Conducting an Augmentative and Alternative ...

Perspectives on School-Based Issues Volume 16, August 2015, Copyright © 2015 American Speech-Language-Hearing Association

Conducting an Augmentative and Alternative Communication Assessment as a School-Based Speech-Language Pathologist: A Collaborative Experience Janet Dodd Department of Communication Sciences and Disorders, Chapman University Orange, CA

Alicia Schaefer Speech-Language Specialists, Santa Ana Unified School District Santa Ana, CA

Aaron Rothbart Department of Communication Sciences and Disorders, Chapman University Orange, CA Disclosure: Financial: Janet Dodd, Alicia Schaefer, and Aaron Rothbart have no financial interests to disclose. Nonfinancial: Janet Dodd, Alicia Schaefer, and Aaron Rothbart have no nonfinancial interests to disclose.

Abstract In addition to providing services to children who demonstrate speech and language impairments, it is within a speech-language pathologist’s (SLP’s) scope of practice to “recognize and hold paramount the needs and interests of individuals who may benefit from AAC [Augmentative and Alternative Communication]” (American Speech-LanguageHearing Association (ASHA), 2005, Position Statement section, para. 3). However, in spite of nearly one-half of all school-based SLPs reporting they provide services to nonverbal students who utilize AAC systems (ASHA 2012; Kent-Walsh, Stark, & Binger, 2008; Proctor & Oswalt, 2008) many SLPs across the country still do not feel adequately trained to assess and provide therapy services to these children (Costigan & Light, 2010; Kent-Walsh et al., 2008; Light, Drager, Currall, & Roberts, 2012). It is becoming increasingly necessary for all SLPs to assume responsibilities in the AAC process. The case study presented in this article illustrates the collaborative process of conducting an AAC assessment for a preschool-aged child. Nearly 2 million individuals in the United States of America have complex communication needs (CCN; American Speech-Language-Hearing Association [ASHA], 2004). As a result of speech, language, motor, and/or cognitive impairments these individuals cannot meet their daily communication needs in conventional ways (Justice, 2010), and often benefit from the use of augmentative and alternative communication (AAC) systems. With current advances in medical interventions, the overall population and lifespan in the United States have increased and, congruently, so has the number of persons with CCN (Beukelman, 2012; Light & McNaughton, 2012). More specifically, there is a greater prevalence of children with disabilities (Boyle et al., 2011; Light & McNaughton, 2012) who have AAC needs due to several factors: higher survival rates and lifespans of children with both developmental and acquired disabilities (Beukelman, 2012; Light & McNaughton, 2012), and the increased incidence of children diagnosed with developmental disorders (Centers for Disease Control & Prevention, 2011). It is not uncommon for a school-based speech-llanguage pathologist (SLP) to have young students with complex communication needs on his or her caseload.

