How to use this section:

The information included in this section should be read by anyone involved in facilitated communication, or anyone involved in considering the use of facilitated communication by someone with a communication impairment. Administrators and program coordinators are encouraged to make the contents of this section available to anyone involved in supporting a current or potential facilitated communication user.

This section contains a summary of currently acknowledged best practices related to the responsible, effective and sustainable implementation of facilitated communication training (FCT); it also grounds these practices in a set of beliefs and values which inform and sustain them.  The principles and practices here can serve as a basis for

• evaluating existing services;
• setting goals and a long-range direction for services being planned; and
• bringing collaborative teams "up to speed" on this aspect of their shared enterprise.

1. Citizenship and the Presumption of Competence

Citizenship is membership in a community which is a person's by right, regardless of her or his specific qualities, skills or characteristics. Citizenship carries with it a presumption that a person's interests and those of her or his community are somehow intimately linked with each other.

Acknowledging the citizenship status of individuals with significantly impaired communication directs us towards making certain presumptions on behalf of those persons -- most specifically, that they belong in, and have a direct interest in, the surrounding community, and that they are capable of communicating when properly supported with the assistance of appropriate aids and techniques.

It is especially important that difficulties with communication not be taken as evidence of intellectual incompetence. Although a person may be unable to demonstrate what she or he thinks and feels, or may have great difficulty being understood, she or he should not be further handicapped by the attitudes of others.

2. The Right to Communicate

The right to communicate is both a basic human right and the means by which all other rights are realized. All people communicate. In the name of fully realizing the guarantee of individual rights, we must ensure:

• that all people have a means of communication which allows their fullest participation in the wider world;
• that people can communicate using their chosen method;
• and that their communication is heeded by others.

Where people lack an adequate communication system, they deserve to have others try with them to discover and secure an appropriate system. No person should have this right denied because they have been diagnosed as having a particular disability. Access to effective means of communication is a free speech issue (TASH, Resolution on the Right to Communicate, November, 1992).

3. Empowering the Facilitated Communication User

Language and communication have many functions. For example, 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 facilitated communication users to use language to accomplish all of these functions.

To do this, facilitated communication users need to be provided with opportunities for empowerment. This is accomplished through the shared efforts of facilitated communication users, their facilitators and those with whom they interact. As in all forms of communication, especially those where prominent power and status differences exist among the participants, we know it is possible for facilitated communication users to be influenced by their facilitators.

So what can we do as facilitators to acknowledge and take responsibility for this while supporting the empowerment of the person with whom we work? The first step in changing our practices is always our awareness of those practices.. We can ask ourselves such questions as, "Am I determining the pace or am I allowing the facilitated communication user to determine the pace?", "Am I getting a third person's attention or am I teaching the facilitated communication user how to do that?", "Am I determining who reads or hears what the facilitated communication user has typed, or am I letting the facilitated communication user determine who receives his or her communication?"

By identifying the decisions one makes as a facilitator, sharing that information with the facilitated communication user, and then gradually helping the facilitated communication user to assume responsibility for those decisions, we decrease the facilitated communication user's dependence on the facilitator, increase the facilitated communication user's autonomy and control during interactions, and empower each individual to use language and communication to the fullest (Sabin, 1994).

4. Total Communication Approach

The approach of facilitated communication training is not meant to replace established, effective strategies currently being used by a person; rather, it is meant to provide a means whereby that person can expand current strategies and develop a more comprehensive means of expression. As a person learns to use facilitated communication, his or her current strategies should not be ignored but utilized, both to build intent and to expand his or her interactions. Facilitated communication should always be offered as part of a full system of strategies which might include sign language, simple gestures and facial expressions, single words and phrases, and independent pointing. This would allow a person the greatest opportunity to communicate in various situations and to decide which strategy can be used most effectively in a given circumstance. New communication strategies may develop from the use of facilitated communication; for example, many individuals who use facilitated communication have experienced an increase in their ability to use speech effectively. It is expected that, over time, individual facilitated communication users will grow in their use of facilitated communication, and that the ways they use facilitated communication will change. This might include both changes in the way they use it to interact with others, and in the way they combine facilitated communication with other communication strategies. Facilitators need to be ready to

1. provide appropriate support,
2. use an effective combination of strategies, and
3. promote the user's ability to change the combination of strategies to improve effectiveness (e.g., using word prediction software, reading aloud what is typed).

