Empowering parents to use a core board with children who have complex communication needs : a multiple case study : a thesis presented in fulfilment of the requirements for Doctor of Philosophy in Speech and Language Therapy at Massey University, Albany Campus, Aotearoa New Zealand

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Massey University
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Augmentative and alternative communication (AAC) for children with complex communication needs is an area that has seen rapid recent change, both in the AAC systems that are provided, and the methods used to support implementation. AAC is recognised as an evidence-based approach in early intervention that can increase successful communication outcomes for children with complex communication needs. There is increasing awareness that for implementation to be successful, the child’s communication partners need to be supported to learn strategies that will help the child to use their new AAC system. The 77-cell core board with fringe vocabulary used in this study is widely used in Aotearoa New Zealand, but there has been little research conducted to provide evidence that it is an effective or appropriate tool for beginning communicators. This thesis describes a multiple case study with a mixed methods research design, capturing the implementation of an AAC support intervention that was carried out over a year. The study sought to explore the effectiveness of a training and coaching intervention for parents to support the implementation of a core board with their pre-school children who had complex communication needs and used less than 10 spoken words. The intervention described in this study, named Empowering Parents for AAC (EP-AAC), took place over a year, and included an intervention phase of 9 weeks and a long maintenance phase. Six families were recruited, and one parent from each family participated. The children had no prior experience with using AAC. After an initial intervention phase consisting of group workshops and in-home coaching to learn evidence-based strategies to support their child’s communication through AAC, parents continued to receive bi-monthly maintenance coaching sessions for the remainder of the year. Quantitative data were collected on both the adults’ use of the taught AAC strategies and the children’s use of the core board and spoken language. Additionally, qualitative data were collected through a variety of sources including two surveys and a final semi-structured interview aimed at gaining deeper insights into the supports and barriers to AAC use, and how the family had experienced the intervention and implementation of AAC. The findings suggested that the intervention was successful, with all the adults learning and maintaining the supportive strategies alongside all the children making significant gains in their communication. Five children learned to use the core board to communicate within the first few weeks of the intervention, and all six children were able to communicate using a core board by the end of the year. Family retention over the duration of the study period exceeded expectations, despite a challenging year during the pandemic. Four children used spoken language as their main form of communication by the end of the intervention, whilst the other two continued to use AAC to communicate. The parents reported positively about the intervention, in particular the on-going coaching. The core board was viewed as a helpful tool, but not as a long-term AAC solution. For the children who still required AAC for communication, parents wanted to explore high tech AAC options. The findings from this study provided additional evidence that parents are a key component to ensuring the success of an AAC system. Initial training and ongoing personalised coaching proved to be a successful combination for this group of parents to learn and maintain the supportive AAC strategies. Core boards were found to be an adequate initial AAC system when implemented within this supportive framework and were a contributing factor in the improved communication skills of all the participating children. The EP-AAC intervention was a useful framework that could be used in the future by service providers to support the implementation of a range of AAC options with young children who have complex communication needs.
Listed in 2023 Dean's List of Exceptional Theses.
Communicative disorders in children, Communication devices for autistic children, Communication devices for people with disabilities, Parents of children with disabilities, Services for, New Zealand, Dean's List of Exceptional Theses