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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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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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print 5 AAC Course Session 2 091025 HANDOUT

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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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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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augmentative and alternative communication (aac)

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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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National Joint Committee for the Communication Needs of Persons With Severe Disabilities

About this Document

This position statement was developed by the National Joint Committee for the Communication Needs of Persons With Severe Disabilities. This position statement is an official policy of the American Speech-Language-Hearing Association. National Joint Committee member organizations and their respective representatives who prepared this statement include the American Association on Mental Retardation, Mary Ann Romski; the American Occupational Therapy Association, Jane Rourk; the American Speech-Language-Hearing Association, Beth Mineo Mollica, Rose Sevcik, Diane Paul-Brown (ex officio), and Alex F. Johnson (monitoring vice president); the Council for Exceptional Children, Division for Communicative Disabilities and Deafness, Lee McLean (chair); RESNA, Kevin Caves; TASH, Pat Mirenda and Martha Snell; and the United States Society for Augmentative and Alternative Communication, David Yoder. This statement was approved by ASHA's Legislative Council (LC4 2002) at the Spring 2002 meeting.

Eligibility policies and practices often preclude children and adults with severe disabilities [1] from accessing needed communication services and supports. Communication services and supports may include instruction of individuals and their communication partners, assistive technology, and environmental modifications, and may be delivered through a variety of service delivery models. [2] The expected outcome of such services and supports is to increase or to prevent decline in the individual's meaningful participation in daily activities. Categorical denial of communication services and supports without consideration of a person's unique communication needs may violate federal statute, and may also violate state law, regulation, and policy.

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It is the position of the National Joint Committee for the Communication Needs of Persons With Severe Disabilities that eligibility for communication services and supports should be based on individual communication needs. Communication services and supports should be evaluated, planned, and provided by an interdisciplinary team with expertise in communication and language form, content, and function, as well as in augmentative and alternative communication (AAC). Decisions regarding team composition, types, amounts, and duration of services provided, intervention setting, and service delivery models should be based on the individual's communication needs and preferences. Eligibility determinations based on a priori [3] criteria violate recommended practice principles by precluding consideration of individual needs. These a priori criteria include, but are not limited to: (a) discrepancies between cognitive and communication functioning; (b) chronological age; (c) diagnosis; (d) absence of cognitive or other skills purported to be prerequisites; (e) failure to benefit from previous communication services and supports; (f) restrictive interpretations of educational, vocational, and/or medical necessity; (g) lack of appropriately trained personnel; and (h) lack of adequate funds or other resources.

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Morris, W. (Ed.). (1981). The American Heritage Dictionary of the English Language. Boston: Houghton Mifflin Company.

National Joint Committee for the Communication Needs of Persons With Severe Disabilities. (1992, March). Guidelines for meeting the communication needs of persons with severe disabilities. Asha, 34(Supplement #7), 1-8.

Paul-Brown, D., & Caperton, C. (2001). Inclusive practices for preschool children with specific language impairments. In M. J. Guralnick (Ed.), Early childhood inclusion: Focus on change (pp. 433-463). Baltimore: Brookes.

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Service delivery models include both direct service and "indirect," consultative/collaborative service models, and any combination of these models identified as most appropriate to meet the individual's needs ( See Paul-Brown & Caperton, 2001).

a priori is defined as "made before or without examination and not supported by factual study" ( Morris, 1981).

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Index terms: admission/discharge criteria, people with disabilities

Reference this material as: National Joint Committee for the Communication Needs of Persons With Severe Disabilities. (2003). Position statement on access to communication services and supports: Concerns regarding the application of restrictive "eligibility" policies [Position Statement]. Available from www.asha.org/policy or www.asha.org/njc.

Copyright © 2003, National Joint Committee for the Communication Needs of Persons With Severe Disabilities

Disclaimer: The American Speech-Language-Hearing Association disclaims any liability to any party for the accuracy, completeness, or availability of these documents, or for any damages arising out of the use of the documents and any information they contain.

doi:10.1044/policy.PS2003-00227

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Position Statement on Access to Communication Services and Supports: Concerns Regarding the Application of Restrictive "Eligibility" Policies

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It is the position of the National Joint Committee for the Communication Needs of Persons With Severe Disabilities that eligibility for communication services and supports should be based on individual communication needs.

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School-Based AAC Evaluation

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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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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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Social Networks

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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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AAC in Classrooms

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AAC/AT Classroom Evaluation Tool

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AAC/AT Classroom Evaluation Key

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Classroom Engineering for Communication

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Communication Matrix Website

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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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Communication Matrix Questions

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Every Move Counts Website

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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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Communication Sampling and Analysis

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CSA - Communication Sampling and Analysis

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CSA is for clinicians to get an objective measure for sampling and analyzing communication behavior in natural interactions.

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Communication Supports Inventory Document

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AAC/SGD Report Coach (Word Doc)

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AAC/SGD Report Outline

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Bridge School Assessment Process

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Bridge School Assessment Tools

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Functional Communication Profile

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Early Functional Communication Profile

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INteraction CHecklist for AAC

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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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Participation Model Flow Chart

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Participation Inventory Example

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Communication Forms and Functions Checklist

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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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Bloom and Lahey Data Sheet

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

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Meaningful Use of Speech (MUSS)

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Meaningful use of speech scale- application to orally educated he

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The 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 S...

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Children's Speech Intelligibility Measure

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Communication Means and Functions Checklist (Wetherby)

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Communicative Means and Functions Explanation