1/21/2015
The 3 A’s: Assessment,
Accommodations, and Adaptations
Meher Banajee, Ph. D., CCC-SLP
Associate Professor
LSU Health Sciences Center
Overview
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•
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Introductions and overview
Definitions
Preparation for assessment
Adaptations and accommodation procedures
and demonstrations
• Practical applications
• Conclusions
Assessment
• Two parts
–Initial assessment to determine AAC
Systems
–On-going assessment to determine
efficacy of intervention
Assessment
• Definition
– It is any activity, either formal (through
the use of norm-referenced standardized
criteria) or informal (through the use of
developmental profiles or checklists) that
is designed to elicit accurate and reliable
samples of the student’s behavior upon
which inferences relative to particular
skill status may be made.
Preparation for assessment
• Gather information from a variety of sources
• Determine current communication techniques
• Determine factors that might interfere with the
assessment process
– Seating and positioning status
– Sensory issues
• Provide necessary accommodations and
adaptations
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Best practices in assessment
• Best practices in assessment
1. Multi-source
2. Multi-discipline
3. Multi-method
4. Multi-cultural
5. Multi-domain
6. Multi-context
7. Multi-occasion
Preparation for assessment
• Variety of sources are used to gather information
– Parental data
• Parental reports are usually accurate
• Use interview methods
• Listen to information provided by parents
• LATI
• Case history children (Goossens’, Crain & Elder,
1990)
• Case history adult (Goossens’, Crain &
Elder,1990)
– Medical records report
• Become familiar with range of medical concerns
• Lens through which behaviors can be interpreted
Current communication
techniques
SETT Framework by
Joy Zabala
• The Student
• The Environment
• The Tasks
• The Tools
Preparation for assessment
– Other intervention reports
• Reports of other team members
– Test results
• A system that uses a variety of means to
assemble and analyze the samples of
behavior
• A means of structuring observations and
reporting results
• Significant limitations in all available tests
• Assessor should be an effective elicitor,
observer and interpreter of samples of
behavior
Current communication techniques
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Preparation for assessment
• Every move counts (Jane Korsten,
http://www.everymovecounts.net/)
– Sensory-based communication program.
– Based on the idea that everyone communicates
– Developed for individuals perceived as unable to
communicate due to severe multiple disabilities
– Functioning below the 18-month level in the area of
communication
– The assessment targets six sensory areas: visual, auditory,
gustatory, olfactory, vestibular and tactile.
Positioning
• Motor development
– Proximal
– Distal
– Cephalo
Current communication needs
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During a 10- to 12-minute session
Gain information on how each individual communicates
Motivating activities
Abilities versus disabilities, no right/wrong answers.
The transdisciplinary team determines response mode
Responses range from a slight body movement (eye gaze,
affect or body position)
– Assessment materials are common items (easy and
economical to assemble)
Positioning
• Movement
– Mobility
– Stability
– Gross motor (e.g. walking) stability
superimposed on mobility
– Fine motor (e.g., writing) mobility
superimposed on stability)
– Caudal
Positioning
• Tone
– Hypertonic
– Hypotonic
– Fluctuating tone (Athetoid)
Positioning
– Abnormal reflexes
• Asymmetrical tonic neck
reflex (ATNR)
– Extensor tone on the
face side
– Flexor tone on the skull
side
• Symmetrical tonic neck
reflex (STNR)
– Extensor
– Flexor
• Positive supportive reaction
• Tonic Labyrinthine reflex
– Prone
– Supine
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Positioning
• General principles of seating
– Pelvic stability
– Lower extremity support
– Trunk stability
– Head support
Positioning
• Pelvic stability
– Sling back or sling seat
– Buttocks positioned back and secured in
seat
– Extensor thrust – rigid pelvic restraints
– Proximal pelvic positioners (e.g., roll,
sacral pad or bi-angular back)
– Upper extremity support
– Manipulation of orientation in space
Positioning
Positioning
Positioning
Positioning
• Lower extremity support
– Distal pelvic positioners (e.g., roll or wedge in
front of the seat).
– Abductor pommel
– Widened abductor pommel
– Adductor pads
• Lower extremity
– Feet should be supported with a
foot plate
– Angle of the foot plate should be
adjusted to prevent extension
– Shortened foot plates
– Straps on the feet
– Customized seating
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Positioning
Positioning
Positioning
Positioning
• Trunk support
– Thoracic pads (removable or swung
away)
– Lateral pads built into the seat
– Harness (v-harness v/s a butterfly
harness)
– Shoulder straps (do not come from the
top but from shoulder height)
Positioning
Positioning
• Head support
– Access a switch and to visually monitor
a target
– Extended back and side pads not
appropriate
– Curved headrest, neck ring or an Otto
Bock headrest
– Not too far back or too far in front
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Positioning
Positioning
• Upper extremity support
– Lap tray
• Too high (bunching of shoulders)
• Too low (cannot weight bear)
• Angled or easel tray
– Bumpers
• Behind elbow and along forearm
• Inhibit extension of arms to the side and
shoulder retraction
• Forward arm position
Sensory issues
• Sensory integration
– Organizing information received through the
senses
– The developing child attaches meaning to
sensations, shifts attention, organizes play
behavior, builds skills, gains control and
regulation of emotions
– Occurs in sub-cortical levels of the brain
– Involves complex interactions with parts of
brain responsible for attention/arousal,
emotions, memory, autonomic functioning and
coordination
Sensory issues
• Tactile sensation
– Primary source of comfort and security
– Learning to tolerate early touch is one
aspect of early self-regulation
– Touch sensations help an infant to suck,
chew and swallow
– Tactile discrimination and perception
play critical roles developing hand
skills
Sensory issues
• Sensory integration
– Vestibular: Gravity and Movement
– Proprioceptive: Body Position and
Movement through Space
– Tactile: Touch throughout the Body
Sensory issues
• Postural control and balance
reactions
– Gravitational Security
– Assists in orienting oneself in space
and in initiating exploratory and
adaptive movements
– A well-regulated vestibular system
helps to integrate both sides of our
bodies
– Regulating: Arousal and Alertness
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Sensory issues
• Proprioceptive system
– Develops through weight bearing and
movement against gravity
– Enables a child to know where he is in
space and how he is moving
– Contributes to development of body
awareness and body scheme
– Calming and organizing input:
normalize arousal levels / aids in self
regulation
Sensory issues
• Sensory modulation
– Registration of sensory input: orient/alert to
novel events
– Response to sensory input: direct proportion
– Well-modulated system results in appropriate:
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Arousal
Self-regulation
Attention
Focus
Behavioral and emotional responses
Sensory issues
• Sensory processing
• Sensory modulation
• Sensory discrimination
• Motor planning
Sensory issues
• Sensory integration
– Sensory Modulation / Self-Regulation
– Sensory Discrimination
– Praxis / Skill Output
Sensory issues
• Sensory discrimination
– A well-developed discriminatory
system allows for:
• Skilled hand use
• Oral motor control
• Coordinated body movements
• Complex actions
Sensory issues
• Problems with Intake/Registration:
Over-orient/ habituate
• Abnormal Responses to Sensory
Input
– Over-responsive: Sensory
Avoidant/Sensory Defensive
– Under-responsive: Sensory
Seeking/Passive
• Influences Self Regulation/Arousal
/Attention
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Sensory issues
Sensory issues
• Sensory discrimination problems
• Sensory diet
– Well-balanced variety of sensation that
match a child’s individual needs
– Combinations of input for regulating state
and enhancing skill
– Sensory input is embedded in the child’s
daily routines or in meaningful activity
– Active engagement of the child, not
“sensory stimulation”
– Monitor response to input through the
child’s behavior, interaction and play
– Fine motor problems
– Breaks toys / difficulty judging force
– Difficulty judging source of sounds,
localization of sounds
– Difficulty judging depth, distance, and
space between self and objects
– Clumsy
Sensory issues
• Sensory input
– Calming and Organizing
– Body-based sensory input most regulating:
• Rhythmical and slow swinging,
• Bouncing
• Firm hug / deep touch pressure
• Resistive activities / heavy work
– Soft or muted colors
– White noise or music with rhythmic and
slower tempos
– Sucking or blowing / chewy snacks
Sensory issues
• Accommodations during testing
– Over responsive child
• Weighted blanket, weighted vest
• Chewy snacks
• Slow rhythmic music
• Bottoms up cushion
• Fidget toy
• Schedule testing after a strenuous activity
• Picture schedule for testing
• Give breaks
• Alternate hard and easy tasks
Sensory issues
• Sensory input
• Arousing and Organizing
• Repetitive and fast movements
• Light touch
• Bright lights and colors
• Vary frequency, intensity or beat of
sound
• Vary temperature and texture of food:
crunchy snacks /sour tastes / cold
Sensory Integrative Dysfunction
Dysfunction of Sensory Integration (DSI)
– Under responsive child
• Teeter-totter stool
• Crunchy or sour snacks
• Cold drinks
• Fidget toy
• Stimulating music
• Alternate hard and easy tasks
• Give breaks
• Picture schedule for testing
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Adaptations
• Adaptations are:
– Changes that make learning- or work-more
manageable for someone, regardless of diagnosis
Accommodations
• Accommodations are:
– Legally required adaptations that ensure persons
with disabilities have an equal chance for success
Accommodations
• Accommodations are
– Chosen for the individual person’s need
– Are needed when you do similar tasks in other
places
Examples of adaptations
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Changes in the pace of learning
Changes in how material is presented
Environmental changes
Changes in the amount of material presented
at one time
Accommodations
• Accommodations are
– Required by law
– Help individuals with disabilities have a fair
chance for success
– Give an equal chance to work in, learn in, and/or
enter a building
Accommodations
• Examples include
– Using special equipment
– Performing work in a different way
– Performing work in a different place
– Changing how others think about disabilities
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Accommodations
• Examples cont’d.
