Year of Award

2026

Document Type

Dissertation

Degree Type

Doctor of Philosophy (PhD)

Degree Name

Counselor Education and Supervision

Department or School/College

Phyllis J. Washington College of Education

Committee Co-chair

Veronica Johnson, Kirsten Murray

Commitee Members

Jayna Mumbauer-Pisano, Emily Sallee, Jennifer Schoffer Closson

Keywords

augmentative and alternative communication, case study, communication accessibility, disability, mental health counseling

Abstract

Communication accessibility is a critical yet underexamined factor influencing access to and engagement in mental health care for individuals who use augmentative and alternative communication (AAC). Existing literature suggests that AAC users experience significant barriers to obtaining communication-accessible mental health services, including limited provider preparation, communication-related assumptions, and broader structural inequities. Despite growing recognition of these concerns, little research has explored how AAC users experience and navigate mental health counseling or how communication accessibility shapes participation in care.

This single-case study explored communication accessibility within the context of an adult AAC users' experiences accessing and engaging in mental health counseling. Guided by critical disability theory and social constructivism, the study examined the central research question of: How does an individual who uses augmentative and alternative communication navigate access to and engagement in mental health care? Data were collected through interviews, poetic artifacts, and policy documents and analyzed using thematic analysis within a case study framework while maintaining reflexive journaling. Analysis resulted in four themes: (1) Communication Accessibility as a Condition of Care, (2) Communication Normativity in Mental Health Systems, (3) Provider Responsiveness as a Facilitator of Access, and (4) Training Gaps for Mental Health Professionals. Findings suggested that communication accessibility functioned as a prerequisite for meaningful participation in mental health care rather than a supplementary accommodation. Structural barriers, normative assumptions regarding communication, and limited professional preparation often restricted access to and engagement in care, whereas provider flexibility, responsiveness, and collaborative communication practices facilitated participation and therapeutic connection. Collectively, the findings demonstrated that communication accessibility is shaped by interacting individual, relational, and structural factors.

This study contributes to the limited counseling literature examining AAC users' experiences in mental health care and highlights the need for disability-informed clinician training, communication-accessible clinical practices, and systemic advocacy to promote equitable access to mental health services.

Download

Share

COinS
 

© Copyright 2026 Kanbi Faith Knippling