're modeling or trying to work on
56:13things that aren't appropriate yet and
56:15just kind of reframing where the goals
56:17should be at for the kiddo I like what
56:19you did before was you gave like a
56:21really good goal example of like this is
56:24something you can work on yeah yes like
56:26to give when my kiddo gets a device give
56:28the bcba give the team we're going to
56:30work on these words we're going to work
56:32on these preferred items um some
56:34different things that that they can work
56:36on and then the bcba can stay within the
56:38frame of that and we can work together
56:40maybe we try that for a couple weeks
56:41it's going good it's not going good and
56:42then switch it up I like the idea of
56:44like once our goals are written showing
56:46them to the speech path like hey what do
56:48you think about this do you have any
56:49feedback for me and then also like being
56:52willing to take that
56:53feedback you know like once you ask for
56:55it yeah and you know we only see kids
56:58for maybe 2 to three times for 30
56:59minutes and a lot of times it's in our
57:01nice little setting in our speech room
57:03with our swing and the child's
57:05regulated perfect setting and I'm seeing
57:07the child independently request 10 times
57:09now in the ABA session maybe that's not
57:12happening but I don't have that data and
57:14I don't know if the bcba is not telling
57:15me and we can't help help the child
57:18communicate in different settings if
57:20we're not having those tough
57:21conversations exactly I feel like it's
57:22on us like as clinicians to just seek
57:25out that collaboration and as bcbas we
57:27can seek out slps and understanding like
57:30how can we promote this language in an
57:31net environment what motor planning
57:33things should we be working on with this
57:35learner just really considering those
57:37yeah and then I've noticed or I've seen
57:40or I've read a lot about bcbas that are
57:44maybe not working in a setting like this
57:46where they're not working closely with
57:47the speech path and they may have to
57:49seek a speech path out so maybe they're
57:51not and they're going ahead and
57:52implementing AC devices or you know PEC
57:55system on their own what do you have to
57:58say about that I know a little off topic
58:01like we didn't get into it that much but
58:03you especially have a lot to say about
58:05PEX I want you to go into it yeah um so
58:09I think um BCBS if you don't have access
58:12to a speech therapist it's important
58:14that you're referring your kiddo out so
58:16if you if they have an AC device and
58:17they're not actively in speech therapy
58:19and they are still learning to use it
58:21you should be sending that that kiddo to
58:23a speech therapist or taking a CE
58:26getting educated on it um like I said
58:28the speech therapist should be making
58:29the targets and the bcba can be
58:30implementing it within the everyday
58:32setting um so jumping back to P MH I
58:36like I hate that word I'm like it makes
58:38me cring it's like triggering you know
58:40when I was Googling P like apparently
58:43like there's PEC system is copyrighted
58:45so you can like so may like I know we
58:48can talk more about like the picture you
58:49called it like picture communication yes
58:52so p p you have to do the whole six
58:53steps yes P stands for picture
58:56Communication System it is a systematic
58:58way of teaching language which is an
59:01exchange of pictures between a learner
59:03and a communication partner um kids go
59:06through this different steps to learn it
59:08and if you are implementing that you
59:10should really be trained in P reques
59:12training yes I think a lot of times um
59:15in ABA um BCBS are saying they're using
59:17PCS but it's really more of a visual
59:20Choice board with velcro pictures and
59:23and that's a choice board it's not using
59:25PS to communicate I hear this a lot like
59:28even like I'll hear like people through
59:29the H be like oh you dropped your packs
59:30and it's like one icon that's an icon
59:33yeah it's it's just an icon or it's like
59:35a visual schedule or a visual Choice
59:37board and if a kiddo needs that um maybe
59:40in the meantime well they don't have a
59:41device or they're using that um visual
59:44Choice board with an a device CU they're
59:46still learning that button a lot of
59:48times kids might use a lowtech system
59:50first um that's okay but we know that we
59:53need to support the kiddo long term and
59:56that they need to have access to lots of
59:58words in a robust system and Hightech a
1:00:01is always the answer for our kids that
1:00:03are nonspeaking minimally speaking um we
1:00:06just we know better we can do better now
1:00:08we can't be using those PEC systems
1:00:10anymore love
1:00:12it I do have a third code word for our
1:00:14BCBS who are receiving cus so code word
1:00:18three is learner how do you spell that l
1:00:21e a r n e r great all right all right do
1:00:26you have anything for us no thank you so
1:00:28much for having me thank you for coming
1:00:30on Happy AAC month everyone woo talk to
1:00:34you later
1:00:36[Music]
1:00:39bye all right guys thank you so much for
1:00:42listening please don't forget to like
1:00:43And subscribe and if you want your ceu
1:00:45credits go to our website at Blossom
1:00:47children.com talk to you later see you

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