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AB 605 - California Assembly (20192020) - Open States

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Details on California AB 605 (California 2019-2020 Regular Session) - Special education: assistive technology devices.

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Product Features: Helps professionals and family members work with individuals with complex communication needs
Professional’s Manual includes a disc with PDFs of reproducibles
Includes Inventory Booklet, Professional’s Manual, and Social Networks DVD

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AAC Needs Assessment from Tobii Dynavox (1)

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Communication Sampling and Analysis (CSA)

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Communication Sampling and Analysis (CSA)

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What is CSA?

CSA is an assessment tool designed for infants, toddlers, and children with multiple physical, sensory, speech, and cognitive/linguistic challenges. CSA is an objective measure for sampling and analyzing communication behavior (means and functions) in natural interactions.

Why should you use CSA?

CSA allows a clinician to objectively evaluate a nonverbal or severely speech impaired child that is difficult to test. It provides evidence that the child with complex communication needs is in fact communicating. CSA will yield an inventory of the child's communicative means and functions. The clinician can use this information to demonstrate a need for communication systems (unaided and aided), develop intervention goals and objectives, train partners, and engineer the environment to increase communication opportunities both quantitatively and qualitatively. The CSA can serve as a pre and post treatment measure to document progress and justify continued treatment.

What is the theoretical background of CSA?

The sampling methodology used in CSA is based on Interaction Research methodology that considers the dyad as the minimal unit of analysis. CSA samples the communication behavior of the child with a partner in context during interactive settings. The analysis methodology is based on Speech Act theory (pragmatics) and is derived from existing taxonomies modified specifically for this special population.

How do we sample the Interaction?

For the purposes of this tool, we sample the child's observable communication behavior (nonverbal, vocal, verbal) and the consequences or effects the behavior has on the partner. CSA samples the interaction, not the individual. Sampling of the child occurs in a natural context (home, school, community), during an interactive setting (mealtime, play activity), with a partner. The observer chooses, contexts, settings, and partners based on a formulated question, e.g. "What is the baseline level of communication functioning for this child across contexts (home and school)".

How do we collect and analyze the communication sample?

The evaluator observes (does not interact with) the child and partner and makes notations regarding the interactive setting, child's behavior, and partner response on the CSA Sampling Form. The observer samples as much of the interaction as possible given the length of the activity but makes notes only what is most obvious and transparent in the interaction. Each complete line on the form is an interactive event sequence. At least 25 Interactive Event Sequences are gathered; which is a minimum number for establishing a representative sample in the specified sampling conditions. To complete the analysis the observer logs onto the CSA and follows the step by step instructions in the quick start guide.

Why use an online version?

CSA online expedites the analysis process and produces a printable sample report and summary report which can be included in an evaluation report. While the analysis can be conducted long hand, the online application makes the process faster and insures accuracy of results. In addition, subsequent sampling sessions can be entered and compared to a previous session. Thus the clinician can compare two samples entered at different times.

What is the reliability and validity of the CSA?

Preliminary data on coding reliability yield reliability greater than 90%. Sampling reliability for two observers sampling the same interaction yielded only 50% of the interactive events in common. However, the profiles were essentially the same. The authors are currently conducting more extensive sampling and reliability data.

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Marilyn Jean Buzolich, Diane Barnes Russell, Judith Lunger-Bergh & Deborah Burns-McCloskey 2011

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CSA - Sampling and Analyzing Communication Behavior

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CSA allows a clinician to objectively evaluate a nonverbal or severely speech impaired child that is difficult to test.

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Functional Behavior Assessment (AAC) Process

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Functional Behavior Assessment (AAC) Process

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"Few other assessment and intervention programs can offer as extensive and converging perspectives as does the TPBA2 and TPBI2. The TPBA2 is strongly recommended for early childhood intervention assessments."

"The ability to collaborate with other professionals, facilitate the involvement and empowerment of families in assessment and intervention, and provide services in natural settings are skills that are keys to success in practice . . . the transdisciplinary system described in the TPBA2 and TPBI2 is one that readily promotes these skills."

"What a phenomenal resource!"

"Emphasizes observing the child through the lenses of many domains to determine appropriate interventions...an excellent resource for physical therapy professionals who routinely perform early-intervention assessments as part of an interdisciplinary team, as well as for faculty and researchers."

"We are using TPBA to develop our transdisciplinary play-based assessment strategies to be used with young deaf and hard of hearing children. TPBA has proven to be helpful in this initial development stage."

"Makes the evaluation process a very positive experience for children and families . . . provides the team with an incredible amount of nuanced information for developing integrated, functional goals for intervention."

"TPBA is an ideal tool for assessment teams."

"Using TPBA assessment procedures and strategies has proven to be a useful framework for our professionals to grow into a truly transdisciplinary team."

"Embedded in child development theory and research, TPBA/I 2 have revolutionized assessment methodologies for preschool age children . . . consistently yields comprehensive, rich data as evidence to develop intervention teaching strategies that address the development of the whole child."

"Allows the family to be actively involved in the assessment, calls attention to play behaviors and engagement, and provides rich information that proved useful to intervention planning. TPBA/I are pivotal to providing quality services within the child's natural environment and integrating the child's goals into daily activities and routines."

"Outstanding works which have been important in the field of early intervention . . . excellent way of illustrating clinical observation from a team perspective."

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FIATS-AAC Outcome Measure: Access the Measure

The FIATS-AAC Outcome Measure (including a French translation) is available for free download through Flintbox, a third-party site. To access the FIATS-AAC, visit our Flintbox page.

Instructions:

Click on the Flintbox link above

Select one of the Offerings at the bottom of the page and click Download

You will be required to provide your name and email address. Flintbox will only use your email to confirm your download.

Review the Copyright License Agreement.

Select 'I have reviewed and accept the license terms' and continue

Confirm your choice by clicking 'Complete purchase' a second time

Click Download for the desired "component" to open the PDF and save to your computer.

You can access the component again through the emailed order summary

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The FIATS-AAC Outcome Measure (including a French translation) is available for free download through Flintbox, a third-party site. To access the FIATS-AAC, visit our Flintbox page. Click on the Flintbox link above Select one of the Offerings at the bottom of the page and click Download You will be required to provide your name and email address.

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The Lingraphica QuickAssess app gives you the ability to assess clients' readiness for a Lingraphica speech-generating device. It's designed to help you determine whether your client is a device candidate, how they might be able to use the device, and where to start with setup. Simply work with your clients through three simple sections.

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Posted on 2023-06-30 09:18:39 by Admin under News

Check out the latest improvements to TouchChat®, LAMP Words for Life®, and Dialogue® AAC when you update your iOS apps to version 2.43.

Additional head tracking options for TouchChat & Dialogue

There are several ways to customize head tracking in the settings menu including tracking speed, trigger action such as hover, cursor smoothing, and more. With app update 2.43, you'll now have more options for hover time with head tracking. Choose the time that works best for you to access your vocabulary system .

Looking for more information about head tracking within the TouchChat app? Check out these head tracking support articles including a list of the most frequently asked questions.

