#193: Writing AAC Goals with Rachel Madel

Marisha Mets (00:00)

Hello there and welcome to the SLP Now podcast. I'm really excited to be continuing our Goal series. We are going to be chatting about goals for AAC with Rachel Maydell. She is a board certified speech language pathologist and AAC specialist. She also co -hosts the podcast Talking with Tech, which is an incredible resource. And she's also been featured in tons of publications and

has created some amazing courses. And so I'm gonna turn it over to Rachel. So hi, Rachel, welcome. Hi, I'm so excited to be here. Yeah, I'm so excited to have you and to dive into this conversation. And I'm curious, just before we start chatting about all things goals, how did you end up learning so much about AAC and having this become your specialty? You know, I always like to share the story.

when I was in graduate school, I remember walking into a preschool classroom and seeing a few of the students using picture exchange and watching the SLP that we were kind of there to observe just using pictures and visual supports. And I remember thinking to myself, like, why is she just not working on having them talk? And so I'm just like, wow, like young, like fresh me.

just being so judgy about AAC. And it's ironic that that's now my specialty and definitely an area of passion for me. But I think it's a testament to not truly understanding the power of visual supports, the power of AAC. And so very quickly I realized that many students benefit from AAC. And I was in a situation early on in my career where

I had a lot of students that just weren't making progress with traditional approaches with, you know, they weren't imitating verbally. They didn't have a lot of sounds. their speech was very inconsistent and unreliable. And I remember one of my first cases where I was like, okay, I think this is a really good candidate for AAC. Like, let me call the AAC specialists. And she came in and helped support, you know, me in kind of an assessment and

it was incredible to see the progress that we could make. And so as soon as I had that experience, I was just like, okay, what other kids could I introduce AAC to? And then one thing led to the next. And my personality is very much intense rabbit holes of research. And so as soon as I was just like, my gosh, I need to learn more about AAC. I don't know, hours and hours and hours later, I...

was like, is so awesome. And the more I learned, the more I integrated into my clinical practice. And then here we are. And now I'm like teaching others about AAC. it's definitely an area of passion for me simply because the kids that were helping to support communication with AAC, they're very complex cases oftentimes. And communication is not coming easily. And it's become, you know,

a passion of mine to help support that population of students because it can feel very overwhelming as a parent. And I've had a lot of families come to me in my practice and just feel hopeless that like nothing will work. And when we get the right tool in front of a student and we know how to utilize that tool and support them through that tool, it's really incredible to see language develop, to see all different skills.

and really get to know who that student is because now we have a way to connect with them. And so that's kind of the short version of how I got interested in it and I think why I'm so passionate about it. Yeah, I love that. And I could just see you lighting up. That passion definitely comes through. I love that. so the goal of this podcast is to chat about goals and help SLPs navigate that.

But that's clearly a very small piece of the puzzle when we're thinking about our ultimate goal of helping students, students a form of communication. And we're thinking about high quality assessment and implementing treatment strategies and all of that. So what are your favorite resources? Maybe we can just call out a few things or maybe just mindset types of things just to help SLPs

navigate those elements and maybe point them towards some resources. Yeah. So I think the first thing to mention is that if you're working with students, making sure that they have access to a robust AAC system. So it's like, before we can dive into kind of the goals, like we need to make sure that we have all the elements of an AAC system that will help support our students fully.

And so when I'm thinking about robust AAC, I'm making sure that that system has access to lots of core language. It's not just a bunch of nouns. It supports motor planning for communication, which we know is so important when it comes to AAC, meaning the buttons don't move and they stay in one place. The more kind of touches you need on an AAC device to get to where you're going, the harder it becomes, the longer the motor plan.

the more complex it is, the less likely our students are going to be communicating with us. And the less likely communication partners are going to be modeling on that device if it's six hits to get to where I'm going. so motor planning becomes an important principle of robust AAC grammar, being able to change from singular to plural, from regular tense to past tense and future tense. All of those things become really important.