– Note takers
– Additional time to complete tasks
– Repeated instructions or directions
– Large print text or Braille text readers
– Environments free from interruptions and distractions for learning and completing tests
– Sign language interpreters
Adaptations vs. Accommodations
• Accommodations alter the manner of administration of the assessment
– No special approval needed
– Use of large print
– Use of a paper or non‐paper guide (non‐ruled) to facilitate reading
– Use of different color overlays to facilitate reading
– Use of large diameter pen Adaptations vs. Accommodations
• No special approval needed
– Use of ear plugs
– Use of a seat cushion
Accommodations
• Assistive Technologies
– Work processor
– Word prediction
– Speech recognition software
– Screen magnification
– Text to speech
Adaptations vs. Accommodations
• No special approval needed
– Seating near natural light
– Completing individual test sections on different days
– Use of graph paper for math
Adaptations vs. Accommodations
• Adaptations that alter the construct of the
assessment
– Prior approval required
– Audiocassette
– Private room
– Braille
– Extended time
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Adaptations vs. Accommodations
• Prior approval required
– Off-site testing
– Supervised frequent breaks
– Scribe
– Use of special equipment
Adaptations vs. Accommodations
• Typical language assessment consists of
– Formal language assessment
• Criterion referenced tests
• Norm referenced tests
– Informal language assessment
• Language sample
• Discourse analysis
Formal tests of communication
– AAC Profile identifies
• areas of strength and those that need
intervention and instruction
• determines functional, long-range outcomes
and the steps toward achieving them
• compares individual performance over time
• ways that AAC support team members can
define and coordinate their roles for
intervention and instruction programs
• identifies and provides optimal learning
environments
Adaptations vs. Accommodations
• Instructions should be adapted for students as
needed
• Professionals should help students become
familiar with available accommodations
Formal tests of communication
– Test of Early Communication and Emerging
Language (TECEL)
• Ages: 2 weeks to 24 months (standard
scores, percentiles, and age equivalents)
• Older children, adolescents and adults who
have language delays (age equivalents only)
• Testing Time: 15 to 45 minutes
• Administration: Individual observation
and/or parent/caregiver interview
• Can be administered to verbal and
nonverbal respondents and is suitable for
assessing individuals who communicate by
means other than speech
Formal tests of communication
– AAC Profile has the following subtests:
• Operational Area of Learning
– Turning on and off device
• Linguistic Area of Learning
– Demonstrate receptive and expressive
language skills
• Social Area of Learning
– Pragmatics of language
• Strategic Area of Learning
– What can be communicated
– Repair, etc.
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Formal tests of communication
• Norm referenced tests look at the
individual’s performance and
compare it to that of a group
• View an individual’s performance
with reference to group
performance on similar levels
• Direct elicitation of desired
behavior
• Developmental ages, quotients,
age level scores, mental age or IQ
scores
Formal tests of communication
Formal tests of communication
• Limitations include
administration of the test in a
limited narrowly defined fashion
• Child’s response must fit into this
narrow fashion
• Violation of either of these
principles places the
normalization and standardization
in jeopardy (e.g., tracking of
object vs. tracking a person across
the room)
Formal tests of communication
• Lack of predictive ability until 3 years of age
• Therefore the predictability of norm-referenced
tests is questionable at the best
• Scoring difficulties related to item validity or do
the scores actually measure what they actually
are suppose to measure
• In determining an overall score, the items are
not weighted and therefore unable to determine
an accurate overall score
• Norm-referenced tests are of little value in
determining the intervention strategies
• Criterion referenced tests
– Look at mastery of a particular item in a
domain
– Clinician can elicit desired behaviors in a
manner best fits a child (spontaneous
naming of an object vs. naming of an object
on demand)
– Determine strengths and weaknesses
– Seamless transition between test results to
intervention
– More sensitive to change
– Not a diagnostician but an inference maker
– Can be adapted for use with physically
challenged children
Test adaptations
Test adaptations
• Research
– Bristow and Fristoe (1987)
• Compared scores using the standard
protocol and 6 alternative response
modes
• Peabody Picture Vocabulary Test
• Preschool Language Test
• Eye gaze, scanning, headlight pointing,
pointing, head pointing
• Scores correlated highly
• General guidelines
– Use criterion referenced rather than
norm based standardized measures
– Standardization violated
– Document the adaptations you have
used in a narrative and descriptive
manner
– Attempt to get to the skill the test item
represents (e.g., “uses a stick to attain an
out of reach object”. Underlying skill
being measured is tool use.)
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Test adaptations
• Examples of modifications
– Providing choices of answers
• Test item – “assemble 3-piece body puzzle
correctly”
– Provide 1 correct puzzle and 1 incorrect
– One correct answer and 2 foils
– Asking “yes/no” questions
• Test item – “match colored cubes (field of
5)”
– Provide 5 colored containers and colored cubes
– Hold each cube over each container, asking the
child if the cube belongs in that container
Test adaptations
– Test items or other picture based items
– Cut apart pictures and place on
• Choice board
• Communication vest
• Eye-gaze frame
Phonological Awareness Test
• 7 subtests
– Rhyme
• Identification
• Response
– Letters to sounds
– Sounds to letters
– Isolation
• Initial
• Medial
• Final
– Segmentation
– Substitution
Test adaptations
– Eye gaze
• Test item – “identifies three objects by their use”
– Place 3 objects in front of the child and
score based on which item they look at in
response to each question
• Test item match sound to letter
– Place correct letter with 2 foils on a choice
board
– Eye gaze or point with finger
• Test item- identify initial, medial and final
position of sound in a word
– Use train with engine, carriage and caboose
– Use eye gaze or pointing
Test adaptations
• Use a low technology
communication device such as a
rotary scanner
• Use numbers or letters as choices
on a high technology
communication device such as a
Springboard, etc.
Boston Diagnostic Aphasia Examination • Subdivided into five functional sections.
• Conversational and Expository Speech
• Auditory Comprehension
• Oral expression (including the Boston Naming Test)
• Reading
• Writing
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Informal tests
• T-10
– Language activities
• Color recognition
• Letter recognition
• Number recognition
• Same and different
• Association
• Categorization
• Object identification
• Reading comprehension
• Word recognition
• Sentence construction
Language sample
• Elicitation methods & tasks
– Naturally occurring interaction/conversation
– Play-based samples
– Narrative samples
• “Recording” methods
– Video
– Audio
• Size of sample
– Communication Sample: usually timed (6 to 20 min.)
– Spoken Language Sample: 100 permissible
utterances recommended (minimum of 50)
Managing language samples
• Including/Excluding Utterances in a Language Sample
– All productions transcribed in Standard English orthography
– Exclusions:
Imitations
Unintelligible utterances
Identical utterances
Answers to elliptical questions
Rote passages
Noises that are not meaningful
• Defining Utterances
– An utterance may be a sentence OR a shorter unit of language
(even a word) separated from other utterances by a drop in
voice, a pause, and/or a breath that signals a new thought
– Retherford, K.S. (2007). Guide to analysis of language transcripts (3rd ed.). Austin, TX: Pro‐Ed.
•
Informal tests
• Prentke Romich - Unity
–Catch the rabbit
–Picture identification
–Categorization
• Tobii/ATI
–Catch the rabbit
–Games for calibration
Collecting Samples with People Who Use AAC
• Elicitation methods and tasks
– Tasks with available & known vocabulary
• “Recording” Methods
– Use of automatically collected data
– Use of data collected in F2F interaction
• Size of sample
– Rate/volume of communication
• Issues in Language Sample Collection and Analysis
With Children Using AAC by Gail Van Tatenhove, SIG
12 Perspectives on Augmentative and Alternative
Communication, April 2014, Vol. 23, 65‐74. Managing language samples
• Including/Excluding Utterances
– Exclude:
• Prestored sentences and long phrases
• Stored songs, riddles, noises, etc.
– Include:
• Prestored words and short phrases (2 – 3 words)
• Spelled words
• Defining Utterances
– terminal punctuation, time span custom to user
• Issues in Language Sample Collection and Analysis With Children Using AAC Gail Van Tatenhove, SIG 12 Perspectives on Augmentative and Alternative Communication, April 2014, Vol. 23, 65‐74. 14
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Analyzing language samples
• Number of different words
• Type‐token ratio (TTR)
• Semantic relationships
• Comprehension
• Narrative development Use
• Gestures
• Phonetic inventory
• Percent intelligibility
• Mean length of utterance (MLU)
• Brown’s Stages
• Sentence types
• Narrative development Content
Form
Analyzing Language Samples
(microstructure)
• Joint attention
• Extralinguistics
• Pragmatic functions
• Topic Maintenance • Turn‐taking: Discourse ratio
• Narrative development (macrostructure)
• Communication repairs
(microstructure)
Tools for analyzing language samples
• Pragmatics
• Vocabulary
• Syntax
– Brown’s Stages of Linguistic Development
• Morphology
– MLU‐W and MLU‐M
• Conversation & Discourse
• Issues in Language Sample Collection and Analysis With Children Using AAC Gail Van Tatenhove, SIG 12 Perspectives on Augmentative and Alternative Communication, April 2014, Vol. 23, 65‐74. Tools for analyzing language samples
• Traditional LSA Tools
Systematic Analysis of Language Transcripts (SALT)
• http://www.saltsoftware.com/
Language Environment Analysis (LENA) • http://www.lenafoundation.org/
Computerized Language Analysis (CLAN)
• http://childes.psy.cmu.edu/
Computerized Profiling
• http://www.computerizedprofiling.org/
– transcribe the language into the software vs. automatically collected data
– not designed to analyze AAC issues (rate, representational method, device operation, etc.)
