What is facilitated communication (FC)?
It’s a hands-on training technique which aims to give people the skills they need to use communication aids effectively with their hands.
To facilitate is to make easier. In facilitating communication, the task of using a communication aid is made easier for a person with a severe communication impairment. The degree of facilitation needed varies from person to person, ranging from an encouraging hand on the shoulder (to boost confidence) to full support and shaping of the communicator's hand (to enable them to isolate and extend of an index finger so they can point).
Facilitated pointing provides a temporary remedy for the hand function impairments of some people and may result in a permanent improvement in hand function when used as part of a structured teaching program.
What is facilitated communication training?
Most of the time facilitated communication training (FCT) is a better term than facilitated communication (FC). FC isn’t an end in itself – it’s a stage that we hope people will pass through on their way to improved communication.
FCT is a strategy for teaching individuals with severe communication impairments to use communication aids with their hands. In facilitated communication training a communication partner (the facilitator) helps the communication aid user overcome neuromotor problems such as impulsivity and poor eye/hand co-ordination and develop effective pointing skills.
The immediate aim of facilitated communication training is to allow the aid user to make choices. People who can make choices can communicate in a way that was impossible before. Once they can make choices we encourage them to practice using a communication aid (a picture board, for example, or a speech synthesizer or keyboard) in a functional manner, to increase their physical skills and their self-confidence and to reduce their dependence on the facilitator. As the student's skills and confidence increase the amount of facilitation is reduced. The ultimate goal is for students to be able to use the communication aid(s) of their choice independently.
Some agencies call facilitated keyboard use Supported Typing.
Who can be helped by facilitated communication training?
Use of facilitated communication is not restricted to any specific age or any diagnostic group. It’s been used successfully by people with diagnoses including autism, Down syndrome, intellectual disability, cerebral palsy and acquired brain damage. We’d say it was worth trying for anybody who isn’t speaking, or who isn’t speaking roughly around the level of their peers (because we do have clients who have some speech – just not enough for their needs) who has not been able to use other communication strategies (e.g. hand signs, hand writing, electronic communication devices) fluently and effectively.
Facilitated communication training generally isn’t considered as an option for an individual if they:
- have fluent functional speech
- have a fluent alternative communication strategy
- have the potential to acquire manual signing or handwriting skills easily
- can clearly and unambiguously select sequences of items from communication displays in order to create sentences
- are able to use other direct or indirect access options such as headpointers or scanning systems effectively (some people can’t use these means because of physical control problems, some can’t use them for practical reasons - people who walk instead of using wheelchairs, for example, have trouble carrying a scanning system around with them).
Importantly, that list does not include “don't have the intellectual capacity to use a communication aid.” Never make any assumptions about the intellectual abilities of anyone who has difficulties communicating. Training first, testing afterwards.
Everyone who can’t communicate should certainly not be started on FCT as a matter of course. There are many other AAC techniques that work well for many people, and many clients never use facilitation at all. Facilitated communication training is most useful for people with severe communication impairments who are not able to use their hands effectively, who can walk, and who need to use easily-portable communication aids.
The target group is people who have either been unsuccessful with other augmentative communication techniques, or whose communication with other techniques is very limited - fewer than 500 handsigns or picture symbols. To put this in context, typically-developing 5-year old children often have spoken vocabularies of 5,000 words, and adults 50,000 words!
What does a facilitated communication training program include?
Once it’s been decided that an individual is a candidate for facilitated communication training it’s then necessary to:
- work out the nature of the problem(s) which are preventing them from accessing communication aids successfully;
- select appropriate remedial strategies, including facilitation strategies if needed
- ascertain what representational systems (concrete objects, pictures, pictographs, written words, letters) are currently meaningful to the potential user
- enable the individual with severe communication impairments to use the most empowering of the representational systems and selection strategies currently available to them by obtaining/making appropriate communication aids and teaching those in the individual's environment how the aids are used.
