READING
“Facilitated Communication Training” (Special Education S.) by Rosemary Crossley Publisher: Teachers College Press; ISBN: 080773327X
“Contested Words, Contested Science: Unraveling the Facilitated Communication Controversy” Douglas Biklen (Editor), Donald N. Cardinal (Editor) Paperback 245 pages (June 1997) • Publisher: Teachers College Press; ISBN: 0807736015 •
“Speechless: Facilitating Communication for People Without Voices” (1997) Rosemary Crossley Publisher: Dutton ISBN: 0-525-94156-8
Facilitated Communication Training (FCT)
Practice Standards (Bolton, UK)
June 2004
By
Marion Stanton
With input from
Rosemary Crossley
PRACTICE STANDARDS IN FACILITATED COMMUNICATION TRAINING (FCT)
BACKGROUND
1. The development of these practice standards has come about as a result of discussions with various agencies and individuals involved in the development of Facilitated Communication Training (FCT) in the UK and a general consensus that there is a need for some common agreement in regard to the way in which FCT is practiced. This guide is being developed in collaboration with Rosemary Crossley of the DEAL Communication Centre, Melbourne, Australia, where FCT originated. These practice guidelines may also be useful to those who use FC (Facilitated Communication), a similar technique which originated in the USA.
2. FCT is part of a wider provision of AAC (Alternative and Augmentative Communication).
3. AAC encompasses the provision of support for anyone who needs additional resources in respect of their expressive language. Many people whose speech is not clear or fluent, or who do not speak, need to augment their speech by using communication aids, or use an alternative method of communication. There is a wide range of communication aids, including cards with pictures of wanted items, letter-boards, mini typewriters which talk, and sophisticated portable computers which speak and allow internet access and environmental control. Regardless of the nature of their aid, in order to communicate the user has to select the symbol(s) they require. Most communication aid users point with their fingers but some use their whole hand, fist, chin, head, feet or eyes.
4. Even though pointing is physically far less demanding than sign language or handwriting, many potential communication aid users still require active intervention before they can point accurately to sequences of items on communication boards or keyboards. The terms FCT and FC both refer to an augmentative communication strategy in which individuals with limited speech receive physical and/or emotional support from trained facilitators to enhance their skills in using communication aids.
FACILITATED COMMUNICATION TRAINING
In FCT a communication partner (facilitator) helps the communication aid user overcome difficulties with accurate movement so that they can improve their control of their movements. The facilitator provides physical support in a way that will help the user to be more accurate in their pointing. This might involve supporting them under the arm or wrist to counteract muscle weakness, providing resistance to the movement to counteract impulsivity and allow the person time and control to reach their chosen target, steadying the head of someone who uses a head pointer to select items or providing other appropriate physical support.
The immediate aim of facilitation is to allow the aid user to make choices and to communicate in a way that was not previously possible. Practice using a communication aid is encouraged to help the user to increase physical skills and self-confidence. As the student's skills and confidence increase the amount of facilitation is reduced. The ultimate aim is for the students to be able to use the communication aid(s) of their choice independently. It is acknowledged that not all students will reach the goal of independence but work towards it will continue both by practicing with FCT and by varying the technology used.
Many students previously diagnosed as having significant learning impairments have benefited from facilitation to the extent that they have been able to develop the skills needed to follow the mainstream curriculum. Others have been able to increase the range of options that they can make choices from by improving pointing skills. All users of facilitation are given every possible opportunity to develop literacy skills; however literacy is not a requirement for involvement in a FCT program.
5. Facilitation looks deceptively easy - it appears as if you just provide physical touch to help someone point. However, first the person needs to have their current communication, fine motor skills and literacy assessed by a professional who is knowledgeable about AAC and skilled in FCT so that an individualised programme can be devised utilising a range of communication techniques in which facilitation is only used when essential.
FACILITATOR TRAINING
6. The level of facilitator training required varies depending on the tasks the facilitator wants to undertake:
Ø LEVEL 1: Facilitators of one communication aid user.
Ø LEVEL 2: Multiple user facilitators.
Ø LEVEL 3: Facilitator trainers.
Ø LEVEL 4: AAC/FCT assessors.
The different levels require different sets of skills and knowledge. Where only a higher-level facilitator would be expected to understand and practice one of these standards this is indicated in brackets.
The training breaks down into 6 stages as follows:
STAGE 1: Attends one-day introductory workshop.
STAGE 2: Undertakes hands-on training in order to facilitate one or two people under the supervision of a facilitator who has completed at least stage 4 training.
Attends two-day training workshop.
Has monitored for validation and is able to present examples of anecdotal and/or structured validation.
STAGE 3: Facilitates more than 3 people, including at least 1 who is communicating by typing sentences and at least 1 who is successfully working on fading towards independence.
Observes 2 assessments.
Attends advanced assessment workshop and/or undertakes a short course in AAC if no previous background in the field. (Alternatively, completes the first module on facilitating communication at the University of Bolton.)
STAGE 4: Participates in the supervised assessment of people with severe communication impairment for AAC, including FCT, for a period of 6 months or more.
Attends trainers’ workshop (or completes the second module on facilitating communication at the University of Bolton for training in training and assessment).
Presents introductory workshop(s) under supervision.
STAGE 5: Present training and assessment workshops under supervision. Gives hands-on training to new facilitators.