• AAC‐Specific LSA Tools
– Performance Report Tool (AAC Institute)
– Realize Language (Prentke Romich Company)
IGDIs for Infants and Toddlers
• http://www.igdi.ku.edu/
Tools for analyzing language samples
• Universal Language Monitor (ULAM)
– AAC institute
• Performance report tool (PeRT)
– Generates a Performance Report with 6
appendices
– Self-Study course available at the AAC Institute
website
http://www.aacinstitute.org/Resources/Products
andServices/PeRT/030820_co_i_exam.html
Tools for analyzing language samples
• Collect and download data files from (LAM)
• Segment utterances and mark words
• PeRT will analyze on 7 Utterance-based Measures
– Total utterances, complete utterances, method of generating
utterances, MLU-W, MLU-M, communication rate, peak
communication rate
– 10 Word-based Measures
– total number of words, different root words, core vocabulary,
representational method, rate by representational method,
selection rate, rate index, errors per selected words, errors per
spelled/predicted words, deletions errors
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Tools for analyzing language samples
Tools for analyzing language samples
• Realize Language™: An AAC‐Specific Tool for Language Sample Analysis • Available from Prentke Romich Company • www.prentrom.com
• $85.00 Yearly Subscription
• PC and Mac Compatible
Tools for analyzing language samples
• Rate
– Time marker for the word entry
– Time for each keystroke to retrieve the word entry
• Accuracy & Automaticity (fluency)
– To retrieve icon for concept
– To retrieve icon for part‐of‐speech
• Language Representational Method
Tools for analyzing language samples
Top Ten
Similarity to Frequency of Use Lists
A-Z List
Share with parents to show growth in vocabulary
Frequency of Use list
Teach spelled words that are pre-stored in device
Add frequently spelled words to custom vocabulary
Review unknown spelled words for literacy development or exploration of
words in device
Parts-of-Speech Graph & Break-down of Word Groups
Focus intervention in areas where you see deficits
Example: Increase question asking using /wh/ words
Example: Expand use of verbs
(CCSS goal = use of synonyms in Language Arts)
Manage Vocabulary Goals
Create, upload, and track vocabulary targeted for intervention
Tools for analyzing language samples
Words Used
Create a Word Cloud
Graph of Top Ten Words Used
A-Z List of all words used
Frequency of Use
Word Analysis
Parts of Speech Graph
Breakdown of Word Groups
Vocabulary Goals
Clinical application
• David
• 6 years 1 month
• Loves trains and animals
• Diagnosis of autism spectrum disorder
• Limited use of gestures such as pointing and
grabbing another person’s hand
• Some use of manual signs such as “more” “all done”
• Inconsistent use of vocalizations
• Occasional echolalia
• Few word approximations and verbalizations, but
mostly unintelligible speech
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Clinical application
• Assessment, Evaluation & Programming System for Infants and
Children (AEPS), Second Edition
• Age Range: Birth to 6 years
• Type: Criterion referenced
• Scored using observation, direct elicitation of behavior and/or
caregiver, teacher, or related service provider report
• Purpose: to identify appropriate targets, formulate
developmentally appropriate goals, conduct before and after
evaluations to ensure interventions are working, and families
involved in the whole process
• Domains: Fine Motor, Gross Motor, Cognitive, Adaptive,
Social-communication, and Social
Clinical application
Clinical application
AEPS Social- Communication:
• Social-Communicative Interactions
• Make commands to and requests of others
i.e., independently signed ‘more’ and ‘open.’
• Production of Words, Phrases, and Sentences
• Uses adjectives i.e., use communication book with
pictures to demonstrate the concept of using
adjectives independently to request color and size of
cars.
Clinical application
Clinical application
Intervention plan
• Goals and objectives
• Increase expressive language skills to an age appropriate level
• Increase interaction with others
• Initiation
• Turn taking
• Commenting
• Describe objects, events, or people
• Two- three symbol combinations
• One- two word combinations/increase mean length of
utterance
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Clinical application
Clinical application
• Analysis of language samples:
– Describe current expressive language abilities
– Use real-life communication tasks
– Identify areas of strength and need
– Supplement or can be used as an important
alternative to standardized tests
• Benefits extend beyond diagnosis
– Useful for writing intervention goals
– Developing intervention activities
– Tracking a client’s response to intervention
Clinical application
Clinical application
• Provides a wide range of information on a child’s
language abilities
– Semantics
– Syntax
– Morphology
– Ability to organize information for different
communication purposes
• Reduces time and effort
• Makes language sample analysis a more realistic
option!
• Provides a wide range of information on a child’s
language abilities
– Semantics
– Syntax
– Morphology
– Ability to organize information for different
communication purposes
• Reduces time and effort
• Makes language sample analysis a more realistic
option!
Summary
• Missing piece of the puzzle
• Formal language assessment
• Adapt test procedures for AAC use
• Develop goals and objectives based on formal
and informal language procedures
• Monitor goals and objectives using both
subjective and objective procedures (e.g., SALT,
PeRT, Realize)
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Apps for learning, play and
communication: Good, Bad
and Ugly
Overview
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•
•
Meher Banajee
Associate professor
LSU Health Sciences Center
Introduction
Universal design for Learning
Apps for AAC
Apps for Speech Language Pathology
Apps for Social story
Apps for Behavior management
Apps for Literacy
Apps for Math
Miscellaneous
Resources for Apps
2
Introduction
Introduction
• What is an idevice?
– Mobile tablet device with a touch screen
– Hybrid between an smart phone and a
full laptop computer
– Used to browse the internet, use apps,
e-book reader, listen to music, watch
movies, play, games, etc.
– Only as powerful as the APPS!
• Why is it an effective tool?
– Mobile revolution (tech-savvy kids)
• Manipulate and interact with devices easily
• Very little instruction
• Keeps them engaged
– Key tool in intervention
• Multifunctional
• Engaging
• Quick access
• Inexpensive
• Readily available
3
4
Introduction
Introduction
• Challenges
– Informed (ever growing selection of
apps)
– Creative (apps not specifically for
speech language pathology)
– Customize (NO SINGLE TOOL FITS
THE NEED OF ALL)
5
• Wi-Fi
– Settings determine when and
how iDevice joins a Wi-Fi
network.
• Brightness
– Screen brightness affects
battery life
– Dim the screen to extend
battery life
– Use Auto-Brightness to
conserve battery life
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Introduction
Introduction
• General
– Settings that affect more than one
application
• Mail
– Use Mail settings to customize your
email account for iDevice
• About
– Gives information about iDevice.
• Sounds
– Settings to play sounds for an
appointment
– Lock or unlock iDevice
• Wallpaper
– Set the wallpaper with one of the
preloaded images or one of your own
• Location Services
– Allow apps to gather and use data based
on your location
– To conserve battery life, turn location
services off
– Type on the keyboard
7
8
Introduction
Introduction
• Bluetooth
– Connect wirelessly to a wireless or Bluetooth device
– When Bluetooth is on, icon in the status bar at the top of
the screen
– To conserve battery life, turn Bluetooth off
• Spotlight Search
– Specify the content areas to search on using Spotlight
– Touch next to an item, and drag it up or down to
rearrange the search order.
9
Introduction
• Auto-Lock
– Locking turns off the display & save your battery
– Prevent unintended operation of iDevice
– Guided access –locks user into an app
• Passcode Lock
– A passcode can be set to lock the iDevice.
• Restrictions
– Set restrictions for what can be accessed on the
iDevice
• Side Switch – Lock Rotation/Mute
– The Side Switch locks screen orientation
– Silences notifications and sound effects.
10
Customizing
• Date and Time
– Time shown in the status bar at the top of the
screen, world clocks, and calendar
• Keyboard
– Auto-capitalization
– Enable caps lock
– “.” shortcut
– International keyboards
• Reset
– Preferences and settings are reset
– Data and media are not deleted.
11
• Rearrange icons
– Touch and hold any Home screen icon until all the icons
begin to wiggle.
– Arrange the icons by dragging them.
– Press the Home button to save your arrangement.
• Enlarging the Screen
– Zoom in and out by pinch your fingers together or apart
– For photos and web pages, double-tap to zoom in & doubletap again to zoom out.
– For maps, double-tap to zoom in and tap once with two
fingers to zoom out.
• Editing text
– Touch and hold to see a magnified view, then drag to
position the insertion point
12
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1/21/2015
Customizing
Customizing
• Screen Captures
– Press & hold both the “home button” & the
“sleep/wake” button simultaneously, for about 1/2
a second & release.
– Screen will flash white & you will hear a “camera
snapshot” sound
– The screen capture will appear in “Photo”
application, under “Camera Roll.”
13
Universal design for
Learning
• Web Site Icons
– Press the + button to open new tab
– Use book icon to
• Add Bookmark, Add to Home Screen, and Mail
Link to this Page
– Select the 2nd button to remember exact position on
the page & automatically generate a thumbnail icon
• Web Extensions
– When typing a web address in Safari, the keyboard
features a .com button
– By holding the .com button down, it will change to
.net, .edu, and .org buttons
14
– Slide to the desired extension, and release
Visual impairment
• Universal access features
• Voice Over
– Visual impairment
– Deaf or hard of hearing
– Physical disability
– Learning disability
– A gesture‐based screen reader
– Allows the user to touch the screen to hear
a description of the item under their finger
• Zoom
– Allows the user to magnify screen of any
application
15
Visual impairment
16
Hearing impairment
• Contrasting screen
• Closed captioning
– White on Black
– Lets the user change the display to white
on black
– Can be used in any app
– Home, Unlock, and Spotlight screens,
– With Zoom and VoiceOver
– Display subtitles and closed captioning
when playing movies and during podcasts
• Mono audio
– Allows you to channel all audio into the left
or right ear or both ears
17
18
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1/21/2015
And … there is an app for
that!!!
Learning disability
• Word prediction or Speak Auto text
• What is an app?
– Suggested words are displayed before the
user finishes typing them
– Suggested words can be also be spoken
with speak auto text
• Triple click Home
– Set the triple‐click Home button to toggle
Voiceover, Zoom, or White on Black on or
off instantly
– A compact software application
– iDevice has two types of apps
– Native
• Preinstalled
• Downloaded (free or purchased)
• Notepad, Calculator, Settings, Video, Pictures,
iPod/Music, Internet Browser (Safari), Email
– Web-based
19
AAC apps
• Require the internet
20
AAC apps
• Tap to talk
• Proloquo2go ($299.99)
– Free but $99.00 a year for full features
– Mix of clip art and photos
– Recorded, male voice
21
AAC apps
– Vocabulary arranged in categories
– Website provides user support (tutorials,
videos)
– Acapela Voices, downloadable multiple
choices and accents
– Customizable
– Uses SymbolStix symbols
– Word Prediction
22
AAC apps
• Proloquo4Text
– Text based app
– Designed for literate users
– A literate user is defined as reading and
writing with at least a third grade level.