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Recent surveys have shown that nearly one-half of school-based SLPs regularly serve nonverbal students who utilize AAC systems (ASHA, 2012; Kent-Walsh, Stark, & Binger, 2008; Proctor & Oswalt, 2008) including children with autism spectrum disorders, cerebral palsy, and traumatic brain injury (Binger & Light, 2006; Kent-Walsh et al., 2008). An increasing cognizance of the benefits of AAC in the development of communication, language, and literacy (Light & McNaughton, 2012) has necessitated the provision of AAC systems to children with CCN. Just as SLPs are required to serve children who demonstrate speech and language impairments, it is also within an SLP’s scope of practice to “recognize and hold paramount the needs and interests of individuals who may benefit from AAC and assist them to communicate in ways they desire” (ASHA, 2005, Position Statement section, para. 3). Literature suggests that many SLPs across the country do not feel adequately equipped to assess and treat individuals who require AAC due to their limited training and practice (Costigan & Light, 2010; Kent-Walsh et al., 2008; Light, Drager, Currall, & Roberts, 2012). In one study, a significant number of practicing SLPs reported receiving little to no pre-service training in AAC, and those that did have pre-service training typically received it in a traditional classroom setting. Universities that provided AAC practicum opportunities mostly did so in a laboratory setting. Real-world application and fieldwork opportunities were not prevalent in SLP programs and less than one-half of graduating SLP students were deemed competent to provide AAC services following training (Costigan & Light, 2010). In the schools, problems for SLPs do not only arise when considering issues directly related to the AAC system itself; They often occur when dealing with logistical and bureaucratic hurdles such as adhering to timelines, collaborating with school personnel effectively, and securing funding for the AAC system (Kent-Walsh et al., 2008). Although many school districts across the country offer the services of an AAC specialist, limitations exist in solely relying on this individual to fulfill all AAC needs for students. First, the specialist may only be available on a consultative basis due to a high AAC demand throughout the school district (Van Tatenhove, Kovach, Privratsky, & Costello, 1994) and may not have adequate time to frequent the school to ensure accurate and thorough assessment and implementation of AAC services. Second, the specialist may not be as familiar with the student as the professionals with whom the child works on a daily basis; in addition to family and staff interviews regarding the student, the specialist may rely on relatively few observations and limited data collection in order to make decisions regarding AAC. It is paramount that students’ regular SLPs assume more responsibility in the AAC process. The following case study is offered to illustrate the collaborative process of conducting an AAC assessment for a preschool-aged child without the assistance of an AAC specialist.

Identifying a Student With CCN A person with CCN should not be required to meet additional eligibility criteria in order to be referred for an AAC assessment. People with CCN are diverse in age, socioeconomic status, ethnic backgrounds, and racial backgrounds (Beukelman & Mirenda, 2013). Within a school setting, regardless of cognitive, motoric, or linguistic capabilities, AAC may be an option for a student who is not an effective communicator. With this knowledge, school-based SLPs have reasonable grounds to suggest AAC services (Beukelman & Mirenda, 2013) by advocating for and initiating AAC assessments. At the initiation of the AAC assessment process, the student, who will be referred to as CD, was a 4-year, 7-month-old boy with a diagnosis of cerebral palsy. CD was placed in a preschool special day classroom (SDC) at his local public elementary school. In addition to specialized academic instruction, he was receiving speech and language therapy for 60 minutes each week. Occupational therapy and physical therapy were also provided through California Children’s Services (CCS), a statewide program that provides health care services to children with health problems. Although CD was a verbal communicator, his speech was considered highly unintelligible due to moderate to severe dysarthria. He often relied on eye gaze and facial

