Communication barriers are everywhere, and experienced by everyone, every day. Familiar examples include the following:

* Captioned signs to museums that are too small to read, and that contain information that is skimpy, and not helpful.

* Medical information that is provided in technical language, conveyed quickly, and in complex, dismissive ways.

* Legal information that is not only difficult to see, but full of jargon, and difficult to understand.

* Restaurant menus that are complicated and contain vocabulary that needs translation.

* Cashier receipts that are printed in faded ink with items insufficiently indicated.

* School subjects that are taught in disjointed, nonengaging ways, and in a punitive atmosphere.

* Web sites that are difficult to find, difficult to interpret, poorly linked, and poorly organized.

These same barriers experienced by people with disabilities are likely to be even more difficult to overcome. One of the reasons is that those with disabilities are blamed for the difficulties. Problems like those in the above list are likely to be attributed to the person's incompetence rather than to external barriers. For instance, when people with communication disabilities have trouble reading signs, or restaurant menus, or legal documents, their difficulty is commonly interpreted as stemming from a reading impairment rather than from problems with the readability of the document. Or, a person using an augmentative and alternative communication (AAC) system who is left out of a conversation may be seen as being an incompetent communicator rather than as someone whose communication is thwarted by a communication device.

The authors of the articles in this issue focus their attention on situational barriers-barriers that are caused by factors outside the individual. By doing this, they are subscribing to a social model of disability. Their main concern is that the communication event, whether it be a visit to an art museum or an interview with a speech-language pathologist, be made communicatively accessible. This is a departure from medical model approaches in which the efforts of speech-language pathologists are focused mainly on improving the communication skills of those accessing the events.

The social model relies heavily on an access metaphor, borrowed from the disability literature and from legislation that has focused on physical access. The metaphor, as applied in these articles, treats communication access as a journey in which the destination is a communication domain, such as a healthcare service, a legal service, or a conversation, and the goal of the intervention is to remove access barriers to the event (see Parr et al. and Duchan et al., in this issue for more on the journey metaphor).

The job of the service provider in this social model framework is to circumvent or remove environmental and social barriers to access. The job of speech-language pathologists, as identified in a social model framework and as reflected in these articles, is to work (1) to make their own service communicatively accessible (see Hand in this issue), (2) with the person with the communication disability to identify the communication barriers in his or her life and provide support for overcoming them (see Parr et al., Duchan et al., and Waller in this issue), and (3) to work with other service providers to make their service more communicatively accessible (see Parr et al., Togher et al., Duchan et al., and McSheehan et al. in this issue).

ACCESS TO DIFFERENT MINIWORLDS

These articles on communication access identify a wide variety of access barriers. Some barriers are similar across contexts, such as ones caused by lack of skill of service providers in making information accessible, while others are more unique to particular contexts, such as when communication devices fail to allow AAC users to engage in storytelling during conversations. Each article addresses barriers in different miniworlds. The worlds include

* healthcare services (Parr et al.)

* legal services (Togher et al.)

* arts in the community (Duchan et al.)

* storytelling during conversation (Waller)

* explanations by speech pathologists (Hand)

* school curriculum (McSheehan et al.)

BARRIERS TO COMMUNICATION ACCESS

Among the many types of barriers talked about by the authors are the following four, selected to give a flavor of what the articles are all about: negative attitudes toward people with communication disabilities, inadequate knowledge and skills of service providers for dealing with people with communication disabilities, limitations of AAC systems, and complicated or opaque professional discourse.

Attitude barriers

All the authors in this issue allude to the barriers arising from misassumptions and biased attitudes of service providers. The most dramatic example of the powerful effect of attitudes is offered in the article by McSheehan and his colleagues. They asked school team members to change their planning about students with significant communication disabilities. The change they requested was that team members shift their curricular plans from ones that presumed the students' incompetence to ones that presumed their competence. The ability of the teams to change their attitudes, with training and guidance from facilitators, is both remarkable and enlightening. It reveals the dramatic negative effects of attitude barriers on social inclusion. And, what is more important, this article shows the exciting potential of providing support to service providers so that they are able to change their attitudes and thereby change the way they work with people with significant communication disabilities.

Knowledge- and skill-based barriers

Several of the articles in this issue have developed training programs for service providers, so as to reduce barriers to communication access. The training programs described in the articles by Parr et al., Togher et al., Duchan et al., and McSheehan et al., while all different in content and focus, provide information and methods to facilitate communication skills of service providers. Significantly, also, they all involved consumers in the design and execution of the training.

Together, the variety in these training programs attests not only to the ingenuity of their creators but also to the many directions one can go when tailoring social model interventions. Some of the unique features of these training programs are as follows:

* A framework to use to audit healthcare programs for their communication accessibility (Parr et al.)

* Teaching scenarios, composites of actual experiences of people with communication disabilities, that are used to identify and get around communication barriers (Parr et al.)

* Video scenarios of a person with significant communication disabilities conveying his problem to a service provider (Togher et al.)

