Considerations and tools I use for AAC evaluations

1. AAC Assessment for Children
Private Practice
Vicki Clarke
Dynamic Therapy Associates, Inc.
11/12/2015 ASHA 2015 V. Clarke

2. 11/12/2015

3. Procedures & Protocols
11/12/2015

4. AAC Evaluation Components
1. Interview
2. Intake Visit
3. Equipment & Materials Preparation
4. Assessment: Communication and Skills
5. In-Clinic Trials
6. Family Consideration Meeting
7. Report and Funding Docs
8. Intervention Planning
9. System Customization
10. Delivery
11. Family/Patient Training
12. Treatment & Training
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5. Barriers Identified
• Partner/Family Knowledge
Limitations
• Limitations in Professional
Collaboration
• Clinical Knowledge and Experience
Gap
• Funding Restrictions Causing Time
Constraints
11/12/2015

6. Partner/Family Knowledge Limitations
• Family comes to evaluation seeking a
particular piece of equipment or software
solution.
• Family comes to the evaluation with a AAC
system which has not been adequately
matched to their child.
• Family expects equipment ownership to solve
the communication deficit.
• Family does not anticipate or appreciate the
need for on-going support.
11/12/2015

7. Immediate Solutions: Family/Partner
Preconceived Notions
• Educate families about the different components that impact
successful AAC use.
• Take every opportunity to explain why you are asking specific
questions about motivations, sensory skills, fine motor access.
• Include families in the decision making process.
• Attempt to respect the family’s preferences as much as possible. Use
active listening for all interactions to understand their actions and
decisions.
11/12/2015

8. Challenges in Professional Collaboration
• Professionals are rarely housed in the same
location
• Limited time allowed by administration for
non-billable collaboration
• Time limitations of consulting professionals
• Knowledge and experience deficits in other
professionals
11/12/2015

9. Immediate Solutions: Collaboration Logistics
• Recognize that this is IMPORTANT.
• Make a contact list for each patient to
include all pertinent providers and their
email and phone numbers.
• Consider using shared on-line file storage
to give multiple providers access to each
other’s evaluations and considerations.
• Interact via virtual meetings through
services such as Skype, FaceTime, Oovoo
and Google Chat.
• Give yourself time to consult with these
professionals.11/12/2015

10. Clinical Knowledge and Experience Gap
Requirements:
• Familiarity with equipment and software/app solutions
• Knowledge of the necessary components of the evaluation
• Standard tools and procedures to guide evaluation activities
• Access to tools and equipment needed for evaluation
11/12/2015

11. Immediate Solutions: Time & Experience
Barriers
• Use protocols which are already developed matching funding
guidelines to guide the evaluation process.
• GPAT AAC Assessment
• Dynamic AAC Evaluation Procedures and Protocol
• Use currently available assessments
• Every Move Counts 3
• Communication Matrix
• Dynamic AAC Goals Grid-2
• AAC Evaluation Genie app
• Test of Aided Symbol Performance
11/12/2015

12. Immediate Solutions: Familiarity with
Equipment and Apps
• Make use of cheap and FREE apps
• Tobii Dynavox Compass App for Professionals
• Register at www.mytobiidynavox.com, download app and sign in
• Avaz Together- extended trial for Professionals
• Register at https://avazapp.viewpage.co/Workshop
• Aacorn AAC App
• Register at http://aacornapp.com/evaluation
• SonoFlex Lite
• Download Free Editing Software from Major SGD
Manufacturers
• Saltillo’s Chat Editor
• Tobii Dynavox Compass Editor
• Prentke Romich PASS Software
11/12/2015

13. Immediate Solutions: Experience Barriers
• Google It! The internet is full of professionals sharing pre-made materials,
protocols, and checklists. Know your sources and a quick Google search may
have the answers you need.
• Find some friends! We are no longer constrained to only shadowing
experienced professionals who live near us. We can follow along via blogs,
video tutorials, Facebook and Twitter messages and even Instagram.
• SHARE YOUR STUFF if you are an experienced AAC professional! People are in
desperate need of appropriate, accurate advice. There are plenty of
inexperienced professionals and families taking the time to consult with each
other. Those of us who have extensive hands on experience and training need
to participate in sharing and responding to social media to increase the
amount of correct information provided to families and less experienced
clinicians.
11/12/2015

14. Funding Restrictions Causing Time Constraints
• Substantial non-billable activities involved in AAC
assessment and implementation
• Lack of recognition from funding sources of need
for sufficient evaluation time, collaboration,
training, modification and on-going support
services.
11/12/2015

15. AAC Evaluation Components
• Intake Interview NON-BILLABLE 1 HR
• Initial Intake Visit BILLABLE 1 HR
• Customized Preparation for Evaluation NON-BILLABLE 1-5 HOURS
• Assessment BILLABLE 2 VISITS IN 1 HR INCREMENTS
• Follow Up In-Clinic Trials BILLABLE IN 30 MIN INCREMENTS, 1/DAY
• Final Consideration Meeting with Family
• Documentation Development NON-BILLABLE >3 HOURS
• Funding Assistance NON-BILLABLE 1 HR MIN.
• Intervention Planning with Partners BILLABLE IN 30 MIN INCREMENTS, 1/DAY
• Customization of AAC System BILLABLE IN 30 MIN INCREMENTS, 1/DAY
• Delivery of System to Family BILLABLE 30 MIN
• Family/Patient Training BILLABLE IN 30 MIN INCREMENTS, 1/DAY
• On-Going Treatment, Modification and Partner Training BILLABLE IN 30 MIN
INCREMENTS, 1/DAY
MEDICAID ALLOWED BILLABLE HOURS: 15
1/2
NON-BILLABLE HOURS: 5-14 HOURS
11/12/2015

16. Immediate Solutions: Time, Funding &
Experience Barriers
• Allow yourself MORE billable time!
• Some of what you are doing as “evaluation” also could
be considered initial therapy/evaluative treatment.
Modification and training are billable activities.
• In school districts, make a case for increasing the IEP
time allotted for initial AAC students.
• Use the experience and equipment of the
manufacturer’s sales representatives. *Use
caution though and make decisions based on trials of
several different manufacturers, NOT solely on the
equipment one representative brings to you.
11/12/2015

17. Systemic Change: Long-Term Solutions
• Development of standard procedures for AAC evaluation developed
based on distinct motor/cognitive/sensory diagnoses.
• Development of evaluation simulation programs to accommodate
standard AAC evaluation procedures (apps or programs on readily
available platforms).
• Continued dissemination of currently available evaluation report
templates to guide assessment components.
• Continued lobbying for appropriate reimbursement for AAC services
given the increased experience and skill level necessary to complete
component activities.
11/12/2015

18. Systemic Change: Long-Term Solutions
• Increased emphasis on AAC at the graduate level of study.
• Increased internship availability for students interested in AAC
practice.
• AAC Specialty Recognition and development of a network of master
clinicians for the purpose of identifying skilled clinicians and making
them accessible to less experienced therapists.
• Increased emphasis on intervention planning and partner training in
the field of AAC.
11/12/2015