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Supported Conversation for Adults with Aphasia (SCA)

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Supported Conversation for Adults with Aphasia (SCA)

  1. 1. Communicating with Those Who Know More Than They Can Say An Introduction to Supported Conversation for Adults with Aphasia (SCA™)
  2. 2. Welcome to SCA TM Self-Directed Learning Module <ul><li>This self-directed learning module (SDLM) includes a combination of: </li></ul><ul><ul><li>Content in text form </li></ul></ul><ul><ul><li>Videos </li></ul></ul><ul><ul><li>Discussion questions </li></ul></ul><ul><ul><li>Prompts for reflection </li></ul></ul><ul><ul><li>Role plays </li></ul></ul>
  3. 3. Welcome to SCA TM Self-Directed Learning Module <ul><li>In order to help you move your knowledge into practice, we encourage you to complete this SDLM in pairs (you may find it tricky to role play with one) </li></ul><ul><li>You will find the ‘talking heads’ icon (see upper left corner) when you are asked to discuss something with your partner. </li></ul>
  4. 4. Welcome to SCA TM Self-Directed Learning Module <ul><li>If at any point you have questions or technical difficulties, please contact our Knowledge Broker, </li></ul><ul><li>Terry Kirkpatrick, at [email_address] </li></ul><ul><li>Let’s get started! </li></ul>
  5. 5. What is Supported Conversation for Adults with Aphasia? (SCA™)
  6. 6. What is SCA™? <ul><li>SCA™ is: </li></ul><ul><li>a communication method that allows you to have a conversation with an individual who has difficulty expressing themselves or understanding your verbal messages. </li></ul><ul><li>SCA™ is useful for addressing a range of communication disabilities, including aphasia. </li></ul>
  7. 7. What is Aphasia? <ul><li>Aphasia is a language problem, caused most often by stroke. </li></ul><ul><li>People with aphasia have difficulty </li></ul><ul><ul><li>expressing themselves </li></ul></ul><ul><ul><li>understanding what others say </li></ul></ul><ul><ul><li>reading and writing </li></ul></ul><ul><li>People with aphasia remain competent </li></ul>
  8. 8. Other Communication Disorders <ul><li>SCA™ is useful for interacting with individuals who have aphasia, and other communication challenges, including: </li></ul><ul><li>Hearing Loss </li></ul><ul><li>Poor literacy (pre-stroke) </li></ul><ul><li>Limited fluency in English, (or other primary language) </li></ul><ul><li>Physical, cognitive, or mental health conditions that interfere with communication </li></ul>
  9. 9. Discussion #1 <ul><li>You are a healthcare professional. Your patient, Judy has aphasia. She appears to understand you when you speak, but when she tries to respond, she says the word “OK” and a few non-word syllables, over and over. You need to know if she is in pain, and where it hurts. </li></ul><ul><li>Discuss how you would handle this situation with your partner. </li></ul>
  10. 10. Helping Someone to be Heard <ul><li>We need a way to communicate with someone who ‘knows more than he or she can say’, because: </li></ul><ul><ul><li>There may be no one available who knows the person well </li></ul></ul><ul><ul><li>Even when someone is available, they don’t know how the person is feeling or what they are thinking </li></ul></ul><ul><ul><li>People who have aphasia prefer to communicate directly, rather than having someone speak for them </li></ul></ul>
  11. 11. Discussion #2 <ul><li>You have aphasia. You are visiting with a healthcare </li></ul><ul><li>provider who is asking you questions and… </li></ul><ul><li>You are intelligent but can’t understand what he/she is saying </li></ul><ul><li>You know what you think but can’t express your thoughts </li></ul><ul><li>The care provider is avoiding discussing complex issues with you, e.g. your health, your situation, and how you feel. </li></ul><ul><li>Discuss how you feel with your partner </li></ul>
  12. 12. How Does it Feel? <ul><li>People who have aphasia, or other communication challenges, are often treated as though they are not competent. </li></ul><ul><li>The experience of aphasia is similar to being in a country where you do not speak the language. You know what you want to say, but cannot make yourself understood. </li></ul>
  13. 13. What is Communicative Access? <ul><li>Meaningful participation in healthcare activities requires: </li></ul><ul><ul><li>Finding and understanding verbal information </li></ul></ul><ul><ul><li>Engaging in conversation with health care providers </li></ul></ul>
  14. 14. “ Communicative Access and Aphasia” <ul><li>Often we refer to “communicative access and aphasia”. We use this phrase because aphasia reduces an individual’s ability to engage in routine communication tasks, which are essential to participation in and access to health care. </li></ul>
