Optimizing Reading Instruction for Students who use AAC

PROJECT SUMMARY
Individuals with severe disabilities who cannot use speech to communicate and use augmentative and alternative
communication (AAC; pointing to pictures, using a speech-generating device) are at high risk for life-long health
issues that are exacerbated by illiteracy and limited communication skills. Over 90% of these individuals leave
high school illiterate, resulting in reduced communication skills and a higher probability of life-long health issues.
The long-term goal for this line of research is to maximize communication and literacy outcomes for individuals
who use AAC through equitable access to evidence-based literacy practices. Daily instruction in literacy practices
that are phonics focused and evidence-based have the potential to change the current poor outcomes. Literacy
intervention with ALLSTAR (Accessible Literacy Learning [application] with Scripted Teaching and Alternative
Response methods) has proven to support acquisition of important phonics-based literacy skills for students who
use AAC (i.e., intervention group (N=20) had a +44% gain after 100 lessons using ALLSTAR on pre-post literacy
assessment). Despite large gains, at the end of the study, 37% of schools who used ALLSTAR with high fidelity
across 100 lessons resorted back to literacy practices that included no phonics instruction or no daily literacy
instruction for AAC learners. It is evident that district-wide adoption and sustainability of the current intervention
is at risk without adaptations and a better understanding of implementation outcomes.
The project goal is to determine contextual factors that influence school capacity for daily implementation
of ALLSTAR and then refine implementation strategies by core and adaptable components to improve fit. We
will employ a concurrent mixed methods study design, collecting and analyzing both qualitative and quantitative
data simultaneously. Through partnership with 16 schools and 175 service providers, we will 1) iteratively use
PRISM to assess multilevel contextual factors throughout pre-implementation/planning, implementation, and
post-implementation/evaluation phases, and 2) Use the Framework for Reporting Adaptations and Modifications-
Expanded (FRAME) to map, document, and revise core and adaptable components of ALLSTAR that influence
school capacity for daily implementation. Our expected outcome is a co-developed refined ALLSTAR by mapping
models of adaptations through FRAME and using PRISM for understanding key implementation outcomes that
will improve implementation, sustainment, and the “fit” of the reading intervention. This proposal is timely, in that
it is responsive to the NIDCD D&I mission and responsive to AAC users research priorities. The study is
innovative in applying implementation science methods to the school context with students with limited or no
speech, with the potential for high clinical impact in changing poor literacy outcomes for a population that unjustly
denied evidence-based literacy instruction.

Grant Number: 1R21DC022893-01
NIH Institute/Center: NIH
Principal Investigator: Jessica Caron