What is facilitated communication  (FC)?
It’s a training technique. And we’ve found it a surprisingly powerful one.

To facilitate is to make easier. In facilitating communication we try to make the task of using a communication aid easier for a person with a severe communication impairment. The degree of facilitation needed varies from person to person, ranging from an encouraging hand on the shoulder (to boost their confidence) to full support and shaping of a student's hand (to enable them to isolate and extend of their index finger so they can point).

This training may be most useful for people with severe communication impairments.

Facilitated pointing can provide a temporary remedy for the hand function impairments of some of these people, and may result in a permanent improvement in hand function when used as part of a structured teaching program.

Most of the time facilitated communication training (FCT) is a better term than facilitated communication (FC). FC isn’t an end in itself – it’s a stage that we hope people will pass through on their way to improved communication.

FCT is a strategy for teaching individuals with severe communication impairments to use communication aids with their hands. In facilitated communication training a communication partner (the facilitator) helps the communication aid user overcome neuromotor problems such as impulsivity and poor eye/hand co-ordination and develop effective pointing skills.

The immediate aim of facilitated communication training is to allow the aid user to make choices.  People who can make choices can communicate in a way that was impossible before. Once they can make choices we encourage them to practice using a communication aid (a picture board, for example, or a speech synthesizer or keyboard) in a functional manner, to increase their physical skills and their self-confidence and to reduce their dependence on the facilitator. As the student's skills and confidence increase the amount of facilitation is reduced. The ultimate goal is for students to be able to use the communication aid(s) of their choice independently.

Use of facilitated communication is not restricted to any specific age or any diagnostic group. It’s been used successfully by people with diagnoses including autism, Down syndrome, intellectual disability, cerebral palsy and acquired brain damage. We’d say it was worth trying for anybody who isn’t speaking, or who isn’t speaking roughly around the level of their peers (because we do have clients who have some speech – just not enough for their needs).  

Facilitated communication training generally isn’t considered as an option for an individual if they:
•    have a reasonable amount of functional speech
•    have a fluent alternative communication strategy
•    have the potential to acquire manual signing or handwriting skills easily
•    can clearly and unambiguously select nominated items from communication displays
•    are able to use other direct or indirect access options such as headpointers or scanning systems (some people can’t use these means because of physical control problems, some can’t use them for practical reasons - people who walk instead of using wheelchairs, for example, have trouble carrying a scanning system around with them).
Importantly, that list does not include “don’t have the intellectual capacity to use it.”  Never make any assumptions about the intellectual abilities of anyone who has difficulties communicating.  Training first, testing afterwards.  
On the other hand, that doesn’t mean that anyone who can’t communicate should be started on FCT.  There are a whole lot of other AAC techniques that work well for many people, and many DEAL clients never use FC at all.  

What does a facilitated communication training program include?
Once it’s been decided that an individual is a candidate for facilitated communication training it’s then necessary to:

• work out the nature of the problem(s) which are preventing them from accessing communication aids successfully;
• select appropriate remedial strategies, including facilitation strategies if needed
• ascertain what representational systems (concrete objects, pictures, pictographs, written words, letters) are currently meaningful to the potential user
• enable the individual with severe communication impairments to use the most empowering of the representational systems and selection strategies currently available to them by obtaining/making appropriate communication aids and teaching those in the individual's environment how the aids are used.

What is facilitated communication training?
Most of the time facilitated communication training (FCT) is a better term than facilitated communication (FC). FC isn’t an end in itself – it’s a stage that we hope people will pass through on their way to improved communication.

FCT is a strategy for teaching individuals with severe communication impairments to use communication aids with their hands. In facilitated communication training a communication partner (the facilitator) helps the communication aid user overcome neuromotor problems such as impulsivity and poor eye/hand co-ordination and develop effective pointing skills.

The immediate aim of facilitated communication training is to allow the aid user to make choices.  People who can make choices can communicate in a way that was impossible before. Once they can make choices we encourage them to practice using a communication aid (a picture board, for example, or a speech synthesizer or keyboard) in a functional manner, to increase their physical skills and their self-confidence and to reduce their dependence on the facilitator. As the student's skills and confidence increase the amount of facilitation is reduced. The ultimate goal is for students to be able to use the communication aid(s) of their choice independently.

