Laura Baggley explains where to look for support for Augmentative and Alternative Communication (AAC) technology.
AAC includes communication other than speech. There are various subcategories of AAC including no-tech AAC, low tech AAC and high tech AAC. High Tech AAC includes electronic systems that use batteries or power. They are likely to produce a synthetic voice that speaks aloud. Students use these to support their voice or to replace non-verbal speech. High-tech AAC devices are also known as communication aids. Low Tech AAC systems do not need power to work. These systems include paper-based communication books, communication boards, photos, symbols and pen and paper to name a few.
Many young people require access to High-tech AAC. The services available to assess students can be limited depending on the area. In addition, services have strict criteria that young people should meet to access an assessment, often requiring evidence that low-tech AAC has been successful. For some students though, low tech AAC (without voice output) is just not motivating, or it’s difficult to facilitate for those students whose most reliable access method is eye pointing.
Hubs
The hub-and-spoke model is referenced in an NHS commissioning document in 2016; Guidance for commissioning AAC services and equipment. In the guidance, numbers of people requiring AAC services are identified and roles and responsibilities of local and Specialist Hub services are outlined.
We know that in a lot of areas across England, the hub-and-spoke model has not been implemented in its intended form. There are a number of regional hubs across England but in many areas there are few or no effective spoke services. While there are a number of specialist hubs across the UK that are able to assess students with communication difficulties, accessing an assessment for AAC equipment or trial of some AAC equipment from them can be challenging. It is worth noting that specialist services for AAC assessment in England are commissioned by NHS England. For specialist assessments in Scotland, Wales and Northern Ireland, other routes should be available.
Barriers to accessing a specialist assessment from the hub include the strict criterion for assessment as often students cannot demonstrate the skills for the criteria without first having had an opportunity to use or try out AAC. Referral to the hub relies on a referral from a Speech and Language Therapist or a LA funded service, this means that these professionals become the gatekeeper to an assessment and must believe that the student can meet the hub criteria. In addition, due to Speech and Language Therapy service pressures, many students may not have access to a speech and language therapy that can refer them into their local specialist hub.
Specialist AAC hubs are expected to assess and provide AAC equipment for only 10% of the population that need it. This is because there should be a local service such as a local health or education service that should be assessing, funding and supporting access for the remaining 90% of the population for this AAC equipment. I have no doubt there are large numbers of students who would benefit from the opportunity to trial AAC equipment to support their communication and learning, but are left without a way to access this vital equipment.
If the student is assessed by the Specialist Hub and is provided with AAC equipment long-term, ongoing AAC support may be minimal. The Specialist Hubs are a health service that provide assessment and AAC Equipment, and a lot of Hubs are not able to provide longer term ongoing support in the implementation of the AAC system in the home, classroom or other setting. For example, Specialist Hubs may not be able to train high numbers of teaching staff in implementing the equipment, or advise on educational vocabulary to be added such as technical vocabulary to be used in exams.
Other Funding Routes
A number of families have accessed AAC equipment through charitable funding. Charities such as The Sequal Trust may be able to assess and provide AAC equipment to students, and I know of several families that have self-funded AAC equipment to support their child. The difficulty with self-funded and charity funded equipment is that there has been resistance from Local Authorities in including this in the student’s Education, Health and Care Plan (EHCP) because it is privately funded and other external agencies may not have been involved. I have to add, some Local Authorities that I have worked with have embraced the funding and provision from third party services to provide AAC equipment, but this shows that it is indeed a postcode lottery.
For other students, local Speech and Language Therapists can access local funding through the local health board to provide AAC equipment. This is again different per local health commissioning area. It usually requires the Speech and Language Therapist to write a report for a panel to determine if the student meets their criteria for funding of an AAC device. If you would like to access funding this way, it is best to discuss this with your local Speech and Language Therapy team for more information.
Local authorities can also provide funding for AAC equipment, especially if that equipment is the only way a student can access learning materials and to communicate effectively within their educational settings. In this case, a request can be made to the Local Authority to consider AAC equipment as part of the EHCP review process. A student can also be funded for an AAC device through a Personal Budget if the AAC equipment is directly linked to the needs of the student and achieving outcomes set out in their Education Health and Care Plan.
Some AAC users can use their equipment to access learning materials on screen. This is beneficial for students as they can use their most reliable access method to not only access communication but learning too. This means the learning resources can be accessed more efficiently by the student, reducing barriers that may occur when using other equipment. For example, a student using an eye-gaze system for everyday communication, should not be expected to use a second eye-gaze system to access their learning materials. Especially if one device can be used for both purposes: communication and learning. It would be impractical and add unnecessary barriers for the student.
There are a range of routes that a student can access an assessment for an AAC device depending on the location, situation and circumstances. Many students have already been able to access high-tech AAC assessments successfully, however for those students who have not been accepted for a specialist AAC assessment, other routes should be available to them.
Laura Baggley
Laura Baggley is the Assistant Head of Education and Specialist AAC Teacher at CandLE, a not-for-profit company supporting students who use AAC with communication and learning in a range of settings.
Website: candleaac.com
X: @candleaac
Facebook: @CandLEAAC
Instagram: @candleaac