And another huge one is access to a keyboard and literacy. Because we know that we can only program so many words into an AAC system. We have to give kids access to letters and spelling so that they can fully communicate all the things that they want to share and what they want to say. And so those are kind of like the big points. So if you're working with a student who doesn't have access to high tech, robust AAC, then there's definitely some,

things that you can do to start trialing, it's okay, because that's the reality of the nature of the work that we do, right? I just saw a kid the other day and he's using a pecs book and I'm like, okay, like how do we start aligning that student on a trajectory for high tech robust AAC? And so I just wanna kind of call that out because I think that sometimes we can feel like stuck as clinicians, like, okay, like I know that.

He might be a good candidate for something more robust or I don't know the private SLP recommended this system, but I'm not seeing a keyboard and I'm not seeing core language. so definitely making sure that our students are on that path because so often I see families come to me in my practice with AAC systems that are already set up. And I'm like, there's some tweaks that we need to make here because

This is just like a bunch of nouns, right? We know we need lots of different parts of speech and all of those kinds of elements of robust AAC. So I wanna start there just because I think it's an important reminder for everyone. Does it necessarily have to be high tech? Although that's the easiest for most students in this day and age, but there are things like pod books and things that are robust that are not necessarily on a high tech speech generating device. But for most of our students, we're looking towards high tech.

and so anyway, I just want to, I want to share that first and foremost. Yeah. And I think this is, cause I feel like in grad school, in my AAC class, they went through like all of the different options and there is kind of like, if we see these things, like use this type of system. and I feel like that's one thing that I've learned from you is that like, like, like, there anyone who you wouldn't use? Like anything that would exclude a kiddo from using, like a

high tech device that has that robust AAC system with the core language supporting more motor planning? No, the only exception potentially to that would be a student who is really young and we're just trying to get them initiating on AAC. So I just did that assessment with that kid with the PEX book. We actually recommended more of a stepping stone AAC, which is what I like to call it. It's like not

Super robust, however, we know that we're not gonna stay there forever. And I'm very clear with the family and the whole team, like we're using the system so that we can improve fine motor so that we can eventually get to this system. And I show that system, that kind of end goal. So that would be the only exception. Sometimes we need an in -between system where we're trying to really target the fine motor and just kind of.

get this young little one to understand the cause and effect of an AAC system. But no, I feel like so often we can go directly to high tech AAC and have a lot of success. I think it's a myth that we need to get to a certain level of PEGs or we need to try paper -based or light tech AAC before we do something robust. I've worked with two -year -olds that are on a high tech robust AAC system.

Granted, have to make some modifications sometimes and use some masking of some of the vocabulary, but like it's really cool that we can, you know, right out of the gate, start with something more robust. And again, we have to design with the end in mind, meaning if we know this is where we're headed, then like we need to get there as soon as possible and kind of reverse engineer our ways, our way back instead of like, well, right now.

gonna start with this system that has super big buttons and there's only six words on the screen. And it's like, that might be where the student is now, but if that's not where we want them to go, then we're gonna have to change the system over time. And so my biggest concern is that I don't wanna have to change that AAC system if I can avoid it. Cause that's like metaphorically pulling the rug out from underneath a student, like to completely change their AAC system takes time and.

all of that energy we've spent for that first system, now we have to kind of start fresh with a new one. So my goal in an assessment and the selection process is like, how can we get to that end goal and then work our way back? It's like, okay, we know we want this system long -term. How do we make those modifications to help support it more? They are currently knowing that over time, these skills will build, their vocabulary will build, all of these things will improve and we'll be in a really solid place.

Yeah. And it's almost like a kid starting preschool in English, and then he starts to master it. And then in kindergarten, like, just kidding. We have to speak Spanish now. It's almost like telling them to learn a whole new language because they're starting over with that motor plan and all new icons and all of that. So yeah, that makes sense. OK. And then anything else you wanted to share?

No, I mean, that is just like a really important reminder. And if you think that it is student might benefit from AAC, like you're right. So like try it. AAC hurts no one, helps everyone. And if it's not necessary, eventually we don't need to use it, but it can definitely be such a great support for students in learning language. Even, you know, many of the students in my practice, they have verbal speech. They just, they're autistic and it's not consistent and reliable. And so they need some type of backup.

