AAC services in schools: a special educator’s perspective

Abstract

Objectives: Students with intellectual and developmental disabilities often require augmentative and alternative communication (AAC) to fully meet their academic and social potential. AAC supports can be challenging for some educators to implement. This study sought to bring light to these challenges.

Methods: A qualitative interview approach was utilized to examine the perspectives of 14 special education teachers who supported students using AAC systems. Participants described their experiences regarding providing AAC services.

Results: Despite receiving some supports, the majority of teachers identified challenges, including inadequate training, lack of comprehensive assessment, inadequate preparation time, and inconsistent AAC implementation across team members.

Conclusion:This study highlighted key factors that impacted AAC access and outcomes of students with complex communication needs. Practical implications and future research needed to enhance the communication outcomes of students were discussed.

Introduction

A key indicator to a high quality of life is a person’s ability to communicate — to express and advocate for themself, to build meaningful relationships, and to actively contribute to their communities. There are estimated to be more than two million people with communication disorders in the USA who require appropriate supports and services to fully participate in everyday activities (American Speech and Hearing Association [ASHA] 2016). Students with intellectual and developmental disabilities (IDD) are a heterogeneous group, with ranges of speech, language, intellectual, motor, and sensory skills (Beukelman and Mirenda 2013; Light and McNaughton 2012). For many students with limited or no speech, acquiring at least one means of symbolic communication is critical, especially through communication opportunities embedded throughout the day, with different partners, and across environments (Chung and Douglas 2014).

One of the common supports provided to students with IDD is augmentative and alternative communication (AAC) systems, a range of communication modes designed to promote meaningful participation in all aspects of life (Beukelman and Mirenda 2013). AAC systems can be categorized as aided and unaided modes (Beukelman and Mirenda 2013). Unaided AAC modes involve the use of the person’s body to communicate, including using gestures, eye gaze, and sign language. Aided AAC modes require tools and or equipment beyond the person’s body, ranging from pictures and communication boards, to switches and speech-generating devices. Together, aided and unaided AAC systems may be used to supplement or replace a person’s natural speech, and provide opportunities to develop the communicative competence to express wants and needs, develop social closeness, exchange information, and participate in social etiquette of daily interactions (Light and McNaughton 2012).

In the USA, educational teams are mandated to consider students’ assistive technology needs during the process of developing individualized education programs (IEP) for students with disabilities (Individuals with Disabilities Education Act Amendments 1997). As the use of AAC has emerged as an evidence-based practice that promotes student outcomes (Chung et al. 2012; Walker and Snell 2013), researchers, practitioners, and families have advocated the importance of establishing effective AAC system for students with complex communication needs (TASH 2015). The provision of appropriate AAC systems is especially critical, when preparing students with complex communication needs to develop language and communication skills, to engage in academic learning, and to make adequate progress (Johnston et al. 2012). To facilitate the integration of consideration, acquisition, and implementation of AAC, researchers recommended a comprehnsive process of assessment, using the Particpation Model (Beukelman and Mirenda 2013). This model is designed to address potential barriers that prevent students with complex communication needs from meaningful participation, through evaluating students’ skills, capacities, and preferences, as well as external factors, including environments, personnel, and supports (Beukelman and Mirenda 2013).

Over the years, the underlying principles of the Participation Model have been verified by intervention studies and professional organizations (e.g. Brady et al. 2016; Hunt et al. 2002). However, educational teams continue to report challenges associated with delivering AAC services (Baxter et al. 2012; Chung and Stoner 2016). These challenges often include limited AAC use, lack of knowledgeable personnel, and inadequate training, which sometimes resulted in device abandonment and student frustration (Costigan and Light 2010; Johnson et al. 2006). To better understand these issues, researchers have examined the needs of educational teams supporting students who use AAC through interview studies (e.g. Bailey et al. 2006; Lund and Light 2007).

