Facilitated Communication Revisited
Contributed by Nancy Kalina

In its brief time in the public eye, facilitated communication (FC) has generated an incredible amount of publicity and controversy. In one sense, the controversy is surprising since the techniques used in facilitated communication are similar to the techniques used by parents, teachers, and therapists for many years. On the other hand, the controversy is very understandable, since facilitated communication challenges how we view the individual whom we are attempting to support.

As we embark on the summer of 1995, it seems like a good time to take a step back and think about the actual application of facilitated communication. Let's begin by defining the word facilitation. Facilitation is a strategy that can be used to assist people to make voluntary movements, whether it is to use a spoon, to make a selection from a supermarket shelf, to use scissors, to kick a ball, or to write. In other words, facilitation is a tool to assist a person in accomplishing an act. Building on this notion, facilitated communication could be defined as a technique to assist an individual to communicate his/her thoughts. More specifically, facilitated communication involves physical, emotional, verbal, and conversational support which assists the person to make selections on a keyboard that spell out his/her individualized message.

PHYSICAL SUPPORT

The physical support generally involves backward pressure applied to the hand, wrist, or arm. This pressure creates a resistance that the person who is typing must push against to make a selection on the keyboard. Physical support is not limited to supporting the individual's hand or arm. Support also includes positioning the person while typing, positioning of the keyboard to the person, and selecting and/or adapting the augmentative communication device.

EMOTIONAL SUPPORT

Emotional support is more involved and harder to describe. It involves two general areas. The first is treating the individual as a competent, intelligent person who has important messages to contribute.

The second facet of emotional support is providing verbal encouragement, reassurance, and a safety net. It has been described by many people who facilitate that it is a tremendous risk to communicate not knowing if you will be listened to or taken seriously. It is the facilitator's responsibility to create an atmosphere of safety upon which the person can rely. Creating a safe environment includes:

• Listening to what the person has to say.
• Not judging what the individual has to say.
• Responding, both verbally and behaviorally to the person.
• Telling the person that what he/she has to say is of value and is important to be shared.
• Not talking and being patient while the individual collects his or her thoughts and types them out.
• Supporting the person while he/she determines what works for him/her. For example, a person may need to decide what is the most effective way of communicating once he/she is already upset.
• Allowing the individual to have private conversations.
• Informing the person that his or her information will not be shared with anyone unless he/she gives approval.
• Displaying reciprocal behavior. For example, people need to learn the expectations of a reciprocal conversation. Hence, facilitators need to model reciprocal behavior. This involves listening, sharing experiences, apologizing for being late, asking typical conversational questions, and coordinating schedules with the individual.
• Expressing confidence in the person's abilities.
• Not talking in front of the person as if he/she is not there.
• Sharing information on a sophisticated level. In other words, paying attention to how the information is communicated as well as to what information is communicated. This pertains to the messages one presents when altering the tone, style, pitch, and manner of one's voice.

VERBAL SUPPORT

Facilitators need to be aware of the questions they ask so they can assist an FC speaker to develop communication. It has been noted that it is more difficult to reply to an open ended question than it is to a yes/no question. Therefore, verbal support involves structuring questions to enhance verbal interactions. In addition, verbal support refers to asking a person to clarify what s/he has typed. This is done when the actual message is unclear to the reader.

CONVERSATIONAL SUPPORT

The role of the facilitator is more than physically assisting the person to facilitate. Rather, the facilitator is responsible for assisting the person to engage in conversation with others by helping them to access the board, by helping them to access individuals with whom to converse, and by promoting their involvement in interactions. For example, a support person may need to encourage an FC speaker to become involved in a conversation. In addition, the support person may need to encourage others (e.g., staff, local merchants, principal, clergy, family members) to speak directly to the person and to acknowledge the FC speaker's comments that are presented through facilitated communication.

Individuals should be encouraged to engage in conversation despite their initial level of facilitation. For example, if the person's initial ability with facilitation is limited to yes/no or single word statements, it is important to include that person's communication whenever naturally occurring turn-taking would allow. By encouraging typical conversation the individual learns that facilitation is an effective method of relaying their messages.

The facilitator must assume that people would take part in conversation if they could. Therefore, it becomes the responsibility of the facilitator to ask the individual if s/he has anything to contribute to the conversation. This status might change throughout the conversation. For example, if a person has nothing to add at one point, it is important to ask again as the conversation continues and takes on new form.

It is important to realize that providing the combination of supports mentioned above does not guarantee that an individual will facilitate. Training is still found to be of utmost importance for the novice as well as for the experienced.

Finally, it is important to note that all people use many forms of communication throughout a day. Anything from speaking to writing to faxing to gesturing to silence are accepted means of communication. The difference between these forms and many others is that no single method is effective in all situations. Likewise, people who utilize facilitated communication need to expand their competency for communicating across home, school, work, and community settings. Below are suggestions for promoting communication across settings:

• Each FC speaker should be encouraged to have multiple facilitators.
• Discuss with the FC speaker where facilitated communication works well and where it is difficult.
• Identify communication options of what to do when there isn't a trained facilitator present and the FC speaker wishes to express him/herself. The person may decide to work on independent typing, signing, picture boards, or verbalization as options to utilize when facilitated communication is not feasible.
• Encourage people to problem-solve how to facilitate with more people and how to make facilitation more accessible across settings.
• Encourage people to incorporate all forms of communication (e.g., gesturing, leading, helping oneself, signing, verbalizing, using communication boards). Regardless of the method chosen, the FC speaker should be involved in determining what other forms of communication will be used to complement facilitated communication.

Kalina, N. (1995). Facilitated communication revisited. Indiana Resource center for Autism Newsletter, 8(3), 6-7.