5. Collaborative Team Approach

Support and commitment from an aid user's team (program planning team, circle of support, etc.) is critical to long term success with augmentative/alternative communication (AAC) and facilitated communication training. In order to be empowered and personally invested in any communication evaluation, planning, and teaching/learning, the aide user must be included and involved from the outset, and on a regular ongoing basis, in decisions which relate to

• the types and levels of support that person needs for successful communication;
• activities, therapy and training to be undertaken;
• communication aids and devices to be used; and
• plans for dealing with specific concerns.

In addition to the facilitated communication user, parents, other family members, and others who know the person well will usually play a vital role in obtaining and providing this information, in initiating action, and in other aspects of the decision-making process.

It is important to gain consensus from the team on the use of facilitated communication training when an individual has been assessed as a candidate for training. While members of a team may have varying perspectives on the efficacy and validity of facilitated communication, it is helpful that their discussions not become polarized. To assist team members in making decisions about the use of facilitated communication, they should all receive the most current information on what facilitated communication is and how it works as well as a comprehensive look at the issues surrounding it. They need to be able to understand why the person they are involved with might be a good candidate. As part of this educational process, it is helpful to have people with extensive experience with facilitated communication and a broad range of other AAC approaches available to answer questions, provide new information, and problem solve around specific issues and concerns. In the end, the individual and his or her team must determine the appropriateness of facilitated communication training and other educational and augmentative approaches to communication, and whether or not to pursue them.

6. Assessment

In order for facilitated communication training to be considered and successfully implemented, two things must occur: an individual needs to be identified as a candidate and those who support that individual need to show commitment to the training process. Both of these elements begin with the assessment.

The goal of assessment in facilitated communication training is to determine the benefit of facilitated communication for an individual, and, if applicable, give recommendations concerning the specific use of the method with that candidate. In determining the benefit of facilitated communication training for an individual, the following should be taken into consideration:

• current communication strategies,
• current and past use of AAC strategies,
• independent pointing skills,
• history and current description of movement problems,
• current and past use of support strategies across the person's range of social contexts.

In cases where other AAC strategies have been effective, facilitated communication training may be considered as an additional benefit. In cases where current communication strategies are ineffective and AAC strategies have not been tried, facilitated communication training may be recommended on the basis of significant and specific movement problems. It is important to note that facilitated communication training is not seen as a substitute for AAC approaches, but rather as a way of effectively and rapidly gaining access to a wider range of AAC than might otherwise be possible.

Minimally, people are considered candidates if they have no speech or their speech is limited, erratic or inconsistent; and if their ability to point independently is not consistently reliable. It is not necessary that the person demonstrate literacy skills in the assessment in order to be considered a candidate. The assessment should carefully consider what has been tried, and what has been effective. It should compare independent skills with facilitated skills and have a rationale for the need for support through facilitation by the potential candidate. It should also consider the effectiveness of other support strategies such as structuring communicative interactions, making environmental accommodations, and using routines and scripts.

If it is determined that facilitated communication training would benefit an individual, recommendations should be given through the assessment that helps develop the person's initial use of facilitated communication. Recommendations should include

• specific support strategies for dealing with hand function issues (e.g., the amount of resistance and pull back needed)
• specific support strategies for general movement issues (e.g., support for trunk positioning and eye gaze)
• minimum effective level of physical support (i.e., degree of fading achieved while allowing for reasonably accurate pointing)
• optimal positioning of the candidate and the device relative to each other
• description of observed literacy skills
• device options, with recommendations addressing both short-range and longer-range access issues
• other supports necessary for successful communication (e.g., the commitment of the support team to create a positive environment, give consistent access, and allow time to practice)
• strategies that would enable the user to focus his or her attention on the task at hand
• plans for a continuing training process, including scheduling designed to optimize opportunities for effective practice for the candidate and his or her facilitators.

