Using ICF-CY for Planning Educational Goals for AAC Students
We present the The Communication Supports Inventory- Children & Youth (CSI-CY), a field-tested code set which provides content and guidance to professionals for the development of AAC-related IEP goals. A code set based on ICF-CY items is "a reduced item classification set that defines standard minimum content areas to document child functioning by developmental age group" (Ellingsen and Simeonsson, 2011). This contrasts with the Uniform Core Sets that have been developed to describe specific diseases and conditions, such as spinal cord injury (Cieza et al., 2010), traumatic brain injury (Bernabeu et al., 2009), multiple sclerosis (Khan and Pallant, 2007), and stroke (Geyh et al., 2004).
We chose to preserve the functional emphasis of the ICF-CY to describe a functional condition (complex communication needs) that is independent of the myriad of diseases or disorders that might be associated with that condition. Table 1 offers an overview of the contents of each section. Table 2 contains all of the individual items in the code set. We include the ICF-CY code numbers (ie., d880) for reference to the original ICF-CY items upon which we based our Inventory items.
Table 1: List of the sections of the CSI-CY, with a brief description of each subsection.
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RESTRICTIONS IN PARTICIPATION CAUSED BY COMMUNICATION LIMITATIONS |
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SCHOOL RELATED ACTIVITIES This section lists a wide variety of activities that happen during the school day or after the school day in which the student may potentially partake and may have difficulty participating due to communication restrictions. This includes activities in the community that are part of a vocational training or transition program. This section is used to emphasize that instruction is not occurring in a pull-out model. |
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INTERPERSONAL INTERACTION AND RELATIONSHIPS This section considers whether the student has difficulty with a specific type of relationships or communication partner due to communication restrictions. This section does not include specific skills found in Functions of Communication or Rules of Social Interaction. It addresses relationships, as opposed to specific social or communication skills. |
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COMMUNICATION LIMITATIONS |
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RECEPTIVE Language and Literacy The student’s activities related to comprehension of typical spoken and written language. This includes reading, decoding, sight words. Reading skills are not covered under AAC Receptive. |
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EXPRESSIVE Language and Literacy The student’s activities related to typical speaking and writing language (as opposed to expression using AAC). This section does not include oral motor skills, articulation, quality of voice and speech production, which are located in the Body Function section. This section also includes all writing skills (whether using AAC or not). Writing skills are not covered under AAC Expressive. |
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FUNCTIONS OF COMMUNICATION The student’s reasons for communicating, the purposes for communicating or specific communicative intents (includes refusing/rejecting, requesting, gaining/directing attention, social conventions, exchanging information, telling someone to do something, and conveying an abstract idea). |
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RULES OF SOCIAL INTERACTION IN CONVERSATION The skills needed to have a conversation. These are the discreet skills needed to initiate, sustain, modulate and end a conversation. |
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AUGMENTATIVE AND ALTERNATIVE COMMUNICATION: RECEPTIVE STRATEGIES The skills involved in understanding the symbol system of a particular AAC system. |
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AUGMENTATIVE AND ALTERNATIVE COMMUNICATION: EXPRESSIVE MODES AND STRATEGIES The skills involved in using a particular AAC system to express thoughts and ideas. |
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AUGMENTATIVE AND ALTERNATIVE COMMUNICATION: MOTOR ACCESS The skills that are needed or may be needed to physically operate a particular AAC system. |
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IMPAIRMENTS IN BODY FUNCTIONS THAT LIMIT COMMUNICATION |
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(NO SUBSECTIONS) This section broadly addresses those physical functions that are needed to communicate, including hearing, vision, oral motor, sensory, respiratory, intellectual and motor functions. Articulation, Speech Production, Hearing (including sound discrimination). |
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ENVIRONMENTAL FACTORS THAT SERVE AS BARRIERS OR FACILITATORS FOR COMMUNICATION |
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PHYSICAL ENVIRONMENT Those factors in the physical space that may help or hinder the student’s communication. |
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ASSISTIVE TECHNOLOGY The products and technology for AAC in the student’s environment that help or hinder communication. |
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PEOPLE The type of support that the people in the student’s environment provide for communication (physical, emotional or knowledge base). |
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SERVICES AND POLICIES Those services or policies that are in the environment that help or hinder the student’s communication by their presence or absence. |
Table 2: The CSI-CY Code Set: The first column lists the inventory items as they appear on the CSI-CY. The second column provides the code(s) for the ICF-CY items upon which the Inventory items are based.