1/21/2015
free template from
www.brainybetty.com
23
24
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1/21/2015
AAC apps
AAC apps
• Sonoflex ($99.00)
– Tobii /ATI
– Flexible category keys
– Core and fringe vocabulary
– Over 50 pre-made context vocabularies;
– 11,000 SymbolStix® symbols
– Uses the camera and photo to create your own symbols
– 5 high quality Acapela voices; one boy, one girl, two
women and one male voice
– Available for iPhone, iPod, iPad, Android devices and
PCs and Tobii Communicator
• Touchchat ($149.99)
– Core and fringe vocabulary
– Customizable
– 5 voices
– Vocab PC, Multi chat, spelling,
primary and Word Power
– Ishare
– Windows editor
25
AAC apps
• Go talk app
– 1-25 locations per page
– Images from your iPad camera, photo library, built-in
internet search
– Crop, scale & rotate using fingers
– Custom backgrounds, borders & text
– Record own speech or text to speech ($.99 each in over
20 languages)
– Auditory cues
– Customizable navigation tools
– Four important messages into the core vocabulary
– Unlimited menu and communication pages
– Integrated scanning - either using another iPad or iPod
touch as an accessibility switch or your own physical
switch with the RJ Cooper Switch Interface
– Videos for help with programming
26
AAC apps
• Go talk now (free) – 1 book with 3
pages
• Go Talk now ($80.00) full version
• Go Talk start ($19.99)
• Go talk now plus ($150.00) -unlimited
books and pages, voices, templates,
backup and restore, sharing via WIFI
27
AAC apps
• LAMP – words for life ($299.99)
– LAMP Words For Life™
– Combines PRC Unity® and Language
Acquisition through Motor Planning (LAMP™)
principles and strategies
– Provides a consistent motor pattern for words
– Appropriate for beginning to skilled
communicators
– Three developmentally progressive vocabulary
– Pre-stored core and fringe words
29
– Vocabulary Builder
28
AAC app
30
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AAC apps
AAC apps
• Compass app
– Available for iPad or Windows tablet
– Adult looking icons
– Can be used with younger users
– Multiple access – direct selection,
scanning, auditory cues
– Core and fringe vocabulary, quick fires,
visual scenes, fully customizable
• Compass app (179.99)
• Compass app with Gateway (299.99)
• Compass app with PODD set
($299.99)
• Compass app subscription ($99.99)
31
32
AAC app
AAC apps
• Avaz app ($149.99)
– Built in vocabulary has 5000+ words
– Easy to personalize with new words
– Core and peripheral words
– Color coded
– Progress tracking
– Picture and word prediction
33
AAC apps
1/21/2015
free template from
www.brainybetty.com
34
AAC app
• Predictable ($159.99)
35
– ModelTalker use your own synthesised
voice to communicate
– Nuanace Voices (14 voices)
– Skype
– Bluetooth Switch Box and up to 2
switches
– Word prediction engine that learns your
vocabulary to influence the prediction
36
options
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1/21/2015
AAC app
• Verbally (free), Verbally (premium$99.99)
– Core Words Grid (50 essential words)
– Core Phrases Grid (12 phrases)
– Text Prediction that learns the words &
names
– Three Keyboard Layouts
– Choice of Male or Female Voices
37
– AAC techconnect – free resources
• Jane Farrell consulting
– Symbols
– Text and symbols
– Text
39
Speech language pathology
apps
•
Miscellaneous apps
– Feeding apps
• Allergy guard
– food allergies and intolerances
– dislikes of common foods
– what's in specific ingredients
• Gluten free
– Search, rate or add foods by Category,
Brand or Product Name
– Ability to RATE & add NOTES to products
• Kids food adventure
– Try new foods
– Rate the foods
– Collect stickers for foods tried
38
• Language apps
– Ipractice verbs
– Understanding prepositions
– Wh-questions
– Sequencing
– Prepositions
– What would you do ….. At home and at school
– How would you feel if
– Flash cards in apps to promote language skills
• AAC Devices and Apps
free template from
www.brainybetty.com
free template from
www.brainybetty.com
Speech language pathology
apps
AAC apps
1/21/2015
1/21/2015
40
Social stories apps
• Social skills
• Stories2learn
– Comes preloaded with 12 social
narratives
– Areas of reciprocal play, non-verbal
communication, playground and
school rules, turn taking, etc.
– Add your own stories
41
42
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Behavior management apps
Behavior management apps
•
•
•
•
•
•
• iPrompts ($49.99)
Prompting and cueing
Visual schedules
Multisensory timers
Tracking
Reward charts
Data collection
– Visual schedules, timer and choice
making
– No speech output
– Image and photos
43
Behavior management apps
• Pocket picture planner
• Functional skills system
44
Behavior management apps
• Timers
– Time Timer ($4.99)
• Visual supports for count down
– Shopping list
– Everyday Social skills
– Functional planning skills
– Money equivalency
– Coins and dollars
timer or a clock
• Tone or clapping when time expires
– KidKlock, iHour Glass (free),
– Traffic Light $.99
– Child timer
45
46
Behavior management apps
Behavior management apps
• Behavior Tracker Pro ($29.99)
• Reinforcement apps
– Tracks frequency and duration
of responses
– ABC and/or high frequency data
– Track multiple students and behaviors
– Built in data analysis
– Sync with Behavior Tracker software or
use alone
47
– Designed to track rewards for one or
multiple behaviors in one or more
children
• Star Rewards for $.99
• I Earned That for $1.99,
• iReward for $.99
48
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1/21/2015
Behavior management apps
• Data tracker
Literacy apps
• Writing stories
– Create multiple goals for each student
– Various response types — Tally,
Correct/Incorrect, Approximated, & Cued
– Store data for sessions.
– Add students to multiple groups.
– Write notes for each student
– Email results
– Graph results
49
– Pictello, $14.99
• Create and edit stories using photos, audio,
text to speech
– Stories2Learn, $13.99
• Create and edit stories with audio and
photos
– Story Kit, free
• Combine your photos and recorded audio to
create and edit your own books
50
Literacy apps
Literacy
• Reading
• Comprehension
– ABC Pocket Phonics ($.99)
– Word Cub $1.99
– First Letters and Phonics $2.99
– Sight Words
– Vocab Photo $.99
– Sight Words by Photo Touch, free
– Mini Mod Reading $2.99
• Vocabulary
– GCF Vocabulary Videos Free
• Fluency
– K-12 Timed Reading Practice $1.99
51
eBooks
• iBooks through Apple, Google can be read using
voiceover
• Kindle and Nook Books available on all
iDevices (free to $49.99)
• Bookshare books can be converted to
ePub
• Daisy formatted books can be read with
the Daisy Worm app (Read2go)
• Bookstream (Don Johnston, Inc.) iBook
management system
53
• Firefly (Kurzweil, Inc.)
52
Audio books
• The Overdrive App checked out books digitally from
your local library
• Audible.com offer audiobook apps
• Audiobooks can be played through iTunes
• Stanza – A digital text eReader with links to sites of both
free and purchase
• Books
– Touch and hold a word to enlarge it, get the
definition, or leave annotations.
– Increase font size, and change text/background color.
54
– No text--‐to speech
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1/21/2015
Interactive books
•
•
•
•
•
•
•
Tumblebooks to Go
StoryBoy
VivaBooks
Random Books
Touchoo
Speech with Milo
Read aloud, pages turned using a
flick, automatically, tapping the
screen, or touching an arrow
Spelling apps
•
•
•
•
•
My Spelling test
SpellDown spelling bee
iSpell 123
Word fall
Build-a-word
55
56
Math apps
• Counting
– Arithmaroo $1.99
– Intro to Math by Montessorium $4.99
– Math Girl Number Garden $1.99
– Number Sense $1.99
• Basic Math Facts
– Cute Math $1.99
– Math Magic $1.99
– Math Drills $1.99
– Math Bingo $.99
– Math Girl Addition House $1.99
Math apps
• Measurement
– Measurement $.99
• Time
– Telling Time $1.99
– Learning to Tell Time is Fun $1.99
• Money
– Coin Math $1.99
– A Money Tree $.99
57
58
Calculators
Art apps
• Talkulator (free)
• Glow Draw apps a
– Large buttons,
– Multiple languages
– Great for low vision
• Meritum and Pollock
• Talking Calculator ($.99)
– Fun cause and effect activities
– Scientific calculator
• Doodle Pad
• Hal the Talking Calculator (free)
– Good for fine motor skills
– Customize background
• Colorforms apps
• Graphing Calculator ($1.99)
– Full features
– Great for choice making activities
59
60
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1/21/2015
Speech-to-text apps
Miscellaneous
• Dragon Dictate (free)
– dictation is converted into text
– can be sent as an e-mail,
text message or to clipboard
• Shout OUT (free - $1.99 for 50 text
credits)
– Allows dictating text messages
• Carrying cases
– AMDi iAdapter ($198.99)
•
•
•
•
•
Rugged, rubberized
Rechargeable speaker case
built in handle
home key lock
optional mounting plate for Deassy mount
– iMain Go ($69.90)
61
• Rechargeable speaker case
• Allows full access to touch screen $69.99
Miscellaneous
62
Miscellaneous
• Carrying cases
– Gonow sleek and Gonow Rugged iPad
cases (Attainment, Inc. -$49.99)
• Easily mountable
• Access to all iPad buttons and ports while
in case
• Compatible with iPad Air, iPad 4th
Generation, iPad 3rd Generation, and iPad 2
63
64
Miscellaneous
• Connect for speech (Ablenet, Inc.