Engage for iOS - a new AAC assessment tool for TouchChat

Explore the new Engage for iOS file designed to help evaluators and consultants with assessments related to access needs. Available in SymbolStix (SS) and Picture Communication Symbols® (PCS), this new tool can help determine which vocabulary file and access settings work best for an individual.

Added Canadian French Translations in TouchChat

You may notice a language addition in menu prompts. Within TouchChat, Canadian French translations have been added, so when you put your iOS device in Canadian French or European French, you will now see app menu prompts in Canadian French.

This is also a great opportunity to remind you of the 19th Biennial ISAAC Conference taking place July 24-27 in Canc ú n, Mexico. PRC-Saltillo is pleased to be part of an organization striving to make AAC available around the world.
Watch the video to learn about these new features.
Looking for fun and interactive ways to practice vocabulary with your iOS app? Check out the AAC Language Lab Summer Camp 2023 . Practice AAC with five weeks of action-packed themed materials. Enroll today through AAC Learning Journey.

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Check Out The Latest Improvements To Your AAC Apps In Version 2.43

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When you complete an evaluation, CoughDrop will immediately take you to a report to view the session results.

If you need to view results at a later time, the evaluation information will be saved to your logs and messaging page. You can open a specific evaluation to view results or to restart a saved evaluation from the logs and messaging page.

NOTE: If the evaluation was performed for a communicator account that you supervise, the evaluation report will be available on the logs and messaging page of that account.

You can reach the logs and messaging page by opening the account page and then hitting "logs and messaging" from the menu on the right side of the screen.

Now, hit the paper/report button near the desired evaluation to open that evaluation.

To resume an evaluation that was not completed, scroll to the bottom of the evaluation report and hit "resume evaluation."
You can also choose to print the evaluation results by hitting the "print" button at the bottom of the evaluation report.

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How do I run an AAC evaluation for a student or potential communicator?

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CoughDrop has a built-in evaluation tool which can be used to determine what AAC settings and options may be best for a student or potential communicator. You can access this tool for a specific c...

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AAC in the Cloud: Celeste Helling on AAC Assessments

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AAC in the Cloud: Celeste Helling on AAC Assessments

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The ultimate goal of a comprehensive AAC assessment is effective communication. Given the complexity of AAC evaluation, the diversity of those needing assessment and the constraints imposed by time and reimbursement factors, the need for a systematic, comprehensive approach to assessment is critical to the goal of successful AAC use.

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‎Are you looking for a fast and efficient process to streamline AAC evaluations? AAC Evaluation Genie is an informal diagnostic tool that is intended to assist speech-language pathologists and others with identifying skill areas that relate specifically to the language representation methods common...

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Test of Aided-Communication Symbol Performance

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Test of Aided-Communication Symbol Performance

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Home / All / TASP: Test of Aided-Communication Symbol Performance

M3MJ205

TASP helps assess symbolic skills quickly and easily. It provides a starting point for designing or selecting an appropriate AAC device page set. TASP uses results to design communication boards and establish appropriate AAC intervention goals and strategies targeting symbolic and syntactic development. Some additional features of TASP:

Serves as a tool to benchmark progress in aided communication performance

Uses Picture Communication Symbols (PCS) and complements other components of the AAC assessment process

Includes subtests, which can be administered over a period of sessions to test understanding of:

Symbol size and number

Grammatical encoding

Categorization

Syntactic performance

Establishes basals and ceilings for each subtest

Appropriate for children through adults who have the physical ability to function by pointing

Saves time with an administration time of just 10 to 20 minutes

Scoring procedures are objective and rapid

Test forms are reproducible

Includes customizable worksheets for a variety of practice exercises

TASP is also effective with preschoolers and kindergartners! Use it to count functional objects, stimulate math practice with colorful activities and more!
I ncludes reproducible subtests (with basals and ceilings), case study examples, manual, answer sheet (for completion during testing) and assessment folder.

This website uses JavaScript to apply discounts. To be eligible for discounts, please enable JavaScript for your browser.

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TASP: Test of Aided-Communication Symbol Performance

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TASP helps assess symbolic skills quickly and easily. It provides a starting point for designing or selecting an appropriate AAC device page set. TASP uses results to design communication boards and establish appropriate AAC intervention goals and strategies targeting symbolic and syntactic development. Some additional

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Working in inter-professional teams, Bridge School staff use the Participation Model (Beukelman & Mirenda, 2013) to guide the process of AAC system development and assess appropriate communication tools for each student. Students with SSPI and CCN learn to use a range of communication support technologies to meet daily communication needs. Taken together, these tools, and the strategies for how and when to use them across interactions, make up an individual's AAC System.

The team assesses current functional participation relative to typical participation patterns of same-aged peers, as well as current barriers to communication and full participation in school activities. This includes an assessment of the student's motor, linguistic, literacy, and sensory/perceptual skills and levels of current functioning in the school environment. (See section on Assessment: Documenting Present Levels of Performance, setting goals, and monitoring progress.) We consider a variety of communication support technologies and then test these possible tools and strategies in different situations to determine if they are effective at meeting specific communication needs. We teach the student to use those tools and strategies within classroom activities and meaningful social interactions. The team identifies the best times to provide multiple practice opportunities across the student's day, and trains important communication partners and facilitators. We establish processes for monitoring progress and evaluating outcomes. Selection of communication support technologies and teaching strategies are modified as needed until effective communication tools/strategies are identified. If a commercially-available device is deemed an appropriate tool to meet the student's current communication needs and increase effective participation, we work together with families to proceed with the funding and procurement process. This assessment process is repeated as the team identifies additional unmet communication needs and opportunities to maximize participation.

We view AAC system development as a dynamic, ongoing process. AAC systems are continually evolving to meet a student's changing needs and abilities. An AAC system is unique to each student and may include some or all of the following communication support technologies:

No-technology

Gestures

Manual signs

Spoken words

Non-word vocalizations

Eye contact

Eye gaze

Proximity cues

Low-technology

Object-based symbol sets

Picture symbols

Communication boards or books

Photo albums

Remnants from personal experiences

ABC boards for spelling out messages

Communication books or boards organized for partner-assisted auditory scanning (PAAS)

Voice-output Technologies

Recordable digitized speech devices, single messages or sequenced messages (Step-by-Step Communicator, Talking Brix, etc.)

Multi-level, multi-message digitized speech devices (GoTalk, SuperTalker, TechTalk, etc.)

Complex speech-generating devices (Tobii Dynavox I-Series+, PRC Accent, Saltillo NOVA Chat, etc.)

Mainstream Technologies

Laptop or desktop computer

Mainstream software and apps (MS Office, Google Chrome, iTunes, etc.)

Social media platforms (Facebook, Instagram, Twitter, etc.)

Blogging

Video conferencing

Mobile phone (including texting, media sharing, etc.)

Landline phone

Tablet or other mobile device

Remote controls

Media player (iPod, etc.)

Video games

Digital camera, video camera

Toys

Household appliances

Other Assistive Technologies

Independent mobility device (support walker, power wheelchair, etc.)

Computer interface devices (switch interface, mouse emulator, joystick, etc.)

Alternate keyboard

Capability switches

Mounting hardware

Specialized software (screen readers, talking word processors, etc.)

