by Tanna Neufeld, MS, CCC-SLP (Speech-Language Pathologist); NWACS President
AAC assessment for communicators with developmental delays and disabilities can be pretty daunting, even for seasoned clinicians. With so much technology available and so many individual factors to consider with each unique communicator, it can be difficult to know where to start and how to move forward as an AAC professional. As with any skill, AAC assessment skills are most attainable when we have a framework within which to operate. In this post, I’ll explore some AAC assessment basics that I have found helpful to develop a framework for approaching the task of AAC assessment and provide some resources for further training in AAC assessment.
1. AAC Assessment is an Extension of Communication Assessment
Good news! AAC Assessment starts with a comprehensive assessment of functional communication skills, and as speech-language and special education professionals, you already have many of the skills you need to do this. At the start of the AAC relationship with a communicator is a full picture of receptive and expressive communication skills, including pre-intentional and pre-linguistic communication or potentially communicative behaviors. Starting with the communication skills, challenges, and needs of a communicator helps us shift our focus away from the tech and tools and toward a person-centered perspective. Use a combination of formal and informal assessment strategies - including interview, direct and indirect observation of caregiver and communicator interactions (live during your sessions or via video review) to answer these key questions that support your transition into the AAC feature-matching phase of your assessment process: a) How is the client already communicating?, b) How is that working with each partner within each context?, c) How do the current communication skills compare to developmental expectations and communication needs?, d) What concurrent sensory (vision or hearing) and motor (fine and gross) challenges are present or suspected? Obtaining information about current communication skills compared to needs and developmental norms helps you tease out what Language and Literacy Features are needed in an AAC system. Obtaining information about sensory and motor needs helps you tease out what Access Features are needed in an AAC system. Most importantly, focusing on communication before technology, helps you identify key intervention goals and strategies within which to embed AAC teaching and trials.
2. Typical Communication Development Guides AAC Decision-Making
More good news here! Typical communication development is our best guide for AAC assessment and intervention with developmental communicators (and that is your jam as a speech-language professional!). When we consider the picture we’ve obtained from our functional communication assessment and compare this picture to what a communicator needs in daily living and what the next steps are in development, we have a more defined picture of the Language and Literacy features needed in an AAC system and the intervention and coaching approaches needed to implement AAC tools within natural language learning opportunities. Use what you know of this continuum (you remember Bloom and Lahey’s Content, Form and Use right? Brown’s stages of morphological development? The Bates Model of Communication Development?), because you’ll need the right features available in order to help communicators reach these next steps in communication development.
3. Feature Matching Helps Reduce the Tech Overload
There is certainly a lot of technology at our fingertips these days and I’ve heard from many colleagues and families that this overload of choices can really complicate things when it comes to making decisions about AAC systems. Feature matching really helps us reduce the overload because it shifts our focus away from what’s being marketed to us and toward the underlying factors in a system that really support the developmental and functional goals we have in mind for a communicator. The main feature considerations you will likely encounter for your communicators are: a) What modality or hardware would be best (Device or Tool Features), b) What vocabulary, grammar, and literacy elements are needed? (Language and Literacy Features or “Selection Set”), c) How does the communicator need to visually and physically access this system? (Access Features). Start by making a list of the features you believe the communicator needs to have access to in order to support language and literacy learning in your sessions and at home. You can do this in your own terms, not necessarily in AAC Feature jargon. For example: If a communicator is presenting with intentional communication behavior but isn’t yet consistently using symbols through words, signs, or pictures, developing a “first words” vocabulary that can transition to word combinations will likely be Language Features needed in a system for trial. This communicator will need access to powerful core and fringe words to start communicating symbolically, just like a child who is in the first word stage of verbal development. But the communicator will also need modeling of new words and word combinations, so the Language Features considered should have enough word density and diversity to support modeling from partners. This is just one example of applying a skills and needs approach to feature consideration, but a helpful framework for supporting other scenarios that may come up in your practice. Once you’ve got your features list, you can start looking more critically at what is available in AAC tools and apps that you are familiar with and transition with a bit more clarity to the system trial phase of your assessment process.
4. Try Before You Buy Certainly Applies
You wouldn’t buy a pair of jeans without trying them on first right? This trial principle applies to AAC as well. Once you’ve nailed down the skills, needs, and features on your list, and compared these to what current AAC tools on the market can offer, you’ll start to see some front running apps, boards, books, or devices come to the surface. Develop a connection with the support and sales representatives offering the systems you are interested in and explore what options are available to obtain systems to try with your communicator. Sometimes this will come in the form of a loaner device from a company or a trial or lite version of an app. You might find that a printed communication tool is logical for trial and can connect with pre-made supports or create your own to trial. Choose at least three systems to trial and focus on language modeling with these new tools, not on operation or communicative independence. During trials with AAC systems, you’re really trying to narrow in on a few main questions: a) Does this system have all of the features needed for this communicator?, b) Can he or she access the system visually and physically with minimal effort?, c) Are partners open to modeling and operating the system?, d) Is the communicator interested in the system? Having systems to compare not only helps you and families make more informed purchase decisions, but these trials also offer much needed data, an element of your trial that payers will look for if you submit a request for AAC system funding from a third party source (e.g., insurance company, school district).
5. Funding is Hard, But you can Get By with a Little Help from your Friends
The buzz is true - writing AAC reports for insurance funding is no party. But, this is where your AAC village and your device representatives come in really handy. There are great templates and funding support resources available to help you navigate this step in the AAC assessment process. Map out the key elements and then connect with others in your local and social media communities for support in finalizing the paperwork. And don’t overlook non-insurance funding options for families as well, such as funding sources offered by state health departments like DSHS, grants and gifts from non-profit organizations with missions to support assistive technology and AAC, and private fundraising endeavors through sites like GoFundMe.
If you’re looking for more great posts and events related to AAC Assessment, check out our AAC/AT Education and calendar pages for training opportunities in AAC Assessment.
Do you have a resource or training on AAC assessment you’d like to share? Comment below!