If a person is thought to be a candidate for facilitated communication training, he or she should be properly assessed by an experienced facilitator who has been trained to do assessments. An assessment for the use of facilitated communication should preferably be done by a communication therapist with extensive experience in facilitated communication, or lacking that, by a para-professional trained in AAC.

7. Elements of Facilitated Communication Training

Facilitated communication is a type of Augmentative/Alternative Communication (AAC) for people who do not speak or whose speech is highly limited and disordered, and who cannot point reliably (Biklen & Cardinal, 1997; Crossley, 1994). The method has been used by people with autism, Down syndrome, cerebral palsy, pervasive developmental disorders, and other developmental disabilities (Crossley & Remington-Gurney, 1992; Biklen, 1993; Crossley & McDonald, 1980; and Crossley, 1994).

Facilitated communication training involves developing communication skills through pointing (e.g., typing or pointing at pictures or letters) with a partner, or facilitator. The facilitator provides physical support (e.g., holding the person's wrist or forearm during pointing, providing backward resistance as the person tries to move the arm forward to point, placing a hand on the shoulder as the person points or types). This support is helpful in overcoming such movement-related difficulties as tremor, impulsivity, low muscle tone, poor eye-hand coordination, and/or difficulty in forefinger isolation (Crossley, 1994).

Facilitated communication training also involves far more than physical support. Like training in all AAC methods, it involves

• various forms of prompts and cues, (e.g., constant feedback concerning the letters typed or pictures and letters pointed to, reminders to look at the target, verbal cues to start pointing or to stop pointing repeatedly at one target item, the asking of clarification questions, such as "I'm not sure what you mean by that, could you explain?"), and
• encouragement and emotional support (e.g., "Keep going, you're doing fine" or "Go ahead, you can do it").

Central to best practice is facilitator attention to providing quality feedback/monitoring for the facilitated communication user. Crossley (1996) has described the key elements, including these:

• Monitoring to make sure the facilitated communication user looks at the communication board.
• Facilitator saying each letter as it is indicated; otherwise, the communication user has no way of knowing if he or she had conveyed what was intended. Some communication devices have voice output. Those with visual display may still not provide any guarantee of sufficient feedback if the facilitator is not certain that the person is focusing on the monitor or other display as well as on the letters to which he or she is pointing.
• The communication board or device needs to include correction strategies, especially a delete key and back space.
• The facilitator needs to teach correction strategies to correct errors; the facilitated communication user should be given the confidence (through encouragement) to correct his or her communication partners' (i.e., facilitators') errors if they miscall letters.
• The facilitator needs to check with the facilitated communication user both during the writing of the message and once the message is complete to ensure that the facilitator got it right.

8. Introducing the Technique

The information learned in the assessment process is used to develop a plan for teaching skills to the communicator and for providing supports to people who would be facilitators for that person. This process of "getting started" is highly individual, but can be guided by the following considerations:

• Follow the recommendations of the assessment regarding choice of hand, type of support, and seating.
• Plan in advance the choice and position of device(s), and appropriate activities for getting started.
• Establish a regular schedule by which the practice of pointing through facilitation can develop.
• Clearly explain to the communicator what is being done and why, and have the use of the technique demonstrated either by an experienced facilitated communication user, or through use of a video.
• Use challenging material that is meaningful to the communicator.
• Structure activities to maximize the success of the communicator.
• Provide varied and open ended activities, allowing for the opportunity for complex communication.
• Treat the person as a competent communicator, one who has ideas and feelings to share.
• Support the communicator in avoiding or interrupting verbal and typed echoes when they interfere with communication which accurately expresses the communicator's intent.
• Support the communicator in controlling difficult behavior.
• Work with a patient, positive, and persistent attitude.

For communicators who are new to the use of facilitated communication, it is vital that the getting started process be done with the involvement of an experienced facilitator. This person could work directly with the communicator in the getting started process; conversely, he or she could support others to work directly with the communicator. It is important that new and inexperienced facilitators receive training and supervision to ensure appropriate and effective use of the method, as described in Section III of this document.

Communicators who are experienced facilitated communication users often need to train new facilitators so that they can have continued access to communication. As in the situation with a new communicator, it is important that an experienced facilitator/trainer be involved in the process, providing supervision while the new facilitator is developing the skills of support.