Example

Communication need, based on barriers

Student needs a way to participate in social games and exchanges at recess with same-aged peers by: choosing peers to engage with, gaining peers' attention, communicating directly with peers (gain attention, ask to play, communicate during activity, etc.)

Student is positioned in walker with single switch access (no way to safely mount SGD).

Current participation

Instructional Assistant (IA) asks student where/with whom they want to play (IA gives choices and student responds with yes/no gestures).

IA helps student move towards location or peer group, asks peers if student can join in play.

IA continues to facilitate the interaction and "translate" student's non-verbal cues throughout the interaction.

Communication support technologies to try

Low-tech board with choices of favorite playground activities and peers, to use with partner-assisted auditory scanning (PAAS).

Seek OT support to help student navigate playground terrain more independently.

Teach student to use proximity cues, vocalization, and/or an attention-getting message programmed into Step-by-Step (SBS) mounted on walker to gain peers' attention.

Teach student to use pre-programmed message in SBS to ask "wanna play?" or "can I play?" (or similar message of student's choosing).

Practice opportunities

Role play with familiar partners at Bridge School first.

Daily practice opportunities at morning recess.

Once routine is established at school, ask parents about opportunities at playdates, playgrounds, etc.

Partner training

Train IA on PAAS procedure if necessary.

OT trains IA on ways to support independent mobility on the playground.

Train playground peers on student's communication modes: how to ask student yes/no questions and how student answers, how to program student's SBS with messages to support participation in group games, etc.

Train parents on support strategies (PAAS, programming SBS, etc.)

Progress and outcomes

Has student's participation and communication in this context changed following the introduction of communication tools and strategies?

Which tools and strategies have worked to meet the identified communication need?

Was partner training successful?

How have student and partners reacted to the communication support technologies being trialed?

Funding & Procurement

In the United States, funding models for communication support technologies, including speech-generating devices ( SGDs), is locally regulated by individual states and school districts. As mainstream technologies become a more essential part of users' AAC systems, funding models are increasingly in flux and laws are changing rapidly. Funding sources may include primary medical insurance, Medicare insurance, school district funding or, in many cases, privately funded by families. Below are some general resources for SGD funding.

Resources

Roles and Responsibilities of Speech-Language Pathologists With Respect to Augmentative and Alternative Communication: Technical Report.

ASHA Special Interest Division 12: Augmentative and Alternative Communication ( AAC) http://www.asha.org/policy/TR2004-00262/#sec1.7

Guidelines for Meeting the Communication Needs of Persons with Severe Disabilities

National Joint Committee for the Communication Needs of Persons with Severe Disabilities http://www.asha.org/policy/GL1992-00201/

National Joint Committee for the Communication Needs of Persons with Severe Disabilities (NJC) http://www.asha.org/NJC/

Beukelman, D. & Mirenda, P. (2013). Augmentative and Alternative Communication: Supporting children and adults with complex communication needs. Fourth Ed. Baltimore: Paul H. Brookes Publishing Co.

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Developing AAC Systems & Assessing Communication Support Technologies

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Working in inter-professional teams, Bridge School staff use the Participation Model (Beukelman & Mirenda, 2013) to guide the process of AAC system development and assess appropriate communication tools for each student. Students with SSPI and CCN learn to use a range of communication support technologies to meet daily communication needs.

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Wecome to the Communication Matrix

Understanding what individuals are capable of today is the first step toward helping them reach their potential.

Assessment

The Communication Matrix is a free assessment tool created to help families and professionals easily understand the communication status, progress, and unique needs of anyone functioning at the early stages of communication or using forms of communication other than speaking or writing.

"I am very excited about using this Matrix as part of our assessment and treatment plan for students with ASD." - Special Education Teacher

Community

Our Community includes an active forum where SLPs, teachers, families, and researchers can connect, share information, learn from the field, and offer and receive support.

"I love a focus on complex communication needs. Frequently I look at sites or information that does not apply to my students. It is great to have a site that focuses on the students I work with." - Parent

Purchase Paper and PDF copies of the Communication Matrix Assessment here.

See who is using the Communication Matrix around the world

© 2023 Charity Rowland, Ph.D.

Site by State33 and Smith & Connors

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The Communication Matrix is a free assessment tool created to help families and professionals easily understand the communication status, progress, and unique needs of anyone functioning at the early stages of communication or using forms of communication other than speaking or writing.

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Products: Social Networks (Augmentative Communication, Inc.)

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Social Networks Introductory Package $89.00 (SN-11S) This Social Networks assessment and intervention planning tool includes a Manual, full color, 51 pgs.; 1 Inventory Booklet, black and white, 27pgs; Win/Mac CD with PDF and customizable Word document, 2003; and DVD, 2004. For professionals who work with family members and individuals with complex communication needs.

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Wetherby Checklist of Functions and Means, with Instructions

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Wetherby Checklist of Functions and Means, with Instructions

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Scheuerman & Webber Communicative Form and Function Checklist

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Scheuerman & Webber Communicative Form and Function Checklist

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Children's Speech Intelligibility Measure (CSIM)

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Children's Speech Intelligibility Measure (CSIM)

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Children's Speech Intelligibility Measure

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AAC and Classroom Learning Considerations

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AAC and Classroom Learning Considerations

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AAC in Classrooms

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Index of Augmented Speech Comprehensibility in Children (I-ASCC)

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Index of Augmented Speech Comprehensibility in Children (I-ASCC)

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While the Index of Augmented Speech Comprehensibility in Children (I-ASCC) has been around for almost 20 years, few clinicians know and use it. In this post, we welcome back Matthew Baud and Jill Senner to talk about how they are using this assessment tool. Enjoy!

AAC evaluations can be challenging, especially if there is disagreement among team members as to whether AAC is necessary or not. We frequently see disagreements about AAC arise when a student is able to speak. Let's examine the following case.

Mrs. Brown has had Johnny in her class for the last 2 years and she "understands everything" he is saying during their routine calendar time. The new SLP, who only sees Johnny once weekly for 30 minutes, tried to elicit information about his weekend at home and reported that she "didn't understand anything." What is going on here? How can two communication partners have such vastly different experiences with the same student? Who is right and who is wrong? Actually, both reports are true! Extrinsic factors such as partner familiarity and known versus unknown context can have a significant impact on speech comprehensibility (i.e., how well the student's message is understood). The Index of Augmented Speech Comprehensibility in Children (I-ASCC), developed by Dr. Patricia Dowden (1997), is a valuable tool that we frequently use to help teams resolve similar conflicts and develop effective speech-supplementation strategies for students who speak.

The I-ASCC is a non-standardized clinical measure to determine single-word speech comprehensibility in children (Dowden, 1997). Children are shown picture stimuli and their answers are recorded. Familiar and unfamiliar communication partners then listen to the recorded samples with unknown and known contexts.

The following is a video clip of a child taking the I-ASCC. First watch the video without knowing any contexts. Write down the words you think he is saying.

Now, watch the video again but first download and review this list of context cues. When you are finished, download the answer key and see how well you did.

As an unfamiliar communication partner, you probably didn't understand as much as someone who knows him well but you probably did better with context known than when you listened without! This instrument yields quantitative data regarding how well familiar and unfamiliar communication partners understand a child with and without context.