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expressions to communicate wants and needs. Verbalizations often consisted of short phrases (2–3 words) due to limited breath support, resulting in the need for highly contextual supports and repetitions. Speech and language goals were in place to target improved breath support, loudness of speech, syntax, and the implementation of communication repair strategies, but CD was not generalizing the skills across all environments and his speech impairments were limiting his progress in his linguistic, social, and academic development. His SLP determined that an AAC device might be a viable tool to enhance CD’s speech and language development, potentially allowing CD to participate in a regular education setting for the next academic year. Initiating the AAC Assessment As with any assessment in special education, parental consent is required before the assessment process begins. Not only should parents be notified of the AAC referral, they should understand the potential benefits of AAC and be ready and willing to act as AAC facilitators for their children. Augmentative and Alternative Communication facilitators, as described by Beukelman and Mirenda (2013), are “family members, friends, professionals, and frequent communication partners who, in various ways, assume some responsibility for keeping the AAC system current and operational and/or for supporting the person with CCN to use it effectively” (p. 102). The SLP should arrange a time to speak with the student’s family members to discuss and educate on AAC options during parent-teacher conferences, annual IEP meetings, or, if the parents are unable to meet, through a scheduled phone call. This initial meeting allows parents and family members the opportunity to ask questions, provide pertinent input, and voice concerns regarding AAC. There is the widespread misconception that use of AAC hinders speech development. However, several studies, including one by Millar, Light, and Schlosser (2006), have provided evidence that the use of AAC does not inhibit speech production and it may even facilitate it (as cited in Beukelman & Mirenda, 2013). Evidence should be presented to parents in a sensitive and neutral manner so that they may make a well-informed decision for their child. Ultimately, it is the family’s recognition of the potential benefits of AAC and adequate motivation to assist in its implementation that is required for the successful use of the device across all environments, including in the home and community. If the student’s parents have accepted the AAC assessment plan, the SLP can begin by gathering pertinent data to support the need for an AAC referral. In this case study, the SLP, in collaboration with the classroom teacher, met with CD’s mother to discuss the recommendation of an AAC device as a means to improve his communication, academic performance, and social skills. The discussion took place during a parent-teacher conference at the end of the first quarter of school. This was an opportunity to review CD’s progress in all areas of his academic and social development, which segued into the referral for an AAC assessment. As a result of the meeting, CD’s mother agreed to the AAC assessment, and the process to determine an appropriate AAC device and language system commenced. Conducting the AAC Evaluation When gathering evidence that supports the need for an AAC device, it is useful to implement the framework established in Beukelman and Mirenda’s Participation Model (2013). Within the model, “functional participation requirements of same-age peers without disabilities are weighed relative to participation patterns of the potential AAC user. Gaps between the two are identified and addressed along with opportunity and/or access barriers that may be contributing to this gap” (ASHA, 2004, p. 10). The first step in the participation model is to conduct a Participation Inventory for the student with CCN. Participation patterns of both the student with CCN and his or her typical peers are assessed during regularly occurring activities. The peers’ performances are evaluated in terms of independence levels when completing an activity in order to determine what the expectations of the student with CCN would be, given equal opportunity. The next step would then be to describe the current participation patterns of the student with CCN and identify discrepancies in participation between the student and his or her peers. Next, participation barriers need to be identified in order to plan for effective

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assessment and intervention. Participation barriers include opportunity barriers, which are imposed by other people in policy, practice, knowledge, skills, and attitudes (Beukelman & Mirenda, 2013; Pufpaff, 2008). Capabilities, attitudes, and resource limitations also serve as participation barriers. These aspects must be taken into consideration in order to select the most appropriate type of AAC device (see Table 1).

Table 1. CD’s Participation Inventory in SDC Preschool Classroom Activity: Morning Routine Setting: Non-categorical SDC Preschool Classroom Activity Steps

Level of Independence

Communication Mode

Identified Participations Barriers

Free play: played with toys with classroom aide

Physical assistance, cueing

Verbalizations: “Yeah.” “I’m on Angels.”

CD’s motor limitations were an access barrier when manipulating the toys. In addition, he required cueing from the aide to initiate verbalizations during pretend play.

Eye gaze Children walked to circle time area and sat down on carpet.

Needed physical assistance

Not applicable

CD required an aide to push him in his manual wheelchair.

Sang “good morning” song with peers and said “good morning” to classroom teacher

Independent

Verbalization

Although CD did not require prompting to verbalize the words, “Good morning, Mrs. V.” it was noted that his speech intelligibility was low due to decreased volume of voice, imprecise articulation, and a strained vocal quality.

Practiced singing and dancing to songs for end-ofyear recital with peers

Needed physical and verbal assistance

Did not participate in singing.

Despite being prompted to sing loudly, CD did not vocalize. He was observed to mouth the lyrics to the words and sway his torso and head from side to side to approximate the dance steps. CD’s low breath support and motor impairments were access barriers for this activity.

The following is a participation inventory of typical 5-year-old kindergarteners during an in-class group activity. The findings are illustrated in Table 2.

