Key Word Signing Usage in Residential and Day Care Programs for Adults With Intellectual Disability

Abstract

Key word signing (KWS) is a means of augmentative and alternative communication frequently used with adults with intellectual disabilities (ID). Their acquisition of KWS has been described in the literature; however, little is known about the everyday KWS use among adults with ID and their support staff. This study aimed to give an account of the prevalence of KWS and the sign knowledge of adults with ID and their support staff in Flemish residential programs (RPs) and day care programs (DCPs). Communication specialists in all RPs and DCPs for adults with ID in Flanders, the Dutch‐speaking part of Belgium, were contacted by phone and were asked whether they used KWS, and if so, whether they were willing to fill out a questionnaire about the KWS use of support staff and clients. Findings show that of 347 RPs and DCPs in Flanders, 85% met the inclusion criteria. Half (51.2%) of these programs used KWS. Of these 152 programs, 93 (61.2%) completed our questionnaire. A quarter (26.6%) of their adult clients with ID used KWS. Most of them knew 10–50 signs, whereas most support staff knew fewer than 10 signs. The presence of a speech and language therapist as well as sign knowledge and attitude of support staff were significantly related to the sign knowledge of their clients. Motivational problems for staff to use KWS were quite common. KWS support should be more widespread and more easily accessible.

Beliefs and habits: staff experiences with key word signing in special schools and group residential homes

“…The findings of the present study suggest that, by omitting this training step, the self-monitoring became entirely the responsibility of teachers and direct support staff and thus might have increased the cognitive effort. Because direct support staff may have had few KWS skills (Meuris et al, 2014), consistent use of KWS might have required too much cognitive effort. In keeping with the reports that close proximity of a trained colleague was helpful, perhaps the presence of a communication specialist who supervises and provides immediate feedback in natural settings can facilitate self-feedback (Kent-Walsh & McNaughton, 2005;Wooderson, Cuskelly, & Meyer, 2014).…”

“…Augmented input may also support expressive language skills. By observing partners' use of AAC/KWS, individuals with intellectual disabilities may acquire AAC/KWS skills (e.g., Beck, Stoner, & Dennis, 2009;Dodd & Gorey, 2014;Faw, Reid, Schepis, Fitzgerald, & Welty, 1981;Meuris, et al 2014). When staff consistently provide augmented input, clients are also more inclined to generalize AAC/KWS skills to other settings (Dodd & Gorey, 2014;Schepis et al, 1982).…”

“…For example, in the study by Meuris et al (2015), staff produced 0-38 manual signs during a 5-min staff-client conversation; in a study by Rombouts, Maes, and Zink, (2016a), staff supported between 5% and 75% of their utterances with KWS during a 10-min staff-client conversation. In 73% of Flemish services for adults with intellectual disabilities where KWS was implemented, the majority of direct support staff could produce fewer than 10 manual signs, whereas most clients (67%) were estimated to produce more than 10 distinct manual signs (Meuris et al 2014). Such a small difference in proficiency between staff and clients places high demands on communication partners, given the active role they must adopt in AAC implementation (Beukelman & Mirenda, 2013;Bryen & Joyce, 1986;KentWalsh, Murza, Malani, & Binger, 2015).…”

“…In 24.7% of Flemish services for adults with intellectual disabilities where KWS was implemented, communication specialists reported that KWS implementation was difficult despite the fact that the majority of direct support staff were interested in using KWS (Meuris et al, 2014). General behavioral models may provide insight into this discrepancy between KWS intentions and actual use.…”

“…An estimated 12-27% of adults with intellectual disabilities use key word signing (KWS) to support communication (Meuris, Maes, & Zink, 2014;Sutherland, Gillon, & Yoder, 2005). This strategy involves complementing speech with manual signs.…”