Because this tool was described in a research article and it isn't yet commercially available, it took us a while to assemble. Since we have already spent the time to put the materials together, we have made the files available for sharing so you too can take advantage of this helpful resource. Instructions, record forms, and stimulus pictures in Picture Communication Symbols (PCS) and SymbolStixs can be found on our AAC Assessment Pinterest board or by clicking on the image below.

We look forward to Dr. Dowden releasing an electronic version of the instrument in the future. Until then, break out the scissors, glue and note cards!

Direct Link to Document Download (zipped file): http://www.talcaac.com/IASCC%20Share.zip
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Reference

Dowden, P. (1997). Augmentative and alternative communication decisions making for children with severely unintelligible speech. Augmentative and Alternative Communication, 13, 48-58.

Jill E Senner, PhD, CCC-SLP, Owner and Director of Technology and Language Center, Inc. ( talcaac@gmail.com) is a speech-language pathologist with almost 20 years of experience working with children with complex communication needs. She is the owner/director of Technology and Language Center where she specializes in providing augmentative and alternative communication (AAC) and assistive technology (AT) services including assessment, consultation and training, and workshops/lectures. Dr. Senner has presented at numerous national assistive technology conferences and has taught graduate courses in AAC and swallowing disorders. She has published research in the areas of AAC, siblings and disability, and swallowing disorders in cerebral palsy. Her current research interests are focused on communication partner training.

Matthew R. Baud, MS, CCC-SLP, Assistive Technology Coordinator for Niles Township District for Special Education ( Mbaud12@gmail.com; Mbaud12 [Twitter]) has been working with AAC for the past 13 years. He currently is the Assistive Technology Coordinator at Niles Township District for Special Education (NTDSE) performing evaluations, trainings and coaching of AAC with students, staff and families. Matthew also has his own AAC private practice working with individuals with complex communication needs from birth through adulthood. He is an adjunct professor at Saint Xavier University where he teaches a graduate course in AAC and has presented at several national and state conferences.

The Picture Communication Symbols ©1981-2015 by Mayer-Johnson LLC a Tobii Dynavox company. All Rights Reserved Worldwide. Used with permission. Boardmaker® is a trademark of Mayer-Johnson LLC.

© 2005-2015 SymbolStix LLC. All Rights Reserved Worldwide. Used with permission.

This post was written by Carole Zangari

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Say What?!? AAC Assessment for Children Who Speak with Dr. Jill Senner and Matthew Baud

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While the Index of Augmented Speech Comprehensibility in Children (I-ASCC) has been around for almost 20 years, few clinicians know and use it. In this post, we welcome back Matthew Baud and Jill Senner to talk about how they are using this assessment tool. Enjoy!

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This is a curated list of tools that support completing communication evaluations, choosing appropriate AAC/AT tools, creating effective plans, and monitoring progress. We created this collection for educational purposes. It showcases many tools and resources available to collect information not typically gathered using standardized measures. This collection is not an exhaustive list. Inclusion does not signify endorsement. Use of any information provided on this website is at your own risk, for which NWACS shall not be held liable.

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This is a curated list of tools that support completing communication evaluations, choosing appropriate AAC/AT tools, creating effective plans, and monitoring progress. We created this collection for educational purposes. It showcases many tools and resources available to collect information not typically gathered using standardized measures. This collection is not an exhaustive list.

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PrAACtical AAC: AAC Assessment Corner with Vicki Clarke - Standardized Tests For AAC Users

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PrAACtical AAC: AAC Assessment Corner with Vicki Clarke - Standardized Tests For AAC Users

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Do you have a love-hate relationships with formal testing?

Are you required to use normed tests with your minimally verbal clients?

Looking for recommendations on which tests to use?

AAC specialist Vicki Clarke has you covered!

Like many of you, I've had mixed feeling when it comes to using normed assessment instruments with my AAC learners, particularly when we needed to modify the test materials or administration procedures in order for them to be able to participate and respond. If the client can't point to pictures, give a verbal response, or sit through an entire test, we have no choice but to adapt how the test is administered. As we all know, when we adapt test materials (e.g., putting the test items on an eye gaze board) or procedures (e.g., partner-assisted scanning), we lose the ability to use the normative data. We can, though, compare our learners to themselves at a later point in time IF we administer the adapted test the same way every time. Even more importantly, these tests can give us insight into the skill set that our clients have.

In today's post, Vicki shares her thoughts on using formal tests with people who use AAC, and discusses the use of popular instruments for assessing receptive and expressive language.
Standardized Tests For AAC Users: More Than "Less Than 55!"
Assessing the language skills of a person with significant expressive communication deficits is a challenging task. Professionals can't report standardized test scores as reliable measures unless the evaluation instrument included nonverbal individuals in the standardization sampling. I don't know of any standardized language assessments which use nonverbal individuals in their standardization process.
"Does this mean we should not use standardized tests with our nonverbal patients or students?"
I have to be honest: I have expressed a deep, abiding hatred of standardized test scores for many years. My objection was focused on the dismal scores, which are often reported without sufficient explanation. These scores limit partner expectations for my students and usher them into severe/profound placements. At their worst, these scores are used to justify delayed introduction to AAC. Let's face it, a standard score of "less than 55" doesn't help anyone.

However, standardized tests have value for us as we work to understand how our students understand and use language. They can give us ideas about an individual's skills and areas we may need to target. Understanding how a person processes auditory language can help us develop appropriate expressive communication goals. For example, we wouldn't want to target sentence construction for a student who doesn't comprehend sufficient single word vocabulary.

I rarely use standardized tests to gain a standard score. I use them most often as criterion referenced measures to help me focus on the strengths and needs of the patient. Here are some of the assessment measure in my toolbox: (please note, I'm not reporting specific versions as these change fairly often. In addition, these tests fall into categories which may be addressed by other standardized tests. The ideas are the same, just substitute your favorite comprehensive test or vocabulary measure.)
Receptive One-Word Picture Vocabulary Test (ROWPVT) and Peabody Picture Vocabulary Test (PPVT)
These two tests give me a basic idea of a person's understanding of single word vocabulary. I can get a standard score on these for all of my patients, although "less than 55" is still a common score. Of more value is my ability to use these tests to determine if teaching via verbal instruction has any value at all, or whether most of my instruction needs to include visual supports. For example, if my student's single word vocabulary comprehension is less than 50 words, I probably need to supplement most of what I say with some sort of visual information. In clinical practice, however, many patients exhibit an ability to learn to express vocabulary at a higher level than their spoken language comprehension. Often we see students whose expression via symbols is higher than their auditory comprehension. For these students, I use their AAC systems to talk to them for every interaction. Aided language input is not simply a means to teach expressive language, but also a means to supplement understanding.
Expressive One-Word Picture Vocabulary Test (EOWPVT)
I use expressive vocabulary tests to satisfy our insurance/Medicaid requirement for a standardized assessment and to allow me to compare a patient's expressive vocabulary skills using their speech vs. their augmented communication method. When we are justifying the purchase of a speech generating device, there is value in showing a person's ability to express themselves with AAC despite motor speech impairment.

