Opening Conversations: Empowering Youth with Complex Communication Needs

Communication is one of the most important aspects of life, yet many of us take it for granted. Those with complex communication needs (CCN) secondary to different neurological conditions and/or medical diagnoses, such as cerebral palsy, Angelman syndrome and autism spectrum disorders (ASD), typically have co-occurring conditions such as hearing and vision impairments. They face numerous challenges that prevent them from accessing the help they need to communicate effectively with the world. Compounded with economic disadvantages, these difficulties can feel insurmountable, as assistive technology can be expensive.  

For the past six years, Sherri Tennant, Assistant Clinical Professor of Speech, Language and Hearing Sciences (SLHS) at CU Boulder, and her team have worked in Denver with CCN students who experience economic disadvantages and use augmentative and alternative communication (AAC) systems. AAC systems are various low and high-tech methods for communication that can help those who are unable to speak verbally, such as picture-based communication books, iPad apps and speech generating devices (SGDs). These systems are customized to meet individual communication needs.  

In 2019, Tennant began consulting in Denver Public Schools, visiting classrooms and guiding staff who worked with students unable to verbalize through natural speech or reliably use touch screens. Without AAC systems or trained professionals with the knowledge to use them, many students lacked a consistent way to communicate. 

Seeing that the growing need was more than one consultant could handle, Tennant and her colleague, Associate Professor Christine Brennan, decided to apply for a grant from the Office for Public and Community-Engaged Scholarship. 

“We had a couple of goals in mind with different emphasis,” said Tennant. “One was to train our graduate students in the speech-language pathology program in AAC assessments and intervention, as there is a great need in our field, public schools and healthcare settings.”  

During the last six years, Tennant and her team have trained more than 38 graduate students and 30 general education peers in AAC systems, many of whom have gone on to work in public schools.  

“Second goal, of course, was to meet the needs of the Denver School of Science and Technology (DSST), helping those students and empowering them by giving them access to AAC systems through Medicaid,” continued Tennant. “As of now, we have assessed and procured AAC systems for 12 students total.”  

“Our third goal then was to do professional development for all the educators, paraeducators and speech language pathologists that work in the school district. And then, finally train the family members to use these systems at home with the AAC users, the adolescents,” explained Tennant.  

The project has now involved two high schools and one middle school within the DSST school network. The DSST team of educators has continued to support the project, writing letters of support that demonstrate the need for this kind of work and help in the grant reapplication process. 

While some paraprofessionals and teachers initially felt apprehensive about using AAC systems due to their cost and complexity, many have now fully embraced them, actively participating in Tennant’s training and advocating for AAC systems in their schools. 

 “Seeing the change in attitude and progress [from educators] through consistent teaching, patience and modeling has been one of the biggest rewards,” reflected Tennant. 

The team is working to organize and lead a larger workshop in summer 2026 to introduce critical AAC information and provide advanced training to professionals who are new to AAC as well as give more information to families who may be struggling with adopting the AAC systems. This will continue to increase the number of people who will benefit from this grant project. 

Alongside professional training for paraeducators and teachers, the team created multimedia training modules to assist with AAC system use, and they plan to expand this online resource into Spanish. Marcella Manzur, a Spanish-speaking collaborator in Mexico City, has frequently assisted the team by interpreting and translating content for family support and training groups. She is also working with her team in Mexico to translate the multimedia training modules into Spanish. Due to the linguistic importance of this work, Tennant ensures that the team remains sensitive to cultural and linguistic identities when interacting with students and their families. Manzur supports this goal by acting as a translator during therapy sessions, helping students and their families feel as comfortable as possible while learning about how to use an AAC system. 

Despite the wide scope of their goals, Tennant and her team have achieved great success, giving a voice to economically disadvantaged adolescents with complex communication needs in the community while helping educators and CU Boulder students gain critical hands-on experience with AAC systems. In February of 2023, Tennant, Brennan and five graduate students presented the outcomes of this work at the Assistive Technology Industry Association (ATIA) national conference in Orlando. The team plans to present their findings again at ATIA in 2026. Graduate students working on this project not only get the chance to present their work at important conferences in the field but also gain extremely valuable experience in a relatively niche area, leading to great opportunities. 

 “I’ve received emails from [past students] saying it’s because of this grant project that they were able to get their position or that they felt so comfortable and confident working with the school team. That has been really rewarding,” remarked Tennant. 

The collaboration between many different professionals across the SLHS and education spheres provides a uniquely impactful experience for the program’s youth participants. This work is inherently community engaged, heavily depending upon consulting and interacting with the community; Tennant stressed the importance of “family-centered treatment as much as possible.” 

Tennant shared an example of a teenager whose progress depended on being consulted within her natural setting outside of highly structured therapeutic activities with a community- and family-centered approach. While being assessed in a local hospital to demonstrate how she could benefit from an AAC system, the teen exhibited noticeably aggressive behavior. However, at school, the teen had successfully communicated and responded with the trial AAC systems. The teacher, with whom the student had built trust, asked to be included in the hospital assessment but was denied due to post-COVID policies. The hospital’s assessment incorrectly concluded that she would not benefit from an AAC system due to her behavior, which was a result of the teen’s trusted companion, her teacher, being unable to assist.  Tennant’s team was then able to assist in completing the AAC assessment at school where the student was comfortable and included her mother as well. The student was very cooperative, using the AAC system effectively with a smile.  

“Sometimes these policies in outside organizations can be obstacles to what’s beneficial for a client or a patient. The beauty of our grant project is it allows us to go into their [the patient's] most comfortable setting. If that’s home, if that’s school, we can do that. When we do that, we get a clear picture of their potential,” explained Tennant. “ We were able to procure a system for her [the teen] through Medicaid, and she was using it really effectively. She ended up graduating and moved on and out of the school. That conveys one very powerful benefit of this grant project.” 

Students who may have been resigned to silence in their classrooms can now communicate and even make jokes in class, happily surprising the educators who have watched them grow and progress.  

The work of Tennant and the rest of the team has provided hope to these teens and opened doors for them to participate and interact with the world around them. In a world so consumed with communication, everyone deserves access to the human flow of connected ideas—thanks to this grant project, those with complex communication needs can overcome economic barriers to join in on the conversation, too.  

This crucial work continues on. For more information about the multimedia modules, SLHS pathology trainings for graduate students, family-centered trainings at DSST or information on future conference presentations, visit: Empowering Economically Disadvantaged Adolescents with Complex Communication Needs.