And so there's so many different ways that you can utilize AAC to help support students. Yeah, I love that. Great. So should we start diving into some goal chat now? Yes, let's go. So because I feel like we could talk about this for hours and hours and hours. But if you were sitting down with an SLP who is like,

Okay, so I have this new AAC kiddo. Like, what do I think about as I start to navigate goals? Like, what would you say? Yeah, I mean, I think that it comes down to a few different areas that I like to think through when I'm thinking about goals for an AAC student, especially one who's an emergent communicator, because oftentimes kids that are getting AAC...

they're just kind of starting off now having an OO, a way that's reliable to express themselves. And so we're really thinking through that lens of emergent communicator, even if they're 12 or 15 or the age doesn't really matter, right? An emergent communicator is just starting off with language, just starting off, you know, with AAC especially. And so I like to think about how is this student currently

initiating communication because so often I see that especially if they haven't had access to AAC, even if they have some verbal speech, these students become very prompt dependent. And so they're not really initiating communication. And so I'd say 95 % of the students that I start working with, my primary goal is to work on independent initiation.

And that can be across any modality of communication, meaning it doesn't have to just be with AAC, but I really need kids independently initiating more. And the reason why I need that is because one, we know how quickly and easily students can become prompt dependent. And one way to think about this is if you are looking at a student and you're doing an assessment or this is a student that's on your caseload,

happens when you take all of the supports away, meaning like you're not prompting them, you're not asking them a question, you're not modeling language, like what are we left with? And that would be, you know, spontaneous language sample, right? Like what is a student saying completely on their own? And when I, and this is an exercise that I actually have communication partners do. Parents, like when I first meet a student, I send them home with a tracking sheet. like, tell me what your child said and in what context throughout the next week before I see you next.

and we're gonna look at that together. Same thing with teachers. You can even do this, you know, if you're doing an observation with a student that's brand new to your caseload or not brand new, just observe in the classroom, what are they saying? And oftentimes it's not a lot of communication. And so my first goal is how do we get kids more independently initiating communication? Again, whatever modality, it's just important that kids are initiating.

And the reason that becomes so important is because it really forces the communication partners around a child to pull back and give them space and wait time. And all these beautiful strategies that we know are so important to allow kids the space to become independent with their communication. And so that's the number one, I'd say goal area for me. And of course it's looking at what a student's currently doing and building off of those strengths.

But so often I really want to build up the current communication they have and I want to get them using that communication more independently. And that can be a huge shift again, because it's like, seems pretty straightforward. It's like, yeah, independent initiation. However, in order to get there, you often have to do a lot of training and support with the communication partners because

Communication partners like teachers and paraprofessionals, parents, they're jumping in, they're asking the question. They're saying, tell me on your talker, tell me, what do you want? They're giving us super high levels of support. But once you train communication partners to kind of tempt, pause, just give space, all of a sudden we see kids initiating communication more. And then we have a really strong foundation to expand vocabulary.

to go into all of the of nuances that many people think of when they're thinking about goals for AAC students. But if we don't have independent initiation, then we're not going to get very far without super high levels of prompting. And at the end of the day, when I send my student off, like I want them to be able to independently communicate and such an important thing. And again, it takes a lot of kind of training of the circle of support.

But when you see that, and you can oftentimes see that happen pretty quickly if you are capitalizing on what a student's motivated by and you're really doing that communication partner training, that can be huge. And again, you're not coming in with something brand new. It's like building off of the communication the child's already showing you. And so that is a huge topic area for goals, in my opinion. Yeah, I love that. And that makes a lot of sense because we're

if we're focusing on what they're independently communicating, that's what's going to be most important to them and most functional too. Like that's how they communicate. So we can easily work off of that too. Exactly. And when you see that spontaneous language sample come back, right? It's like, I know there's intrinsic motivation for communication because these are the things you were motivated to say in the last week. And so it shows me exactly what kids are motivated by. It's like,

Okay, they said iPad, they said outside, they said more when it comes to jumping on the trampoline, right? It's like so obvious what they're currently motivated by. And then if we look at that, then we can figure out ways to expand on what they're currently doing spontaneously. And that's really how you figure out targets for vocabulary is, you know, take that spontaneous language sample and then figure out how can I maybe...