For example, Bailey and colleagues (2006) interviewed six special educators and one speech language pathologist (SLP) who worked with middle and high school students who used AAC in the midwestern United States. Findings from the interviews yielded factors that contributed to desirable educational outcomes (e.g. opportunities to interact with different partners, appropriate devices) as well as variables that negatively impacted device use and implementation across environments (e.g. lack of time to collaborate, disagreement among team members). To examine factors impacting outcomes of students who used AAC, Lund and Light (2007) recruited seven young adults who used AAC, their family members, and service providers to share their perspectives. Although participants described several challenges associated with attitudes, cultures, devices, and services, they attributed the young adults’ success to personal, family, professional, community, society, and device strengths. More recently, Feiler and Watson (2010) investigated the experience of educational teams who served students with severe disabilities at special education schools in England. Through individual and group interviews, the researchers specifically focused on how teachers, SLPs, and paraprofessionals promoted the decision-making of children who had limited speech. Educators described concerns related to the children’s comprehension and motivation, limited vocabulary programmed, as well as the need for flexible service-delivery schedule and better training for paraprofessionals. Collectively, these interview studies highlighted common challenges for AAC service delivery and called for better collaboration among team members.

To promote effective team collaboration, there is a need to specifically examine the experience of special education teachers who work with students who use AAC. Special educators are often the case managers of the students and assume a team leader position among key stakeholders. According the Council for Exceptional Children (CEC 2015), CEC is the largest professional organization for special education, the responsibilities of special educators include developing curriculum, delivering instruction, coordinating services, collaborating with families, and supervising paraprofessionals. In addition, for special educators working with students with developmental disabilities and autism spectrum disorders, a population that often requires communication support, CEC specifically recommended that delivering AAC services be a required skill. To date, there is no existing study specifically focused on the experience of special educators who work with students who use AAC. Given that two decades have passed since the mandate of assistive technology for students with disabilities in the USA (Individuals with Disabilities Education Act Amendments 1997), such investigation is especially critical to provide recommendations for needed support and training for special educators working with students who use AAC. Therefore, this study was designed to address this knowledge gap and to influence educational practices through answering the following research question: What factors impact AAC services of students with IDD, as perceived by special educators?

Method

Teacher’s perceptions of factors that impact AAC access and outcomes for students with IDD were examined through individual interviews. A qualitative approach was appropriate because individual interviews allow the interviewer to explore the experience of teachers serving students who use AAC in the educational settings (Creswell 2013). Through guided interview questions, the interviewer can ask follow-up questions for clarification and confirmation.

Participants

A large sample (n = 9,577) from a previous survey study targeting special education teachers was utilized (Andzik et al. 2017) when recruiting participants for the current study. Initially, a total of 2,885 teachers indicated an interest to participate in future research after completing the survey. Each teacher (n = 66) that responded to a follow-up email was invited to participate in this study. To be included in this study, a special educator must have worked with at least one student who used AAC during the time of the interview. AAC systems were defined as a high- or low-tech system that was provided to students to support their communication. As a result, 14 teachers participated in this study. Participants ranged in ages 26–67 (M = 42) and had 2–35 years of teaching experience (M = 14). All but one participant was female (93%). Table 1 presents participant demographics and school information including students’ overall socioeconomic status (as indicated by the percentage receiving free or reduced priced lunch) and geographic locations (suburban, n = 7; rural, n = 5; urban, n = 2). Two participants were from California and each of the remaining 12 teachers were from different states. It should be noted that despite the range of classroom types and overall student population, all teachers reported that all of their students who used AAC had an intellectual disability or development disability (i.e. autism). Pseudonyms were used in place of participant names to protect their privacy.

Table 1. Participant information.

Name	Age	Gender	Years teaching	Classroom type	Student Population	School lunch status	Setting
Mary	43	Female	20	Resource	Mild/Mod.	Some	Suburban
Cathy	39	Female	16	K–5	Mod/Intense	Most	Suburban
Marsha	26	Female	4	4–12	Mod/Intense	Most	Rural
Betty	49	Female	25+	Special class	Mod/Intense	Most	Suburban
Nancy	36	Female	11	Inclusion & pullout	Mixed	All	Urban
Alfred	55	Male	16	Mixture	Mixed	All	Urban
Barbara	48	Female	2	Special class	Autism	Most	Suburban
Diane	35	Female	14	Special class	Mod/Intense	Most	Suburban
Helen	26	Female	3	Special class	Mod/Intense	Most	Rural
Jennifer	48	Female	35	Resource	Mild/Mod.	Most	Rural
Jody	28	Female	5	Resource	Mild/Mod.	Most	Rural
Lillian	67	Female	14	Special class	Mixed	Most	Rural
Carrie	28	Female	6	Inclusion	Mixed	Some	Suburban
Elizabeth	60	Female	26	Transition class	Mod/Intense	Some	Suburban

Notes: School lunch status indicates the student population as all, most, or some students eligible for free or reduced-priced lunch; Mod/Intense = moderate to intensive; Mild/Mod. = Mild to moderate; Mixed = both Mild/Mod and Mod/Intense.

