A new client walks in the door, and the parent hands you a binder with a bunch of random pictures hanging halfway off of it with no rhyme or reason. Or better yet, here’s this iPad app he uses at home that you have never seen, can you program it and teach him how to use it and train all his therapists on it? Tomorrow? Yes, I know we have all been there. In this situation, most people are thinking about the logistics of how to organize and use the system handed to them and train everyone else. That is a task in itself, I know. But before you launch in head first, here are some other things to add to your list:

• What is the previous and current status of the child’s communication system?  You want to know if the child has experience using a picture exchange system, signs, different iPad apps, etc. The approach to this will be different if you have a child who is brand new to a functional communication system or if they are a seasoned learner with lots of different modes under their belt. Maybe she/he is a proficient communicator regardless of the system. It is also possible there is a long history of confusion with several methods used at once or inconsistency at home or school. If that is the case, your program needs to be highly structured to be successful. All of this is essential information to know before you start anything.

• What are you trying to accomplish in the short and long term?  Your assessment and experience may tell you that this child is likely going to be a verbal communicator, and an AAC system is just going to be a bridge to get there over the next several months. This child may already be talking, has pretty good motor skills, is very active, and needs that push to initiate communication. In that case, instead of messing with an elaborate program, you might start with some signs and see how it goes. Or maybe this child is someone who will need a system to be set up to grow with them over time. In that case, you might choose an iPad program. Whatever the case may be, think through your ultimate goals before deciding what to do.

• Who is going to be in charge of initial programming/organization and ongoing maintenance of the AAC system? Where AAC is concerned, we are still living in the wild, wild west. There are no rules for this. I have worked in places where the Lead RBT does this; I have worked in situations where the Speech-Language Pathologist (SLP) does this; I have worked where the Special Education Teacher does this; I have worked in places where the parent does this. I have my own opinions on who should do what, but that’s a different topic. Regardless of who does it, there needs to be someone in charge of it. If not, what will happen is everyone will be expecting someone else to do it and everyone will be frustrated that the program is such a mess! There needs to be a designated person in charge. Don’t get me wrong; specific tasks can be delegated, but ultimately there has to be a “boss” of the AAC program for that child.

• What is the status of the buy-in with mom and dad? This is important because no matter how amazing and elaborate your program is if a parent is not involved in a meaningful way, that is going to change the outcome of therapy. Now if you are working with a child who has “less” involved parents, does that mean you don’t teach that child functional communication? NO. But you will need to be thoughtful in how you go about things. For example, you might have an involved, stay-at-home parent who has a picture exchange system to promote communication in every room. You may work with them on how to prompt speech with their already existing system. Or perhaps you have a parent who is very busy working, has other kids at home and is always on the move; in that case, you might consider that this person is not going to take your beautiful PECS book everywhere he/she goes. And that’s okay. Maybe it’s a better option for that child to use signs at home because you know that is what the parent can handle. Every situation is different, and it is essential to recognize the role an AAC system will play in the real world outside of your clinic or school.

• How are all the individuals on the child’s team going to communicate with one another with the selected AAC system when things change or questions arise? You are on your own with that one! All jokes aside, this is the hardest part of the whole process of using an AAC system to develop functional communication for a child. This is why dedication to collaboration is so important. If this is not done consistently, it can make learning to communicate more difficult for him or her. There is no wrong or right answer here. It does not matter what it is or how it is developed, but there needs to be a clear system for this. If you come up with something great, please share!