Professionals’ decision-making in recommending communication aids in the UK: competing considerations

Abstract

Existing research suggests the provision of communication aids for children with complex communication needs can have significant positive impacts on health and quality-of-life. The process of clinical decision-making related to the recommendation of high-tech communication aids is not well documented or evaluated, and research evidence related to the provision of these aids remains limited. This study aimed to understand the factors that specialized AAC professionals in the UK consider when recommending high-tech communication aids. Purposive sampling was used to recruit teams to six focus groups, each of which centred on a team’s recent recommendation process (i.e. a discussion following a real-time assessment session, where the team attempted to arrive at an agreed recommendation for a specific child). Thematic network analysis was used to interpret data from the focus group discussions. Participants identified a wide range of child characteristics, access features, and communication aid attributes in weighing up decisions for individual children. Findings suggest that specialized AAC professionals in the UK prioritize access features over language considerations in their communication aid recommendations. An explanatory model was developed to illustrate the interaction effect that several competing considerations may have on decision-making. Implications for clinical practice and future research are discussed.

Keywords:

• Clinical decision-making
• high-tech communication aids
• augmentative and alternative communication
• children
• evidenced-based practice

Note

Acknowledgements

Our thanks to the I-ASC advisory group, Chris Sherlock, Helen Whittle, and Beata Batorowicz for their input into the study.

Disclosure statement

The authors report no conflicts of interest.

Notes

1 The Hub and Spoke model of AAC service provision was commissioned by NHS England. The “Hubs” are specialized high-tech AAC assessment services whose personnel provide consultative services to children and adults who have especially complex requirements. The Hubs also have a responsibility to support service development for local, or “Spoke”, services that provide assessment and intervention to the majority of people who need AAC. This model does not exist in other parts of the UK.

Additional information

Funding

This independent research was funded by the National Institute for Health Research, UK (Health Services & Delivery Research Project: 14/70/153 - Identifying appropriate symbol communication aids for children who are non-speaking: Enhancing clinical decision-making). The views expressed in this article are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.