Researchers

At the time of the study, the research team included two special education doctoral students, both were former special education teachers. The primary coder was also a behavior analyst for students with IDD and communication needs with 10 years of experience working with educational teams supporting students who used AAC. The secondary coder was a licensed SLP with 15 years of experience working with students with IDD. She was also an assistive technology professional credentialed through the Rehabilitation Engineering and Assistive Technology Society of North America. The data auditor who reviewed the developed codes of five randomly selected transcripts was a SLP (M.A., CCC-SLP) with over 10 years of experience working with students with complex communication needs and provided training and supports in educational settings. In addition, the research team consulted with a university professor with experience publishing qualitative methodology (the last author).

Procedure

A list of interview questions (see Appendix 1) were developed by a panel of four experts in the field of severe disabilities, communication impairments, and AAC (i.e. an associate professor in special education, two graduate students in special education, and one current special education teacher). Two hypotheses guided the development of the questions. First, special education teachers face multiple challenges when implementing, developing, and monitoring AAC use across environments. Second, students with IDD may not consistently access needed AAC with appropriate support. After reviewing the literature, the first author created an initial draft, which was reviewed, discussed, revised, and accepted by the expert panel. A trial interview was conducted with a special education teacher who worked with students who used AAC to obtain feedback on the sensitivity and ease of use of the revised questions. The questions were further refined into a final version.

The final interview questions included three themes: preparation, assessment, and implementation of AAC. Specifically, the questions addressed (a) special educators’ experiences and/or perspectives on instructional materials for teaching communication and financial assistance for purchasing those materials; (b) the preparation time teachers spent at school, home, as well as any professional development they received; (c) initial and ongoing communication assessments conducted with their students; (d) the implementation process and factors involved when implementing communication supports; and (e) the availability of the communication systems to their students. In addition, a vignette was provided to help teachers recall a student they may have taught in the past. Researchers wanted to avoid close-ended questions and thus, presented this vignette to gain a better understanding how teachers might prioritize communication when presented with a challenging case. Finally, teachers were asked to provide background information, including their age, years of experience, type of classroom (e.g. resource, inclusion), numbers of students who used AAC, and types of AAC systems used.

Individual phone interviews were conducted lasting between 18 and 66 min (M = 37 min) and were recorded with participant permission. The difference in interview duration was due to the varying participant personalities and willingness to share stories and tangents. Some participants answered each question succinctly and others provided long, drawn out stories and personal reflections. Prior to the interview, teachers were informed about their rights as study participants, including the options to terminate the interview at any time and to decline to answer any questions. All 14 teachers completed the interview and answered all of the questions. The first author transcribed the interviews. To ensure transcription accuracy, another former educator was recruited to audit 100% of the transcripts and found no substantial disagreements beyond spelling and grammar errors. To maintain confidentiality, pseudonyms were used for students and district and geographic information were not transcribed. In addition, if any confidential information shared that did not directly relate to the study (e.g. reports of child abuse to authority), the comment was noted but not transcribed, to ensure the privacy of each participant and the corresponding student.

