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As I have discussed, understandings of communication disability have been medicalised and steeped in the individual-tragedy model of disability, and there has been little engagement of this research with the issues that have been foregrounded by disability studies. It is also likely that the study of communicative participation has been somewhat limited by the reliance on the ICF (World Health Organization, 2001), which is aligned with health and disease-related conceptualisations of communication disability. Many of the authors of studies on

communicative participation mention the ICF, and indeed justify the study of communicative participation on the basis of the framework suggested by biopsychosocial model of the ICF, but without deep exploration of the issues encompassed by the participation aspects of the ICF (see for example Ashton et al., 2008; Baylor et al., 2011; Baylor et al., 2010; Bricker- Katz et al., 2009; Doyle, McNeil, Le, Hula, & Ventura, 2008; Eadie et al., 2006; Hartelius, Elmberg, Holm, Lövberg, & Nikolaidis, 2008).

Nevertheless, the ICF (World Health Organization, 2001) has been most influential in providing researchers with a framework in which to visualise the participation of

communicatively disabled people in life’s activities (Hammel et al., 2008; Ma, Threats, & Worrall, 2008; Threats, 2006, 2008), and is the reason why I gave it as much attention as I did in the previous chapter. There has been, of course, important work by authors who have worked with the concept of communicative participation independently of the ICF (e.g. LPAA Project Group et al., 2001; Simmons-Mackie & Damico, 2001; Worrall, 2000). Biopsychosocial models have played a significant role in boosting the changing philosophies of communication disability. Aligning themselves with the ICF conceptualisation of

72 participation as involvement in life situations, Eadie et al. (2006, p. 309) described

communicative participation as “taking part in life situations where knowledge, information, ideas, or feelings are exchanged”. Their definition includes various communicative forms including speaking, listening, reading, writing, or nonverbal means of communication. Central to their definition is the core notion that “life situation” implies that communicative participation occurs in a social context of “what is being communicated, where, when, why, and with whom” (Yorkston et al., 2007, p. 435). Hence, the definition views communication as a reciprocal process, involving more than one person, and as involving a communicative exchange (Yorkston et al., 2008). A communicative exchange involves a message being delivered and an opportunity for a communicative partner to respond. Communicative participation may take place for a defined social goal, for a function /role, and/or in a particular context, and may occur in multiple life situations or domains.

A similar definition was offered by Doyle et al. (2008), who considered communicative participation as embedded within the construct of communicative functioning. They defined communicative functioning as “the ability to engage in common, everyday behaviours, tasks, activities, and life situations that involve understanding and/or producing spoken, written, and/or non-verbal messages, signs, and symbols” (Doyle et al., 2008, p. 720). Aligning with the ICF model, this definition

conceptualises functioning as an umbrella term that encompasses body/mental functions, activities and participation. Thus communicative functioning

encompasses body/mental functions of voice, speech, language, communication, and communication related tasks and activities, and life situations involving spoken, written, and nonverbal communication. (Doyle et al., 2008, p. 721) Kovarsky, Culatta, Franklin and Theadore (2001) presented a model of communicative participation that was based on the understanding of communication needing to extend to “specific facets of human interaction and the broader, inclusionary, communicative context” (p. 1). The philosophy behind their model is as follows:

Humans do not simply exist in a physical, material world the way an apple is housed in its skin (Buber 1965b); rather, they construct a life-world (Habermas 1987) by imbuing it with meaning through inter-subjective experiences and interactions with others that are constituted primarily through language (Stewart 1995). Without communicative participation through language where

73 individuals, there would be no life-world (Habermas 1987). (Kovarsky, 2008, p.

50)

Kovarsky et al. defined communicative participation as “how individuals participate in talk and interaction” (p. 2). Their model comprises five overlapping levels:

1. The first level is “life-world participation”, which Kovarsky et al. see as the broadest level. Life-world is expressed in various ways. Communicative participation at the life-world level is the expression of people’s identities, their agendas as well as their values. In addition, watershed events provide information about the life-world of people. The barriers and facilitators that affect inclusion and exclusion are included in the life-world level of their model.

2. The second level of the model is “participant structure”. This involves the acceptance of ways that communication happens; the ways in which knowledge or information is exchanged; and the way in people are afforded opportunities to participate.

3. The third level is “participant stance”, meaning the roles that the person takes in the communicative exchange. At times a person might be a listener; at other times a speaker. At times a person might be dominant and at other times might be less controlling of an exchange. There is tremendous variability here, and the expectation is that there will be shift and negotiation.

4. The next level is “participant accommodation”, which refers to the way in which the communicative partners accommodate to one another.

5. “Participant resources” are the strategies that the communicative partners bring to communicate with one another. These include verbal and nonverbal resources.

The Participation Model (Beukelman & Mirenda, 2005) was developed to guide the

assessment and intervention of persons who use AAC. (A figure of this model is included in the appendix.) This model has been endorsed by the American Speech-Language and Hearing Association (2012b) as well as by Speech Pathology Australia (2004) for the assessment and management of AAC. The model is based on the ICF conceptualisation of participation, in that the goal of the provision of AAC is viewed as the participation of the individual in society. In this model, the assessment is based upon a comparison with a non-impaired age- matched peer’s performance. The AAC user’s performance is matched to that of the peer. The systematic steps that are recommended include the assessment of the AAC user’s abilities, potential to use AAC, as well as the barriers, in terms of access and opportunity, to

74 communication and participation. Intervention is provided in natural contexts with the aim of enhancing the individual’s specific skills, as well as those of the communicative partner. Interventions are then directed at facilitating opportunities and natural ability, environmental support and adaptations, as well as the required interventions with regard to the AAC system selected. Of significance is that this model encourages clinicians to assess the current

communication potential, skills and needs of the AAC user, as well as consider future needs. There are definitions of communicative participation that are not grounded in the ICF model, and/or which do not necessarily use the term “communicative participation”. For example, building on the work of Lomas et al. (1989), Donovan, Kendall, Young and Rosenbek (2008) defined “communicative effectiveness” as a person’s ability to actively and efficiently get his or her message across successfully in his or her home and community settings to fulfil life roles. Authors have also referred to “social communication” (e.g. Davidson et al., 2008). Researchers have examined concepts that are similar to communicative participation, such as quality of life (e.g. Klompas & Ross, 2004), or lived experiences in which aspects of the research point to communicative participation (e.g. Cruice, Worrall, Hickson, & Murison, 2005). Not all of the terms used when referring to social communication/ communicative participation/ communicative competence are synonymous, and some are used

interchangeably. This lack of consistency points to the relative lack of understanding of what communicative participation is, and the impact of this lack of consistency is significant for researchers, clinicians, and for policy makers.