Historically, the Speech-Language Pathologist has been the primary agent in the delivery of all aspects of services. They provided diagnostic services, recommended devices, provided related therapy intervention, coordinated funding efforts, dealt with maintenance problems and any other interfering factor that appeared along the way. The commitment was time and energy intense.

Though it is still a fact that Medicaid funding criteria mandates an assessment by a certified, speech-language pathologist, they also require evaluations by an occupational therapist, physical therapist, doctor, vision specialist, and audiologist, as well.

Service coordination is often lacking in this process with no one taking responsibility to achieve consensus, determine consistencies and inconsistencies, and coordinate long and short term goals. A team decision making process is essential and it must be ongoing throughout the entire process.

Consensus among service providers and consumers in the field indicate clearly that AAC intervention is most effective when a team approach is used.

First, we know that communication is highly varied across environments. It is critical for staff in each environment to access the communication successes and breakdowns in each setting. It would be foolish to assume that any one setting reflects the communication skills across all settings. Were that the case, we would all be as comfortable in the superintendent’s office as in our own home. We must respect the differences across environments as natural variations and not presume that one setting must not be as environmentally friendly as another.

Secondly, we know that communication is also highly variable between different partners. It is critical for staff and family members to look at all of the variations noted between different communication partners. Communication skills in one-on-one interactions will vary greatly from the skills needed in larger group settings. Communication skills between partners will also vary with different contexts. The emotional context of the interaction will play a strong role so we need to be very cautious about making assumptions too rapidly. We must recognize that no speaker should be required to like everyone equally or generate the same level of proficiency with all partners.

David Beukelman and Pat Mirenda (Augmentative and Alternative Communication: Management of Severe Communication Disorders in Children and Adults, 1992) describe three models commonly used to provide AAC services.

The Multidisciplinary Team is set up to enable each specialist to independently assess the individual and make their own recommendations appropriate to their specific discipline. Results may be shared at a team meeting and then individual intervention is provided. This system has been termed by many as a medical model.

The Interdisciplinary Team maintains the same assessment procedures as the previous model but then the team meets to discuss findings and make collaborative recommendations. Implementation is often assigned to a particular individual or two. These teams may meet periodically to review progress and consider changes. This has been the most frequently used team process associated with the I.E.P. process.

The Transdisciplinary Team employs a different assessment and intervention format.

All team members collaborate in the assessment and jointly share information to develop goals and objectives together. Then, all members would be responsible for all aspects of care rather than a single specialty area focus.

With this model professionals relinquish their traditional roles, which empowers all members of the team to work in a more holistic fashion. It is important to note that a process called role exchange needs to occur so that there are opportunities for team members to be taught needed skills with some supervision provided.

Roles and responsibilities of the AAC Team need to be discussed and a level of consensus must be achieved so that roles are clear. Problems are likely to arise if only some of the team members accept the Transdisciplinary Team approach while others resist it.

It is also of critical importance to include the AAC user and their family in the team process as active participants.

A key element to the success of a team includes training. It is unrealistic to expect a team member to become an expert in several fields over night.

In addition, many professionals realize that they themselves were not taught needed skills in the area of AAC during their own college training. It is exciting to see our roles and responsibilities in the area of AAC grow.