As members of the interdisciplinary team, the Speech-Language Pathologists provide assessment, consultation, treatment and referral for clients and their families. They assist local school teams or community-based teams and families with the development and maintenance of an AAC system for a child. AAC methods may include: eye gazing, signing/gestures, communication boards/books, computers or systems with voice output (VOCA).

Speech-language services are provided to preschoolers and school-aged children who meet the criteria of the AAC Program. We value early identification and intervention. Any child up to age 21 (if still in school) who has a communication difficulty primarily because of physical disability is eligible for service.

Principal Functions
Client Care

• consultative services
  
• assessment and evaluation of communication status
  
• suggestions, ideas and program planning to enhance the development of communicative skills and encourage communication interactions
  
• recommendations regarding AAC systems including: equipment, input method, vocabulary, layout and communication strategies
  
• one-on-one interventions in specific situations
  
• equipment loan to clients for a trial period
  
• provision of symbols and communication boards
  
• follow-up / referral
  
• advocacy / funding support

Support

• information resource
  
• professional development / inservices and workshops
  
• planning and continuous quality improvement
  
• research and development /communication system design

Referral Process
Referral can be made by any member of the child's community based team or by his / her family. An AAC referral form is completed by the local team and forwarded to the Director of the AAC Program.

• all applications are screened for eligibility. The referring source is then notified of the decision.
  
• an initial contact meeting is arranged in order for the AAC team to meet with the child's local team to gather information regarding the child's communication skills and needs. The initial contact meeting may be held at the child's school or other convenient site. At the initial meeting time, a service plan is made. This plan encompasses (a) the goals and objectives for the child's communication and (b) the assistance needed by the community-based team to achieve implementation of an AAC program for the child.
  
• a written report is provided for the community-based team after this initial contact meeting.
  
• arrangements are made for AAC assessment / training sessions or equipment loan, as required.
  
• when the client's AAC program is underway, a follow-up visit by the AAC team or its speech-language pathologist is planned (usually in three to six months). The child's communication intervention program is updated following each AAC team / speech-language pathologist visit or contact, as necessary.
  
• a written report is provided for the community-based team after this initial contact meeting.

Admission Criteria
The client population is preschool-aged and school-aged children up to age 21 (if still in school) who, primarily for physical reasons, are unable to communicate verbally, and who require alternative strategies to augment or replace speech. Children requiring AAC services may demonstrate problems in the following aspects of communication:

• speech production
  
• receptive language
  
• expressive language
  
• receptive-expressive language gap
  
• voice/resonance
  
• fluency
  
• oral motor development

Priority for Service
The following priorities have been identified:

• Non-verbal children demonstrating a communication difficulty primarily because of a physical disability and who require augmentative or alternative strategies for communication.
  
• Receptive-expressive language gap.
• Demonstrated need.

In addition to these priorities, the following factors are considered when determining priority status:

• length of wait
  
• ability to benefit from treatment
  
• level of support for AAC intervention (team and family)
  
• physical and learning factors
  
• age of child
  
• environmental/social/emotional factors
  
• equipment availability

Assessment/Diagnosis
The AAC team may be involved in assessment of the following areas important for AAC planning.

Planning
Based on the assessment results, a plan of care is developed in conjunction with the child's team/family/caregivers. This care plan not only establishes common goals, but also suggests strategies to achieve these goals.

Treatment
Treatment goals focus on the needs and strengths of the client and may take the form of:

• Direct Treatment - individual or group
  Children may receive direct treatment
  Children with similar needs are grouped whenever possible

• Indirect Treatment
  Treatment is often conducted in the least restrictive environment to optimize students' communication development. This requires the assistance of all team members and the child's caregivers. Indirect treatment may be accomplished using:
  • training workshops
    
  • consultation
    
  • home programming
    
  • general education

Follow Up
Clients who do not require active intervention may be placed on monitor or recheck status and seen on an "as needed basis". Intensity of supports may be determined in discussion with the child's local team/family/caregiver.

Consultation/Communication
Clients and their families are provided with information and recommendations that are clear and concise using terminology, which can be clearly understood. Communication occurs but is not limited to: written reports, verbal updates, case conferences, telephone communication.

Referral for Additional Services
Clients and their families may be referred for services, internal and external to the Rehabilitation Centre for Children, to ensure that their needs are addressed.

Evaluation of Clinical Interventions
Clinical activities specific to individual clients are evaluated in order to determine the effectiveness of intervention and to make recommendations for the future treatment planning.

Evaluation may take the form of:

• Re-assessment using objective assessment tools
  
• Assessment of goal attainment
  
• Team/parental/caregiver report

Discharge Criteria
Clients are discharged from the speech-language service at RCC when any of the following occur:

• Children are ineligible for services because of their age (finished school).
  
• Child transfers from the RCC's service areas.
  
• Services are no longer required.
  
• In the clinical judgement of the Speech-Language Pathologist, service is no longer necessary.

Programming, Planning and Continuous Quality Improvement
At the program level, the activities, processes and systems related to speech-language pathology are evaluated with a view to continually improving them.

This evaluation may take the form of, but is not limited to:

• AAC program reviews through meetings, analysis of data, etc.
  
• Questionnaires