Speech and language therapy provision for children using augmentative and alternative communication systems

A proportion of children with physical impairments experience significant difficulties in communicating with others and may be recommended augmentative and alternative communication (AAC) systems such as speech synthesizers and symbol charts to support 'natural' communication skills. However, AAC systems are often under-utilized. Parents have identified barriers to AAC system use to include the organization of speech and language therapy. Speech and language therapists are developing services to school-aged children in response to changes in education, health reforms and models of speech and language development. However, there is little evidence for commissioners of children's services about what constitutes 'enough' or 'good' speech and language therapy. This paper examines speech and language therapy provision to 23 children using AAC systems in six London authorities. Research strategies include documenting the amount, type, organization and objectives of provision. Evidence for collaboration between school staff and therapists is explored, analysis is made of child characteristics associated with provision and criteria for decision-making documented through interviews with therapists. However, little conjunction exists between what therapists said guided their decision-making concerning provision and observed provision. For the children surveyed in this study it seems that that provision in amount of therapy is related to educational placement rather than individual needs.