Best practice is to use_____ devices.
Three
•At least one device needs to be in a different code category
CODES
•iPads, apps, and cases are E2599
OPPORTUNITY BARRIER INTERVENTIONS
- Policy Barriers
- Practice Barriers
- Knowledge and Skill Barriers
- Attitude Barriers
POLICY BARRIERS
(Medicare rules preventing attaining a device)
•Resolved through advocacy efforts
Practice barriers
Things people do, but not necessarily because of the law. “We don’t offer extended services because we don’t have enough money”
“Person minded change”
- Advocacy efforts are often needed
- Educational and sensitization efforts
- Easier to eliminate than policy barriers
- Communication Bill of Rights – Page 189
Help find a solution for them.
UALITY INDICATORS FOR ASSISTIVE TECHNOLOGY (QIAT)
- Quality Indicators: breaks down processes so you can grade yourself. Tells us what best practice is
- Intent Statements: back up for EBP
- List: can ask and answer questions
- ABLE Tech Videos
KNOWLEDGE AND SKILL BARRIERS
Remediated through educational efforts:
- In-service training
- Courses
- Workshops
- Directed readings
- Etc.
Need to be directed toward providing: •Guided practice •Coaching or mentoring •Technical assistance •Other individualized “hands-on” efforts
ATTITUDE BARRIERS
These are the most difficult (can’t control others)
- Advocacy efforts
- Story about profane language
EVIDENCED BASED PRACTICE
•Integration of best and current research
evidence with clinical/educational expertise and relevant stakeholder perspectives
- To facilitate decisions for assessment and intervention that are deemed effective and efficient for a given stakeholder (have to evaluate outcome of the decisions over time to determine this)
- Table 7.2; Page 191
EBP PROCESS
- Asked a question
- Selected sources
- Searched literature
- Examined evidence systematically
- Applied evidence to make decisions
2 SETS OF AAC-RELATED DECISIONS
Those aimed at “today”:
•Aim to meet person’s immediate communication needs
•Match the existing capabilities and constraints identified during the assessment process
Those aimed at “tomorrow”:
•Based on projections of future opportunities, needs, constraints, and capabilities that are likely to result from instruction and practice
COMMUNICATION INTERVENTIONS:
3 COMPONENTS
- Interventions designed to increase natural abilities
- Interventions that utilize environmental adaptations
- Interventions that incorporate AAC strategies and techniques
NATURAL-ABILITY INTERVENTIONS
•Consider goals
- Consider compromise is a reasonable solution – combination of both natural-ability and AAC approaches
- 50% and 50%?
- 10% and 90%?
ENVIRONMENTAL ADAPTATION INTERVENTIONS
- Space and location adaptations
2. Physical structure adaptations
SPACE AND LOCATION ADAPTATIONS
- Space adaptations: may be necessary for removing physical barriers
- Location adaptations: more related to the location of the person with CCN than to the equipment.
- Page 193
PHYSICAL STRUCTURE ADAPTATIONS
- Ex. Adding a mount to the bed where the person spends much time
- Widening doorways
- ADA
- IT Accessibility
AAC INTERVENTIONS
Interventions for today:
•Meet the person’s immediate needs
•Accurate, efficient, and non-fatiguing
•Should require a minimum of training and practice
Interventions for tomorrow (progress, and degeneration):
•May involve providing instruction to improve specific motor, symbol recognition, social-pragmatic, or literacy skills
•May need to anticipate the loss of the above skills as well
•Can be an expansion or extension of the system for today
•Can be a different device or technique
WHEN THE LOGICAL DIRECTION FOR TOMORROW IS NOT CLEAR…
- A multiple-target approach is vastly preferable
* Single training targets are tested in succession until the best one is selected
PROVIDE INSTRUCTION TO PEOPLE WITH CCN AND THEIR FACILITATORS
- Instructional plans that emphasize natural context interventions are more likely to result in better response generalization and better stimulus generalization than those that emphasize isolated skill training in artificial settings do.
- Facilitators need training on interpreting communication from person with CCN, programming and maintenance of the device
MEASURE AND EVALUATE INTERVENTION OUTCOMES
- Functional Limitations
- Consumer Satisfaction
- Quality of Life
- Focus on the overarching goal:
- Can the person participate successfully in activities?
- Has the person’s social network expanded?
FUNCTIONAL LIMITATIONS
•Measure the impact of AAC intervention to see improvements in specific, functional skills.
Count the number of : •Interactions initiated •Responses to partner’s messages •Repairs of communication breakdowns •Choices made •Social conversations engaged in •Take a language sample and analyze
CONSUMER SATISFACTION
- Measure the person’s opinion of the impact of the service, technique, or intervention
- ABLE Tech does this
Interview person with CCN and facilitator regarding: •Communication •Independence •Productivity •Community inclusion
QUALITY OF LIFE
- Focuses on the impact of the AAC intervention on the person’s ability to access and participate in preferred environments:
- School
- Home
- Recreational
- Vocational
- Has intervention resulted in:
- Self-determination
- Self-advocacy
- Social inclusion
- Independence
- Participation
- Employment
- Academic achievement
- Academic inclusion
- Interview
FOLLOW-UP
- May need to repeat at each transition:
- Pre-K to K
- Elementary to Jr. High, etc.
- Into employment
- Into residence
- Into retirement
- With major changes:
- Status
- Family
- Physical