It is imperative that a communicator have more than one person as a facilitator. Every communicator using facilitated communication should have multiple facilitators in his/her life. This means that getting started should involve more than one person as a new facilitator. It is helpful to involve people from the various aspects of that person's life, so that facilitation is not available only in a limited range of settings.

9. Independence

A primary, long-term goal of facilitated communication training is independent communication. This goal involves

• being able to access communication aids without physical support;
• being able to initiate the process of communication with others; and
• exercising control over the content of one's communication.

The fading of physical support should begin at the outset of the training process, with both facilitators and facilitated communication users aware of the importance of this goal.

Achieving independence is a collaborative and dynamic process. It needs to be viewed within the broader context of individuals' progress towards greater self-determination in their lives. It is critical, therefore, that facilitated communication users be involved on an ongoing basis in decisions relating to the development of plans and strategies for independence. One significant factor in this involvement is the opportunity for facilitated communication users to observe, either in person or by means of videos, other facilitated communication users who have succeeded in typing independently. Facilitators need to be skilled in adjusting their levels of support depending on the content of an individual's communication, the situations those individuals are in, and their particular emotional and physical states. Some people may be able to type independently in social situations where the messages are short and routine, whereas if they are writing an academic course paper, they may need physical support to handle communication of greater complexity and quantity.

The work towards independence is a long-term process and is the result of sustained, high-quality support and training provided by skilled facilitators. It is important to recognize that progress towards independence will vary across individuals. Progress toward independence will be affected by

• severity of movement and hand function difficulties,
• skill and experience level of facilitators,
• availability of facilitators,
• opportunities for regular use of facilitated communication,
• access to appropriate technology,
• types of activities and environments in which an individual is involved , and
• consistency of opportunities to practice more independent typing. (Crossley, 1994)

It is helpful to get input from AAC specialists on appropriate communication aids and devices and input from occupational and physical therapists on strategies that might assist a person in improving their hand function skills, seating or positioning.

10. Competency-based Facilitator Training

All facilitators should participate in a supervised training process so that they learn the appropriate and correct skills for supporting a person in his or her communication. Training programs for facilitated communication should give information about the background and conceptual foundation for the use of the method. In addition, programs need to address the unique needs of the individual user/candidate, develop the skills of facilitators, and give supervision to new facilitators to the point that they are able to both support a facilitated communication user in open communication and systematically fade their physical support.

All facilitators should participate in a training process which includes a combination of classroom learning and direct supervision from an experienced facilitator. This supervision should be provided in the initial stages of the facilitated communication training process and maintained over time to ensure both that facilitators are using the technique correctly, and that they continue to develop their skills as facilitators. The competencies described as beginner competencies in Section IV, "Facilitator Competencies," correspond to those which a new facilitator would be expected to master during the early stages of his or her work as a facilitator. Mastery of these competencies should be monitored and documented by an experienced facilitator.

11. Multiple Facilitators

Facilitated communication training must involve ongoing, active widening of the number of people prepared to support an individual's communication. Facilitated communication users should have access to regular training and support from a number of trained and experienced facilitators for several reasons:

• to reduce dependence on a particular facilitator,
• to increase independent communication, and
• for there to be sufficient examples of valid and authentic communication to document in a portfolio.

Facilitation with an inexperienced facilitator, or with one who has not worked previously with a particular facilitated communication user, is likely to be more challenging and frustrating than facilitation with someone with whom the facilitated communication user has an ongoing relationship. Therefore, the contact time of facilitators should be arranged so that experienced facilitators are in a position to support the development of both expertise and comfort within the new dyad. Inexperienced facilitators should not be expected to provide support beyond their skill level (e.g., in test situations).

12. Technical Assistance

Due to the dynamic nature of communication in general, and facilitated communication in particular, family members and professionals who support persons with disabilities who use facilitated communication need to stand ready to problem-solve the many issues that develop as a part of the movement from a specific communication strategy to the establishment of an over-all system of effective communication. Problem-solving includes, but is not limited to, giving a person access to communication across situations throughout the day, developing appropriate technology supports, and helping the person communicate throughout the day with whomever he or she would like.

