Priorities and Fractures in DeafPlus Augmentative and Alternative Communication Decision-Making Teams.

PURPOSE: Children who are DeafPlus often engage in multiple services across a range of settings. For children who are DeafPlus using augmentative and alternative communication (AAC), decisions require further distributed expertise when communication planning. However, the processes that these teams engage in when decision making for this cohort remains underexamined. METHOD: This qualitative study analyzed the transcripts of three focus groups to gain insight into how professionals perceive and experience aspects of multidisciplinary interaction such as negotiating roles, authority, and communication approaches specifically for students who are DeafPlus using AAC. RESULTS: Within these teams and their decision-making processes, data revealed the presence of (a) unclear and overlapping roles, (b) conflicting perspectives on communication modalities, (c) gatekeeping and power in support team participation, (d) fragmented and inconsistent processes, and (e) system constraints shaping decisions. These themes, as well as their subsequent subthemes, were then discussed through the lenses of (a) roles, power, and access; (b) the negotiation of influence and voice; and (c) fragmentation and system constraints. CONCLUSIONS: Findings suggest that decision making is shaped not only by interpersonal dynamics but also by institutional structures that DeafPlus students are situated within. In contexts where language modality, communication access, and additional disabilities intersect, fragmented or authority-driven processes may contribute to inconsistent implementation and reduced efficacy of supports. A conceptual roadmap was developed to support greater transparency and alignment during team-based AAC planning for this cohort.