$349)
– HiFi stereo amplified speech sound
output
– Built-in, wired, or wireless switch
access capabilities
– Mount with AbleNet mounting solutions
– Outer casing protects against impact
– Utilizes Apple’s powerful iPad Air and 65
your choice of AAC app
Miscellaneous
• Mounts
– Daessy
• Wheelchair and Desk Mounts ($900)
– Magic arm (R. J. Cooper)
– Ablenet
• Universal mounting system
• Latitude mounting system
66
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1/21/2015
Miscellaneous
Resources for apps
• GeekSLP (http://www.geekslp.com)
• Therapy App 411 (http://www.therapyapp411.com)
• Spectronics
(http://www.spectronicsinoz.com/article/iphoneip
ad-Apps-for-aac)
• Pocket SLP (http://pocketslp.com)
• AAC-RERC (http://aac-rerc.psu.edu/)
• AAC Techconnect
(http://www.aactechconnect.com)
• I Education Apps Review (http://www.iear.org)
• Access
– Switch interface (R. J. Cooper)
– Blue tooth switches
– Blue tooth switches (Ablenet Inc.)
– Attainment switch
• Turns iOS devices into a wireless
accessibility switch
67
68
Resources for apps
• Scribd apps for Special Needs
(http://www.scribd.com/doc/24470331/iPhone-iPad-andiPod-touch-Apps-for-Special-Education)
• SLP sharing App Resources (http://slpsharing.com/appresources)
• Connsense Bulletin Apps for Education update
• Fun educational apps (http://www.funeducationalapps.com)
• ISTE IPad Apps for education
(http://www.iste.org/welcome.aspx)
• Apps for children with special needs (http://a4cwsn.com)
69
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Outline
Communication vulnerability
Meher Banajee, Ph.D., CCC-SLP
Associate Professor
Communication Disorders Department
LSU Health Sciences Center
• Background information
– What is communication vulnerability?
– What are the causes for communication vulnerability?
– Laws and regulations
– What is effective communication?
• Providing communication access
– Tools for effective communication
– Training for effective communication
• Case studies
• Resources
• References
Acknowledgements
• Harvey Pressman and Sarah Blackstone (AAC
Resource Restoration in the Gulf, Health Care)
• Patient Provider Communication Participants
• Tulane Medical Center
• Speech-Language Pathology Dept. of Tulane
Medical Center
• LSUHSC – Communication Disorders Dept.
Background information
Background Information
• In health care settings, communication breakdowns
between patient & caregiver can have dire
consequences:
–
–
–
–
–
Increased patient pain,
Misdiagnoses,
Drug treatment errors,
Extensions in hospital stay,
Death
• In a six-year (1997-2002) study, The Joint
Commission (TJC) placed “communication” at the
very top of the list of root causes for sentinel
events (Joint Commission, 2007)
Communication vulnerability
(Patak et al., 2009)
• Can result from lack of access to direct communication
• Communication can be inhibited due to:
– Hearing impairment
– Visual impairment
– Speech impairment
– Cognitive limitation
– Intubation
– Disease (ALS, stroke)
– Language
– Culture
– Health literacy
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1/21/2015
Variables contributing to communication
vulnerability
•
•
•
•
•
•
•
•
•
Patient trauma or significant decline in functioning
Unfamiliar environment
Rapid communication, not always in their primary
language
Critical decision making
Pain or discomfort
Hearing aides, dentures & glasses are often at
home
Medications and/or trauma may alter mental status
Temporary mechanical ventilation
Suboptimal positioning and communication
environment
Low Literacy Rates By Parish
% Adults with Level 1 Literacy Skills
Variables contributing to
communication vulnerability
•
•
•
•
•
Pre-existing hearing, speech, cognitive
disabilities who may (may not) have access
to communication tools/supports
Language differences
Limited health literacy
Limited ability to read/write
Cultural differences
People with communication
vulnerabilities
• More Likely to
– Be hospitalized
– Experience medical/physical harm, e.g., drug
complications
– Leave hospital against medical advice
– Be intubated if asthmatic
– Have increase costs
– Delay care
– Receive a diagnosis of psychopathology
– Joint commission, 2007
28% Louisiana Adults are Level 1
National Institute for Literacy 1998
People with communication
vulnerabilities
• Less Likely to
– Adhere to recommended medication regimen
(Andrulis, et. al, 2002; Flores et al., 2003)
– Report abuse
– Access or use medical care
– Return for follow-up appointments after Emergency
Room visits
– Be satisfied with care
– Joint commission, 2007
“Public health emphasis is on getting
information ‘out’ to people not if it has
been understood & used.”
Dr. Richard Carmona,
Former U.S. Surgeon General
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1/21/2015
Research Data
•
Happ (2004) and Patak et al. (2006)
•
Patients with access to communication:
–
–
–
–
•
Receive less sedation
Are transitioned quicker
Have increased satisfaction with health care
Feel more in control…and generally do
better…
Available simple tools and strategies to
improve communication usually go
unused and ignored.
Laws, standards & regulations
Federal Efforts
– Title VI of the Civil Rights Act of 1964. People
cannot be discriminated against as a result of their
“national origin,” including their primary language.
(The National Standards for Culturally and
Linguistically Appropriate Services in Health Care
(CLAS) standards.
– Guidance for healthcare organizations on
compliance with Title VI (United States
Department of Health and Human Services, 2001)
Laws, standards & regulations
Federal Efforts
Laws, standards & regulations
Federal Efforts
• Department of Health and Human Services. National Action
Plan to Improve Health Literacy http://www.health.gov/
communication/HLActionPlan/
• Agency for Healthcare Research and Quality (AHRQ,2010).
Established health literacy as a universal precaution, similar
to hand washing as a way to minimize risks to patients
• New health care reform law
• Requires use of plain language and culturally appropriate
language in health related information about insurance and
other health issues.
– Centers for Medicare and Medicaid Services Revised
Minimum Data Set (MDS) 3.0. Used in skilled nursing
facilities to assess residents (2010).
http://www.asha.org/Publications/leader/2010/100518/Skill
ed-Nursing-Facility-Assessment.htm
Laws, standards & regulations
Federal Efforts
• The Joint Commission communication
Standard Effective January 2011
• Will be included in the accreditation
decision no earlier than January 2012
– Advancing effective communication,
cultural competence & patientcentered care
– A Roadmap for Hospitals
www.jointcommission.org
Laws, standards & regulations
Federal Efforts
• The medical record contains information that
reflects the patient's care, treatment, and
services (Standard RC.02.01.01)
• The hospital respects, protects, and promotes
patient rights (Standard RI.01.01.01)
• The hospital communicates effectively with
patients when providing care, treatment, and
services (Standard PC.02.01.21)
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What is “Effective Communication”?
• “the successful joint establishment of meaning
wherein patients and healthcare providers
exchange information, enabling patients to
participate actively in their care from
admission through discharge, and ensuring that
the responsibilities of both patients and
providers are understood”
• (The Joint Commission, 2010b, p. 91 ).
Healthcare settings and
environments
–
–
–
–
–
Dr's Office/Clinic
First Responders
Emergency rooms
ICUs
Acute Care Hospitals
Rehab Hospital
Nursing Home
Home Health
Hospice
Disaster/emergency
locations (triage area,
police car, ambulance,
shelters)
On The Spot Communication Toolkit for the
Medical Setting
What does Patient Provider
Communication (PPC) mean?
• Providing equal access to
– health information,
– diagnosis,
– treatment and
– follow up care
– across the full spectrum of healthcare
environments and activities
Healthcare settings and
environments
• Specialized nursing units at Tulane Medical Center
– Emergency Department
– Medical ICU
– Critical care unit
– Bone marrow Transplant Unit
– Medical surgical unit
– Surgical ICU
– Pediatric ICU
– Neuro/Stroke ICU
– Abdominal transplant unit
On the Spot Communication Toolkit
On the Spot Communication Resource Book
• Distributed by AAC TechConnect, Inc.
– Pocket Talker
– Communication Boards (Costello, 2000)
• Vidatak EZ Communication boards
(Patak, et al., 2006)
• Critical Communicator
• Health Care Communication Board
– Magnification Glass
– Clipboard & Dry Erase Board with “Writing
Strategies”
– English to Spanish Staff Cards
– Includes: reorder system
$699.00 and $99.00
respectively
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1/21/2015
Vidatak EZ communication board
Barriers with Implementation
• AAC TechConnect Inc. not an established
vendor for HCA
• Adapted call light within the toolkit was not
compatible with Tulane Medical Center patient
call system
• High expense associated with purchase of
toolkit
• Minimum initial “Buy-in” by nursing staff for
implementation of toolkits
Solutions Implemented
• Customized assembly of the toolkits
– Low-tech devices
• Dry-erase boards with writing strategies and
dry-erase markers
• Magnifying glasses
• Writing tablets and pens
• Manual communication boards:
– Vidatak EZ Communication Boards (Spanish
and English)
– Critical Communicator
– HealthCare Communication Boards
Solutions Implemented
• Persistence in identifying nursing
manager(s)
– Interested in implementing tools on the
units
– To attend a meeting for orientation of
toolkit contents and process for
replenishing contents.
– To establish a secure location on the
units for storing the toolkits
Solutions Implemented
– Mid-tech devices
• Pocket talker
• Modified call bell
• Removed from toolkits until
further training
• Assigned to patients on as
needed basis
Case presentations
HX: JT, a 20 year old man residing in a nursing
home for ~1 month due to recent spinal cord
injury due to MVC with residual tetraplegia,
tracheostomy and ventilator dependent,
dependent on alternative modality of nutrition
(PEG). JT was transferred from a nursing home
and admitted to the CCU with dx of acute
respiratory distress.
• What would you do?
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1/21/2015
Case Presentation
• Turn away and decline the order because the
patient is medically fragile.
• Send the patient to RIC.
• Start the swallowing evaluation.
• Evaluate his communication vulnerabilities and
strengths.
Case Presentation
• Plan of Care in the ICU and Med Surgical unit
– Passy-Muir in-line with the vent (PMSV) with SLP,
RT, and trained nursing staff.
– Established alternative communication modalities
when pt was aphonic:
• Adaptive call light with head control switch
• Low tech communication board
• Mouthing words with slow rate
• Staff training on ways to facilitate repair of
episodes of communication breakdown.
