Intervention Planning for Children who use Augmentative and Alternative Communication: Exploring the Expert-Novice Gap in Speech-Language Pathologists’ Clinical Reasoning

Abstract

Although supporting people who use augmentative and alternative communication (AAC) is included in the American Speech-Language-Hearing Association’s certification standards, many speech-language pathologists are not competent supporting AAC (Costigan & Light, 2010; Ratcliff & Beukelman, 1995; Ratcliff, Koul, & Lloyd, 2008). The purposes of the study were to (a) inform a working definition of competency in AAC service provision, and (b) describe the bottlenecks to student learning in this area. The expert-novice gap in intervention planning was explored. Eight experts, practicing speech-language pathologists with work activities primarily related to AAC participated, as well as eight novices, speech-language pathology students who had completed their first semester of graduate study, including an AAC course or clinical practicum. Participants completed two think-aloud tasks. They read two case studies of children who used AAC and thought aloud as they developed intervention plans for therapy. Data were qualitatively analyzed using grounded theory methodology. Member checks and peer debriefing validated the accuracy of the findings. Four themes emerged, representing groups of clinical reasoning skills used by both groups: (1) developing intervention plans, (2) measuring and evaluating progress, (3) decision-making, and (4) teaming. Experts and novices used the following clinical reasoning skills similarly: planning activities, selecting or developing materials, planning teaching strategies, selecting targets, collecting data, goal setting, summarizing, interpreting, hypothesizing, and rationalizing. Clinical reasoning differed across groups in selecting treatment style, feature matching, comparing, deferring, seeking outside input, collaborating, and educating others. Novice speech-language pathologists in the study were developing competency in developing intervention plans, measuring and evaluating progress, decision-making, and teaming. Data analysis provided preliminary evidence that novices were developing skills in generating intervention plans, goal setting, collecting data, seeking outside input, and collaborating, but additional implementation data would be useful in triangulating these findings. Novices needed additional knowledge and skills related to feature matching and educating others. It is recommended that educators help novices build a database of prototypes during their graduate programs, so that they can more effectively compare clients and populations of clients and also defer less frequently during practice. Limitations and recommendations for future research are discussed.