No single discipline subsumes all of the expertise and experience needed to address these issues. Therefore, a plan for technical assistance to the facilitated communication user and his or her facilitators should be developed collaboratively by such support personnel as AAC specialists, speech and language pathologists, assistive technology specialists, occupational therapists, educational specialists, and specialists in positive behavioral supports.

13. Documentation

Documenting the progress of facilitated communication users and their facilitators over time is essential. This is an area that should be addressed formally within the facilitated communication user's individual support plan, as described in the following sections on "Portfolio Approach" and "Validation, Authorship and Authenticity").

McSheehan and Sonnenmeier provide one excellent framework for documenting both the skills of the facilitated communication user and the skills of his or her facilitators. Their approach is based on a collaborative view of communication (Duchan,1993; Sonnenmeier & McSheehan, 1993), which emphasizes the contributions of both participants to the communication process and the construction of messages.

The documentation process is grounded in a set of assumptions about competency, the nature of physical supports, and the purpose of documentation. It is also based on the premise that in order to understand how facilitated communication access is being used by a particular individual and facilitator, it is necessary to examine skills and supports in six areas: physical, communicative, literacy, contextual, technological skills and supports, and ongoing training and technical support. Based on clinical experience and analysis of facilitated interactions, these areas are relevant to describing the nature of facilitated interactions and for making recommendations regarding ongoing training and skill development (McSheehan & Sonnenmeier, R. FC Documentation Protocol 1994)

[SEE APPENDIX I: BIBLIOGRAPHY].

    a. Portfolio Approach

A communication portfolio provides a flexible approach to documenting progress over time for both the facilitated communication user and his or her facilitators. The portfolio documents over time instances of valid communication. It is important to note that validation represents a set of skills to be learned in the process of becoming a competent, responsible communicator; it is not a test of the user's abilities. In addition to the facilitated communication user's portfolio, a portfolio of the facilitators' training, skills, and abilities should be kept, documenting each facilitator's progress through competency training. This documentation should be used to determine the facilitator's level, and which supports he or she is prepared to provide for the facilitated communication user.

For the facilitated communication user, indicators of validity to be documented could include the following:

• similar patterns of spelling and typographical errors across facilitators;
• typing of similar topics and themes across facilitators,
• consistent style of typing across facilitators,
• instances of independent and/or initiated communication,
• self-correction of mistakes,
• effective use of protest strategies,
• sharing of information not known to the facilitator,
• successful participation in message-passing exercises,
• behavior or actions that confirm typed communication,
• speech that correlates with typed communication,
• consistent physical style of typing across facilitators, and
• physical attention to the typing (e.g., eye contact with the communication device).

    b. Validation, Authorship and Authenticity

If the use of more formal validity testing is pursued, careful consideration needs to be given to such factors as the types of tasks used, the familiarity and naturalness of the test environment, the experience level of the facilitator, and both the facilitator and facilitated communication user's feelings about doing the test.

Biklen and Cardinal (1997) have performed a meta-analysis of experimental studies of authorship in facilitated communication. In this analysis, they have identified 14 conditions which increase the likelihood that facilitated communication users will be able to demonstrate their authorship. Any responsible attempt at formal validation of authorship should consider the following factors:

• extensive experience with facilitation by both facilitator and facilitated communication user;
• practice using multiple trials;
• consultation with facilitated communication user on test and format;
• familiar facilitators;
• monitoring for facilitated communication user's style;
• no-risk, or low-risk testing;
• building of confidence; with limits on opportunities to fail
• naturally controlled conditions;
• ongoing feedback on performance;
• minimization of word retrieval tasks;
• presentation of information through multiple modalities;
• age appropriate content;
• personally relevant content; and
• extensive time to respond to questions.

    c. Sensitive Information

Extraordinary circumstances involving critical life decisions, sensitive information, or allegations of abuse require the use of specific validation protocols involving the use of outside, objective facilitators. A particularly useful set of guidelines for such procedures is contained in the publication of the Facilitated Communication Institute, "Severe Communication Impairment, Facilitated Communication, and Disclosures of Abuse" [see Appendix I: Resources], any administrator supervising facilitators or services being provided to individuals who use facilitated communication should be familiar with the content of these guidelines.