The first step is to find simple empowering strategies that the student can either use independently straight away, or that can be acquired quickly. If the student has no functional communication these will include pointing to YES and NO widely spaced on a laminated card and selecting from 3 to 5 widely spaced items - picture symbols, written words, letters or numbers.
Usually, we find that students can answer YES/NO questions meaningfully after one or two therapy sessions, and we immediately provide them with YES/NO strategies to use in all environments while we continue to work on more complex skills and obtain appropriate communication technology (funded by the state government).
What benefits does facilitated communication training offer?
Facilitated communication training has enabled some people without functional communication to take charge of their lives, make their wishes known for the first time, and join the life of their communities. Parents have been enabled to communicate with their children. Children who have had only restricted education, or no education at all, have gone into regular classes; some have completed high school and gone on to university. For some people with challenging behaviours frustration has been relieved and behaviour has improved.
Some people who started spelling slowly with facilitation are now typing independently. And some people who started to use communication aids with facilitation have found their speech has improved significantly.
That doesn’t happen with everybody, but almost all of the thousands of people with severe communication impairments who have been seen by our Communication Centre staff over the past 25 years have been able to improve their communication. And communication – any communication, from being able to answer yes or no upwards - changes the lives of people with disabilities, and the lives of their families and friends.
Facilitation is a last resort
Facilitated communication training is difficult, limiting, time-consuming, and controversial. If you can find another satisfactory way for a person to communicate (that is, a means of communication that allows the person to generate utterances of age-appropriate length) then jump at it. If you can't, try FCT - and try to work your way out of it as soon as is feasible. And while you're using FCT, don't forget to develop independent strategies for answering yes/no questions and making choices. These may involve wide-spaced options for fist pointing or eye-pointing, cards velcroed on a carpet board for grasping, head turns - whatever suits the individual.
A few people find that after typing with facilitation for some years their speech. Others find that with sufficient practice they can learn to use communication devices without assistance. Some people find they can work independently some of the time but revert to dependence when under stress. Some people communicate independently on important matters but use facilitation to speed up communication when they just want to get a simple message across quickly. In either case, the choice should be theirs.
Facilitated communication is not a great way to communicate; however, if you can't make any other way work as well, then FC is better than nothing. Remember that what's really important is the right to communicate.
As the 2008 UN Convention on the Rights of Persons with Disabilities says, we must: "Take all appropriate measures to ensure that persons with disabilities can exercise the right to freedom of expression and opinion, including the freedom to seek, receive and impart information and ideas on an equal basis with others and through all forms of communication of their choice ......."
More detailed information about FCT can be found in the textbook Facilitated Communication Training, Rosemary Crossley, 1994, Teacher's College Press, Columbia University, N.Y.
Will finding a means of communication help with behavioural problems?
Often. Many bad habits are caused by frustration at not being able to say what’s wrong. That said, people without speech tend to have a wide range of problems, and bad habits can get to be, well, habits, and it’s often a slow job working through them.
Will using communication aids stop a child learning to speak?
Often parents are anxious that early use of non-speech communication will prevent a child talking. In fact, there is every indication that the reverse is true. Children who have access to an alternative means of communication speak more, not less. Probably this is because they are encouraged to communicate more and experience more success in communicating. Most of the published research concerns children who have augmented their speech with communication boards or sign. However, many therapists have also observed significant speech improvements in some children after they started using communication aids that talked. Often children try to imitate what the communication aid says.
Ideally young children should continue to receive speech therapy while also learning to use augmentative strategies. It may be some years before it is clear whether a given child’s speech will be functional. We want children to have the best possible chance of developing speech, but children should not be left frustrated, without a means of communication, while waiting on speech.
Does NDIS funding cover therapy at the Anne McDonald Centre?
Yes, if you have it written into your plan.
Does NDIS funding cover communication devices?
Yes, if you have it written into your plan.