  15. 15. Discussion #3 <ul><li>The individual with a communication disorder is often not included in health care conversations as their competence is questioned, based on their inability understand and express themselves easily. </li></ul><ul><li>What barriers do you think a person with aphasia faces when they are in our health care system? </li></ul>
  16. 16. Did you think of these barriers? <ul><li>Professionals that do not know how to communicate with the person </li></ul><ul><li>Inability to read consent forms, prescriptions, information about medical conditions, etc. </li></ul><ul><li>Inability to read signage and directions </li></ul><ul><li>Exclusion from case conferences or care planning </li></ul><ul><li>Necessity of having a support person to advocate </li></ul>
  17. 17. Providing Communicative Access through SCA TM <ul><li>We provide physical access to healthcare services by altering the physical environment, adding wheelchair ramps, automatic doors, and other improvements. </li></ul><ul><li>We can provide communicative access by changing the way we interact. SCA™ is a ‘communication ramp’ for someone with aphasia, or other communication disorder. </li></ul>
  18. 18. What does Communicative Accessibility look like? <ul><li>The elements of a communicatively accessible environment include: </li></ul><ul><ul><li>Trained service providers who use special communication skills (e.g. SCA™) </li></ul></ul><ul><ul><li>Health care information that is translated into a pictographic format that is more easily understood </li></ul></ul><ul><ul><li>Ensuring that the individual is included in important decision-making events , such as case conferences </li></ul></ul>
  19. 19. A Communication Ramp <ul><li>SCA™ is a set of techniques that includes: </li></ul><ul><li>spoken and written keywords </li></ul><ul><li>gesture and body language </li></ul><ul><li>hand drawings </li></ul><ul><li>sophisticated pictographs designed to support conversation on complex topics. </li></ul>
  20. 20. A Communication Ramp <ul><li>The SCA ™ method has been developed by the Aphasia Institute, over many years of direct service and validated through research. </li></ul><ul><li>It has been taught to thousands of health care workers from a variety of professional backgrounds. </li></ul><ul><li>Feedback from those who have learned the method and used it in their daily practice has indicated that both the service provider and the patient benefit. </li></ul>
  21. 21. A Communication Ramp <ul><li>SCA ™ u sers say: </li></ul><ul><li>They view their treatment as more successful. </li></ul><ul><li>They interact more confidently with patients who they may have avoided in the past. </li></ul><ul><li>They are often surprised by the interactive changes possible by using a few basic techniques. </li></ul>
  22. 22. Role Play #1 <ul><li>If you are in a pair, you two will be engaging in role play exercise in which one of you will play the Health Care Professional and the other will play The Person with Aphasia. </li></ul><ul><li>The Person with Aphasia should choose an important personal message to try and convey to the Health Care Professional in 5 minutes – with the constraints listed on the next page. </li></ul>
  23. 23. Role Play #1 <ul><li>Person with Aphasia </li></ul><ul><li>Cannot speak </li></ul><ul><li>Cannot write </li></ul><ul><li>Cannot use right hand </li></ul><ul><li>Health Care Professional </li></ul><ul><li>Notices that the person is upset </li></ul><ul><li>Must figure out the problem </li></ul>
  24. 24. Role Play #1 <ul><li>If you are not in a pair, consider a time when you attempted to communicate with someone who ‘knows more than he/she can say’ without success. </li></ul><ul><li>Recall the scene – allow it to play over in your head again and think about as many details as possible. (make notes if necessary) </li></ul>
  25. 25. Role Play #1 <ul><li>Now take a few minutes (both pairs and individuals) to reflect on your experience. </li></ul><ul><ul><li>How did each of you feel as you tried to exchange information? </li></ul></ul><ul><ul><li>What communication strategies did you use? </li></ul></ul><ul><ul><li>What strategies or materials would have helped you to be more effective? </li></ul></ul>
  26. 26. Video: Healthcare Conversation Part 1 <ul><li>Now you will engage in an observation exercise by viewing video #1 </li></ul><ul><li>While viewing this video consider the following questions: </li></ul><ul><ul><li>Does the doctor treat the person as a competent? </li></ul></ul><ul><ul><li>Does the doctor make his own messages clear? </li></ul></ul><ul><ul><li>Does the doctor give the person a way to answer or ask questions? </li></ul></ul><ul><ul><li>Does the doctor check to make sure that he has understood the person correctly? </li></ul></ul>