* A way to insert the training module in an already established disability awareness training program (Togher et al.)

* A journey metaphor within which to evaluate and plan for enhancing communication access to different parts of a service (Duchan et al.)

* Use of trained volunteers to support people with communication disabilities in arts courses (Duchan et al.)

* A means for changing curricular planning for students with significant communication disabilities from a deficit-based one to a competence-based one (McSheehan et al.)

* A supported team training approach for including students in a general education curriculum (McSheehan et al.)

Communication device barriers

Annalu Waller directs our attention to the communication barriers experienced by children with complex communication needs that originate from their communication devices. She focuses in her article on the inability of most devices to provide children with a means for being spontaneous as they tell stories and jokes during ongoing conversation. The devices for children who do not spell disallow improvisation of vocabulary, sentences, and plots and force the children to resort to preformed monologues when they want to insert their stories or jokes into a conversation.

Waller has worked to overcome these barriers by designing and promoting software programs that allow the children to make online changes in their pre-formed texts in the course of their conversations.

Discourse barriers

Yet another kind of barrier is that which arises in the ways language and discourse is mismanaged by service providers. Linda Hand examined how speech-language pathologists delivered information to clients in the initial interview. In particular, she shows the lack of clarity and elaboration in explanations given about the speech and language service, about what will be happening in the evaluation, about why certain information is being gathered, and about the purposes and practices of assessment. Her transcripts and analyses reveal that even speech-language pathologists, who specialize in facilitating communication, need to work on making their service more accessible to their clients.

EVALUATION OF ACCESS EFFORTS

The focus of these articles is to identify barriers in particular access domains and spell out how one might go about circumventing them. Several of the articles describe their circumvention program in detail, including the difficult tasks of involving people with disabilities in the program and of designing and carrying out inservice training for service providers. Some of the articles are reports of innovative programs that are not yet implemented, and therefore not yet evaluated. Nonetheless, all of the articles directly or indirectly address the important issue of how to go about evaluating communication access both before and after implementing their intervention.

The ways these authors are going about evaluating their innovative programs are, in themselves, innovative. They include (1) using consumer input to audit a service's accessibility (see Parr et al., this issue); (2) conducting and analyzing interviews of people with disabilities about their experiences with a service (Duchan et al., this issue; McSheehan et al., this issue); (3) analyzing the breakdowns and successes of the discourse during the interactions (Waller, this issue; Hand, this issue); (4) having service providers evaluate the training (Togher et al., this issue; McSheehan et al., this issue); (5) measuring whether the training has an impact on the behaviors of the trainees (Togher et al., this issue); and (6) tracking to see whether the service is used by more people with communication disabilities following the training (Togher et al., this issue). In many cases, they are using traditional evaluation methods for validating their efforts. What is different about their evaluations is that they are examining changes in communication access in the environment, rather than the more typical evaluations that measure improvements in the performance of the person with the disability. Their evaluations, like their projects, are true to the social model.

SUMMARY

The six articles in this issue of Topics in Language Disorders have a strong commonality-they all focus on projects designed to eliminate or minimize communication access barriers. Four of the articles in this issue describe training programs for service providers. They authors report on what they did as well as why they did it. A fifth article identifies computer design barriers and how to overcome them. A sixth article shows the inaccessibility of information provided by speech-language pathologists, indicating that we need to do some housecleaning of our own to make our services more accessible.

The articles, when taken together, are notable for several reasons. First, they represent an effort by people from very different areas of the globe (Scotland, England, Australia, United States) who are responding to the need to promote communication access. Second, the projects have involved the strong input of people with communication disabilities at different levels: as advisors (Parr et al.), as project facilitators (Parr et al., Duchan et al., and McSheehan et al.), and as researchers and authors (Parr et al., Togher et al., Duchan et al., and Waller). Third, the authors also are exploring a variety of evaluation methods, since the usual instruments, designed to measure the improvement in a client's communication, are not appropriate for evaluating programs aimed at changing things in the environment.

CONCLUSION

The articles in this issue represent an emerging new phase in our profession's development, one that has come to be called communication access. The increasing emphasis on communication access reflects a conceptual shift that is taking place in the field, a shift that relies less on a medical model and more on social model principles (see Byng & Duchan, 2005, for a sample listing of some social model principles). The communication access phase has grown naturally out of the thinking that went into the pragmatics revolution, out of the methods that have emphasized functionality over accuracy, and out of the practices designed to provide communication support in classrooms. This communication access phase in our development is also grounded in cultural changes resulting from the disability and consumer rights movements and from disability legislation.

The articles in this issue take these recent trends in the field a step further in that they direct their attention to communication access. In each article, the authors identify a miniworld of society that has excluded people with communication disabilities, and then describe their efforts to make that miniworld more accessible. Taken together, the articles argue eloquently for the feasibility of creating a more inclusive society for people with communication disabilities, and eventually making the society more communicatively accessible for everyone else.

-Judith Felson Duchan, PhD

Issue Editor, Professor Emerita, University at Buffalo

REFERENCE