In order to improve outcomes for individuals who use augmentative and alternative communication (AAC), it is important to understand what factors contribute to or detract from positive outcomes. Seven young men who had used AAC systems for at least 15 years, their family members, and professionals who had worked with them, participated in the study. Qualitative interviews were used to identify contextual factors that may have contributed (both positively and negatively) to the young men's outcomes. Factors that impeded positive outcomes included: attitude barriers, cultural differences, technological barriers, and service delivery limitations. Contributions to positive outcomes included: community support, parent and family support, personal characteristics, and appropriate and high-quality AAC services. The results are discussed with implications for clinical practice and directions for future research.