Data analysis

An opening coding process was used to analyze the interview findings and to develop a theory on special educators’ experience when serving students who used AAC (Charmaz 2014). First, the first author and a secondary coder independently reviewed the completed transcripts of each participant, took notes, and generated initial codes. Next, both coders met to compare their codes, discussed notes, and developed preliminary categories (e.g. training, preparation time, assessment, implementation, access to materials, access to devices). Early theory development began after discussing the initial codes created independently by both coders. Several broad categories began to emerge (e.g. training, social media use, outside classroom preparation time), which were then refined and revised. Third, the next phase of coding allowed each of the two coders to collapse and attribute deeper meaning to participants’ statements, to build subcategories based on that meaning, and to meet together to attain consensus. Fourth, theoretical coding took place in which relationships among four identified factors (i.e. training, assessment, preparation time, implementation) were articulated and defined. The final stage involved identifying the overall conceptual factors (Charmaz 2014). Three factors were identified as being related to successful communication outcomes. The research team discussed and confirmed that saturation of the data had been attained as all relevant categories and subcategories were accounted for in the emerging theory. Theoretical saturation was achieved after repeated comparative coding and analysis of interview data, which confirmed that no additional factors were uncovered (Charmaz 2014). It should be noted that there were no outliers that needed further investigation.

Trustworthiness

Several approaches were used simultaneously to maintain the trustworthiness, credibility, and validation of the study findings (Creswell 2013). First, the research team was transparent in discussions about pre-research assumptions and expectations. Second, the team practiced reflexivity in continually processing experiences and reactions to the data during analysis to reduce bias. Third, 100% of the transcripts were audited to ensure transcription accuracy. Fourth, member checking was conducted by sharing the finalized themes with participants and seeking feedback. Twenty-five percent of the participants responded and all were in agreement with the themes identified. Fifth, the various interview lengths allowed flexibility for engagement and rapport building based on the needs of the interviewees. Sixth, an external expert reviewed the developed codes of five randomly selected transcripts. The auditor agreed the codes were accurate and did not identify additional codes needed to be considered. Together, these efforts yielded substantial, credible, and trustworthy findings.

Findings

Three themes, including AAC training, assessment, and implementation were identified through the analysis of interviews with special education teachers.

Theme one: AAC training

Despite that the majority of participants recognized that teacher training specific to AAC was a key factor to successful student outcomes, they had inconsistent access to such training. Four (29%) of the teachers reported receiving AAC training provided by school-based SLPs. Lillian mentioned a single training, specific to the eye gaze system for a student, was provided by the SLP. However, she was unable to attend due to personal reasons. Two teachers reported their districts trained teachers on specific AAC interventions (i.e. the use of PowerPoint and the Pragmatic Organization Dynamic Display [PODD]; Barbara and Diane, respectively). Barbara reported creating communication messages with the PowerPoint system, which were loaded on her students’ personal tablets. This system had not been implemented at the time of the interview. Diane indicated that she had previously used the PODD system for her students to share what they did the previous night or weekend during a journal activity. The PODD system was not being used during the time of the interview.

Few teachers pursued formal training outside of the school day, and others used social networking tools and online resources to enhance their knowledge and skills on AAC. Some teachers indicated using Facebook, Google, Pinterest, blogs, and manufacturer resources as self-training tools, but also reported difficulties with AAC implementation following self-training. Nancy indicated that trainings were no longer useful or necessary in her case. She expressed that the trainings her district offered were repeated every year. This year, she explained,

I am currently going to a workshop right now that I’m looking forward to… It’s a math workshop that is all hands on in technology and math. And it’s probably the first time I’ve learned something in a workshop in about six years.

Only one teacher, Claire, had mixed feelings about the need for formal training. She said, ‘If you are intelligent enough to have a degree then you are intelligent enough to read research papers and find out what’s out there.’

Five teachers (35%) indicated that their current school systems did not provide any training or provide any financial resources to attend trainings. For example, Lillian received training on communication over 12 years ago, Elizabeth explained that she took an AAC class, ‘before there were iPads,’ and when Haley was asked about training on communication, she laughed. Two teachers described that their schools would pay for a substitute teacher if the teachers funded the training. However, Cathy indicated that she was required to take a personal day, and pay for both her own training and the substitute teacher.

Theme two: AAC assessment

Special education teachers reported using standardized tests, informal assessments and observations, review of students’ IEPs or cumulative files, and consultation with other professionals to determine if a student may need an AAC system. Many teachers stated that it was their responsibility to identify appropriate AAC for their students. For example, Helen stated, ‘Everyone is communicating in some way and it’s just for us to figure out what and how.’ Rachel described using ‘Every Move Counts’ to identify student interests and communication abilities. Mary indicated that she is part of a collaborative assessment team called Student, Environment, Tasks, and Tools (SETT). She described this as,

[Device experts or consultants] would come in and show the speech clinician and myself and the teaching assistant, and you know, we invited the parents in to kind of come in and do that with us…we were trialing [devices]. They would come in and show us how to do that and then touch base with us and you know if we had questions they were available to us to answer questions and things.