| Restrictions in Participation Caused by Communication Limitations | |
|---|---|
| School Related Activities | |
| Play as an educational activity | d880 |
| Classroom activities (attending classes and interacting appropriately to fulfill the duties of being a student) | d8201 |
| Communal activities (classroom games, assemblies, eating in the cafeteria, field trips) | d550, d2203 |
| Recreation (physical education, recess, playground games) | d5701, d9200, d9201 |
| Creative activities (art classes, orchestra/band, chorus) | d9202 |
| Civic activities (school paper, student government, school club, serving as student aid, safety patrol member) | d835 |
| Other academic activities (computer labs, science labs, library use, gifted/talented classes) | d3601 |
| Social activities (school dances, pep rallies, hanging out with friends at school) | d9205, d9100 |
| Social independence activities (driver's ed., home economics/shop, after school organized sports) | d475, d9201 |
| Vocational training (community work experience, community college, community based recreation) | d825 |
| Transition planning (independent living skills practicum, transportation training) | d6108, d570 |
| Looking after one's safety at school (avoiding risks that can lead to injury or harm) | d571 |
| Maintaining one's health (caring for oneself by being aware of and doing what is required for one's health) | d5702 |
| Interpersonal Interaction and Relationships | |
| Relating to teachers, and other adults at school. | d7400 |
| Relating with peers at school | d750 |
| Making and maintaining friends | d7500 |
| Dating or romantic relationships | d7700 |
| Relating to persons in the home (family or other co-inhabitants) | d760 |
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Relating to a new people |
d730 |
| Communication Limitations | |
| RECEPTIVE Language and Literacy | |
| Intentionally attending to human touch, face and/or voice | d1600 |
| Comprehending the meaning of single spoken words | d3100 |
| Comprehending the meaning of 2-3 spoken word phrases | d3101 |
| Comprehending the meaning of spoken sentences | d3102 |
| Comprehending the meaning of a spoken narrative | d3102 |
| Understanding sound/symbol relationships (sounding out letters) | d1401 |
| Comprehending the meaning of single written words | d325, d1660 |
| Comprehending the meaning of written sentences | d325, d1661 |
| Comprehending the meaning of a written narrative | d325, d1661 |
| EXPRESSIVE Language and Literacy | |
| Using body language, facial expressions and gestures to communicate | d3350 |
| Using non-speech vocalizations for communication (e.g., laughing, cooing, "hmmm") | d331 |
| Using single spoken words to communicate (includes word approximations) | d1330, d330 |
| Combining spoken words into 2-3 word phrases | d1331, d330 |
| Using sentences with appropriate syntax in spoken communication | d1332, d330 |
| Combining sentences to convey a cohesive topic in spoken communication | d1332 |
| Choosing correct spoken and/or written words | d1330 |
| Demonstrating knowledge of sound/symbol relationships (writing a letter for a given sound) | d1451 |
| Using single written words to communicate | d1700 |
| Using written sentences to communicate | d325, d1702 |
| Using a written narrative to communicate | d325, d1702 |
| Using correct spelling conventions | d345, d1701 |
| Functions of Communication | |
| Refusing or rejecting something | d3501 |
| Gaining the attention of another person | d3500 |
| Requesting more | d3501 |
| Requesting something specific | d3501 |
| Directing another person's attention | d3501 |
| Using social conventions (e.g., hello, good-bye, polite forms of address, please and thank you) | d3500 |
| Exchanging information (e.g., asking, answering, naming, or commenting) | d3501 |
| Telling someone to do something | d3503 |
| Conveying an abstract idea | d3501 |
| Rules of Social Interaction in Conversation | |
| Orienting towards communication partner through eye contact or body positioning | d3350 |
| Making and responding to physical contact appropriately | d7105 |
| Keeping socially appropriate distance between oneself and others | d7105 |
| Adjusting language according to one's social role when interacting with others (e.g., "what's up?" to a friend versus "How are you, sir?" to an authority figure) | d7203 |
| Starting a conversation appropriately | d3500 |
| Sustaining a conversation appropriately | d3501 |
| Revising conversation or repairing breakdowns during interaction appropriately (e.g., able to repeat, restate, explain so as to successfully communicate) | d3501 |
| Ending a conversation appropriately | d3502 |
| Conversing in a group | d3504 |
| Augmentative and Alternative Communication: Receptive Strategies | |
| Comprehending the meaning of body gestures (facial expressions, posture, hand gestures or movements) | d3150 |
| Comprehending 3-dimensional objects/representations used to communicate | d3150 |