  27. 27. SCA ™ – A Framework for Conversation <ul><li>The SCA TM framework is an approach that prompts the care provider to: </li></ul><ul><li>Acknowledge Competence: Help the person feel as though they are being treated respectfully </li></ul><ul><li>Reveal Competence: Get and to give accurate information via: </li></ul><ul><ul><ul><li>In – communicate your message to the person </li></ul></ul></ul><ul><ul><ul><li>Out – receive information from the person </li></ul></ul></ul><ul><ul><ul><li>Verify – ensure your understanding is accurate </li></ul></ul></ul>
  28. 28. Acknowledging Competence <ul><li>Are you treating the person respectfully? </li></ul><ul><li>Some ways to help you acknowledge competence include: </li></ul><ul><ul><li>Speak naturally (with normal loudness), using an adult tone of voice and a conversational style </li></ul></ul><ul><ul><li>Acknowledge the person’s frustrations and fears of being thought of as stupid e.g. “I know you know” </li></ul></ul>
  29. 29. Acknowledging Competence <ul><ul><li>Deal openly with situations in which you have to communicate with a partner to obtain or give information </li></ul></ul><ul><ul><li>Explicitly attribute breakdowns to your own limitations as a communicator (humour) </li></ul></ul><ul><li>Can you and your partner think of at least one more technique? </li></ul>
  30. 30. Video: Acknowledging Competence <ul><li>The following videos demonstrate how to acknowledge competence </li></ul><ul><ul><li>Acknowledging fears and frustrations: clips #2 and #3 </li></ul></ul><ul><ul><li>Explaining the need to obtain information from someone else: clip #4 </li></ul></ul>
  31. 31. Revealing Competence <ul><li>Are you getting and giving accurate information? </li></ul><ul><li>Revealing Competence has three components: </li></ul><ul><ul><li>In: Is your message clear? </li></ul></ul><ul><ul><li>Out: Does the person have a way to answer you or ask questions? </li></ul></ul><ul><ul><li>Verify: Have you checked to make sure you have understood? </li></ul></ul>
  32. 32. Revealing Competence: IN <ul><li>Is your message clear? </li></ul><ul><li>You help reveal competence and ensure that your message is getting ‘in’ when you: </li></ul><ul><ul><li>Use short, simple sentences and expressive voice </li></ul></ul><ul><ul><li>As you are talking: </li></ul></ul><ul><ul><ul><li>Use gestures that the patient/client can easily understand </li></ul></ul></ul><ul><ul><ul><li>Write key words/main idea e.g. ‘pain’ in large bold print </li></ul></ul></ul><ul><ul><ul><li>Use pictographic materials – focus on one at a time </li></ul></ul></ul>
  33. 33. Revealing Competence: IN <ul><ul><li>Eliminate as much distraction as possible (noises, other people, too much material) </li></ul></ul><ul><ul><li>Observe the patient/client to assess comprehension (facial expression/eye gaze, body posture, gestures </li></ul></ul><ul><ul><li>Use a hierarchy of techniques to support talking including talking PLUS: </li></ul></ul><ul><ul><ul><li>Gesture </li></ul></ul></ul><ul><ul><ul><li>Writing </li></ul></ul></ul><ul><ul><ul><li>Pictures/objects </li></ul></ul></ul><ul><ul><ul><li>Drawing </li></ul></ul></ul>
  34. 34. Video: Revealing Competence: IN <ul><li>View the following short video clips that demonstrate the tips for getting the message “in”: </li></ul><ul><ul><li>Using gestures: clips #5 and #6 </li></ul></ul><ul><ul><li>Using pictographic resources: clips #7 and #8 </li></ul></ul><ul><ul><li>Reducing distractions: clips #9 and #10 </li></ul></ul><ul><ul><li>Using drawing, key words and pictographic resources: clip #11 </li></ul></ul><ul><li>While you view these videos, look for gestures, writing key words, the use of pictographic materials, the type of environment used for communication, and signs of the care provider observing the person </li></ul>
  35. 35. Revealing Competence: IN <ul><li>Pictographic Materials </li></ul><ul><li>The Aphasia Institute has developed a large library of pictographic images that depict complex adult topics in a nonverbal format. </li></ul><ul><li>For a health care provider who is using adapted communication skills, this type of pictographic support can make all the difference in the success of an interaction. </li></ul><ul><li>The following 3 slides show examples of pictographic materials </li></ul>
  36. 39. Revealing Competence: OUT <ul><li>Does the person have a way to answer you or ask questions? </li></ul><ul><li>Tips for ensuring the person has a way to get information ‘out’ include: </li></ul><ul><li>Ask “yes/no” questions and make sure that the patient/client has a way to respond </li></ul><ul><li>Ask one thing at a time </li></ul>