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Table 2. Participation Patterns of Peers in General Education Kindergarten Classroom Activity: Sound-letter correspondence group activity Setting: General education kindergarten classroom Activity Steps

Peers’ Level of Independence

Predicted Participation Barriers for CD

Children gather on carpet, sit on floor and converse and wait for lesson to begin

Independent

The children are allowed to converse with each other while they waited to transition into the activity. CD is highly unintelligible in a noisy environment as a result of his dysarthria. When he is unable to be understood, he promptly withdraws from conversation. CD’s low speech intelligibility would likely be an access barrier in this situation.

Children verbally answer closed questions presented verbally by the teacher.

Independent

The children raise their hands and answer questions aloud using a moderately loud volume of voice. CD’s low breath support makes it difficult for him to be heard and subsequently it is predicted that this task would be difficult for him.

Children are instructed to tell their “neighbor” words that began with Z.

Needed verbal assistance

Most children were able to do the task independently. However, there were 2 children that required verbal prompting to follow through. CD’s imprecise articulation and low speech intelligibility are predicted to be access barriers during this activity.

Children gather materials to complete literacy booklet

Independent

Children ambulate across the room to retrieve materials from different locations. This requires them bending over or squatting down to pick up materials off the ground and carry them to their desks. CD’s limited motor capabilities would prove to be an access barrier in this situation.

Children color and glue to complete booklet

Independent; Independent with verbal assistance; Independent with physical assistance

Many of the children require verbal and physical assistance in order to glue their letter in the correct orientation. It was noted that children were observed to talk to each other to gain access to materials, assist each other, ask each other questions, and comment on each other’s work. Due to the ample verbal interaction and use of fine motor skills during this activity, a wide discrepancy would be expected between CD and his peers.

Adapted from Beukelman & Mirenda (2013, p. 123)

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The participation inventory reveals that CD would not be able to adequately participate in the same way as his peers in a general education kindergarten classroom. Subsequently, AAC assessment team members were asked to evaluate capabilities across a variety of environments and disciplines in order to create a capability profile for CD, which resulted in recommendations for appropriate AAC options.

Creating a Capability Profile Not all AAC devices will be suitable for an individual with CCN. Advancing technology continues to increase the vast market of tools ranging from low-tech devices (e.g., communication boards) to high-tech devices (e.g., dynamic display speech-generating devices). With a wealth of options available for AAC, it is essential that the SLP, along with other team members like the occupational therapist, create a capabilities profile that summarizes the student’s abilities and needs in order to appropriately match an AAC device to the student. Specific areas to be assessed include, but are not limited to, physical, cognitive, language, and sensory capabilities. Though SLPs are accustomed to using standardized tests to evaluate a child’s communication skills, they are often not appropriate for individuals with CCN because they cannot be administered in a standardized manner and the norms are not appropriate for individuals with severe disabilities. However, standardized tests with adaptations may be used as needed to glean qualitative information about general skill levels (e.g., utilizing eye gaze responses). SLPs can also use criterion-referenced assessments to determine the abilities of a student with CCN (Beukelman & Mirenda, 2013; Fishman, 2011). A review of CD’s case history and multidisciplinary report provided a wealth of information regarding his birth, developmental, social, and academic history. The SLP conducted an informal diagnostic assessment through play activities. For example, as CD worked on a puzzle, the clinician probed CD in counting puzzle pieces and identifying colors, shapes, and nouns. The clinician also elicited an informal conversational speech sample to affirm CD’s ability to understand and respond to who, what, where, why questions and calculate his mean length of utterance. All of the aforementioned procedures helped in verifying the clinician’s understanding of CD’s present cognitive and linguistic skills. Additionally, the clinician consulted with CD’s classroom teacher, classroom aides, and occupational therapist regarding their observations and assessment results. Selecting a Device for Trial Period Once the AAC team has determined the student’s communication needs, this information is provided to AAC vendors. The regional consultant for the AAC vendor can then assist the team in deciding which devices to demonstrate during a scheduled presentation. This demonstration facilitates the selection of the device that the student will eventually trial. Because CD was already a verbal communicator, it was established that a symbolic language system would be appropriate for him. CD required a word-based semantic compaction program that would facilitate the development of his language and literacy skills. Subsequently, Prentke-Romich Company (PRC), a vendor whose devices support the Unity language system, was contacted. The PRC consultant selected two different speech-generating devices (SGD) for demonstration. CD’s communication needs were compared with the various features of each device in a process called feature matching (See Table 3; Beukelman & Mirenda, 2013; Blischak & Ho, 2000; Fishman, 2011).

