Professionals’ decision-making in recommending communication aids in the UK: competing considerations

Abstract

Existing research suggests the provision of communication aids for children with complex communication needs can have significant positive impacts on health and quality-of-life. The process of clinical decisionmaking related to the recommendation of high-tech communication aids is not well documented or evaluated, and research evidence related to the provision of these aids remains limited. This study aimed to understand the factors that specialized AAC professionals in the UK consider when recommending hightech communication aids. Purposive sampling was used to recruit teams to six focus groups, each of which centred on a team's recent recommendation process (i.e. a discussion following a real-time assessment session, where the team attempted to arrive at an agreed recommendation for a specific child). Thematic network analysis was used to interpret data from the focus group discussions. Participants identified a wide range of child characteristics, access features, and communication aid attributes in weighing up decisions for individual children. Findings suggest that specialized AAC professionals in the UK prioritize access features over language considerations in their communication aid recommendations. An explanatory model was developed to illustrate the interaction effect that several competing considerations may have on decision-making. Implications for clinical practice and future research are discussed.

Finding the best fit: examining the decision-making of augmentative and alternative communication professionals in the UK using a discrete choice experiment

“…Receptive and expressive language had the lowest RIAI overall, with only a single interaction term in the final model. This contrasts with some previous findings that a child’s language abilities play a large role in selecting an appropriate AAC System 13 28 30 37. One possible explanation is that the aspects of language ability which were most relevant were captured in this study by other child attributes, but this remains a question to be addressed by future research.…”

“…Preinstalled vocabulary sets were always preferred over no preprovided set, in line with other studies showing that selecting core vocabulary was an important part of AAC professionals’ decision-making process 33 37…”

“…Teams also generally make recommendations, rather than unilaterally choosing a system. However, there is evidence that AAC professionals compare the attributes of AAC systems in everyday practice,13 and that they make trade-offs between system attributes,37 akin to DCE tasks. In addition, it is still useful to study the individual decision-making of AAC professionals.…”

“…There is currently a lack of documented evidence for assessment and decision-making processes,33–35 and what does exist is largely individual case studies 3 25 36. AAC professionals must often make difficult and complex decisions in a complicated, heterogeneous and rapidly evolving environment, balancing the needs of an individual child and available resources 30 37. They must also take account of the cultural and contextual influences shaping each assessment 13 38.…”

“…This study was part of a wider project entitled Identifying Appropriate Symbol Communication aids for children who are non-speaking: enhancing clinical decision making (I-ASC) which examined provision of AAC systems for children in the UK. I-ASC had several components, using different research methods30 37 44 45 to generate a body of evidence on current practice and recommendations for best practice. This has resulted in resources to aid AAC decision-making (available at…”