Exploring the Use of Communication Supports Inventory- Children and Youth (CSI-CY) - to Identify Barriers and Facilitators in Implementing Augmentative and Alternative Communication in India: Preliminary Evidence from Two Case Reports

Dafiah PM, Krishnendu Sreekumar, Vineetha Sara Philip
2021 Disability, CBR and Inclusive Development  
Purpose: Augmentative and Alternative Communication (AAC) systems are very often abandoned by the users and caregivers due to potential challenges in implementation. This study aimed at exploring the use of Communication Supports Inventory-Children and Youth (CSI-CY), based on the International Classification of Functioning, Disability, and Health-Children and Youth (ICF-CY), as a potential tool for identifying barriers and facilitators in AAC implementation in the southern part of India.
more » ... : The CSI-CY was administered to the parents of a child with cerebral palsy and a child with autism spectrum disorder, respectively. Environmental facilitators and barriers that affect communication were rated. A semi-structured interview was also conducted to identify additional barriers and facilitators as identified by parents. Results: Barriers related to services and policies, people and assistive technology, were identified for both cases. Additionally, the semi-structured interview identified barriers related to myths, clinicians, child, AAC use, economy and society. Conclusion: CSI-CY is a potential tool for clinicians to systematically identify and document barriers and facilitators to implement AAC. It can further assist them in setting goals and defining the necessary intervention for each child Vol. 31, No.4, 2020; doi 10.47985/dcidj.434 www.dcidj.org 135 with disability. Early use of AAC contributes to better therapeutic outcomes. Training should be given to professionals, special need educators and school teachers about different AACs and the appropriate techniques to be used. Counselling and evidence from earlier successful AAC interventions can dispel existing myths. Awareness programmes, group discussions and training on AAC can be done to eliminate barriers that may exist among rehabilitation professionals in India. (CSI-CY), barriers, South India along with a list of communication partners, and the type of communication the child using AAC is expected to have with each of them. Tactile, visual, positional, interactional and communication preferences of students, along with any other preferences that might influence the use of an AAC system, can also be identified using the protocol. In addition, family and caregiver preferences for communication modes/ methods can also be obtained. The Communication matrix assessment tool is designed to evaluate any type of communicative behaviour, including different forms of AAC such as picture systems, electronic devices, sign language and 3-dimensional symbols, pre-symbolic communication such as gestures, body movements, sounds, eye gaze and facial expressions, as well as the typical forms of communication such as speech and writing (Rowland & Fried-Oken, 2010) . It allows organisation of observed communication behaviour into 7 levels, such as pre-intentional behaviour (level 1), intentional behaviour (level 2), unconventional pre-symbolic communication (level 3), conventional pre-symbolic communication (level 4), concrete symbols (level 5), abstract symbols (level 6), and language (level 7). Thus, the AAC assessment tools used allowed a comprehensive evaluation of the child's language, sensory-motor and communication skills, communication needs, communication environment, communication partner skills, symbolic abilities using objects and Picture Communication Symbols (PCS) (Johnson, 1981) , and feature matching. Barriers related to services and policies were found to have an influence on the effective implementation of AAC for both Susan and Anna. The regular and special schools lack the option to facilitate the use of AAC, not only in classrooms but also in services related to transportation, canteen, or even before-and after-school care. For example, a person who serves the food or manages the transportation facility is neither accustomed nor patient enough to communicate with the child with a disability using AAC. This barrier should and can be addressed by proposing and implementing new policies and schemes that provide opportunities for using AAC in conjunction with different provided services. For instance, by targeting spontaneity in communication during therapy sessions, Anna was helped to improve her communication competency. Children should be given opportunities to learn communication strategies by providing proper feedback and prompting the correct form of expected responses
doi:10.47985/dcidj.434 fatcat:nyh4tadtkvgs7ei3kihmwxef5y