However, collaboration with SLPs in AAC assessment was not an option for all participants. Some teachers indicated their school SLPs only operated within the scope of their professional practice and competence, which did not consistently include AAC. Betty noted with frustration, ‘As a whole, the speech pathologist and assistive technology teams just don’t have the knowledge of everything that is out there and that’s available to be able to help me.’ Lillian shared a similar comment, ‘I decide [what device my students uses]. I know my students better. My speech path only sees the students maybe 20 min a week.’ Half of the participants reported that either their schools did not have SLPs or their SLPs were not effective or collaborative, due to turnover or the lack of experience some had with AAC systems. Two teachers indicated that they wanted to bypass the SLPs in order to get needed AAC systems for their students. Nancy, when discussing obtaining AAC systems for students stated, ‘We haven’t had a decent SLP in the last couple years and they have to be the one to request it.’

In addition to assessment for needed AAC systems, some teachers also shared assessments for monitoring AAC progress, although none of the data teachers described collecting was ultimately used to guide decisions (e.g. changing or continuing with an AAC system). Kathy and Betty indicated that they collected data on AAC use, as part of the students’ IEP goals. Helen and Jody described gathering information on students’ communication attempts across school environments. Six (43%) teachers described using a more anecdotal approach for summative assessment — the successful implementation of an AAC system occurred when they observed students using the system functionally or independently. One teacher stated, ‘We know it’s usually working when they start [using AAC] without our assistance,’ and Rachel made a similar comment, ‘I think the way I know it’s working is if the child uses it spontaneously. To either answer questions or request something. That kind of thing.’

Theme three: AAC implementation

Special education teachers described various factors affecting the implemention of AAC services across settings and communication partners, including: preparation time, team collaboration, and support from paraeducators and SLPs. Participants reported having between 0 and 90 min per day (M = 31 min) of paid preparation time. Teachers explain that they have to prepare academic materials, behavioral supports, and communication systems during their preparation time. When describing the lack of paid preparation time provided by the school, Barbara commented, ‘I get an hour of planning time per day and that is not enough.’ Given the complexity of AAC systems and the demands of providing special education services, several teachers described using their own personal time, ranging from ‘a couple’ to 30 hours each week to complete work-related tasks and often worked on the weekends. For example, Mary reported that she could not start preparing for school until her own children were asleep, often requiring her to work from about 8:00 pm to 12:00 am every day. On the other hand, Betty indicated that her own children are grown, leaving her more free time (i.e. several hours) in the evenings to prepare academic and communication materials for her students.

Across participants, teachers described challenges of team collaboration, including inconsistent supports for AAC use, limited staff for AAC service delivery, and lack of collaboration time and training. Barbara commented, ‘The general ed teachers, they tend to let the paras handle things. I mean, they will interact with our kids but they don’t tend to mess with the accommodations and modifications.’ Claire also provided insight on inclusion of students who use AAC, ‘[the general education teacher] don’t think it’s their problem to deal with … they told me that these students needed to be in a self-contained classroom and that they shouldn’t even be in the general education room.’ Kay further expressed,

Because they look at my kids and you see disability. The majority of people say that, and don’t have high expectations for my kids. They are here at school that’s great. Some people even question why my kids come to school. Low expectations and not having the belief that my kids can do it. That’s probably one of the hardest barriers to overcome throughout the day.

One teacher, Kay, stated feeling that she was working in isolation with limited assistance to implement AAC systems. She said, ‘I have no one to help me.’ Betty mentioned that she received support on using iPad communication applications from the district autism specialist, who only visited her school once a month.

Among the 11 teachers who had paraeducators in their classrooms, five indicated that their paraeducators were primarily taking care of students’ basic needs (e.g. toileting, feeding), without additional time for working on communication. Kay mentioned that because she had so few paraeducators and a large group of students who needed medical assistance, ‘It’s just easier to do it yourself than waiting for the kid [to ask for help]. She explained that her paraeducators indicated, ‘I don’t have time for this.’ Marsha described having six students with extensive support needs (i.e. requiring full assistance with daily living tasks). She explained that ‘there are some long days’ because she only had one paraeducator in her classroom. Other teachers also described the lack of available knowledgeable staff (e.g. paraeducators, general education teachers) with time to address the communication needs of their students as a barrier to AAC implementation.

