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Issues Related to the Communication Environment

Meeting the specific communication needs of a survivor with a voice, speech or language disorder requires a flexible and open environment.  The survivor should be encouraged to identify the best solution and the provider should demonstrate a commitment to both flexibility and the use of additional time. There are a number of universal techniques, assistive technologies, and other tools that providers can use to ensure clear communication. 

For some, like people with autism, expressing emotional content or asking for help can make speech even more difficult

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. Speaking may work in one context, but not in another, so people will switch among different methods of communication. Alternatives to speaking take more time and emotion can be lost with the use of assistive devices. Alternatives for those that do not speak include typing on a computer, use of communication boards, internet, instant messaging, portable text-to-speech synthesizers, TTY(TDD), and facilitated communication.

Examples of Problems

  • A thirty-year old woman with cerebral palsy and who uses a wheelchair is brought in by ambulance after an assault. She is clearly distraught and makes sounds but cannot be understood. Aside from the evidence of rape and assault communicated by her injuries, neither the paramedics nor the emergency room personnel have determined what happened or who she is. She was found with no handbag or other ID.
  • A forty-five year old woman who had a stroke a year ago has come to the shelter after her arm was broken by her husband. She seems to think that she is speaking clearly but no words or sentences can be understood by staff.

Possible Solutions

  • As a universal design strategy, train all staff and volunteers to understand the diversity of communication limitations and be prepared to try a variety of options to communicate.
  • Consider having a collection of visual aids for the topics you discuss with survivors. Visual aids have been developed for people with intellectual limitations or people who are speech-impaired for use with communication boards. Pictography can be adapted from such aids, so that your services have a collection to assist communication in any number of situations - people who do not speak English as a first language, fatigue, learning disability, etc. - where clarity of communication is your utmost concern.
  • There are a number of augmentive communication devices that can be used by people with impaired speech.  Research the options so that you can provide options to survivors. 
  • A form of Telecommunications Relay Services (TRS) is the Speech To Speech (STS) service. Like all forms of TRS, STS uses specially trained operators – called Communications Assistants (CAs) – to relay the conversation back and forth between the person with the speech disability and the other party to the call. STS CAs are specially trained in understanding a variety of speech disorders, which enables them to repeat what the caller says in a manner that makes the caller’s words clear and understandable to the called party. Dial 711 to initiate the relay call and specify you need STS. 
  • If the survivor chooses, it may also be possible to communicate via a trusted third party of her choice who understands her speech using a conference call. It may be a friend, family member or service provider.  You will need to have the capacity for conference calling.  It may be odd to use a telephone to communicate with someone sitting across from you but it may work.
  • Speak in plain language without use of jargon, slang, metaphors, and irony.
  • Do not take casually that a survivor may have to use a computer to carry on a conversation. If someone cannot take notes without a computer, the accommodation should be provided.  
  • When giving verbal instructions to an individual, ensure that the survivor has a quiet location to receive them. Also have patience when instructions are not understood.
  • Provide one instruction at a time. Do not move on until it is clear that the instruction is understood.
  • If the instruction is something that can be demonstrated, then demonstrate and have the survivor demonstrate back to you her understanding. Confirm that she understands.
  • If the instruction is something that cannot be demonstrated, then both speak it and write it. If it is already written, have the survivor tell you what she understands has to be done. Writing it herself may help her to remember it. Confirm that she understands.
  • Allow a person more time, even additional meeting time on another day, if necessary.
  • Use rehearsal or role-play strategies.
  • Mnemonics or rhymes or images might be used to create associations with an instruction to assist memory.
  • Consider tape recording important instructions, so that the survivor can play back and review them.

Assistive Technology

In a shelter environment, if a survivor arrives without communications equipment (her assistive technology was either harmed or she left home without it), there is the potential to get an assistive technology loan. The purpose of loan programs is for a person to test what works best using 30-day trials.

During Workshops

  • Follow Information Environment suggestions.
  • Provide paper or digital copies of overheads, powerpoint slides.
  • Have a clear schedule of the workshop always available and clearly indicate when ending one section and moving on to the next.
  • Tape each large-format flip chart paper (or use self-stick) to wall when completed before starting a new page.
  • Some people may need to tape record what workshop leaders say. The workshop leaders should indicate when it is safe to tape and when is not (because of confidentiality issues among participants speaking).