  37. 40. Revealing Competence: OUT <ul><li>Ask the person to give clues by gesturing, or pointing to objects, pictures and written key words (e.g. “can you show me…?”) </li></ul><ul><li>Give the person time to respond </li></ul><ul><li>Multiple choice formats are preferable to “yes/no” questions when you have a list of potential answers </li></ul><ul><li>Phrase “yes/no” questions in a logical sequence (general to specific) </li></ul>
  38. 41. Video: Revealing Competence: OUT <ul><li>View the following short video clips illustrating the tips for revealing competence “out”: </li></ul><ul><ul><li>Using yes/no questions and key words: clips #12 and #13 </li></ul></ul><ul><ul><li>Using pictographic resources and writing: clip #14 </li></ul></ul><ul><ul><li>Using a multiple choice format: clips #15 and #16 </li></ul></ul><ul><ul><li>Using gesture: clip #17 </li></ul></ul><ul><li>While you watch these clips, look for yes/no questions or multiple choice questions, time provided to respond, logical sequence of questioning, and asking for clues </li></ul>
  39. 42. Revealing Competence: VERIFY <ul><li>Have you checked to make sure you understood? </li></ul><ul><li>The following tips will help you to verify that you have understood what the person is trying to tell you: </li></ul><ul><ul><li>Reflect: repeat the patient/client’s message </li></ul></ul><ul><ul><li>Expand: add what you think the patient/client may be trying to say </li></ul></ul>
  40. 43. Revealing Competence: VERIFY <ul><ul><li>Summarize: pull things together at the end of a longer discussion; summarize slowly and clearly what you think the patient/client is trying to say, e.g. … “so let me make sure I understand. …”. Add gesture or written key words, if necessary. </li></ul></ul><ul><ul><li>Reflect – Expand – Summarize </li></ul></ul>
  41. 44. Video: Revealing Competence: VERIFY <ul><li>View the following short video clips illustrating the tips for verification: </li></ul><ul><ul><li>Summarize: clip #12 </li></ul></ul><ul><ul><li>Reflect and Expand; Summarize: clip #18 </li></ul></ul><ul><ul><li>Note: here the health care professional is not able to fully understand the message, but the interaction is successful as she acknowledges competence throughout </li></ul></ul>
  42. 45. Video: Healthcare Conversation Part 2 <ul><li>Watch video clip #19 </li></ul><ul><li>This clip involves the same care provider as ‘Health Care Conversation Part 1’. He is talking with Gerry after completing SCA TM training. Look for the differences in his approach and consider the SCA TM Framework for Conversation </li></ul><ul><li>Review and discuss the following questions with your partner (next slide) </li></ul>
  43. 46. Video: Healthcare Conversation Part 2 <ul><ul><li>Acknowledge Competence: Did the doctor treat the patient as a competent person? </li></ul></ul><ul><ul><li>Reveal Competence: Did the doctor help the person reveal what was on his mind? </li></ul></ul><ul><ul><ul><li>IN: Did the doctor make the message clear? </li></ul></ul></ul><ul><ul><ul><li>OUT: Did the doctor give the patient a way to answer or ask questions? </li></ul></ul></ul><ul><ul><ul><li>VERIFY: Did the doctor check to make sure that he has understood correctly? </li></ul></ul></ul>
  44. 47. Summary <ul><li>Communication is an essential element in health care delivery: </li></ul><ul><li>Health care providers routinely talk with patients in order to make diagnoses and provide treatment </li></ul><ul><li>Patients are more likely to participate actively in health care interventions if they are involved in discussions with providers </li></ul>
  45. 48. Summary <ul><li>Communicative Access depends upon: </li></ul><ul><li>Health care providers using specialized communication strategies, such as Supported Conversation for Adults with Aphasia™ (SCA) </li></ul><ul><li>Health care organizations facilitating communicative access through policies, education, and organizational culture </li></ul>
  46. 49. <ul><li>Thank you and we wish you successful conversations! </li></ul><ul><li>Elyse Shumway and Terry Kirkpatrick </li></ul><ul><li>Communicative Access and Aphasia CoP </li></ul>
  47. 50. Want to learn more about SCA TM ? <ul><li>The Aphasia Institute provides ‘hands-on’ and intensive training courses in SCA™ and has a vast array of pictographic resources to facilitate your conversations. Tel: 416-226-3636 Fax: 416-226-3706 Email: 73 Scarsdale Road Toronto, ON M3B 2R2, Canada </li></ul>
  48. 51. Join the CoP! <ul><li>Are you a member of the Communicative Access and Aphasia Community of Practice? </li></ul><ul><li>Check us out at and get involved! </li></ul>

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