Some special education teachers reported that some of their students who used AAC received SLP services up to three times a week, while other students were on consultation only without direct SLP services. Over half of the special education teachers (n = 8; 57%) described receiving support from and collaborating with knowledgeable SLPs. On the other hand, six teachers (43%) noted limited support from SLPs. Helen expressed frustration with one SLP, ‘The speech therapist was not my favorite. She was saying that she is supposed to work with speech not behavior, and she doesn’t think she should have to work with him.’ Across participants, the AAC implementation discussed linked to the training needs for all professionals working with students in the educational environment, including SLPs.

Discussion

The findings of this study identified themes that impact adequate access to AAC systems and services for students with IDD. Participants described how a number of obstacles complicated their abilities to support communication outcomes for students who require AAC systems, including a lack of training, inadequate assessment, limited preparation opportunities and inconsistent implementation. Through presenting the experiences of 14 special education teachers, our findings added to the knowledge and understanding of a teacher’s experiences and perspectives related to AAC services in schools.

First, this study identified several challenges faced by special educators who provided AAC services, including inadequate training, limited preparation time, and inconsistent team support. These barriers are similar to findings reported by educators from prior studies in and outside the USA (e.g. Bailey et al. 2006; Tönsing and Dada 2016). For example, in Bailey et al. (2006) study, secondary school educational team members reported inadequate time for meeting and programming, and suggested need for more staff training on AAC. In addition, some educators also described using after-school personal time to learn about AAC (Bailey et al. 2006). Teachers in South Africa also described similar barriers to AAC implementation, including issues with time, training, and personnel (Tönsing and Dada 2016). Findings from our study confirm that special education teachers continue to face these challenges that interfere with effective AAC service delivery. This is especially concerning, given that researchers and professional organizations have proposed guidelines and recommendations for best AAC practices for decades (ASHA 2016; Light and McNaughton 2012). However, little has changed in today’s AAC service provided in schools. As communicative competence is a foundation of student social, behavior, and self-determination outcomes, this study presents an urgent need for policy-makers and administers to better support special educators and other team members in the process of AAC service delivery.

Second, our findings also illustrated the strong connections between teachers’ knowledge of assistive technology, including AAC, and use of assistive technology in educational settings (Bell et al. 2010). Teachers require professional development to expand their knowledge and practice and to support student outcomes. Participants in this study identified professional development and training as a pressing need and felt that limited supports resulted in alternative solutions — the use of social networking tools and online resources. Our findings confirmed the use of logic model in examining AAC services, as proposed by Chung and Stoner (2016) in a meta-synthesis of AAC team perspectives. Professional development and training for teachers is one of the critical ‘inputs’ that impacts the ‘activities’ of AAC services (e.g. assessment and implementation) and ultimately the outcome, the overall success of AAC use for students with complex communication needs.

Third, this study highlighted the need for collaborative teamwork during the complex process of AAC system assessment and service delivery (Beukelman and Mirenda 2013). Beukelman and Mirenda’s (2013) Participation Model provides a framework that guides the ongoing and multi-level process of identifying the most appropriate AAC system to support a student’s participation across contexts and communication partners. This process includes feature-based assessment that matches individual features of AAC systems with specific needs of a child (e.g. physical, cognitive, sensory needs), through observations, trials, and data collections (Beukelman and Mirenda 2013). In our study, coordinated assessments, a key approach to identify appropriate AAC systems, was described as either inconsistent or nonexistent across participants. This particular challenge may be the source of many barriers reported by teachers. For example, if a general educator is not an active member on the AAC team, he or she may have less positive attitude toward AAC use or doesn’t have the skills to promote AAC use in the inclusive classroom. Or, an administrator, who is not informed or educated about the significance of AAC, is less likely to value the preparation time needed in this process.