Case Presentation
• Outcomes upon hospital discharge
– Patient required max assistance with
feeding due to tetraplegia, consuming
a Regular diet consistency
– Patient initiated an active role in his
care by speaking to physicians, family,
nursing, and therapists during his stay
Case Presentation
• Dynamic assessment:
– Modalities pt capable of accessing for
communication (mouthing words and facial
expressions, head nods)
– Is the patient a candidate for a Passy-Muir
Speaking Valve in-line with the ventilator?
– Collaborated with the pulmonary physicians and
respiratory therapy to determine ventilator
weaning protocol for the patient.
– Patient and family goals.
Case Presentation
• Outcomes upon hospital discharge:
– Inpatient rehabilitation candidate because he was
weaned from the ventilator and participating in
multi-discipline treatment
– Primary modality of communication was natural
speech with the PMSV
– Family trained on donning/doffing, care, and
contraindications of PMSV
– Patient participated in conversations with his
children for the first time in over 4 months (since
the MVC)
Case Presentations
Hx: AT was a 22yrs woman with cerebral palsy
and multiple neurological impairments
including profound receptive and expressive
communication impairments, severe
oropharyngeal dysphagia (PEG tube) who
resided at home with 24 hour assistance for all
ADLs admitted to the hospital for pneumonia
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1/21/2015
Case Presentations
Case Presentations
• Nursing reported to SLP in the ICU hall that
her pt was with obvious discomfort evidenced
by protracted periods of vocalic phonation,
grimace, and awkward body posture.
Protracted periods of phonation were intense at
times interfering with the care of other ICU
patients.
• What would you do?
Case Presentations
Dynamic assessment:
• Family/caregiver interview to identify the
patient’s “stressors” and “motivators.”
• Communicative intent of non-verbal
communication per family/caregiver
interview.
• Ongoing evaluation of the frequency of the
patient’s signs of discomfort with direct
observation, staff and family interview
Case Presentations
• Outcomes on the ICU:
– Existing patients on the ICU were provided with a
quiet healing environment.
– Nursing reported overall sense of decreased stress
with the patient resting without overt signs of
distress.
– Communication about the patient’s preferences
and communication modality was transmitted to
nurses on all shifts, respiratory therapy, lab, and
her physicians
• Patient’s discharge disposition:
– Returned home with her caregivers within 24 hours
of the speech-language pathology consult
•
•
•
•
Tell the team to sedate the patient to prevent harm to
herself and to minimize the interference with other
patient care “There is nothing that can be done.”
Determine the patient’s prior level of function was
“non-verbal” therefore, ST services are not warranted
and then discharge the patient
Ignore the order because the patient will be
discharged from the hospital in 24 hours
Evaluate and identify stimuli that calmed the patient
when she was in her natural environment
Case Presentations
• Patient Outcomes on the ICU:
– CD player with patient’s favorite music was
placed at her bedside (e.g., Patsy Cline).
– Overt signs of discomfort were eliminated.
Patient rested comfortably in her bed with
NO SEDATION
– Vocalic phonation during music often
suggested that pt did not like the song.
Nursing and other staff members changed
the song to improve her comfort.
Resources
• Support communication and health literacy
– Typical Patient Provider Interview
• Between general practitioner and person
without a disability
• 20 minutes in length (Mann et al., 2001)
• Verbal and non-verbal communication
positively associated with health
outcomes (Beck et al., 2002)
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1/21/2015
Resources
• Verbal behaviors positively associated with health outcomes
included (Beck et al., 2002)
– Empathy, reassurance and support
– Various patient-centered questioning techniques
– Explanations
– Both dominant and passive physician and therapist styles,
– Positive reinforcement, humor,
– Psychosocial talk,
– Time in health education and information sharing,
– Friendliness, courtesy,
– Orienting the patient during examination
– Summarization and clarification
Resources
• Nonverbal behaviors positively associated with
outcomes included (Beck et al., 2002)
– head nodding,
– forward lean
– direct body orientation
– uncrossed legs and arms
– arm symmetry
– less mutual gaze.
•
Resources
• Support communication and health literacy
– Preparing our clients
• Introduce oneself and one’s communication
system;
• Make use of appropriate vocabulary and
language to communicate concerns and needs;
• Make use of appropriate communication
strategies to ensure that previous health care and
current health concerns are understood by the
health professional.
• Preparing communication assistance
Resources
Resources
• Communication matters
– http://www.patientprovidercommunication.org/i
ndex.cfm/article_2.htm
– www.communicationmatters.org.uk/page/focus
-on-leaflets
• Health passports
– www.healthpassport.co.uk (Talkback-UK Ltd)
• Communication passports
– http://www.accpc.ca/pdfs/passport.pdf
– http://www.patientprovidercommunication.org/i
ndex.cfm/article_6.htm
Resources
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1/21/2015
Resources
Resources
• Tool kits
– http://www.aactechconnect.com/
– http://rnt.over-blog.com/article-kit-decommunication-44780636.html
• You tube videos
– Search for:
• Augmentative communication
• Patient-provider communication
• Health literacy
• Cultural competence health care
• Medical interpreters
Resources
Resources
• Patient provider website
–
–
–
–
–
–
–
–
Patient Provider
Communication Website
AAC TechConnect
Articles
Presentations
Bibliography
Examples of Materials
Case Examples
Newsletters
International Newsletter
Resources
• Other resources
• Books
– Augmentative Communication Strategies for Adults
with Acute or Chronic Medical Conditions Book
with CD Rom. Beukelman, Garrett & Yorkston
– University of Nebraska website -http://aac.unl.edu
• Books, aphasia resources, visual scene display
resources, demographics, Speech Intelligibility
test
– AAC-RERC website and upcoming webcast –
www.aac-rerc
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1/21/2015
Resources
Resources
• Newsletter
– Augmentative Communication News
– http://www.augcominc.com/
– Free Download (Vol 21, #2)
• Information about Promising
practices
• The Joint Commission Standard and
Implementation Manual
• Tools of the trade
References
•
AAC TechConnect (2008). Augmentative communication tools for the
medical setting [Brochure]. Boulder, CO: McBride, D & Trautman-Pearson,
J. Retrieved July 14, 2009, from
http://aactechconnect.com/events/materials.cfm
.
•
Andrulis, D. , Goodman, N., & Pryor, C. (2002). What a difference an
interpreter can make: Health care experiences of uninsured with limited
English proficiency. Boston, MA: The Access Project.
•
Beck, R., Daughtridge, R., & Sloane, P. (2002). Physician-patient
communication in the primary care office: A systematic review. Journal
of the American Board of Family Medicine, 15(1), 25-38.
•
Blackstone, S., (August 2009). Communication access across the
healthcare continuum. Augmentative Communication News, 21(2), 1-16.
•
Balandin, S., Hemsley, B., Sigafoos, J., Wallace, C., Forbes, R. &
Parmenter, T. (2001). Communicating with nurses: The experiences of 10
individuals with an acquired, severe communication impairment. Brain
Impairment, 2(2), 109-118.
References
• Beukelman, D., Garrett, K. & Yorkston, K. (Eds.) (2007).
Augmentative Communication Strategies for Adults with Acute or
Chronic Medical Conditions. Baltimore, MD: Paul H. Brookes
Publishing Company.
• Costello, J. (2000). AAC intervention in the intensive care unit:
The Children’s Hospital Boston model. Augmentative and
Alternative Communication, 16, 137-153.
• Flores, G., Laws, M., Mayo, S., Zuckerman, B., Abreu, M.,
Medina, L., et al. (2003). Errors in medical interpretation and their
potential clinical consequences in pediatric encounters. Pediatrics,
111(1), 6-14.
• Happ, M. B. (2004). Communicating with mechanically ventilated
patients: state of the science. Western Journal of Nursing
Research, 26(1), 85-103.
References
•
•
•
•
•
Hurtig, R. & Downey, D. (2008). Augmentative and Alternative
Communication in Acute and Critical Care Settings. San Diego, CA:
Plural Publishing, Inc.
Mann, S., Sripathy, K., Siegler, E., Davidow , A., Lipkin, M., & Roter,
D. (2001). The medical interview: Differences between adult and geriatric
outpatients. Journal of the American Geriatric Society, 49(1), 65-71.
Patak, L., Wilson-Stronks, A., Costello, J., Kleinpell, R., Henneman, E.,
Person, C. & Happ, M.B. (2009). Improving patient provider
communication: A call to action. The Journal of Nursing Administration,
39(9), 372-376.
Patak, L., Gawlinski, A., Fung, N., Doering, L., Berg, J., & Henneman, E.
(2006). Communication boards in critical care: patients’ views. Applied
Nursing Research, 19(4), 182-190.
The Joint Commission. (November 2007) Improving America’s hospitals.
The Joint Commission’s Annual report on Quality and Safety, 2007.
www.jointcommissionreort.org/assets/1/6/2007_Annual_Report.pdf
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Agenda
Issues and funding strategies for AAC
•
•
•
•
•
Introduction
Different sources for funding
Eligibility for different sources of funding
Strategies for obtaining funding
Funding resources
Meher Banajee, Ph.D., CCC-SLP
Introduction
Who needs to know about funding?
• Who needs to know about funding?
• Why is funding important?
• How do funding programs decide what
they will pay for?
• What is my role in the funding process?
• Where do I go for help?
• Speech language pathologists
• Students of speech language pathology
• Teachers and school administrators or any
one who works in public schools
• Family members
• Advocates
Why is funding important?
Why is funding important?
• Families can’t buy speech generating devices on their own
• Knowledge about funding helps with proper assessment
and treatment
• Knowledge about funding creates expectations about the
outcomes clients can achieve through SLP intervention
– If you do not know with confidence that a device or a
treatment will be funded then you would not be able to
recommend it with confidence in your assessment
– Tailor your assessment for the kind of funding
• Knowledge about funding is the antidote for
“learned helplessness”
• Knowledge about funding informs SLPs about requirements
for assessment and reporting
• ASHA Code of Ethics
– Individuals shall honor their responsibility to
hold paramount the welfare of persons they
serve professionally . . .
– Individuals shall use every resource,
including referral when appropriate, to ensure
that high quality service is provided.
