ABSTRACT
The field of augmentative and alternative communication (AAC) continues to advance at a rapid pace. Speech-language pathologists (SLPs) and other professionals providing services to people who rely on AAC need to keep their knowledge and skills current. Some also have continuing education unit (CEU) requirements that must be met. Barriers to learning include time, scheduling, and cost. This paper describes an Internet-based self-study shell that addresses these needs. It can be populated with course material of value to AAC stakeholders.

BACKGROUND
The goal of AAC is the most effective communication possible. The life experience of people with significant communication disability who rely on AAC is closely related to their ability to communicate. Speech-language pathologists (SLPs) and other AAC professionals provide services with the goal of optimizing communication performance.
The field of AAC continues to develop rapidly. One example is the recent and ongoing development of new methods, tools, services, and evidence to support evidence-based clinical practice (1). AAC professionals must keep abreast of these and other innovations in order to help their clients achieve the most effective communication possible.

STATEMENT OF PROBLEM
While over two thirds of practicing SLPs include AAC in their caseload (2), few of these individuals routinely read the research journals, attend major conferences, or even belong to the ASHA (American Speech-Language-Hearing Association) Special Interest Division on AAC. The presumption is that other AAC professionals face a similar situation.
Barriers to pre-service and continuing education that are commonly cited include time, schedule, and cost (3). AAC professionals frequently have difficulty obtaining release time to attend educational events such as workshops and conferences. The costs of travel, accommodation, and registration are further deterrents. The costs of journal subscriptions and even organizational memberships can be significant and often are not reimbursed by employers. Many educational opportunities occur at times that make them inconvenient or impossible to attend.

METHOD
The AAC Institute (AACI) undertook an initiative to create a self-study program that would address this need. The AACI mission includes education and training activities. The College of Wooster (Ohio) offers computer science students the opportunity to participate in the Applied Mathematics Research Experience (AMRE). Through AMRE small teams of students, supervised by a faculty advisor, work on a project for an eight-week period in the summer. The AAC Institute contracted with the AMRE program for the development of a self-study shell.

A list of attributes was identified by the AACI and by surveying potential users. The list included minimal cost of development, and general comments about ease of use by participants (students), low or no cost to participants, and ASHA CEU availability and registration for professionals. Specific criteria identified included 1) ease of registration, 2) inclusion of links to other Internet sites, 3) ability to interrupt the course and return later, 4) organization by modules, 5) a quiz following each module, 6) randomization of questions and answers, 7) maintaining a record of courses, 8) printing of a certificate of completion, 9) ease of entering new courses, 10) linking to a directory of those who have successfully completed at least one course. The ten criteria were used to evaluate the effectiveness of alpha-testing the software shell.

The AMRE team started with the definition of the need and design criteria provided by the AACI. The team explored the alternatives, including commercially available programs and freeware. The drawbacks of the commercial products were their high prices as well as, more importantly, the difficulty anticipated in trying to augment a system to match the requirements for this site without having access to that system's source code. There were several free, open-source products available for producing and managing online courses. phpTest (http://www.resynthesize.com/code/phptest.php) was chosen because it had the most readable, organized source code, and it was the closest to the course setup that the self-study site requires.

The shell was set up to accept Microsoft Word document content. This allowed easy population from existing materials available in other formats.

RESULTS
The program was ready for initial population and alpha testing prior to the end of the eight-week project term. The first course to be entered was “Achieving Success in AAC: Assessment and Intervention” based on a paper published by the AACI Press <www.aacinstitute.org>. The content was divided among five modules, with a sixth module providing references. Alpha-testing achieved 80-100% accuracy for criteria 1- 7, and criteria 8-10 failed to be successfully accomplished with better than 50% accuracy. Overall effectiveness of using the shell was judged acceptable for this phase of testing, and the shell was ready for field-testing.

Field-testing was conducted using undergraduate and graduate students (N=15) enrolled in an AAC course, and two professional peer-reviewers. The same criteria were used to evaluate the effectiveness of the shell. In addition, participants were required to log the time taken to complete each module and the course. Feedback in the form of user satisfaction was solicited from the participants. Field-testing achieved 90-100% for criteria 1-8. The results for entering a new course and registering on the directory indicated that improvements were needed. Seventy-five percent of the participants completed the modules and quizzes successfully on the first attempt. All but one participant was able to complete a failed module successfully on a second attempt, and complete the course to receive a certificate. Completing the six modules took on average 153 minutes (±SD 45 minutes) with a range of 104-280 minutes.

The content of the second course has been completed, but not yet entered. Two additional courses have been identified.
The directory of local resources was completed. This directory lists individuals who have successfully completed at least one course and who agree to be available as a resource to others with AAC needs. The directory is available at the AAC Institute web site. It is organized by country. The United States section is organized geographically and will return a desired number of individuals that are closest to an entered zip code. Various professional and demographic information on the listed individuals is available.

ASHA CEUs are provided without cost. Initially, the processing of ASHA CEUs must happen manually, through the completion of bubble sheets that are mailed to ASHA by post. Automatic electronic processing is not yet a reality, but is expected in the future.

DISCUSSION
Completion of field-testing has established the feasibility of the basic design approach of an Internet-based self-study course. Participant feedback indicated an overwhelming positive user satisfaction with acquiring information and professional development through this format. Feedback from professional reviewers and field-test participants confirmed the potential applications for Internet self-study as 1) professional in-service training, 2) student pre-service training, and 3) non-professional education or identification of resources. Results from the field-testing have contributed to future improvements to shell features that will include the generation of a variety of statistics related to participant use and performance.

To date, three university programs have requested the website for use in teaching AAC topics at the university level. The instructor can assign one of the courses as homework and confirm successful completion either by having students turn in a copy of the certificate of completion or by going to the web site and looking for their names in the directory.

Parents or other family members can use the directory to find resources in their area. While this is not a certification, it does indicate that the individuals listed have taken some initiative to improve their knowledge and skills in the area of AAC.

REFERENCES
1. Blackstone, S. (2002) Evidence-based practice (EBP): A next step for AAC clinicians? Augmentative Communication News. Vol. 14, No. 4,5. 1-16.

2. American Speech-Language-Hearing Association (ASHA) Omnibus Survery. (2001). Rockville, Maryland.

3. Lloyd, L.L., Ratcliff, A., Koul, R., Beck, A., Finch, A., Zangari, C. & Fishman, I. (2002). AAC preparation: Developing & improving curricula. Presented at American Speech-Language-Hearing Association (ASHA) Convention. Atlanta, Georgia.

4. phpTest – An online PHP testing center. (version 0.6.3) found at http://www.resynthesize.com/code/phptest.php. December 9, 2002.

CONTACT
Katya Hill
AAC Institute
Email: khill@aacinstitute.org
http://www.aacinstitute.org