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Table 3. Feature Matching Chart for CD SGD Specifications Descriptions

CD’s Communication Needs

Types of Devices The iPad with LAMP Words for Life

Accent 800 by PRC

ECO2 by PRC

Vocabulary Representation Method

This feature refers to the organization of the vocabulary on the AAC system. Vocabulary may be arranged by topic, communication function, grammar, or ease of physical access.

CD is a symbolic communicator as demonstrated by his use of spoken language. He also communicates with eye gaze, facial expressions, and change in posture/ head position. CD would benefit from a word-based semantic compaction language program that facilitates ease of access to novel and complex utterances.

Semantic compaction language system (Unity); vocabulary is represented through sequences of multimeaning icons. 3,000+ words are represented.

Semantic compaction language system (Unity); vocabulary is represented through sequences of multimeaning icons. 3,000+ words are represented.

Semantic compaction language system (Unity); vocabulary is represented through sequences of multimeaning icons. 3,000+ words are represented.

Symbol System

This feature refers to the type of symbols that are used to represent language. The symbol system is dependent on the student’s cognitive/ linguistic level and/or sensory-motor capabilities. Examples include pictures, printed words, and photographs.

CD is able to understand and use words, which are one of the highest forms of symbols. This demonstrates his ability to use picture icons, whether they are transparent or not, to represent language.

Minspeak picture icons paired with text with option to spell orthographically. Also has option for picture communication symbols (PCS).

Minspeak picture icons paired with text, with option to spell orthographically. Also has option for PCS.

Minspeak picture icons paired with text, with option to spell orthographically. Also has option for PCS.

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SGD Specifications

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Output modes

This feature refers to the way in which a message is delivered. It may include digitized speech, synthetic speech, text, or gestures.

An SGD can provide CD means to communicate using voice output. Synthesized speech is necessary to produce novel and spontaneous utterances and to prevent the need for preprogramming.

Synthesized speech

Synthesized speech with digitized speech capability; option of various voices and voice customization

Synthesized speech with digitized speech capability; option of various voices and voice customization

Display

This feature refers to what the user sees; it may be static (unmoving) or dynamic (changing display) or a hybrid of the two.

CD is cognitively intact and is able to navigate multiple dynamic pages. He would benefit from an intuitive dynamic screen display that does not require constant preparation of overlays.

Dynamic screen display with option of visual scene displays

Dynamic Screen Display visual scene displays

Dynamic screen display visual scene displays

Correctability of Message

This feature refers to the ability of the device to edit messages that have been entered incorrectly.

CD will need to be taught how to correct his message if it is inputted erroneously. A system with the correctability function can help facilitate this skill.

The user can delete or clear one or more icons/words from the message box.

The user can delete or clear one or more icons/words from the message box

The user can delete or clear one or more icons/words from the message box

Construction and Durability

This feature refers to the device’s hardware construction, durability, and portability.

CD is 5 years of age. He is awaiting the receipt of a motorized wheelchair, which will enable him to independently navigate his environments. He enjoys riding in the wagon on the playground during recess. His AAC system should be durable and portable.

9.5″ H × 7.3″ W, .37″ D, 1.44 lbs. Though highly portable and compact, this device is not durable. It is subject to damage if dropped.

9.8″ W × 5.9″ H × 1.4″ D, 1.95 lbs., durable and portable. Comes with built-in stand, option for wheelchair mount

13.2″ W × 11.2″ H, × 2.9″ D, 6 l.81 lbs., durable and portable, comes with table-top stand, option for wheelchair mount

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Access/ Selection Method

This feature refers to how the symbols/ words are activated on the device. Examples include depression, pointing, and eye gaze.