Who can be helped by facilitated communication training?
Use of facilitated communication is not restricted to any specific age or any diagnostic group. It’s been used successfully by people with diagnoses including autism, Down syndrome, intellectual disability, cerebral palsy and acquired brain damage. We’d say it was worth trying for anybody who isn’t speaking, or who isn’t speaking roughly around the level of their peers (because we do have clients who have some speech – just not enough for their needs). 

Facilitated communication training generally isn’t considered as an option for an individual if they:

• have a reasonable amount of functional speech
• have a fluent alternative communication strategy
• have the potential to acquire manual signing or handwriting skills easily
• can clearly and unambiguously select nominated items from communication displays
• are able to use other direct or indirect access options such as headpointers or scanning systems (some people can’t use these means because of physical control problems, some can’t use them for practical reasons - people who walk instead of using wheelchairs, for example, have trouble carrying a scanning system around with them).

Importantly, that list does not include “don’t have the intellectual capacity to use it.”  Never make any assumptions about the intellectual abilities of anyone who has difficulties communicating.  Training first, testing afterwards. 
On the other hand, that doesn’t mean that anyone who can’t communicate should be started on FCT.  There are a whole lot of other AAC techniques that work well for many people, and many DEAL clients never use FC at all. 

What does a facilitated communication training program include?
Once it’s been decided that an individual is a candidate for facilitated communication training it’s then necessary to:

• work out the nature of the problem(s) which are preventing them from accessing communication aids successfully;
• select appropriate remedial strategies, including facilitation strategies if needed
•  ascertain what representational systems (concrete objects, pictures, pictographs, written words, letters) are currently meaningful to the potential user
• enable the individual with severe communication impairments to use the most empowering of the representational systems and selection strategies currently available to them by obtaining/making appropriate communication aids and teaching those in the individual's environment how the aids are used.

.

What benefits does facilitated communication training offer?


 Facilitated communication training has enabled some people without functional communication to take charge of their lives, make their wishes known for the first time, and join the life of their communities. Parents have been enabled to communicate with their children. Children who have had only restricted education, or no education at all, have gone into regular classes; some have completed high school and gone on to university. For some people with challenging behaviours frustration has been relieved and behaviour has improved.

That doesn’t happen with everybody, but of the thousands of people with severe communication impairments who have been to DEAL Communication Centre over the past thirty years, almost all have been able to improve their communication.  And communication – any communication, from being able to answer yes or no upwards - changes the lives of people with disabilities, and the lives of their families and friends.

Facilitation is controversial

Facilitated communication has been criticised by some professionals as an unproved technique that is open to abuse and can lead to words being put in the mouth of a person with a disability.  That’s true enough (what human activity isn’t liable to abuse?) but some critics jump from there to the conclusion that FCT should never be used, which is a baby = bathwater error. However, users should certainly be aware of possible pitfalls and necessary precautions.   For more details on the debate, have a look here; for a full bibliography, look here. For a discussion of abuses in facilitation, look here.

Facilitation is a last resort.

Facilitated communication is difficult, limiting, time-consuming, and, as I say, controversial.  If you can find any other halfway satisfactory way to communicate with a person, jump at it. If you can’t, try FCT – and try to work your way out of it as soon as is feasible. A few people find that after a year or two of FC they can get a bit of speech back (have a look at Penny’s story). Others find that with sufficient practice they can learn to use communication devices without assistance. Some people find they can work independently some of the time but revert to dependence when under stress. Some people communicate independently on important matters but use FC when they just want to get a simple message across quickly. In any case, the decision is theirs.

Facilitated communication  is the worst possible way to communicate. If you can't make any other way work, though, it's being recalled to life.   Do what you like - but remember what's important.




The early development of FCT is covered by Rosemary Crossley in Flying High on Paper Wings.

Chris Borthwick looks at some of the sociological aspects of the FCT debate here.

Joan Dwyer writes a long but rewarding article on FCT and the law here.

An extensive bibliography on FCT is available here.