Single word expressive vocabulary tests also assist us in treatment planning. Even though we can't report standard scores using augmented communication, we can use raw scores to compare an individual's expressive vocabulary development over time. I use the EOWPVT to establish a baseline and then re-administer every few years to see the gains made in vocabulary expression. Often this shows gains in navigation and category comprehension. We can get an idea of which categories of vocabulary are important in our patient's lives. In addition we can also have an idea of vocabulary that may be necessary but not yet developed.
Preschool Language Scale and Test of Early Communication and Emerging Language (TECEL)
These are standardized tests that I use very often, but rarely for the purpose of reporting a standard score. The PLS and the TECEL are standardized on very young children (up to 7 years for the PLS and, up to 3 years for the TECEL). The both offer us language age equivalencies, but I strongly discourage the use of these scores when describing a nonverbal person. Frankly, no one wants to hear their 23 year old child is "functioning at 11 months." It's functionally inaccurate, because no person who has existed on this earth for 23 years functions like a 1 year old. Their performance in an isolated test situation may be similar but their life experiences paired with experience in understanding and using social and environmental cues usually leads to substantially more communicative competence than a young child.

These tests are, however, quite good for giving us ideas about a person's isolated skill development in language and communication. They help us determine goals which may be of value to improve a person's communicative competence. Does a student understand and ask questions? Does he pair more than one word/symbol to communicate? Does he understand and use descriptive terms? Are these skills significant to this particular individual?
Comprehensive Assessment of Spoken Language (CASL) and Comprehensive Evaluation of Language Fundamentals (CELF)
I find that I can rarely use these tests in their entirety for evaluating my students but, they do offer the ability to gain raw scores and standard measures for expressive language development on individual subtests. Generally speaking, if my student struggles with the single word vocabulary tests, these tests are too difficult to give me much additional information. If my student does well on single word measures, I can often get some additional information from these comprehensive assessments. They seem to work best for my students who have comparatively good receptive language skills but struggle with motor speech difficulties or expressive language impairment.

Once you begin to look at standardized tests as a means to gain information beyond a simple standard score, you can use these tests to inform your treatment methods, goal development and augmentative communication system selection. At a simplistic level, standardized testing allows you to meet the demands of insurance to show need for continued services. With a little more in-depth analysis of your student's performance, the results have significant impact on our decisions and support of our AAC users.

This post was written by Carole Zangari

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AAC Assessment Corner with Vicki Clarke: Standardized Tests For AAC Users

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Do you have a love-hate relationships with formal testing? Are you required to use normed tests with your minimally verbal clients? Looking for recommendations on which tests to use? AAC specialist Vicki Clarke has you covered!

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Participation Model Flow Chart

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Tool for Analysis of Language and Communication (TALC)

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Tool for Analysis of Language and Communication (TALC)

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The Pragmatics Profile for People who use AAC

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The Pragmatics Profile for People who use AAC

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The Pragmatics Profile for People who use AAC | Ace Centre

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Ace Centre is a charity specialising in Augmentative and Alternative Communication (AAC) and Assistive Technology (AT). Free Advice Line 0800 080 3115

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augmentative and alternative communication (aac)

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Communication Supports Inventory: Children & Youth (CSI-CY)

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Communication Supports Inventory: Children & Youth (CSI-CY)

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© 2009 by Design to Learn Projects, Oregon Health & Science University. The contents of this instrument were developed under a grant from the U.S. Department of Education, #R324A090028. However, those contents do not necessarily represent the policy of the U.S. Department of Education, and you should not assume endorsement by the Federal Government.

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Communication Supports Inventory (CSI) doc

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Communication Supports Inventory (CSI) doc

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School-Based AAC Evaluation

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ASHA Medicare Information

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Introduction

Pursuant to EB 36-2002, an ASHA Ad Hoc Speech-Generating Devices (SGD) Committee was formed and charged with the responsibility to a) pilot and refine an SGD reimbursement protocol; b) make recommendations for a variety of educational opportunities focusing on Medicare SGD coverage and documentation; c) develop a proposal for a mentoring program for speech-language pathologists (SLPs) who wish to become proficient in SGD assessment and treatment; and 4) make recommendations for articles to be published in The ASHA Leader and special interest division newsletters that highlight issues such as documentation for SGD assessments. Members of the committee were Deborah Parker Wolfenden (chair), Laura Ball, Katherine Hill, Joanne Lasker, Patricia Ourand, Celia Hooper (monitoring vice president for speech-language pathology practices, 2003-2005), Diane Paul (ex officio), and Silvia Quevedo (ex officio).

Committee members developed an information packet to assist SLPs in the SGD funding request process for Medicare coverage. The packet provides a brief summary of the key points regarding Medicare funding of SGDs and the roles and responsibilities of SLPs in submitting an SGD funding request. The packet contains an SLP Checklist to assist SLPs in completing an SGD funding request. Internet resources are provided for SLPs to access additional information, tools, and support in working through the SGD funding process. Also included are committee recommendations for resources and educational programs to be considered by the ASHA Executive Board for possible implementation. As in the provision of any clinical service, SLPs are guided by the ASHA Code of Ethics and SLP Scope of Practice.

Medicare Funding of SGDs

The ASHA SGD Committee developed a checklist to assist an SLP in the completion of a SGD funding Request. The SLP Checklist stems from the Regional Medical Review Policy (RMRP) (see Appendix A) issued by Medicare. The items on the checklist reflect the required components of the SLP report for funding by Medicare. SLPs should be aware that when any one of the items in the SLP Checklist is not properly submitted, the SGD funding request will be denied. The recommended SGD and accessories are covered if and when the coverage criteria have been met and medical necessity has been documented clearly in the formal report by the SLP.

SLPs are cautioned that the SLP Checklist reflects the SLP funding documentation requirements ONLY. The SLP Checklist does NOT specify or identify the elements required for a comprehensive augmentative and alternative communication (AAC) assessment. The SGD funding process is not a substitute for exemplary AAC clinical practice. All AAC assessments are individualized and differ according to diagnosis, the individual's abilities, communication needs, as well as other individual variables and environmental factors.

Prior to submitting a SGD funding request, patients must have a formal evaluation of their cognitive and communication abilities by an SLP. For a SGD to be covered by Medicare, it must:

be eligible for a defined Medicare benefit category,

be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member,

meet all other applicable Medicare statutory and regulatory requirements.

In addition to the SLP report, other information NOT included in the RMRP is required for Medicare coverage. This required information is collected by the vendor/manufacturer and includes physician's prescription, UPIN, and co-payment check. The SLP may wish to assist in the process of gathering this information with the patient and vendor/manufacturer to expedite the completion of the documentation.

Also, the SLP should be aware that for an item to be considered for coverage and payment by Medicare, the vendor/manufacturer must be able to corroborate the information that has been submitted. Documentation such as the patient's medical records, physician's office records, records from other healthcare professionals, or test reports should be available and can be requested to show that the coverage criteria have been met.

This packet was prepared specific to Medicare funding. However, other funders of SGDs (e.g., Aetna, TriCAre, BCBS) may have adopted similar documentation requirements. Therefore, the information may be used as a reference for a variety of funding agencies.