Finally, another noteworthy finding was the value of communication shared by participants. When provided a case-example of a child with profound disabilities, all participants shared the opinion that regardless of ability, every child can and does deserve the right to communicate. Some teachers reflected situations when they worked with a student who either had multiple disabilities or was displaying challenging behaviors that made targeting communication difficult. Carrie stated, ‘Communication comes before anything’ and Mary questioned ‘[without communication], how do you teach that person?’ Cathy expressed when describing her belief, ‘I think communication is one of the fundamental things that we teach for our students.’ An example of how teachers persist through challenges is evident in the overwhelming response to ‘What do you do when students destroy materials?’ Jennifer was creative and only used disposable materials. She simply replaced the materials that were destroyed. Cathy would staple or tape items until they could be replaced. Lillian stated, ‘I usually have a backup. It’s just not a big deal. I’ll do it again.’ Most teachers laminated their materials as Mary said, ‘Laminate everything!’ (Followed by laughter). In addition, many teachers commented on the money they spent on their students, but it was Nancy who reported spending over $3700 in the last school year and nearly $7000 in her first year of teaching when setting up her classroom. Although this example may be unusual and extreme, it was evident that many teachers interviewed committed to using their personal time and resources to improve their students’ outcomes.

Limitations and future research

Findings from this examination of AAC support provided by special education teachers were informative. However, some limitations should be taken into account when interpreting the findings given the subjectivity of data collection and the qualitative nature of the data analysis. Although this small sample included a group of teachers across age range (range, 26–67 years), with a range of teaching experience (2–35 years), who taught at different school settings (50% suburban, 36% rural, and 14% urban), it should be noted that the nature of qualitative investigation is not intended to be generalized to a greater population. In addition, although several male teachers initially indicated interest in participating in this study, only one responded to the recruitment email, representing 7% of the sample. We encourage future researchers to continue making deliberate efforts to recruit participants with diverse backgrounds who have direct experience working with students who use AAC.

Next, qualitative researchers bring their own personal assumptions to a project prior to starting data collection. Given that researchers were former special education teachers, preconceptions had to be carefully bracketed prior to gathering and analyzing data to ensure an unbiased response (Tufford and Newman 2012). Prior assumptions included (a) special education teachers face barriers when implementing, developing, and monitoring AAC use, (b) special education teachers are likely to persevere through difficulties, and (c) students with complex communication needs are not consistently accessing AAC in meaningful ways. In spite of our efforts to enhance trustworthiness discussed in the methods section (i.e. bracketing and triangulation of the researchers), it is possible that individual perspectives influenced our analysis of the interview results. Additional studies with a variety of data sources that focus on the meaningful AAC access would enhance understanding of these issues. For example, researchers may consider ethnographic and case studies. Observing teachers within the natural classroom environment, coupled with an open-ended interview protocol would complement this qualitative work (Charmaz 2014).

Implications for practitioners

Successful assessment and implementation of AAC systems takes time, effort, and commitment (Chung and Stoner 2016). A collaborative team can support the daunting task of finding an appropriate AAC system for a student, setting it up, teaching communication skills and language, monitoring student progress, and making ongoing necessary changes. In this study, despite feeling overwhelmed with the responsibilities and inadequate teaming, all teachers persisted, demonstrating the key disposition of effective educators — problem-solving. We chose to share some examples as encouragement to practitioners who work with students using AAC. A few teachers stood out as utilizing creative strategies to overcome budget deficits. Betty, Lillian, and Jody participated in grant writing to gain funds used to send teachers to training and to get classroom supplies, one using those funds to purchase Boardmaker. Alfred seeked technical assistance free training opportunities through his state education department and local universities and seeked free technical assistance from consultants who provided technology support to the classroom (i.e. SMART boards). Although there might be a lack of resources, teachers’ efforts and creativity compensated for this challenge.

To support learning and AAC use across contexts, selection of appropriate AAC systems must be followed by interventions and systematic data collection that guide formative and summative assessments (Chung and Douglas 2014). In response to the call for more progress monitoring and accountability measures, we urge special education teachers or case managers to lead the AAC teams in making data-based decisions. Through developing data collection measures, collecting data across settings, and discussing student progress, educational teams can hold each other accountable, while working toward shared goals (Jung et al. 2008).