CD has motor impairments that limit his range of motion in his arms and fingers. A touch screen facilitates ease of access. In addition, a device with the option of alternative access (i.e., head tracking, eye gaze, switch access) is beneficial.

Direct selection

Future Expansion Capabilities

This feature refers to the device’s ability to adapt to the user’s increasing linguistic capabilities.

CD’s instruction in AAC is just beginning; his system should be flexible and have the ability to be added to as his linguistic and motor capabilities develop.

Word Predictability

This feature refers to the ability of a device to predict words and/or symbols from a portion of the word or message that has been formulated.

Word predictability is not necessary at this time; however, it should be considered as a future option.

Direct Selection;

Direct selection;

Single- or Dualswitch Scanning; USB Connectivity allows use of mouse, joystick and mouse emulation access products

Single- or dualswitch scanning; USB connectivity allows use of headpointing systems, mouse, joystick and mouse emulation access products.

Preprogrammed with Unity 84 and allows for three developmentally progressive vocabulary levels. Vocabulary builder function allows chose words to be visible while remaining vocabulary is hidden.

Preprogrammed with Unity overlays from 4, 8, 15, up to 144 locations. Allows for progressive vocabulary levels using vocabulary builder.

Preprogrammed with Unity overlays from 4, 8, 15 up to 144 icons. Allows for progressive vocabulary levels using vocabulary builder.

Yes

Yes

Yes

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Analysis of the Feature Matching Chart allowed the team to determine the device thought to best meet the required features criteria was the Accent 800 by PRC. It has a dynamic screen display with a touchscreen. The visual screen display is high quality and accessible through direct selection. It is small, lightweight, durable, and portable, and has the option to be mounted on a wheelchair, if needed in the future. The Accent 800 is programmed with Unity, which facilitates generation of linguistically diverse novel utterances through motor planning. The Accent 800 has synthesized speech capabilities, and key guard options are available. Of the three devices that were considered, the Accent 800 best fulfills the features required to augment CD’s communication. Identifying a Funding Source Identifying the funding source, and ensuring that the necessary steps are taken in order to receive financing can be a complex process, especially for a high-tech SGD. The identification of the funding source guides the AAC team in determining which documents need to be gathered and what to include in the assessment report. Funding may come from an array of sources including state Medicaid programs, private insurance companies, and special education services under the Individuals with Disabilities Education Act (IDEA). It should be noted that if a school district purchases a device through special education services, the device is the considered the property of the district, and not of the student. Some schools may not allow the device to follow the student outside of the school environment (Standal & Rudnicki, 2007). After the SLP has pinpointed the source(s) of funding, the SLP should contact those entities to determine if they will cover SGDs and obtain the paperwork that is needed for submittal, including criteria for the assessment report. CD was a Medi-Cal recipient, a statewide Medicaid program in California. Most state Medicaid programs cover SGDs for children as long as the SGD is determined to be a medical necessity for the child. As Golinker (2009) points out, “most states have SGD specific coverage criteria that outline the SLP evaluation and report” (p. 64) and policies may vary greatly from state to state. The PRC consultant was an excellent resource when navigating the Medi-Cal requirements; she provided the clinician with an outline of mandatory procedures and paperwork for Medi-Cal and CCS. She also directed the clinician to CD’s CCS case manager and CCS medical therapy unit (MTU) occupational therapist (OT). From the MTU OT, the clinician gleaned the required Medi-Cal forms. In addition, the OT provided an assessment report template that fulfilled Medi-Cal’s criteria. The OT also assisted by collecting several of the required documents, such as the physician prescription, medical report, OT report, copies of the insurance cards, and the DME referral. The funding process requires a great deal of time and energy to complete the requisite documentation, which is why it is critical to rely on the support of the AAC assessment team. Once the paperwork is submitted, State Medicaid agencies may take anywhere from 2 to 6 months to approve an AAC device (Standal & Rudnicki, 2007). It took approximately 3 months to gather and submit all of CD’s required documents, and another 1.5 months to wait for authorization and shipment of the device. School SLPs need to be aware that the AAC assessment process is lengthy and should plan accordingly. Special education timelines need to be adhered to, and if the trial period has not been completed before the assessment plan deadline, an addendum will need to be made to the assessment. Trialing the Device After receiving the rental device, the trial period commences. This typically lasts between 2-4 weeks, but may be requested for up to 3 months. During the trial period, the student’s family, teachers, and other support personnel need to be trained to use the device and its language system. Many companies’ regional consultants will come to the student’s school to train the SLP. The SLP then should educate relevant family members and staff. Parents expect “professionals who work with their children to know the basic technical operation of an AAC device and to be prepared to teach this information to others” (McNaughton et al., 2008, p. 52).

