INTERACTION CHECKLIST FOR AUGMENTATIVE COMMUNICATION

INCH
Communication Modes Description Key () Strategies Scoring Key
;::
VI
L ~ Linguistic (verbal language skill) :; () + Present (effective without prompts)
PA ~ Paralinguistic (nonverbal vocalizations, inflection) ()
;:: (!)
z
()
:';i!
:';i!
w
- Emerging (needs prompts, inconsistent) J:
VI
VI
w
K ~
Kinesic (facial expression, body movement, gestures) VI
:; :::; ()
w Z - Absent (or not observed) tD z
Viw 0>< 0 zw
PR
C
~
Proxemic (physical positioning and distance)
Chronemic (timing and rate) z:::;
(!)
'"c.. 52z '""- '"()J:
/ Not applicable
'"w

~

'"
l-
VI S;
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1.0 INITIATION, page 7 of manual L PA K PR C S W
.

1.1 Responds to greetings from others ,

! !
,
i i
1.2 Gains partner's attention ,
:

I
1.3 Uses social greetings I !
i
I

!
1.4 Introduces self when appropriate
I

1,5 Ask questions to initiate conversation

,

1.6 Establishes topic consistent with situation

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2,0 FACILITATION, page 10 of manual L PA K PR C S w
2,1 Uses eye contact to indicate attention to partner
i
I
i
2.2 Maintains optimal physical distance from partner .
i

2.3 Positions self to enhance communication f I

2,4 Uses AAC system without prompting ,

.
2,5 Seeks help when needed

2.6 Gives partner instructions when necessary

I
!
2.7 Uses shortcuts whenever possible
i

I
?R I k", n"litp ,,,('inl fnrm' - -
 -'- -~-- ,--"'- ---.-- -- .. ..
I I I I
2.9 Maintains topic consistent with situation !
I
: : : I
I
i
I I I
2.10 Shifts topic smoothly I
I I i I .
I I I I
2.11 Uses pauses or spaces for greater clarity
I I I I

2.12 Defines sentence types I ! I I

I I I

2.13 Uses linguistic forms to clarify time frame I I I I I

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I'~!'5 ~H
3.0 REGULATION, page 15 of manual L , PA K PR C W

3.1 Maintains partner's interest and monitors understanding I I I I

~
3.2 Gives feedback to partner I !

i i I

3.3 Restates message when necessary I I I I

3.4 Adds detail; expands on message

-1 I I I

3.5 Adapts vocabulary appropriate to partner's needs

j : : 1 I
i

I I I I \

3.6 Adjusts rate of production

I I I I j

3.7 Adjusts volume of Me system as appropriate I I I I

I
3.8 Keeps trying; persists; repeats if necessary I I I I
I
3.9 Alerts partner that more time is needed to finish message I I I I
I

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4.0 TERMINATION, page 19 of manual L PA K PR C 5 W

4.1 Uses social farewells I I I I

I
I
4.2 Recognizes need for topic closure I I I I
I

I
!
4.3 Stops composing when partner indicates understanding I

4,4 Indicates when finished with conversation I I I I

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:. ;'. ',. ;" ... .iIT'
Copynght 1984, Imaglnart Communication Products, Revised 1991 9/95
All Rights Reserved
 -- --------- - - - - - - - - - , - - - - ,

Worksheet
Summary
Present level of Functioning Strengths Weaknesses

of 6 Initiation Strategies

of 13 Facilitation Strategies

of 9 Regulation Strategies

of 4 Termination Strategies

Intervention Plan
Target
Strategy Mode Context
What How Where - With Whom
 INTERACTION CHECKLIST FOR AUGMENTATIVE COMMUNICATION

INCH
An Observational Tool to Assess Interactive Behavior
Revised Edition

SUSAN OAKANDER BOLTON & SALLIE E. DASHIELL

NAME OF AUGMENTATIVE SYSTEM USER: _ _ _ _ _ _ _ _ _ __ D.O.B.: _ _ _ _ _ OBSERVER: _ _ _ _ DATE(S): _ _ __

DESCRIBE AUGMENTATIVE SYSTEM(S) USED: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

DESCRIBE THE USER'S PHYSICAL POSITIONING AND MOTOR SKILLS: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

DESCRIBE THE USER'S COMMUNICATION CONTEXTS (ENVIRONMENTS AND PARTNERS):

Home _________________________________________________________

Educational ___________________________________________________________

Vocational _______________________________________________________________________________________________

Communi~ ________________________________________________________________________________________________

ENTRY SKILLS FOR COMMUNICATION INTERACTION USING AAC SYSTEMS

Skills Present Emerging Absent Comments

Demonstrates desire to communicate

Indicates physical state and emotion

Establishes eye contact

Communicates using nonverbal modes

Uses symbolic/representational forms

Demonstrates motor operation of aids