– Only the SLP will be able to help clients there
may be no other source for referral
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Different sources of funding
• 9 different sources for funding for SGDs
• Each program targets a different population
– Under 21 years of age
– Over 21 years of age
– Particular disorders
• Each program targets a specific need or purpose
– Health care
– Education
– Vocational rehabilitation
– Some covered by more than one program
• Each program has its own financing scheme
– Full payment
– 80% funding
– Warranty
Different sources of funding
• Each program has its own administration
–
–
–
–
Federal
State
Local
Private
• They don’t agree on what to call AAC devices
– Powered communication systems
– Speech generating devices
– Augmentative communication devices
• Pay for them under different funding categories
–
–
–
–
Durable medical equipment
Prosthetic devices
Assistive technology devices
Specialized telephone equipment
Different sources of funding
• Health benefits programs
–
–
–
–
–
–
Medicare
Medicaid
Insurance companies and health benefit plans
Federal employees health benefit plans
Department of veterans affairs
Tricare
• Special education
• Early intervention
• Vocational rehabilitation
Health benefits programs
Health benefit programs
• Four question test
•
•
•
•
•
•
– 1 Is the person “eligible?”
– 2 Is the item or service “covered?”
– 3 Is the item or service “medically necessary?
– 4 Does the request meet any special eligibility
or coverage rules that may apply?
– Must show that 1-4 are “yes.”
Medicare
Medicaid
Insurance companies
Federal employee health benefits plan
Department of Veterans affairs
Tricare
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1/21/2015
Medicare
• Created in 1965
• Provide financial assistance so that older Americans (over
65 years) can obtain health care
• Expanded to include two other groups
– Younger than 65 who paid Medicare taxes and are
disabled
• Qualify for SSDI (social security disabled insurance)
benefits after 24 month wait period
• Immediate eligibility for people with muscular
dystrophy
– Children with disabilities who have a medicare-eligible
parent (either by disability or age) or whose parent has
died
• Administered directly by the federal government
• Contracts with various insurance companies to make dayto-day administrative decisions on funding requests
Medicare
Medicare
• Wide variety of benefits under different categories
– Part A
• Access to hospital care and short-term
rehabilitation care in a nursing home facility
– Part B
• Supplemental insurance
• Payments for physician services, outpatient
therapies (including speech language pathology,
OT, PT), durable medical equipment (DME) and
prosthetic devices
• SGDs covered under DME
– Part C
• Managed care options
– Part D
• Prescription drugs
Table II
• Historical background
– In 1980s AAC devices were called
convenience items rather than DME and hence
declared not covered
– Re-examined in the late 1990s and after an 18month inquiry agreed to rewrite policy for
coverage of AAC devices
– January 2001 Medicare put into effect 2 new
guidelines for coverage of SGDs
– Medicare clearly defines SGDs based on key
device features
Medicare
• Durable medical equipment
• Medical necessity
Medicare
• Durable medical equipment
– Able to withstand repeated use
• Key statements in reporting:
– Device is expected to be used daily for a period of
years;
– Device is designed to withstand years of daily use;
– Device has a rechargeable battery to permit
ongoing daily use
– Is primarily and customarily used to serve a medical
purpose
• Treatment for a condition or disability
• This is the most common excuse to deny SGDs
• SGDs “treat” severe communication impairments:
– Dysarthria – Aphasia
– Apraxia – Aphonia
– Developmental Expressive Communication
Impairment
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1/21/2015
Medicare
• Prove this using
–Receptive – expressive gap
–Behavior challenges
• Use words such as
–Solely because of
–“use” does not indicate “need”
–Similar to use of a wheelchair
Medicare
• Durable medical equipment
– Not useful in the absence of illness or injury
• Dedicated communication devices
• Not useful for anything else
• Speech is faster and more flexible than any other
form of communication
– Is suitable for use in the home
• The beneficiary's home
• A custodial care facility
• An intermediate care facility for the mentally retarded
• An institution with a medical component (e.g., skilled
nursing facility and hospice) not considered to be
home
Medicare
Medicare
• Demonstration that the patient possesses
a treatment plan that includes a training
schedule for the selected device
• New regulations
• The cognitive and physical abilities to
effectively use the selected device and any
accessories to communicate
• For a subsequent upgrade to a previously
issued SGD, information regarding the
functional benefit to the patient of the
upgrade compared to the initially provided
SGD
Medicare
• Medical necessity
– Doctor’s prescription
– Impairment to functional daily activities
– Prior to the delivery of the SGD, the patient
has had a formal evaluation of their cognitive
and communication abilities by a speechlanguage pathologist (SLP)
– The formal, written evaluation must include,
at a minimum, the following 7 elements
– Capped rental for 13 months
– Device belongs to client after 13 months
– If client goes to hospice or to a skilled nursing
facility – device is returned
– Unless hospice or SNIF pays for rental of
device
Medicare
–Current communication impairment,
including the type, severity, language
skills, cognitive ability, and anticipated
course of the impairment;
–An assessment of whether the
individual's daily communication needs
could be met using other natural
modes of communication;
–A description of the functional
communication goals expected to be
achieved and treatment options;
–Rationale for selection of a specific
device and any accessories
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1/21/2015
Medicare
– Demonstration that the patient possesses
a treatment plan that includes a training
schedule for the selected device;
– The cognitive and physical abilities to
effectively use the selected device and any
accessories to communicate;
– For a subsequent upgrade to a previously
issued SGD, information regarding the
functional benefit to the patient of the
upgrade compared to the initially provided
SGD
Medicare
• The patient's speech impairment will
benefit from the device ordered; and,
– A copy of the SLP's written evaluation
and recommendation have been
forwarded to the patient's treating
physician prior to ordering the device
– The SLP performing the patient evaluation may
not be an employee of or have a financial
relationship with the supplier of the SGD.
• If one or more of the SGD coverage criteria
1-7 is not met, the SGD will be denied as
not medically necessary.
Medicare
• Codes
– Main device
• Codes E2500, E2508 - E2511, and E2502 E2506 perform the same essential function speech generation
• Therefore, claims for more than one SGD will
be denied as not medically necessary.
• Laptop computers, desktop computers, PDAs
or other devices that are not dedicated SGDs
are noncovered because they do not meet the
definition of durable medical equipment (DME).
• Software (E2511) that enables a laptop
computer, desktop computer or PDA to
function as an SGD is covered as an SGD;
however, installation of the program or
technical support are not separately
reimbursable.
Medicare
• Regional Medical Review requirements
– A speech generating device (E2500,
E2508 - E2511, E2502 - E2506) is
covered when all of the following criteria
(1-7) are met:
• The patient's medical condition is one
resulting in a severe expressive
speech impairment; and,
• The patient's speaking needs cannot
be met using natural communication
methods; and,
• Other forms of treatment have been
considered and ruled out;
Medicare
• Prosthetic device
– No universal definition
– Medicaid: means replacement, corrective or
supportive devices … to:
• Artificially replace a missing portion of the body
• Prevent or correct physical deformity or malfunction
• Support a weak or deformed portion of the body
– Medicare:
• Devices that replace all or part of an internal body
organ
• Devices that replace all or part of the function
permanently inoperative of a or malfunctioning
internal body organ
Medicare
– Accessories
• Accessories (E2599) for E2500,
E2508, E2510, and E2502 - E2506
are covered if the basic coverage
criteria (1-7) for the base device are
met and the medical necessity for
each accessory is clearly
documented in the formal evaluation
by the SLP
• Medicare pays according to a fee payment
schedule with co-payment or the
manufacturer has to accept assignment
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1/21/2015
Medicare
Medicare
• Fee schedule
• Accepting assignment is a 3 way
agreement between Medicare recipient,
the supplier, and Medicare itself. Its
elements include the following:
– Medicare recipients assign (transfer)
their right to Medicare reimbursement to
the supplier
– In exchange, the supplier agrees to
supply the item or provide the service
upon payment of a sum equal to 20
percent of the cost of the item or service
– The Current Medicare Fee Schedule for SGDs is stated
in the following Table:
HCPCS Code
Fee schedule amt
E - 2500
$391.06
E – 2502
$1,195.80
E – 2504
E – 2506
$ 1,577.42
$ 2,312.96
E – 2508
$ 3,576.61
E – 2510
$ 6,768.25
Medicare
– The supplier also agrees that if the Medicare
payment is less than the full cost of the item,
the supplier will accept the Medicare payment
as payment in full, and will not seek payment
of the difference (balance) from the recipient;
– Finally, even though the recipient has paid only
20 percent of the cost of the item, Medicare
agrees that it will pay its reimbursement based
on the full “reasonable charge” of the device
and that it will pay its reimbursement directly to
the supplier, rather than to the recipient
Medicare
• Typically, Medicare paperwork is retained by the
manufacturer/supplier
• Only a cover sheet, known as a HCFA 1500 form
is transmitted to the DMERCs (Durable Medical
Equipment Regional Centers) electronically
• By sending this the manufacturers/suppliers are
asserting to Medicare that they have reviewed the
paperwork and that the paperwork is in
compliance with Medicare's coverage guidelines
• Medicare does not conduct “prior authorization,”
of SGD claims
Medicare
Medicaid
• It reviews claim documentation, through periodic
post-payment audits
• Manufacturers/suppliers are required to maintain
the Medicare claims paperwork and to present
them for review upon a Medicare auditor's request
• If the audit reveals flaws in the documentation,
Medicare may ask the manufacturer/supplier to
re-pay Medicare for the improper payments
• For this reason, manufacturers/suppliers have a
strong incentive to insist that documentation in
support of Medicare claims is complete
• Created together in 1965 each targeting a distinct
population
• Medicaid provides financial assistance to:
– Enable individuals with limited incomes and
resources
– Families with dependent children
– People who receive or are eligible for
Supplemental Security Income (SSI)
– Pregnant women who meet income
requirements
– Those who receive adoption or foster care
assistance
– To obtain necessary health care
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1/21/2015
Medicaid
Medicaid
• It is voluntary program and not a federal mandate
• States must choose to participate (all do)
• States must agree to follow the requirements of
the federal regulations and guidelines in
exchange for promise to pay between 50 and
80% of the states’ Medicaid program costs
• Federal Medicaid requires coverage of specific