Roles and Responsibilities of the SLP in the SGD Funding Request Process

In addition to satisfying the expectations of professional conduct outlined in the ASHA Code of Ethics and SLP Scope of Practice, the SLP must:

Complete an AAC assessment pursuant to the RMRP outline, recommend the most appropriate device, determine software and/or accessories needed, and determine whether the beneficiary can obtain the most appropriate device (determine whether Medicare covers the device, determine whether the manufacturer will accept Medicare assignment, determine whether the beneficiary can pay full purchase price if not covered or no assignment is accepted).

Prepare a written report and supporting information, addressing any required accessories in addition to the device.

Obtain a prescription from the treating physician that identifies the device and each accessory.

Contact the manufacturer/supplier to determine how claims will be processed and determine whether they will process the entire claim or whether software and accessories must be separate claims.

Assemble all paperwork plus necessary payment/co-payment from the beneficiary and forward it to the manufacturer/supplier.

SLP Checklist

Introduction

For a speech generating device (SGD) to be covered by Medicare, it must:

be eligible for a defined Medicare benefit category

be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member

meet all other applicable Medicare statutory and regulatory requirements

Prior to the delivery of the SGD, the patient has had a formal evaluation of their cognitive and communication abilities by a speech-language pathologist (SLP).
The following SLP Checklist comes from the Regional Medical Review Policy (RMRP) (see Appendix A) issued by Medicare that outlines the required components of the SLP report for funding by Medicare. If any one of the items in the SLP Checklist is not met, the SGD will be denied as not medically necessary. Accessories are covered if the SGD coverage criteria for the device are met and the medical necessity for each accessory is clearly documented in the formal evaluation by the SLP.

Other information is required in addition to the SLP report but NOT included in the RMRP (e.g., physician's prescription, UPIN, co-payment check). This information is collected by the vendor/manufacturer and required for funding. SLPs may wish to assist with this process to aid the patient and potentially speed funding for the SGD. The SLP assessment protocol at the AAC-RERC Web site provides a guide for SLPs to conduct assessments and complete reports that address all of the points identified in the RMRP. The SLP Checklist may be used in conjunction with this document to aid the SLP.

For an item to be considered for coverage and payment by Medicare, the information submitted by the supplier must be corroborated by documentation in the patient's medical records that Medicare coverage criteria have been met. The patient's medical records include the physician's office records, records from other health care professionals, or test reports. This documentation must be available upon request.

Required elements of the SLP SGD Request Report, while specific to Medicare funding, are similar to and/or the same for some (but not all) funders of AAC devices (SGDs) (e.g., TriCare, BCBS, Aetna) and therefore may be used in a similar manner for a variety of funding agencies.

The SLP Checklist reflects SLP funding documentation requirements ONLY. It does not specify the elements of a comprehensive AAC assessment. AAC assessments for SGDs are individualized and will differ depending upon etiology of the communication disorder, the individual's communication needs, the context, setting, access issues, and so on.

The roles of the SLP include:

Completing an AAC assessment pursuant to the RMRP outline, recommending the most appropriate device, determining software and/or accessories needed, and determining whether the beneficiary can obtain the most appropriate device (determine whether Medicare covers the device, determine whether the manufacturer will accept Medicare assignment, determine whether the beneficiary can pay full purchase price if not covered, or no assignment is accepted).

Preparing a written report and supporting information, addressing any required accessories in addition to the device.

Seeking a prescription from the treating physician that identifies the device and each accessory.

Contacting the manufacturer/supplier to determine how claims will be processed and whether they will process the entire claim or whether software and accessories must be separate claims.

Assembling all paperwork plus necessary payment/co-payment from the beneficiary and forwarding it to the manufacturer/supplier.

Instructions for Use

Respond to each of the questions posed in the following grid to indicate whether the SGD funding report contains all of the items to ensure coverage and payment by Medicare. Check "yes" when you have completed or identified the element in the funding report prior to forwarding the request to the manufacturer/vendor.

Include patient information including name, date of birth, and medical diagnosis with date of onset.

The following components are identified by the RMRP as "reasonable and necessary" for Medicare funding.

1. Does the SGD Funding report include current communication impairment, specifically addressing:

Communication diagnosis (apraxia, dysarthria, aphasia, and/or aphonia)

Severity level of the communication diagnosis (mild, moderate, or severe)

Language skills

Cognitive abilities

Anticipated course of impairment

That the medical condition is one resulting in a severe expressive speech disability

2. Does the SGD Funding report include daily communication needs, specifically addressing:

Whether they could be met using other natural modes of communication

That speaking needs cannot be addressed using natural communication methods

That other forms of treatment have been considered and ruled out

3. Does the SGD Funding report include functional communication goals, specifically addressing:

Expected goal achievement

Treatment options

A treatment plan that includes a training schedule for the selected device

That the patient's speech disability will benefit from the device ordered

4. Does the SGD Funding report include cognitive and physical abilities, specifically addressing:

Demonstration that the patient possesses the cognitive abilities to use the selected device to communicate

Demonstration that the patient possesses the cognitive abilities to use the selected accessories to communicate

Demonstration that the patient possesses the physical abilities to use the selected device to communicate

Demonstration that the patient possesses the physical abilities to use the selected accessories to communicate

5. Does the SGD Funding report include a financial relationship statement, specifically addressing:

That the SLP is not an employee of the supplier of the SGD

That the SLP does not have a financial relationship with the supplier of the SGD

6. Does the SGD Funding report include a physician notification statement, specifically addressing:
That a copy of the SLP's written evaluation and recommendations have been forwarded to the patient's treating physician prior to ordering the device

7. If an upgrade to a previously issued SGD is being requested, does the SGD Funding report include functional benefit, specifically addressing:
The functional benefit to the patient of the upgrade compared to the initial SGD

Appendix A

RMRP Coverage and Payment Rules

For any item to be covered by Medicare, it must:

1. be eligible for a defined Medicare benefit category

2. be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member

3. meet all other applicable Medicare statutory and regulatory requirements

For the items addressed in this regional medical review policy, "reasonable and necessary" is defined by the following coverage and payment rules.

A speech-generating device (E2500 - E2511) is covered when all of the following criteria (1-7) are met. If one or more of the SGD coverage criteria 1-7 is not met, the SGD will be denied as not medically necessary.

1. Prior to the delivery of the SGD, the patient has had a formal evaluation of their cognitive and communication abilities by a speech-language pathologist (SLP). The formal, written evaluation must include, at a minimum, the following elements:

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

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

2. The patient's medical condition is one resulting in a severe expressive speech impairment

3. The patient's speaking needs cannot be met using natural communication methods

4. Other forms of treatment have been considered and ruled out

5. The patient's speech impairment will benefit from the device ordered

6. A copy of the SLP's written evaluation and recommendation has been forwarded to the patient's treating physician prior to ordering the device

7. The SLP performing the patient evaluation may not be an employee of or have a financial relationship with the supplier of the SGD

Codes E2500 - E2510 and code E2511 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 not covered 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.

Accessories

Accessories (E2512 and E2599) for E2500 - E2511 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.

SGD Recommendations

Recommendations for a variety of educational opportunities focusing on SGD coverage and documentation.

1. Develop ASHA-sponsored educational opportunities that might include the following:

1. Offer ASHA convention presentations that focus on funding and documentation.

2. Consult with the AAC convention program committee and SIG 12 regarding invited session(s) for the 2004 ASHA convention

3. Conduct the scheduled ASHA telephone seminar scheduled for March 2004 and develop additional telephone seminars on the topic in future years.

