Speech pathologists, who are often responsible for prescribing communication devices, typically look to the future when making their recommendations. Their goal is to select devices that are comprehensive and capable of supporting a robust communication system that will serve the individual throughout their life. While this forward-thinking approach is well-intentioned, it’s essential to consider whether such comprehensive systems are always the most appropriate choice, particularly for children exhibiting behaviours of concern or harm. In some cases, introducing a complex communication device may create additional challenges for the person and their support network.
The Challenge of Complex Communication Devices
Complex communication devices often come with a learning curve that is steep not only for the person but also for their families and support networks. These devices can include sophisticated apps or technology-laden tools that require significant time and effort to master. While these systems are designed to provide a wide range of expressive possibilities, they can create barriers to effective communication.
Developing communication is inherently a learning process. For learning to occur optimally, it is most beneficial for people to be in environments where they are safe and their needs are being met. However, when people engage in behaviours of concern or harm, it is often because of an unmet need or because they do not feel safe. Attempting to teach a complex communication device in this suboptimal learning environment can be counterproductive. Instead of facilitating communication, it may increase frustration, lead to further disengagement and, indeed, the occurrence of more behaviours of concern.
For people with behaviours of concern or harm, the primary goal of FCT is to replace these behaviours with functional communication responses (FCRs). An FCR is a specific, teachable form of communication that serves the same function as the problem behaviour. For example, a child might be taught to use a word, sign, or picture to request a break instead of engaging in a behaviour of concern. The simplicity and immediate functionality of the FCR are critical to its success. (A comprehensive tutorial on teaching functional communication responses is beyond the scope of this article. For an excellent introductory tutorial on FCT, check out the AFIRM Modules.)
However, with the introduction of a complex communication device, the focus often shifts from teaching a simple, functional communication response to teaching the person to navigate and use the device itself. This shift can lead to frustration and confusion, both for the person and their caregivers, especially if the device is difficult to model, not readily available, or requires considerable effort to use effectively.
The CAFE Principle: A Practical Alternative
In contrast to the complexity of these devices, the CAFE principle offers a straightforward and practical approach to functional communication. Developed by Drs Patrick McGreevey and Troy Fry, CAFE stands for Continuously Available, Frequently Used, and Effortless. These principles align closely with the needs of people with behaviours of concern or harm:
- Continuously Available: The communication tool or strategy should be readily accessible to the person at all times. This ensures that the person can use it whenever they need to communicate, without delays or obstacles.
- Frequently Used: The tool or strategy should be something that the person and their caregivers can easily and regularly use throughout the day. This frequent use helps reinforce the communication behaviour and increases its effectiveness in reducing problem behaviours.
- Effortless: The communication tool should require minimal effort for the person to use. This reduces the likelihood of frustration and increases the chances that the person will successfully adopt the communication behaviour.
Complex communication devices often fall short of these criteria. They may not be continuously available, as they can be misplaced, require charging or be placed out of reach. They may not be frequently used if they are difficult for caregivers to model consistently. And for many people, using a complex device is the opposite of effortless, requiring significant motor skills, cognitive effort, or both.
A Balanced Approach to Functional Communication
While there is undoubtedly a place for complex communication systems, it’s essential to recognise that they are not a one-size-fits-all solution. For people with behaviours of concern or harm, it is essential to establish effective, functional communication as quickly and as easily as possible. This often means starting with simpler, more accessible forms of communication that adhere to the CAFE principle.
Once a person has successfully learned and consistently uses a functional communication response, more complex systems can be gradually introduced. This phased approach ensures that the person’s immediate communication needs are met while laying the groundwork for more advanced communication options in the future.
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