If this student's using primarily nouns, it's like, how do I expand into more core language? Which gets me into the other topic area of goals, which is really important is like core language, right? So many of my students are using mostly nouns for communication and we can expand that into core language. There's opportunities when a child says their favorite food to then model eat or drink, right? And so it, but if the,

if you're trying to figure out goals, the best way to do that is to see what a child's communicating independently and spontaneously. And again, build off of that, because you have so much information there about what a child's currently doing. And we don't have to come out of the field with something brand new. It's just like, no, get them better at what they're already doing and nudging them in the right direction as far as expanding into more core language. Another one is pragmatic functions.

Many kids are just using requesting. And so how do we expand their pragmatic functions? These are all things I'm thinking about when I'm looking at that spontaneous language sample to figure out like, okay, where does this child actually need to go? You know, that would make a big impact for them. And those are kind of topic areas that I'm ticking off those boxes. I'm like, yes, most kids need to work on independent and initiation. Many of them need work with more core language and

many of them also are only using language for requesting for the most part. And so I need to expand into all the different reasons that we use language. Yeah, I love that. And then are those like the three main areas that you think about to start or is there anything you would add? Yeah, I mean, there's other kind of topic areas. say I'm working with a student who

I would consider it to be a primarily verbal communicator, meaning they are speaking and talking and the reason that they need AAC is because no one understands what they're communicating and what they're saying. So they have really low speech intelligibility. So for that student, I'd be thinking through repairing communication breakdowns, right? And so that's an area where I would certainly be writing a goal for repairing breakdowns because

So often our students don't even know that there was a breakdown. Like they're not even aware. So it's like building awareness. Like you were not understood my friend. Like, you know, cause oftentimes kids will say the same thing in the same way. And unfortunately some kids don't have the ability to say something more intelligibly. And so my primary goal for that student is getting them to understand, to go say it a different way, i .e. go to their

talker and say it using AAC. But there's very specific things you can do with kids to show that there's a communication breakdown. I'm a really big advocate of being super confused and like, how with this super confused face and my hands up in the air. Those are gestural cues to a student that they're not being understood. It's a naturally occurring thing that we can.

and exaggerate for our students so they can understand, someone's not understanding me right now. And then, you know, making sure that we're scaffolding that support for students. If every time they're not understood, we jump in and we say, tell me on your talker. Then guess what? That child's never gonna learn how to independently go to their AAC and tell you.

because we just come in with that prompt and like, they're like, okay, great, someone just puts my AAC device in front of me and that's what reminds my brain that I can use this, right? So again, it's kind of scaffolding that support so that we can, again, move towards independence. And so that would be one area that if you're working with a student who has verbal speech and is primarily a verbal communicator, they're excited to say things verbally even if they're not intelligible.

Repairing communication breakdowns would be a really big goal area. Yeah, that's great. And this has been a really nice overview of different areas to think about. so hopefully anyone listening feels like, I might have some goals for independent initiation or vocabulary or pragmatic functions. And that would be a good place to start. But if someone is wanting to learn more,

and dive more into all of the goals and all of that. Do you have any resources that you'd recommend? I actually am launching a brand new course. So I have a course called AAC Ally. It's the assessment version, but I'm really excited this fall I'm releasing the treatment edition and I go into tons of details about goals. I actually had an interview on talking with tech with Rachel Dorsey. Rachel Dorsey is

all about neurodiversity affirming practices. She's an autistic adult who talked in detail about goals for AAC. And one thing that I loved during that interview, and this was years ago that I had her on the podcast, but she said she always adds to the beginning of her goals for an AAC user when given unrestricted access to AAC, student will. And I've been like using that ever since. like, yes, I love this.

because it reminds everyone on the team to get that device. This device needs to be in front of the student all the time. I love that and it's actually a really great resource. can send you the show notes. Should I send you the link for the show notes? Because that's just a really, really great interview. Those are the big things that I'm thinking through when I'm thinking through goals and resources. We oftentimes will touch on these things during talking with tech.