4. Consult with ASHA's Professional Development Team regarding putting together ("bundling") a package of existing ASHA products related to AAC/SGD funding for adults.

5. Consult with SIG 12 to suggest that topics such as Medicare funding be the focus for a future SIG 12 leadership conference.

2. Develop other continuing education opportunities on Medicare funding of SGD's.

3. Develop distance learning programs/telemedicine that include funding of SGDs.

4. Conduct a search and appraisal of organizations with similar missions and approved funding streams to support the development of educational resources and tools (e.g., RESNA, ALSA, MDA, AAC Institute). Reciprocal Web site links can be requested to these resources.

5. Collaborate with other agencies and existing committees and groups focusing on SGD funding.

6. Develop materials for course syllabi/curricula that include funding of SGDs.

7. Create scenarios (e.g., written vignettes, videos, flash presentations) so that SLP's can practice SGD funding procedures for continuing education.

8. Write a resolution to update the ASHA family of documents on AAC so that they include information about Medicare funding procedures.

9. Create online resources that offer more extensive information about AAC assessment. For example, consider the document(s) created by this committee (Appendix #).

10. Develop materials based on the variety of Medicare eligible populations; consider variety of ages, diagnoses, environments, and cultures for customizing this information.

11. Create consumer-ready, consumer-focused information (e.g., a Public Service Announcement) to educate families and consumers regarding Medicare funding.

Develop a proposal for an ASHA mentoring program for SLPs who wish to become proficient in SGD assessment and treatment.

1. Develop a mentoring program for SLPs who wish to become proficient in SGD assessment and treatment, as well as funding. Consider as potential partners, the ASHA MR/DD committee, Gerontology (SIG 15), Administration and Supervision (SIG 11), Neurogenic Communication Disorders (SIG 2), National Joint Committee for the Communication Needs of Persons With Severe Disabilities, and Augmentative and Alternative Communication (SIG 12).

2. Develop criteria for mentors based on demonstrated performance- related AAC clinical practice and SGD funding.

3. Explore alternative funding options for the mentor. (e.g., NIDRR funding opportunities, ED grants/personnel preparation grants, private foundations). Consider honoraria for mentors.

4. Develop preservice and inservice educational tracks for the mentoring program.

5. Pair AAC mentors with university programs, perhaps via distance learning techniques.

1. Develop a curriculum/script for mentoring program. See student minority leadership program and AAC competencies for models of mentoring programs.

2. Provide ASHA continuing education units and/or financial compensation for mentors participating in mentorship programs.

1. Make recommendations for articles to be published in The ASHA Leader and Special Interest Group newsletters that highlight issues such as documentation with SGD assessment.

1. Solicit articles highlighting SGD funding and documentation.

2. Expand the list of resources cited above to include: NSSLHA journal, NBASLH publications.

3. Identify ASHA members to write articles highlighting SGD funding and documentation for non-ASHA publications (e.g., state associations, RESNA, Closing the Gap, Advance).

4. Solicit articles focusing on the following topics:

1. AAC assessments: Beyond the funding request.

2. SLP's responsibilities in SGD funding requests.

3. Resources to support meeting Medicare requirements.

4. Comparison of funding request section requirements and AAC assessment procedures.

5. Integration of RMRP requirements into an AAC assessment report.

6. Case studies involving Medicare funding.

7. Retrospective analysis of funding process and timeliness.

8. Medicare coding for services and SGDs

9. Ethical responsibilities when completing AAC assessment/interventions and funding requests.

10. Acceptance rates with SGDs.

2. Implementation

1. Complete a cost benefit analysis for all suggested programs.

2. Appoint a person or persons to be responsible for implementation of these recommendations.

Medicare SGD Funding-Internet Resources
American Speech-Language-Hearing Association (ASHA) AAC Institute AAC Rehabilitation Engineering Research Center on Communication Enhancement (AAC-RERC)

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Pursuant to EB 36-2002, an ASHA Ad Hoc Speech-Generating Devices (SGD) Committee was formed and charged with the responsibility to a) pilot and refine an SGD reimbursement protocol; b) make recommendations for a variety of educational opportunities focusing on Medicare SGD coverage and documentation; c) develop a proposal for a mentoring program for speech-language pathologists (SLPs) who wish to become proficient in SGD assessment and treatment; and 4) make recommendations for articles to be published in The ASHA Leader and special interest division newsletters that highlight issues such as documentation for SGD assessments.

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ACTS Funding Questions and Answers

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Medicare Funding of AAC Technology - Assessment/Application Protocol :: AAC-RERC - Spread the Word

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The Medicare Implementation Team (MIT) members prepared the information in this section to help support SLPs in their efforts to write and submit successful funding requests on behalf of Medicare beneficiaries. The MIT hopes you find the information helpful.

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Dynamic Therapy Associates AAC Ax Protocol

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Medicare Report Outline

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Classroom Environment Inventory

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AAC/AT Classroom Program Evaluation Tool

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AAC/AT Classroom Program Evaluation Tool

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AAC/AT Classroom Evaluation Tool

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AAC/AT Classroom Program Evaluation Tool KEY

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AAC/AT Classroom Program Evaluation Tool KEY

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AAC/AT Classroom Evaluation Key

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Classroom Engineering for Communication

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assistive technology for individuals with significant sensory motor

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A sensory based approach to communication and assistive technology for individuals with significant sensory motor differences, developmental differences and autism.

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AAC/SGD Report Coach (Word Doc)

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AAC/SGD Report Outline

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Montgomery Assessment of Vocabulary Acquisition (MAVA)

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Montgomery Assessment of Vocabulary Acquisition (MAVA)

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MAVA - Montgomery Assessment of Vocabulary Acquisition

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2008 Test for ages 3;0-12;11 evaluates receptive/expressive vocabulary in basic (tier 1), high frequency (tier 2), and curriculum-based (tier 3) word knowledge. Includes Manual, Receptive and Expressive Easels, 30 each of Receptive and Expressive Record Forms, online Qualitative Response Analyzer, calculator-clipboards, and tote.

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Interaction Checklist for Augmentative Communication INCH

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Dynamic Therapy Associates AAC Skills Protocol

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Gail Van Tatenhove AAC Ax Protocol

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Gail Van Tatenhove AAC Needs Ax Checklist

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Gail Van Tatenhove AAC Pre-Ax Questionnaire

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Scenario: You have a six-year-old student who is mainly non-speaking and their evaluation is due in two months. The family would like to explore augmentative communication tools. Where do you start?

Have you experienced the joy (and challenges) of an AAC evaluation yet in your career? It can be an intimidating process for even those who claim to be "experts" in the field. Although there is a large learning curve to be completely independent in this process, any SLP with knowledge of language learning can participate and lead this process. In fact, there are a few differences between your "typical" speech/language assessment and an AAC assessment!

Where should one begin when evaluating a client who may need (or already uses) augmentative communication? First, the SLP needs to determine the type of evaluation that is going to take place. Here are some questions to answer:

Do you need standardized testing results?

Are you evaluating to explain current levels/abilities?

