Language and communication have many functions. Halliday (1975) identifies the seven main functions of language as expression of needs and wants, regulation of the actions of others, establishment of social bonds, expression of self, discovery of information, expression of fantasy and make-believe, and giving of information. The goal of facilitated communication is to allow speakers to use language to accomplish all of these functions. To do this, facilitated communication speakers need to be empowered by their facilitators and those with whom they interact. Given the nature of facilitated communication, we know it is possible for facilitated communication speakers to be influenced by their facilitators. So what can we do as facilitators to prevent this and to empower the person with whom we work?

The first step of "change" is always the realization of what we are currently doing. To address this, we will look at some information generated from a study done of facilitated communication users and their facilitators in a sixth grade general education setting (Sabin & Donnellan, 1993). While it is realized that each facilitating dyad utilizes its own unique method of support, Table 1 lists the types of support that are typically given during interactions with facilitated communication.

TABLE I:
SUPPORT GIVEN BY FACILITATORS

Facilitation does not always look the same.The following supports may be combined or used independently:

1. Providing backward resistance to the hand or arm.
2. Returning hand or arm to midline.
3. Supporting the hand.
4. Supporting the wrist.
5. Supporting the arm at forearm, elbow or shoulder.
6. Isolating the index finger or middle finger using the facilitator's hand or adaptive device.
7. Holding legs down and/or holding shoulders back to limit otherbody movement.
8. Holding the non-typing arm back from keyboard or body.
9. Providing physical boundaries (e.g. placing student closer to table to limit the area between student and communicationdevice.)
10. Using whole body to support student.
11. Interrupting, ignoring or verifying verbalizations that occur simultaneously with typing.
12. Giving student verbal or physical cues to initiate and continue communication.
13. Verbally reinforcing student (e.g. "Good work!" "Keep going...")
14. Physically reinforcing student (e.g. tickles, hugs, pats on the back.)
15. Physically manipulating environment or removing stimuli from the area.
16. Holding communication device at more appropriate angle.
17. Modifying posture (e.g. sitting forward, standing, reclining.)
18. Holding sleeve or wristband.
19. Shaking hand until it feels floppy.
20. Stopping for pauses or breaks.
21. Stopping repetitive movements.

You will notice that these supports vary greatly from providing backwards resistance, to modifying posture, to providing physical or verbal cues to initiate or continue communication.

See if you can identify supports which you are currently providing to facilitated communication speakers. Make a list of these supports for each person you facilitate. You may need to add additional supports to your list(s). Once you have done this, talk about these supports with the person(s) you facilitate. Determine if there are ways to empower the person(s) and to lessen your support, enabling them to gain more control. For example, if you wrote down that you always hold the letterboard at a 45 degree angle, explore the use of an angled plastic wedge or talk to an Occupational Therapist about making an angled holder for the letterboard or device. If you wrote down that you support the person with your whole body and need to limit the lower body movement of the facilitated communication speaker, explore the use of a built-up desk top which extends closer to the person's waist when seated in the desk chair. This may provide enough support for the person to sit independently or with only upper-body support. Likewise, if you usually support the facilitated communication speaker under the wrist, talk with the person about holding a shirt sleeve or occasionally supporting from the elbow. One facilitated communication speaker was able to support his typing hand with his other hand. His facilitator was then able to fade to just support at the elbow.

In addition to realizing the physical and verbal types of support given by facilitators, it is also important for facilitators to be aware of the types of decisions they are making during interactions, because these decisions greatly influence how communication occurs. Table 2 lists decisions commonly made during interactions with facilitated communication.

TABLE II:
DECISIONS MADE BY FACILITATORS

Facilitators are active decision-makers during the facilitated communication process. The following list details commonly made decisions:

1. How do I determine student's pace?
2. How long will I wait for responses?
3. When do I rephrase questions asked of student?
4. When do I clarify student's responses?
5. How do I get the communication partner's attention? Should I?
6. Will I facilitate each time the student requests that I do?
7. Should I interpret the student's physical movements for people?
8. Will I initiate conversations with the student? How often?
9. During a conversation, when will I suggest we stop?
10. When should I suggest a break?
11. Should we take a break (e.g. to calm down)?
12. When will I let the student socialize with others?
13. Will I encourage peer interactions? How?
14. Should I check with the student to see if s/he understands what is being asked?
15. If the student is talking to someone else, should I add my comments?
16. When, if ever, do I add my comments?
17. What do I do if the student types something inappropriate?
18. When do I read aloud what the student has typed?
19. Should I respond to the student's verbal speech during typing?
20. When should I adjust the support I give the student's arm?
21. Should I ask the student to retype an unclear message, or guess at the meaning?
22. Will I allow the student to abbreviate words?
23. Am I going to believe everything the student types?
24. What do I do when I know the student is lying or typing inaccurate statements?
25. Should I allow others to read what is being typed?

This list was generated by observing, recording, and analyzing interactions between facilitated communication speakers, their facilitators, and others during a 7-month period (see Sabin & Donnellan, 1993).

Ask yourself "Am I determining the pace or am I allowing the facilitated communication speaker to determine the pace?", "Am I getting a communication partner's attention or am I teaching the facilitated communication speaker how to do that?", "Am I determining who reads or hears what the facilitated communication speaker has typed or am I letting the facilitated communication speaker determine who receives his or her communication?" Do this for each person with whom you facilitate. If you find this difficult to do on paper, wait until the next time you facilitate and then attend to these decisions during your interactions.

For example, during your next conversation, note which of you is determining when to take a break. If you find yourself doing this, discuss this with the facilitated communication speaker and request that he or she take control of that in future conversations. If a person is having a hard time determining when to take a break, you could perhaps talk about physical signs of agitation you notice the person typically doing and increase the person's awareness of these indicators.

Similarly, if you determine that you are adding your comments into conversations between the facilitated communication speaker and another person, you may decide to discontinue that practice so that you only have to work on fading your physical support and not your verbal additions. For example, many facilitators read individual letters or words aloud as they are being typed, but this could really be done by the person who the message is being typed to. Likewise, if you as a facilitator find yourself deciding when to rephrase questions asked of the facilitated communication speaker, you may determine to add a key to the letterboard which says "I don't understand what you are asking" or "Ask me another way" and then have the facilitated communication speaker practice using that key instead of waiting for you to clarify a question.

By identifying the decisions you are making as a facilitator and then gradually teaching the facilitated communication speaker to assume responsibility for those decisions, you will decrease the facilitated communication speakers dependance on you, increase the facilitated communication speaker's autonomy and control during interactions, and empower them to use language and communication to the fullest.

References

• Halliday, M.A.K. (1975). Learning how to mean: Explorations into development of language. New York: Elsevier-North Holland Publishing Co.
• Sabin, L. A. & Donnellan, A. M. (1993). A qualitative study of the process of facilitated communication. Journal of the Association for Persons with Severe Handicaps, 18(3), 200-211.