This document outlines the development of a multi-country guide for implementing Augmentative and Alternative Communication (AAC). It describes the rationale for creating the guide due to a lack of experience using AAC in many countries. The guide explores practical aspects of implementing AAC based on a successful intervention in Serbia, Croatia, and Montenegro. It discusses establishing partnerships, selecting culturally appropriate symbols, training professionals, and measuring outcomes to ensure AAC is available and effective for all.

1. E.A. Draffan, Charlie Danger and
David Banes
Reflections on Building a Multi-Country
AAC Implementation Guide

2. 2
Introduction
Global Symbols seeks to ensure aspects of Augmentative
and Alternative Communication (AAC) is available for all.
Resources are free and open licensed focussing on
addressing the need for symbols, training and
implementation that reflect local community, language
and culture along with personalisation.
• Board Builder
• Symbol Creator
• AAC Training
• Parents Pack and other resources
• Implementation Guide

3. 3
Background
• Rationale
– Lack of experience found by local UNICEF offices and others
in many countries leading to a step-by-step guide to make
AAC a reality for all
• Description
– An online guide that requires minimal prior experience with
AAC
• How it came about
– Successful Intervention in Serbia, Croatia and Montenegro
– Needed support for replication by UNICEF
• Outcomes
– Better service in those countries (PIADS)
– Free guide!
– A basis for action

4. 4
The AAC Implementation Guide
The guide explores core practical aspects of the UNICEF
experience to address speech, language and
communication needs in Eastern Europe.
Establishing an enabling environment and project
implementation structures
https://globalsymbols.com/knowledge-base

5. 5
Thinking about National / Regional AAC
Readiness (no prerequisites to individual AAC use)
• Partners and Stakeholders
– Do we need a core partner?
– Who are the stakeholders?
• Symbols
– Defining a core vocabulary
– Producing appropriate symbols
– Participation / Collaboration / Voting
• Implementation and Delivery
– Training (that adapts to and exploits the cultural norms of
the people)
– Tools (Mainly open source / Creative Commons licences to
work with the resources of the nation)
– Evaluation and review

6. 6
The Role of the Core Partner
• Provide
– information about the region
– accurate translation
– cultural information
• Coordinate
– actions locally
• Take responsibility
– overall project management
– commitment to long term
engagement and follow up

7. 7
Involving Stakeholders – AAC Forum
• Users and potential users of AAC
systems
• Parents, carers, and families
• Speech and language pathologists
• Occupational therapists
• Teachers
• Experts in a technical field
• University partner(s) with interest
in the field
• Potential external / internal NGOs
and other interested parties
• Build upon
existing AAC
knowledge and
skills
• Promote the use
of AAC
• Apply in practice
and feedback
• Track
performance
indicators

8. 8
Capacity development of professionals
• Undertake a skills audit
• In-person and online
resources
• Combined local knowledge
and external professionals
• Train, mentorship and
coaching
• Match process to availability
• Allow entry at different
levels e.g. 3 levels
1. Valuing and building upon
existing knowledge
2. Putting early knowledge and
skills into practice
3. Use more complex knowledge
of principles, processes,
evidence to support
assessment and
implementation.

9. 9
Rationale for symbol localisation
• Why don’t we just use familiar
symbols that we may know?
• Consider Universal Design for
Learning (UDL) principles, the
role of the Reticular Activating
System (RAS) that filters for
information that is relevant,
concentration and focus
attention – symbols that fit the
lived experience.
• All symbols are products of the
community from which they
emerged; style and content will
vary along with personalisation.
SIL International Ethnologue:
Languages of the World lists over
7,100 spoken and signed
languages.
The International Organization for
Standardization (ISO) assigns
codes for most languages; see ISO
639

10. 10
Selecting symbols for redesign
• Core vocabulary – check language differences
• Local graphic designer advice and guidance
• Ease of learning – guessability
• Range of symbols to cope with increased use in
different settings and for various tasks, whilst
also considering cultural nuances.
• Adaptable symbols for dress etc and make sure
the image does not contain writing hindering
use with any language, allow for a variety of
concepts such as ‘put in or vote’
• Follow a style guide or schema with grammar
and topic rules to ensure consistent design.
Voting for
core
vocabulary
and batches
of symbols

11. 11
Implementation and Delivery
• Caregivers
• Other Professionals
• Kenyan Families /
Communication Partners
Online – Moodle with translations
Paper
based
PicSeePal
Cboard
Board Builder

12. 12
Outcomes Measures e.g. Psychosocial Impact
of Assistive Devices Scale (PIADS)
0.86
1.35
0.96
1.37
0.77
1.09
-3.00
-2.00
-1.00
0.00
1.00
2.00
3.00
1st Assessment 2nd Assessment
PIADS combined average scores for at least two
individual assessments separated by up to six
months
Croatia Serbia Montenegro
PIADS Subscale Competence Self Esteem Adaptability
Description Ability to do
well the
important
things you need
to do in life
How you feel
about yourself
and like yourself
as a person
Ability to cope
with change to
make basic tasks
manageable

13. 13
References
Draffan EA, Wald M, Zeinoun N, Banes D, WAIS E. Democratisation of AAC Symbol Choices
Using Technology. Studies in health technology and informatics. 2017 Sep 5;242:355-62.
Draffan, E.A. and Banes, D., Open Licensed AAC in a Collaborative Ecosystem. In
Computers Helping People with Special Needs: 18th International Conference, ICCHP-
AAATE 2022, Lecco, Italy, July 11–15, 2022, Proceedings, Part I (pp. 483-488). Cham:
Springer International Publishing. (2022)
James, K., 2018. Universal Design for Learning (UDL) as a structure for culturally
responsive practice. Northwest Journal of Teacher Education, 13(1), p.4.
Kan Boon Hock S, Lafi SM. Assistive Communication Technologies for Augmentative
Communication in Arab Countries: Research Issues. UNITAR e-Journal. 2011 Jan 1;7(1).
Lundälv M, Derbring S. AAC Vocabulary Standardisation and Harmonisation. International
Conference on Computers for Handicapped Persons 2012 Jul 11 (pp. 303-310). Springer,
Berlin, Heidelberg.
Parette Jr, H. P., Brotherson, M. J., & Huer, M. B. (2000). Division on Autism and
Developmental Disabilities. Education and Training in Mental Retardation and
Developmental Disabilities, 35(2), 177-190.
Stacey, P. and Hinchliff Pearson, S., ‘Made With Creative Commons’, Creative Commons,
Copenhagen: Ctrl+Alt+Delete Books, 2017 URL: https://creativecommons.org/use-
remix/made-with-cc/
UNICEF 2022 A Voice for Every Child through Open-Source Solutions and Resources URL:
https://www.unicef.org/eca/media/22051/file/Case-study-1.pdf

14. ea@globalsymbols.com
Global Symbols
https://globalsymbols.com
https://www.facebook.com/globalsymbols
Thank you to Adam Urdu, ARASAAC, Jellow, Mulberry Symbols
for the use of their pictographs in this presentation
Thank you