For kids who use tech as their voice, Tracy's team delivers
By Louise Kinross
Tracy Shepherd is a speech therapist who has worked with children who use speech-generating technology and other communication systems for over three decades, mostly at Thames Valley Children's Centre in London, Ont. In 2022 she became the director of the Centralized Equipment Pool (CEP), a program run by Holland Bloorview that leases and sells communication devices and writing aids to children and adults in Ontario. We spoke about her career.
BLOOM: How did you get into this field?
Tracy Shepherd: Good grief! That's going back a long way. I've been a speech therapist for longer than 30 years. When I was in school for speech pathology I worked with a family with three kids who had disabilities. Two of the gals used augmentative and alternative communication (AAC). Both children had very complex needs, and they wouldn't have been able to communicate if they hadn't gotten a device. CEP was just starting up at the time, and the technology was brand new. It was all very exciting to me and I've never done anything but AAC since. Working closely with families who use AAC was what started my passion.
BLOOM: How were you drawn to study speech?
Tracy Shepherd: By happy accident, when I was in high school they did an interest inventory, and it came up with this profession for me. I thought 'This sounds interesting.'
BLOOM: Why were you interested in working with kids?
Tracy Shepherd: Most of my work has been with kids and families. It's fun, it's remarkable, it's hard work. But it's worthwhile.
BLOOM: How would you describe CEP?
Tracy Shepherd: We serve 27 AAC clinics across the province and provide communication systems for face-to-face and written communication. It's primarily leasing, because AAC equipment is so expensive, but we also sell new equipment.
A great benefit is we have a service program, so if you're leasing a piece of equipment and it breaks down—and technology always breaks—it can be sent back to CEP to be fixed and we send out a replacement device within four to five days. We recycle equipment and get it up and running and out to the next client, so they don't have to wait while their device is fixed. This year we had over 1,700 leases and 600 purchases.
The other side to CEP is our education program for speech-language pathologists and occupational therapists, who work together in AAC. Therapists who graduate from those programs don't get a lot of training in AAC. Sometimes it's a class, or three or four, or nothing.
So we offer education to clinicians working in the AAC clinics, to give them more in-depth knowledge and understanding of AAC. There are over 400 staff at these clinics and they come together to learn together in our education program, which is a hybrid of in-person and online workshops.
We have an online community of practice that we're transitioning to Teams where we share resources and ideas. If one person has discovered a creative solution in North Bay it may be of use to people in Toronto.
BLOOM: I know you did some research work with Holland Bloorview as a clinician at Thames Valley.
Tracy Shepherd: We did do research on the reliability of speech-generating devices. And I developed some outcome measures for families and schools with [researchers] Steve Ryan and Virginia Wright. Those looked at the impact of AAC in different environments.
BLOOM: How did you transition from clinical work to your current role?
Tracy Shepherd: CEP was an opportunity that I never really considered. Then the director was retiring and I thought I can do this, maybe. And it all worked out.
There was some restructuring of CEP's leadership and I was hired as a director and Marc Tasipit was hired as operations manager. It was a nice match being a clinician who can look at the bigger picture of service delivery while leaving the day-to-day operations to Marc.
We've been making a lot of process improvements since I came in to the role two-and-a-half years ago. We were very paper based. Some of that was related to Ontario's Assistive Devices Program. Up to the pandemic they would only accept paper forms. So we're becoming more digital and streamlined and efficient, but we still have a long way to go.
BLOOM: What's the biggest challenge?
Tracy Shepherd: Growing. There's so much unmet need: people who could use AAC and don't have access. We don't have enough AAC clinics in Ontario. Depending on where you live, there may not be a clinic. And there are very few adult clinics. If you grow out of the pediatric system, there isn't a place to go for adults in many places of Ontario. The issue is money. It has to be made a priority, but nobody is grabbing it. It's a critically important, but smaller, population of need.
BLOOM: You mentioned there's a lack of tracking of Canadians with speech problems, or who use AAC, in national surveys.
