Facilitated communication

Domain XVI · Historical, discredited & harmful · Rosemary Crossley · 1980 · Australia

What it is

ASHA describes FC as a method in which a person with a disability points to letters, pictures or objects on a keyboard or board while a "facilitator" gives physical support, typically at the hand, wrist, elbow or shoulder. It began as a local practice in Australia in the 1980s; Frontline describes…

Format

• Spread in the United States (around 1990 onward). Promotion from Syracuse University, academic publication, an institute and international AAC conferences carried FC into schools and residential services.
• Psychoeducation and decision support. Share the evidence and professional positions without contempt for the family's hopes; route communication assessment to a speech-language pathologist or speech and language therapist (SLP/SLT). Move on when the family has the information and a referral path.

Evidence status, as the guide reports it

• Psychoeducation and decision support. Share the evidence and professional positions without contempt for the family's hopes; route communication assessment to a speech-language pathologist or speech and language therapist (SLP/SLT). Move on when the family has the information and a referral path.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Requests to "verify" FC messages; decline. Working when the client feels supported and roles are clear.
• Over-certainty about what the person "means". Working when your records stay close to observable behaviour.
• Team pressure and collegial conflict. Working when the service stops basing decisions on facilitated output.
• Schools removing all support; parents feeling blamed. Working when the person has an agreed AAC plan in place.
• Hopelessness, isolation, legal deadlines, loss of employment. Working when the client uses the plan and engages with support.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.