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Topics to address during the training should include a general introduction to AAC, the theoretical bases of core and fringe vocabulary, how to facilitate language acquisition on the AAC device through aided language stimulation (ALgS), and creating communicative environments (Dodd & Gorey, 2013). After obtaining CD’s trial device PRC’s regional consultant trained the classroom teacher, SLP, and resource teacher to use the device’s language system, Unity 60 sequenced. Two weeks later, when the district’s extended school year (ESY) summer school program began, the SLP trained CD’s one-on-one aide and classroom aide. During this time, she addressed core versus fringe vocabulary, how to use Unity, implementation of ALgS, creating communication environments (Cumley & Wirkus-Pallaske, 2007), and demonstrated a sample lesson plan using the AAC device. In addition, the staff members were free to ask questions that came up during the training.

Implementing Intervention During the Trial Period Short-term goals should be established for the trial period and aimed at maximizing communicative competencies: social, linguistic, operational, and strategic (Light, 1989). The SLP should review the data collected throughout the trial period, upon the conclusion of the trial, to determine if the device is appropriate to meet the student’s communication needs. If so, a request for purchase will need to be made. If not, the SLP should consider revisiting the student’s capability profile and identify another device that will better suit the student’s needs.

Conclusion Throughout the assessment and selection process there were many challenges, but through the collaborative efforts of the team obstacles were addressed. For instance, the final phase of AAC assessment process was purchasing the selected device. Due to ongoing delays and time constraints, the IEP team decided to implement the LAMP software application on CD’s iPad while they waited for the device to be purchased. This decision allowed CD to maintain access and continue to familiarize himself with the software in authentic settings. Another challenge that occurred and is expected to occur again in the future is change in instructional support staff. To address this a training protocol was established to assist with fluctuations in personnel which included tips for enhancing participation in classroom activities, (e.g., giving oral presentations utilizing his AAC system). Given the collective understanding that restricted access to implementation within functional settings may result in a loss of skills the team understood the importance of continual access. Ultimately, it is clear that an AAC assessment is an extensive, ever-changing process. From the initial phases, such as creating the capability profile and identifying funding, to the planning phase of feature matching and staff training, the SLP must be aware of current best practices and utilize available resources to adequately implement them. Additionally, the SLP needs to be aware that the AAC process can be rather protracted. Low-tech or alternative AAC options may need to be considered while awaiting authorization and shipment of a device. Although many current school SLPs have reservations when providing AAC services to students with CCN, school districts are beginning to adopt the “workload” approach to allocate adequate time necessary for SLPs to complete all activities within their scope of practice. Our hope is that this article empowers and encourages the school-based to initiate and participate in the AAC assessment process.

References American Speech-Language-Hearing Association. (2004). Roles and responsibilities of speech-language pathologists with respect to augmentative and alternative communication: Technical report [Technical Report]. Available from www.asha.org/policy

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History: Received April 20, 2015 Revised May 15, 2015 Accepted May 16, 2015 doi:10.1044/sbi16.3.105

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