Tracy Shepherd: The last time Statistics Canada asked people if they had a speech impairment was in 2008. In the latest data from 2022, there was no mention of people with speech or communication disabilities. People don't know it's a need and if we don't have the numbers to support the need, we're never going to get funders to back it.
BLOOM: What are the joys of your job?
Tracy Shepherd: Making an impact. At this point I'm painting with a larger brush. Instead of making an impact family by family, it's taking a step back and seeing where we can improve the system. What's really meaningful to me is to have the reins to see some of the snags at CEP—like things taking too long—and looking at how we can smooth them out.
We're very lucky to have CEP in Ontario. It provides great services for equipment and education, and we're doing a really good job putting equipment in place so people can participate in their lives. Now we want to make the system even better.
BLOOM: What qualities do you need to be good in your job?
Tracy Shepherd: Patience, being a good listener, and being calm. I always go to those personable skills. You also have to be good at analyzing data and coming up with solutions to problems.
BLOOM: What emotions come with the job?
Tracy Shepherd: Pride is probably the biggest one. I'm proud of the program and proud of our staff. We have 12 staff altogether, including the education staff and staff on the ground. It's a good team.
Marc, the manager, and I really support each other in different aspects of the business. He takes on things when needed and I take on other priorities. Marc manages the daily operation of CEP—everything to do with the building, the staff and so much more. We have a really big warehouse of 3,000 square feet. There's a lot of equipment coming in and going out from the clinics. There is a new AAC clinic that just started up in Kenora that is so far away it isn't even in our time zone.
The other emotion would be stress. The biggest stress is that we are moving by May of next year. We were notified last February that our building was purchased by Metrolinx, because the Ontario line will be coming through there. Much of my work this year has been finding our new location, which is at Keele and Lawrence. It's been a learning experience. A speech therapist is not trained in commercial real-estate negotiations.
BLOOM: How do you manage stress?
Tracy Shepherd: I do yoga and pilates and try to take some time for me.
BLOOM: How have AAC devices changed over the years?
Tracy Shepherd: When devices first began they were giant, huge. The batteries alone weighed five pounds. Today devices weigh less than five pounds, so they're streamlined and smaller which is a big benefit for folks who are walking around and need to carry them. The technology has gotten a lot faster. And the creativity around how people with various needs access the technology.
Artificial intelligence (AI) is coming in now. How is it going to be used for good? There are many ethical worries.
BLOOM: How might AI enhance a communication device?
Tracy Shepherd: It could garner information from the context of a conversation that a person uses and prepopulate some messages that the person might want to say. So "Here's five things you might want to say when you roll into McDonald's."
AI may help improve speed. AAC is still really slow. The fastest users are still slower than you and I are communicating.
The other thing AAC doesn't do a good job with is conveying emotion and customizing voices. Our voice is so much a part of who we are, and AAC users want a voice that reflects them as a person, and sounds the way they want to sound.
BLOOM: I haven't seen it yet, but I know Jennifer Aniston is the voice in the device of the character in the film Out of My Mind. I saw a clip and it doesn't look like they showed how cumbersome it is to use a voice device.
Tracy Shepherd: No, it doesn't really give a good indication of how slow things are. I guess there's a balance between 'Hollywood' and showing, in an authentic way, how it works. That said, clients and families are pretty pleased with the film, and that's the gold star.
BLOOM: If you could change one thing about how we support AAC users, what would it be?
Tracy Shepherd: Less paperwork. There's a lot of paperwork to apply for ADP funding, and sometimes that slows things down. We'd like to get the technology to folks faster.
BLOOM: What advice would you give a new speech therapist who is interested in AAC?
Tracy Shepherd: They're going to love it. People that come into AAC tend to stay. It's an interesting place to work because it's always changing and new. It's about trying to find the right technology and the right system to meet a person's individual needs. It's a puzzle that you need to find all the right pieces for, and put them in place.
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