Patient Information AAC West: A guide to the service

Background Information

What is AAC?

Augmentative and Alternative Communication (AAC) refers to systems that support or replace speech. This includes the use of signing, symbols and communication aids.

AAC systems include:

  • Low tech – gesture, signing and paper based systems.
  • High tech - devices which require a power source, such as a battery or charger. These may be computer systems or specially made communication aid devices.

AAC services in England

BCAS is one of 15 AAC specialised services funded by NHS England, providing an assessment and equipment provision
service to all people who meet the referral criteria.

BCAS provides a service for both children and adults.

In conjunction with Dame Hannah Rogers Trust based in Newton Abbot, BCAS is the allocated specialised service for the South West Region.

What is a specialised AAC service?

Specialised AAC services are dedicated centres that have an interdisciplinary team to provide a high quality AAC service.
They consider all aspects of AAC to ensure a comprehensive assessment is carried out.

The interdisciplinary team will look at:

  • AAC devices – the technology/computer that could be used to support communication, e.g. tablets, laptops etc.
  • Low tech systems – paper based systems which can be used in conjunction with the AAC devices. 
  • Access devices – how the computer will be controlled, e.g. mouse, joystick, eye-gaze etc.
  • Mounting solutions – how the equipment will safely attach to wheelchairs, tables etc.

The specialised AAC service provides an assessment only service. Once the most suitable AAC equipment has been identified, the ongoing support for that equipment will be provided by the local team that initially made the referral.

Equipment will be maintained by BCAS on the behalf of NHS England, and subsequent reviews and reassessments will be
carried out if the individual continues to meet the criteria. Only those referrals that meet the criteria will be accepted.

For further information about the criteria, please discuss with the referring speech and language therapist.

The BCAS team

BCAS has a team of professionals specialising in AAC, working with both children and adults. The team comprises:

  • Speech and Language Therapists.
  • Occupational Therapists.
  • Technicians.
  • Assistant Practitioners.
  • Clinical Scientists.
  • Access to educational staff and physiotherapists, as required.

The assessment process

AAC west assessment process flow chart

All assessments at BCAS will follow the process described below:

  • Referrals – All referrals to the service will be made by the person’s local team (usually the local speech and language therapist). This ensures that support will be available during and beyond the assessment process for the person using the AAC device.
  • Initial Assessment – The AAC assessment is carried out by the BCAS team (see below for more details).
  • Loan of equipment – If an appropriate AAC device is identified, the person will be invited back to a separate appointment to collect this device and receive training on how to use it. If mounting systems are required, these will usually befitted at this appointment. The identified AAC device will then be loaned for a period
    of six to eight weeks so the person can practice using it in their own environment, and establish its effectiveness in extending their communication. Targets are usually set for this loan period, which can be used as points of discussion at the review. 
  • Review – This appointment takes place to discuss the effectiveness of the loaned equipment, in which targets
    are reviewed. Decisions are made as to whether enough evidence has been collected to establish if this loaned 
    piece of equipment meets the person’s needs. If it does, the equipment will be provided on a permanent
    loan basis. If the loan was not as successful as was hoped, the same equipment can be re-loaned again following adjustments or alternative equipment can be identified and loaned.
  • Provision of equipment – If a device is identified that suits the person’s needs, it can be loaned to that individual on a long term basis. BCAS will review the use of the equipment on a yearly basis.
  • Local team – Once equipment has been provided on long term loan, the care of that person is transferred back
    to the local team. It is the local team’s responsibility to provide the ongoing support for the person using the device.
  • Further reviews and reassessment – Further reviews may be carried out as required to determine if the AAC
    device is still appropriate and meets the person’s needs. A full reassessment may also be required at a future date.

Initial assessments

What does an initial assessment involve?

Initial appointments tend to be divided into three components:

  • Discussions: this is where we gather all the information required to help in the decision making process, as to what device would most suit the person’s needs. The discussion will look at the following areas: 
    • Communication skills.
    • Physical abilities.
    • Sensory skills.
    • Cognitive abilities.
    • Previous experience of technology.
    • Where the person wants to communicate.
    • Where communication breaks down.
    • How an aid might be useful to the individual.
    • Support networks.
    • Lifestyle and interests.
  • Trials: demonstrations and trials of AAC equipment.
  • Planning: making plans for what should happen next.

Who should attend the initial appointment? 

The person should be accompanied to all appointments by their local speech and language therapist. If a child has been
referred, then a member of the educational staff should also be present. It is also important that people who are directly
involved in the person’s care, or who play an important role in their life, attend as well.

The members of the BCAS team who may attend appointments are a BCAS speech and language therapist, an assistant practitioner and an occupational therapist or a clinical scientist.

Where do appointments take place? 

Paediatric appointments will take place at the Claremont School site and adults will be seen at Highwood Pavilions. On
the recommendation of local therapists, BCAS are also able to undertake home or school visits.

How long are appointments at BCAS?

An average initial assessment takes around two to three hours. We are aware that appointments are lengthy and
therefore we make sure that there are regular breaks and that refreshments are offered. In some cases we may split a
session over two appointments if appropriate.


All accepted referrals to BCAS will have their assessment, as well as any identified equipment funded by NHS England.

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.
© North Bristol NHS Trust. This edition published May 2019. Review due May 2021. NBT002977