We encourage special education teachers to continue to seek training and advocate for their students and team members. Often, teachers need to be innovative with existing resources. For example, paraprofessionals can incorporate communication training and embed communication opportunities for students during daily living activities. Teachers in this study who reported the most success with AAC implementation, were creative in finding their own trainings and making their own materials. However, individual teachers alone cannot be responsible for the total communication access of all students. In addition to teachers continuing to use their own time, funds, and creativity to educate their students, a more deliberate effort is needed to increase students’ communication access through collaborative teaming in decision-making, assessment, and implementation.

Conclusion

Students with IDD often require AAC systems with coordinated services from teachers, SLPs, and other team members to fully meet their communication and academic potential. Such support is directly related to successful AAC outcomes. Findings of this study identified key factors that impact outcomes of students with IDD, including training for educational team members, time to collaboratively select, design, and implement AAC systems, and data used to guide both the assessment and implementation process. We hope what we learned from these interviews will encourage educational team members to work together to deliver high-quality AAC services in schools.

Notes on contributors

Natalie Andzik, PhD, BCBA-D is an assistant professor in the Department of Early and Special Education at Northern Illinois University. Her research focuses on supporting the communication independence of students with severe disabilities by ensuring practitioners use the most effective evidence-based practices.

Yun-Ching Chung, PhD, is an associate professor in the Department of Special Education at Illinois State University in Illinois Her research interests include peer interactions, inclusion outcomes of students who use augmentative and alternative communication, and paraprofessional facilitation.

Colette Dollarhide, EdD, is an associate professor in the College of Education and Human Ecology at The Ohio State University. Her research focuses on leadership, social justice, and school counseling using qualitative methodologies.

Janis Doneski-Nicol, M.S., CC-SLP, ATP is a program director at Northern Arizona University. Her interests include assistive technology, alternative and augmentative communication, and severe disabilities.

Appendix 1. Interview questions

• (1)Do you ever make communication materials for students? Have you been provided with money or training when making these? If not, do you have any thoughts why you haven’t been paid for this work?
• (2)Have you had any training related to supporting kids with communication disorders? How long ago? What were they? Did you pay for them? Did you initiate them or did the school offer them? If not, have you been offered training? Why did you not participate in training? (Are there other factors that might encourage/influence you to do additional trainings?).
• (3)Tell me about your paid prep time. What do you usually do? How do you break up your time?
• (4)Do you spend time at home working on work related tasks (such as curriculum development, behavior management development, communication development materials)? About how much time?
• (5)What have you done (outside of school) to increase your training on this topic? Were you able to implement anything in your classroom after your training? Was it done with fidelity (how well do you think you did performing these tasks when you tried these new skills in your classroom)? Do you read newsletters etc.?
• (6)Do your students destroy materials? What do you do when this happens? Have you done anything to try to prevent this? Has this prevented you from buying/making materials?
• (7)How do you assess your student’s ability to communicate when you meet them? How do you assess your student’s ability to communicate when you have put something into place?
• (8)Is everyone on your team consistent when implementing alternative communication procedures for students? Tell me about the occupational therapist, speech therapist, adapted physical education teacher, other teachers, and paraeducators, etc. Where are the inconsistencies? Why do you think these inconsistencies exist?
• (9)Do you have the support staff in your classroom to implement these interventions? How many Para educators do you have? Typical peer models? Is time during the day taken up by feeding, toileting, cleaning, and various services (kids pulled out)?
• (10)What materials/resources do you have to create communication systems? Do you have: Laminate, color ink, Velcro, packing tape, technology (internet access) at school, or even a printer or computer at school?
• (11)Do the parents you work with talk about or ask questions about their child’s communication access? Can you tell me about the nature of these questions? Do your parents ask you to collaborate with their home support providers? Please tell me about the parent involvement in your classroom.
• (12)Do you know what your student’s after school and evening schedule is like? Can you tell me what their evenings are like? Do you think this is important?
• (13)Do you have students who are homeless? Can you tell me how you support those students any differently?
• (14)(Short vignette about a student with a significant disability), is there a point at which communication becomes too hard to target? Can you tell me about these students?
• (15)When implementing a communication system, what challenges have you experienced with your students?

Disclosure statement

No potential conflict of interest was reported by the authors.