| Comprehending the meaning of drawings and photographs used to communicate | d3152 |
| Comprehending the meaning of manual sign language (e.g., ASL, finger spelling, signed English, etc.) | b16702 |
| Comprehending the meaning of single AAC signs/symbols (e.g., MinSpeak icons, Blissymbols, Rebus symbols, Picture Communication Symbols, etc.) | d3152, d325 |
| Augmentative and Alternative Communication: Expressive Modes and Strategies | |
| Using 3-dimensional objects/representations to communicate | d3352 |
| Using drawings, pictures or photographs to communicate | d3552 |
| Using manual sign language to communicate | d340 |
| Using Braille to communicate | d3602 |
| Using communication devices and technologies | d360 |
| Using single AAC signs/symbols to communicate. | d1330 |
| Combining AAC signs/symbols to communicate | d1331, d3351 |
| Conveying a cohesive topic with AAC signs/symbols | d1332 |
| Operating communication device correctly (e.g., on/off, volume, speed of scanning, rate enhancement, etc.) | d3608 |
| Knowing how to access needed vocabulary | d3608 |
| Changing communication strategies depending on social and physical environment (dependent on partner feedback and skills; background noise, etc.) | d369 |
| Giving partner instructions when necessary | d369 |
| Expressing the need for additional vocabulary | d3501 |
| Augmentative and Alternative Communication: Motor Access | |
| Control of involuntary movements that may interfere with communication such as tremors, tics, stereotypies, motor perseveration, or mannerisms. | b755 |
| Maintaining a body position as needed for communication purposes (including head control). | b7355, d4158 |
| Control of gross motor skills (upper and lower extremities) needed to use a communication device or materials (e.g., carrying, pushing, pulling, kicking, turning or twisting) | b760 |
| Control of fine motor skills needed to use gestures, manual signs or a specific device to communicate (e.g., grasping, manipulating, picking up and releasing). | b760 |
| Using eye gaze for message selection | b215 |
| Impairments in Body Functions that Limit Communication | |
| Hearing function | b230 |
| Vision function | b210 |
| Touch functions (e.g., ability to sense surfaces, their texture or quality; includes numbness, anesthesia, or tingling) | b265 |
| Oral motor function adequate for intelligible speech, including articulation, fluency, resonance, and rate of speech | b3101, b320, b330, b3301, b3303, b3302 |
| Respiratory function | b440 |
| Intellectual functions | b117, b164 |
| General gross and fine motor functions | b789 |
| Environmental Factors that Serve as Barriers or Facilitators for Communication | |
| Physical Environment | |
| Sound intensity and/or sound quality | e2500, e2501 |
| Light intensity or quality | e2400, e2401 |
| Arrangement of physical space | e299 |
| Level of surrounding activity | e215, e298 |
| Assistive Technology | |
| Adapted or specially designed HIGH tech products/technology developed for the purpose of improving communication (e.g., speech generating device, FM system, specialized writing device) | e1251 |
| Adapted or specially designed LOW tech products/technology developed for the purpose of improving communication (e.g., systems that have no electricity/battery requirement, such as picture communication board) | e1251 |
| General products and technology for communication (e.g., computers, telephones, or other equipment used by the general public) | e1250 |
| Assistive products and technology for education (for acquisition of knowledge, expertise or skills) | e1301 |
| Assistive products and technology for mobility and transportation | e1201 |
| Assistive products and technology for generalized use in school (e.g., prosthetic and orthotic devices, glasses , hearing aids, cochlear implants, etc.) | e1151 |
| People | |
| Providing physical support at school (e.g., supporting body posture appropriately, making glasses available) | e325 |
| Providing emotional support at school | e325 |
| Knowledge of skills needed to support communication in school (e.g., knowing manual sign language, knowing how to use the communication device, etc.) | e325 |
| Providing physical support at home | e310 |
| Providing emotional support at home | e310 |
| Knowledge of skills needed to support communication at home (e.g., knowing manual sign language, knowing how to use the communication device, etc.) | e310 |
| Services and Policies | |
| Special education services (includes therapy and providers of services) | e5853 |
| Regular education services | e5850 |
| School transportation services | e5400 |
| School food services | e1100 |
| School social services | e5750 |
| Before and after school care services | e57502 |
| School-based health services | e5800 |
| Special education policies (e.g., school and/or family responsibility for purchasing and maintaining AAC equipment) |
e5855, e1650 |