groups of individuals and specific services
• States have option to extend coverage to other
groups and offer as many as three dozen other
services
• Federal payment however, remains the same
• History
– Coverage of SGDs back to late 1970s
– Coverage has gradually widened state – by –
state
– Sometimes law suits are required to remove
coverage barriers
– By 2000, all Medicaid programs covered and
provided SGDs to both children and adults
– Exclusively done within DME benefit category
or as medically necessary equipment
Medicaid
Medicaid
– Cover a full range of SGDs including
those that are computer- or PDA-based
– Under EPSDT all states are required to
cover SGDs for children under 21 years
of age
– Coverage for adults included after 1996
in Louisiana
– Initially only one device purchased
during the life span
– In 1996 approval for replacement of
device every 5 years
Medicaid
• Medicaid is designed to serve individuals with
limited incomes, suppliers must accept Medicaid
payment as payment in full
• Must establish medical necessity
• Devices covered under durable medical
equipment or as prosthesis
• Payer of last resort
– Apply first to other insurance company
(including Medicare) and if denied apply to
Medicaid or Medicare
• Almost every Medicaid program has
written specific, clinical criteria that outline
the SLP assessment and report that must
accompany the funding request
• Require prior authorization – completed
funding request (SLP request and
physician prescription) is submitted by the
device manufacturer and reviewed by
Medicaid staff
Insurance companies and health
benefit plans
• Fringe benefit to employment
• It is delivered in two distinct ways
– The employer purchases an insurance policy
for the benefit of its employees (or an
individual purchases an insurance policy
directly)
– The employer creates a “health benefits plan”
which it funds directly from company assests
• Potential for variation is unlimited
• Most plans cover DME and accept
Medicare’s definition of DME
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1/21/2015
Insurance companies and health
benefit plans
• History
– After SGD coverage by Medicare in 2001, the
number of insurers that cover SGDs increased
significantly
– 1100 insurers and health plans that have
approved SGDs listed in a Insurers Approval
data base
– Created by input from manufacturers – PRC
and ATI continue to update the list
– List contains names of insurers and the
number of devices funded by the insurers
Insurance companies and health
benefit plans
– Great advocacy tool
• SGD coverage by insurers and health plans
is extensive
• SGD funding by insurers and plans is
appropriately viewed as “the rule”
• Non-coverage is “the exception” and is not
justified
• Important for first time insurers and health
plans (Mississippi Medicaid)
• Important for individual funding and appeals
Insurance Companies and Health
Benefit Plans
• Examples of denial reasons:
– SGDs do not fit within our scope of policy or plan
• SGDs are not DME
• SGDs are not medical in nature/medically necessary/no
medical purpose
• SGDs are not covered
• SGDs are useful to people without severe
communication impairments
• SGDs are not treatment/treatment for an underlying
condition
• SGDs are a convenience item
• SGD are prescribed solely for educational or vocational
purposes
Insurance companies and health
benefit plans
– Great advocacy tool
• SGD coverage by insurers and health plans
is extensive
• SGD funding by insurers and plans is
appropriately viewed as “the rule”
• Non-coverage is “the exception” and is not
justified
• Important for first time insurers and health
plans (Mississippi Medicaid)
• Important for individual funding and appeals
Insurance companies and health
benefit plans
• SGDs classified as DME or prosthetic devices
• SLP assessment and a doctor’s prescription
• Some insurers and plans follow Medicaid’s prior
approval plan other follow Medicare’s plan that
the device must be first bought and then claims
submitted
• Dealing with denials
– Check with Insurer Approvals Database
– If the company is listed then ask in writing:
• What the differences are between the prior
policy or plan and the current one
• Significance of those differences
Insurance Companies and Health
Benefit Plans
– SGDs are excluded in our policy/plan
• Can be challenged if they cover wheelchairs
• Disability based discrimination not permitted
• No basis for cost justification (cost is trivial)
– Compare reasons given with previous
approvals and ask for justification
– Also ask for specific exclusions (just because
DME is not listed does not mean that it is not
covered)
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Federal Employee Health Benefits
Plan
Department of Veterans
Affairs/Tricare
• United States the largest employer
• To recruit and retain workers the government offers workers
health insurance benefits (Federal Employee Health
Benefits Plan, FEP)
• Work with private health insurance companies to provide
health benefits to 8 million employees, retirees and their
dependents
• Each year a federal employee can select from a number of
private insurance plans which vary with regard to the design
of benefit packages and cost of premiums
• A request to void the exclusion of SGDs by primary FEP
plans offered by Blue Cross Blue Shield associations is
pending
• Check for update on AACFundingHelp
• Department of Veterans Affairs
– Provides healthcare benefits to US
veterans through nationwide network of
VA hospitals
– Each has a prosthetic service – source
of SGD coverage
Department of Veterans
Affairs/Tricare
• Tricare (formerly known as CHAMPUS or Civilian
Health and Medical Program of the United States)
– Worldwide healthcare benefits program for active
duty members of the armed forces & dependents
and to military retirees & their dependents
– Administered through private contractors
– Has covered SGDs as prosthetic devices to only
active duty members and their dependents
– Extended to all participants in 2001
– New SGD coverage criteria modeled on
Medicare’s criteria were authorized for all Tricare
beneficiaries in 2005
Special education
– A student’s need for AT must be considered
during the IEP development and review
process
– It is the school’s responsibility to ensure that
the student receives the device and related AT
services (training for the student, parent and
staff)
– On a case-by-case basis the use of school
purchased AT devices in a student’s home and
other settings is required if the student’s IEP
team determines the student needs access in
order to receive FAPE
Special Education
• IDEA ensures
– Free and Appropriate Education (FAPE)
– In a least restrictive environment (LRE)
• IEP
– Outlines the student’s educational plan
– Identifies the type and intensity of special
education and related services that will be
provided
– Assistive technology devices and services - an
in integral part of the IEP process
Special Education
•
Three types of issues
– Staffing: who will identify the student’s needs, recommend devices and
develop and implement treatment plan
• IEP team
• LATI
• Framework for conducting assistive technology considerations,
screening and assessment
• Report format
• Louisiana Statewide Assessments, Accommodations and
Assistive Technology
– Clarify the purpose of the SGD: (IEP team)
– Funding: who pays for an SGD, accessories and related services
• LDOE cannot dictate what funds to use for purchase of device
– Can use their own funds or child’s Medicaid or private
insurance monies
• Reimbursement program
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1/21/2015
Early intervention
• Part C of IDEA
– Federal grant program for providing services for infants
and toddlers (birth to 3 years) and their families – Early
Steps
– Lead agency to receive the grant and administer the
program - Office for Citizens with Developmental
Disabilities (OCDD)
– Interagency Coordinating Council (ICC) to advise and
assist the lead agency
– IFSP centerpiece or planning document
• Identifies functional areas in which the child is not
performing at age level and designs services
• Assistive technology can be provided by SLPs, OTs,
PTs
Early Steps
• Early Steps will pay for an Augmentative
Communication Device (ACD)
– When the ACD is necessary for the child to benefit
from early intervention services
– Is appropriate for the child’s developmental age
and needs
– Is listed on the IFSP and related to an IFSP
outcome.
• If the child is enrolled in Medicaid
– Then the provider must bill Medicaid for the device
using their Medicaid provider number
– This is the only circumstance where the provider
does not bill the Central Finance Office (CFO).
Early Steps
Early steps
• When the ACD is not covered through the
Medicaid DME program and/or the child is not
Medicaid eligible
– The ACD is billed through the CFO
– Providers of ACDs must enroll with the CFO
as an Assistive Technology Provider
– Medicaid covered ACDs are reimbursed
according to current Medicaid approved
rates.
The Early Steps Central Office must pre-approve
all ACDs or other assistive technology devices
costing more than $500
– The equipment or devices are considered to be
state property
– Parents should be informed of this
requirement.
• ATD services are billed by the provider and
reimbursed according to the maximum rate that
DHH has established for the provider specialty
(SLP) rendering the service.
•
Vocational Rehabilitation Services
Vocational Rehabilitation Services
• Vocational rehabilitation – federal program
since early 20th century
• Enable a person with a disability to acquire or
retain employment
• Increases ability of a person with a disability to
earn income and pay taxes
• Removing potential dependency on public
benefits
• Receive services outlined on their
Individual Plan for Employment (IPE)
• Recognize the need for AT
• They also coordinate transition services for
teenagers with disabilities with the public
schools
• Provide equipment needed to meet postschool goals
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1/21/2015
Vocational Rehabilitation Services
Summary
• To be eligible for vocational rehabilitation
services, the individual must
– Have a physical or mental disability which for
the individual constitutes or results in a
substantial impediment to employment
– Be able to benefit from vocational rehabilitation
services in terms of employment
– Require vocational rehabilitation services to
prepare for, enter, engage in, or retain gainful
employment.
• Third party funding programs are
responsible for almost all purchases of
SGDs in the United States
• However, this does not ensure that every
American who needs a SGD will have a
source of financial assistance
• Some will fall through the safety net and
will not be able to access third party
funding
Funding needs constant monitoring
Funding evolves
• Lewis Golinker (2006)
• AAC community opens up funding streams
– SGD funding issues in the U.S. can be
compared to a high cholesterol count
– Both require constant attention
– But there are things you can do to keep them
under control
– Despite these issues you can lead a normal,
active life
Funding resources
• www.aacfundinghelp.com
– Joint effort of Assistive Technology Law Center
(Lew Golinker)
– Duke University
– AAC-RERC
– 4 sections
– First identifying why government and private
funding sources should cover SGD
– Advocating for coverage while monitor each
source
– Systematically and rigorously collect facts and
arguments that define the benefits of SGDs for
people with complex communication needs
Funding Resources
• http://www.aac-rerc.com
– Medicare guidelines
• Augmentative Communication News
(December 2006). 18, (4).
• Funding fast facts
• Funding programs
• AAC report coach
• General funding resources
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