But that episode in particular, feel like we really go into goals. And I know Rachel Dorsey has, I believe, a course on goal writing, which again, like she's a big proponent of an advocate of AAC. And yeah, I know that that is something that we're thinking through too, right? It's the goals that we're writing need to be based in neurodiversity affirming practices. And I'm always thinking through that lens too. And one other thing I'll add is that

You know, I think that when you're writing a goal, you have to consider the entire team around a student. And I think that, you know, there's ways that you can kind of build in these safeguards. So say a student doesn't have a lot of core language and you don't see a lot of modeling happening in the classroom. You can write in the goal.

when given aided language import or when given a model on their AAC, student will. And so I just wanna share that because there's ways that you can embed things into a goal that really help get that team bought in, get that team on board. AAC is for everyone. so it's like integrating into all the different goals and in IEP, I think is really important. And so.

Those are just some things too, to kind of keep in mind and consider. Just because I feel like we have an opportunity to integrate and embed AAC into an IEP in very strategic ways. And so that would be one more kind of piece of advice that I would give. Yeah, that's great. And I will make sure to add the links to the courses in the show notes and then also

The interview with Rachel Dorsey sounds great. And so I'll add all of those resources in the show notes so they're easy to find. then, so just a quick recap of the things we talked about. So we talked about considering independent initiation and then using the spontaneous language sample to help as a jumping off point to look at vocabulary goals, pragmatic function goals, and then

I love the snippet that you gave, like when given unrestricted access to AAC. And then definitely diving into Rachel's episode for more details on things to consider for those neurodiversity affirming goals. And then to consider that entire team. And like, if we're not seeing that modeling in the classroom, we can add a phrase like when given aided language stimulation. And I'm sure

that your AAC Ally course goes in or no, would it be the new course that goes into more of this? So they're both going to be called AAC Ally. So it's AAC Ally assessment, AAC Ally entry. So yes, it will definitely go into a lot more detail. There's a whole module on goal writing for AAC because it was an area that many people wrote to me about for the original AAC Ally assessment version. And I was like, man, like I need to help support the goal writing process. That's like such a big piece of this.

So yeah, there's a whole module on goal writing. Awesome. And then also, because I think a huge part of this is supporting the students environment. So of course there's things that we are going to teach the student, but we can potentially have way more impact by training the communication partners in their environment too. So I'm sure you dive into all of those. Totally. Well, that's the thing is like we

in order to be successful in this work, we have to actually be coaching communication partners. And so the other element of this is how do I help communication partners set goals for themselves? How do I help a teacher set a goal for how much she's gonna model during her specific lesson? How do I help a parent figure out how they're going to model this specific word?

in this routine. And so, you know, of course we have goals for our students, but we also can have goals for communication partners and help that communication partner set a goal. And we also can have goals for ourselves if we're new to AAC and we're like, I'm not even sure how to model. You know, we can have those goals for ourselves. And so I feel like the goal writing process can actually be a lot larger than just thinking about the goals for our students.

And yeah, I mean, that's what I do all day is I coach communication partners and part of that coaching is like, okay, we're all gonna, we're gonna sum it up and like, how are we gonna integrate this? How are we gonna make this a part of our routine? How are we gonna create these healthy habits so that it feels more seamless? Because I understand that AAC can feel very daunting and overwhelming and we have an opportunity to start integrating into people's routines in a way that feels really easy and achievable.

and we can kind of build off of those small wins. so, yeah, goal writing, we're in like a goal -writing matrix when we're thinking about AAC, because it's like, there's goals for me, there's goals for communication partners, there's goals for students. Yeah. I love, that's great. So many good things. Thank you so much for breaking this down for us. This was really helpful, and I'm excited to dive into the other resources too, because we're never done learning. There's always more.

Totally, I feel the same way. like, okay, like I get the chance to do a lot of, you know, presenting and speaking at conferences and things. And I'm always like so excited for the learning that happens because we all have our own unique experience and we all have really incredible ideas. And so it's like the more you are just curious to learn, I think the better a clinician you can be. And so it's just really exciting in this day and age how easy information is to get access to.

Yeah, I'm always curious to learn more. And I'm so thankful that I have so many people around me that are able to teach me and help me become a better clinician. Yeah. Yeah. And I'm grateful that you're one of those people who are me. So yeah, thank you so much for your time. This was amazing. And then again, check the link to the show notes is like in the description of the episode. So if you're listening and want access to those resources, go check it out and then.

Yeah. Amazing. Thank you. Thank you so much for having me. This was so fun.