STAGE 6: Delivers a conference presentation or publishes a paper on an aspect of facilitation.
PREREQUISITES
7. Facilitators - family members, teaching assistants etc. - need to be taught to provide appropriate support. It is important to check on the reliability of the communication with each facilitator and to develop independent YES/NO responses that the person can use without facilitation if at all possible. When moving towards free expressive writing it is a good idea to ask the user to confirm that they intended what they just typed using YES and NO.
8. Working towards independent communication is crucial to FCT as is the development of structured programmes to meet this goal. There are some who will not be able to achieve full independence but every effort is made towards this goal. Success rates may well vary in different circumstances. For example an FCT user might be more independent in the home than in school or vice versa.
9. Anyone involved in FCT recognises that communication is a human right and that every non-speaking person should to be helped to achieve communication via facilitation or any other reasonable means.
10. Facilitators should have an understanding of the neuro-motor problems that they aim to address with an FCT programme. These problems may include some or all of the following: variations in muscle
tone, impulsivity, perseveration, reduced proprioceptive awareness, sensory problems including light and/or sound sensitivity, impaired hand/eye co-ordination, distractibility, dyspraxia, initiation problems and unwanted movement. A fuller list of neuro-motor impairments affecting pointing and their remedies can be found in Facilitated Communication Training (Crossley, 1994) and and even fuller list can be obtained from contactcandle@btinernet.com
11. Facilitators should be clear about the steps required for fading back to independence but also aware that it may be necessary to restore higher levels of support if the task or situation demands it. Steps towards independence should be made in collaboration with the FCT user. It is sometimes easier to fade for straightforward communication but necessary to provide more support for complex communication.
12. Facilitators should understand the need for and be able to provide alternative communication strategies that enable or work towards independent selection, such as multiple choice options, in addition to facilitation.
13. Facilitators should have a good understanding of a range of AAC options. This should include: hand pointing, head pointing, eye pointing, switch use using step scan, single switch use and inverse auto scan with and without audio prompt and the use and development of low tech communication boards and letter boards as well as a range of high tech communication aids with digital and synthesised speech. They should be able to recognise the value of various access methods as well as know how to operate communication aids. (Level 3 and above)
14. Facilitators should have some form of professional development built into their practice. This might be through: peer group monitoring on a mutual basis, attendance at relevant conferences, or by keeping in touch with relevant issues via the Internet. In ideal circumstances facilitators should participate in in-depth theoretical and practical training. There are a number of courses available that can be accessed in the UK and abroad. (Level 3 and above)
USER PROTECTION
15. Ideally FCT users should be supported by more than one facilitator, and by multiple facilitators with whom they have regular involvement.
This is essential for successful FCT BUT an individual’s right to use whatever communication they can access is of primary importance, even if multiple facilitators are not available.
16. Ideally FCT users should have multiple opportunities to use FCT throughout their day and across a variety of settings including home, school/work, and community. This is essential for an FCT programme to be really successful but again the user should be allowed to use whatever communication they can access even if there is variation between environments. Facilitators should work together with the FCT user as part of a team remembering that the person who is being empowered should have control of the process.
17. In everyday communication it is important that an agreement exists between FCT user and facilitator in regard to confidentiality. This should be discussed early on in the facilitation relationship and an agreement made about how the FCT user will let the facilitator know what they may convey to others and what should remain confidential.
It is essential that the facilitated communicator is provided with a means of correcting errors – both theirs and their facilitators’ – and taught to use it. On electronic aids this will be the Backspace or Clear keys. Low tech communication boards should always include ERASE, MISTAKE or THAT’S NOT WHAT I WANT.
18. It is essential to use strategies that will ensure that the facilitated communicator is able to indicate when they have finished. This could be pointing to the word STOP, a full stop, FINISHED or some other agreed arrangement.
19. A log of anecdotal evidence of validation should be kept with all regular clients wherever possible.
Anecdotal evidence may include:
Ø Similar patterns of spelling and errors with multiple facilitators.
Ø Typing about similar topics or themes with multiple facilitators.
Ø Consistent style of typing with multiple facilitators.
Ø Instances of independent and/or initiated communication.
Ø Sharing of information not known to the facilitator.
Ø Behaviour or actions which confirm typed communication e.g. going to the refrigerator immediately after typing "I'm hungry".
FCT users should not be subjected to message passing tests or asked to take part in controlled validation experiments without their informed consent and the opportunity to practice the skills required over a period of time prior to testing. Testing should never be carried out in the early stages of facilitation training or during the early training of new facilitators. This is because no one can be assumed to have competence enough to undertake such a task in the early stages of an FCT programme.
20. A log of progress towards independence should be kept wherever possible. An example of such a log is attached.
21. In the event of any kind of accusation being made against another person by a person being facilitated, treat the communication in the same way that you would that of someone who speaks but also:
Ø Invite a second skilled facilitator to work with the complainant (without knowledge of the exact details) so that the complainant can confirm the details of their complaint. contactcandle@btinternet.com for advice if the matter is serious and you have difficulty finding a second facilitator.)
Ø Use independent techniques as much as possible to confirm the complaint e.g. pointing to YES and NO without facilitation to answer questions
Ø Check for other evidence using the child or vulnerable adult protection policy of the relevant agency.
N.B. If the complaint is repeated that does not mean it is true. Normal investigation is still required. No facilitator who does not have at least level 3 training should attempt to verify communication.