Are you evaluating to determine priorities and goals?

Is the purpose of the evaluation to trial different AAC systems?

Do you need standardized testing results?

Although most SLPs understand that standardized testing of children demonstrating early language skills is inaccurate and inappropriate, some states and districts continue to require normed scores. If you can avoid these tests, I recommend that you skip straight to informal assessment as they will yield much more helpful results. If you need to give a standardized assessment (with or without modifications), consider these guidelines:

Age-appropriate standardized language assessment: Use an age-appropriate standardized language assessment, such as the CELF, OWLs, or CASL. The results from the test will not be helpful, but if your agency requires a test, then there is no gold standard.

Receptive vocabulary assessment: Use a receptive vocabulary assessment to allow students to point to pictures. Some students who are unable to do a core assessment can participate in receptive pointing tasks. The PPVT (or similar) can be a measurement of one area of language knowledge.

Non-age-appropriate language assessment: Use a non-age-appropriate language assessment in which the child can participate. For example, some students can participate in the Preschool Language Scale, although they may be too old for normed scores. The test results can be explained by skills that the child has and has not yet mastered.

Are you evaluating to explain current levels/abilities?

If the goal of your assessment is to fully describe a child's communication skills, your time is much better spent completing informal assessments and observations of language knowledge. Your best observations will occur during highly motivating activities, so make sure to find out what these are!

1. Observations: Interact with/observe the child in at least two engaging activities. Note the child's ability to understand language and activities. What expressive language skills do they use and with which communication modalities? Are they using spontaneously using gestures, vocalizations, verbal words, AAC? What kinds of prompts does the child need to communicate and participate in the interaction? Take a language sample if possible.

2. Interviews: Interview one or more familiar communication partners. Ideally, this would be the primary caregiver, however, for school evaluations, you may need to focus on the primary teacher. Ask targeted questions about the child's communication modalities, and language knowledge (phonology, morphology, semantics, syntax, and pragmatics). If the child has an aided AAC system (light, mid, or high tech), ask questions about their operational competence. Can the child independently adjust volume, flip the pages, or keep the system near them?

3. Summarize the information: Based on the observations and interview, summarize the child's strengths, weaknesses, and areas that have the greatest impact on their education and quality of life. The SLP can include priority areas for goals. This is also an appropriate time to suggest a new or different AAC system if current communication needs are not being met.

Are you evaluating to determine priorities and goals?

If there is no need for a full evaluation, a simpler checklist form of communication modalities, five areas of language, and operational skills may be sufficient.

Modalities: Describe the child's current communication modalities.

2. Language knowledge: What level of prompting does the child need for all language knowledge (phonology, morphology, semantics, syntax, and pragmatics)? A rating scale is sufficient for this exercise.

3. Operational skills: If the child is using aided AAC, what are their operational skills?

4. Priorities: What are the highest priority areas and next steps based on their current skills?

5. Baselines: From the priority areas, baseline measures must be obtained. One way to avoid an unrealistic and unmeasurable goal is to clearly measure and define the current levels.

6. Goals: Use the baseline measurement to write a SMART goal (specific, measurable, attainable, relevant, time-based). One example of SMART goal is: By 12/1/2022, Yen will increase their use of independent multi-modal two-word symbolic utterances from one to three times (within a 10-minute preferred activity), as measured three times by a trained communication partner.

Who: SuYen

What: use two-word symbolic utterances

What communication modality: multi-modal (any symbolic modality)

Under what conditions: preferred activity

How many times: 3 times in 10 minutes

How will it be measured: 3 times

By when should this goal be met: 12/1/2022

Who will measure: a trained communication partner

Is the purpose of the assessment to trial different AAC systems?

Adding or changing an AAC system and requesting insurance funding is the most involved of the AAC assessments. The goal is to "prove" to medical insurance that the child has a health need that is not currently being met but can be supported with a communication tool. There are many steps to the funding process and the evaluation write-up is typically long. If you are considering high-tech AAC, the major AAC companies have created funding pages and human specialists to help guide you through the report writing.

1. Team input: Begin with input from the team. I recommend emailing a form to all team members to get their input on the child's strengths, weaknesses, communication needs, and direction to go next. Beginning with team input also gets the team all thinking bout communication before meeting together.

2. SETT: Meet with the team (in-person or virtually) to complete a SETT. The SETT framework was created by Joy Zabala to carefully consider each communicator's needs. It includes four components:

Student - Describe the child's abilities and needs. Go through the child's medical conditions and how that affects their communication (immediate and long-term).

Environment - Describe the communication environments of the child. Do they need to communicate in different locations (loud classroom, quiet resource room, school bus, home, community)?

Tasks - Describe the communication tasks that the child needs to accomplish. Frequently these can be described as the functions of communication (request, ask, answer, comment, social closeness). For insurance funding, it is critical that the child's need to communicate their health and medical status be explained in this section.

Tools - Describe the communication tools that have been or are currently being used by the child. What were the advantages and disadvantages of light, mid, and high-tech communication aids used in the past?

3. Features: Based on the SETT, determine the features that the child needs in an AAC system. These features will include what is needed for symbols, linguistics, voice, access, display, positioning, and operation. One resource for possible features can be found here.

4. Feature match: The team must then consider AAC tools that have some (or all of these features). There should be a list of multiple tools with a range of costs considered. One feature matching chart to be considered (for iOS apps) is from OMazingKids.

5. Plan: From the feature matching activity, a plan must be generated. Determine who will provide the AAC systems, who will train others, who will take data (and what data will be collected), and when the team will meet again.

6. Re-meet: Following trials for multiple devices (I would always recommend 3+ as some insurance providers require this at a minimum), the team meets again to discuss progress. The team compares and contrasts the trialed devices and whether to proceed with a funding request.

7. Recommendation Within your team meeting, develop final recommendations. Determine a plan for training (child and communication partners), distributing the device, and ongoing therapy.

8. Funding report: If the team has enough information to make a decision on the best device for the child, insurance information and a doctor's prescription must be obtained. The SLP writing the report should contact the AAC vendor for additional information, templates, and support at this stage in the process.

Final thoughts

Assessing a student who uses (or you suspect should use) augmentative and alternative communication sounds scary. There are indeed many steps, as this is an important process. The most important components are to include as many team members as possible to get a full picture of the student and to trial multiple systems to make sure you are finding a good fit.
You've got this!

To purchase pre-made assessment templates and suggestions, check out my product, AAC Informal Assessments.

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Scenario: You have a six-year-old student who is mainly non-speaking and their evaluation is due in two months. The family would like to explore augmentative communication tools. Where do you start? Have you experienced the joy (and challenges) of an AAC evaluation yet in your career?

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Pragmatics Profile of Communication Skills

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Pragmatics Profile of Communication Skills

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Sample AAC/SGD Reports

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Funding Resources And Tools - AAC & Speech Devices from PRC

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Despite the best of efforts, not every funding request results in a positive outcome. Many times, however, decisions can be overturned by following the appeal process outlined by the funding source.

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Learn more about the funding of your Augmentative and Alternative communication device. It might seem like an overwhelming task - but it doesn't have to be

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Meaningful use of speech scale- application to orally educated he

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Participation Inventory Example