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Assistive Technology/AAC Archive 2015-16

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Betsy A. Caporale, M.S. CCC-SLP-.
Speech-Language Pathologist
AAC/AT Specialist

Betsy has been working in the field of speech-language pathology for over 18 years, specializing in autism, augmentative communication and assistive technology. She has worked in a variety of settings, including public schools, private clinics, and hospitals. She received her certification as an Assistive Technology Specialist, Communication Services, from the University of South Florida, and earned a Certificate of Competency in Communication Assistive Technology Applications from the National Association of State Directors of Special Education.

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  • AT Credential

Question:

I spoke to you at an UDL workshop about the new requirements for AT specialist. I am the AT specialist at for a school district in Northern California and now have to take the RESNA test because I am a SLP and can now only handle AAC. See the attached update from the summer of 2015 I received from my supervisor. I have lots of experience with all types of AT but when it comes to some things, like some of the seating and mobility and intricate switch access for the very physically challenged, you really need to team up with a PT. Let me know what you think.


Answer:

Thank you for writing about this newly revised document. On July 20, 2015, The California Department of Education updated the description of Assistive Technology to read as follows:

§ 3051.19. Assistive Technology Service

(a) “Assistive technology service” means any service that directly assists an individual with exceptional needs in the selection or use of an assistive technology device that is educationally necessary. The term includes the evaluation of the needs of an individual with exceptional needs including a functional evaluation of the individual in the individual's customary environment; coordinating and using other therapies, interventions, or services with assistive technology devices, such as those associated with existing education programs and rehabilitation plans and programs; training or technical assistance for an individual with exceptional needs or, where appropriate, the family of an individual with exceptional needs or, if appropriate, that individual's family; and training or technical assistance for professionals (including individuals providing education and rehabilitation services), employers or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of individuals with exceptional needs.
(b) Assistive technology services shall be provided only by personnel who possess a:
(1) license in Physical Therapy issued by a licensing agency within the Department of Consumer Affairs, where the utilization of assistive technology services falls within the scope of practice of physical therapy as defined in Business and Professions Code section 2620 and implementing regulations; or
(2) license in Occupational Therapy issued by a licensing agency within the Department of Consumer Affairs; or
(3) license in Speech-Language Pathology issued by a licensing agency within the Department of Consumer Affairs or a valid document, issued by the California CTC, where the function of the assistive technology service is augmentative communication; or
(4) baccalaureate degree in engineering with emphasis in assistive technology; or
(5) baccalaureate degree in a related field of engineering with a graduate certificate in rehabilitation technology or assistive technology; or
(6) certification from the Rehabilitation Engineering and Assistive Technology Society of North America and Assistive Technology Provider (RESNA/ATP); or
(7) certificate in assistive technology applications issued by a regionally accredited post-secondary institution; or
(8) credential that authorizes special education of physically impaired, orthopedically impaired, or severely impaired pupils.

It’s interesting that this document specifically limits the practice of Assistive Technology (AT) for Speech-Language Pathologists (SLPs) and Physical Therapists (PTs), but does not do so for Occupational Therapists (OTs) or those holding baccalaureate degrees, certificates or credentials in related fields. It’s unclear to me exactly what that means, especially when it comes to providing Augmentative and Alternative Communication (AAC) services. It sounds like SLPs can only provide AT services which are specific to AAC, but it doesn’t specify whether AAC services can be provided by someone other than an SLP. The term “AT Certificate” is misleading, as it implies expertise in all areas. No one could possibly be an expert in all aspects AT as the field is so enormous. As you mentioned, you can receive ATP certification from RESNA simply by passing a test. However, this does not make you an “expert”; that comes from experience! I’m a strong advocate for awarding AT certificates based on knowledge and experience in an explicit area or discipline (i.e., mobility, vision, communication, accessibility, computer technology) rather than a universal certificate covering a broad spectrum of specialty areas. As an SLP who specializes in AAC, I am always very careful about staying within my comfort level and area of expertise, and consulting with experts from other disciplines when I know the demands of a case fall outside my scope of practice. As you know, best practice for AT assessment and service delivery calls for a collaborative team approach. Best practice for school districts is to develop AT teams comprised of a group of professionals who each have specialized training and experience in an explicit specialty area who can work in partnership to meet the individual needs of the student. I know many districts who are already doing this with a great amount of success. This is something you may want to address with your school district.

Good luck and please keep me posted!

Betsy


  • AAC Certification Programs

Question:

I am a Speech-Language Pathologist (SLP) with over 20 years of experience but am looking for an online AAC certificate program.  Do you happen to know of any universities that offer such a thing?

Thank you!


Answer:

I’ve received several e-mails over the past several months regarding this topic.  It’s also been a hot topic on the ASHA Sig 12 (AAC) discussion site. 

I am not aware of any university in the United States that offers an Augmentative and Alternative Communication (AAC) Certification course; however; many universities offer Assistive Technology (AT) Certification programs. If you do a Google search you’re sure to find dozens of these programs offered by universities throughout the country. Most of these are on-line “distance learning” programs. You can also earn an Assistive Technology Professional (ATP) Certification through the Rehabilitation and Engineering Society of North America (RESNA).  To be eligible for this certificate, candidates must meet certain educational and work experience requirements and then pass a comprehensive exam. The ATP certificate requires a broad knowledge of assistive technology practices, but does not require or provide specialized experience or training in AAC. The same is true for AT certification programs offered through universities. 

In my experience, there is widespread confusion about the difference between AT and AAC.  According to IDEA (20 U.S.C. Section 1401) AT includes the following definitions:

Assistive Technology Device:
Any item, piece of equipment or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of children with disabilities.

Assistive Technology Service:
Any service that directly assists a child with a disability in the selection, acquisition or use of an assistive technology device.

AAC falls under the very large umbrella of AT, but is specific to communication.  According to the American Speech-Language-Hearing Association (ASHA) AAC refers to “all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas.”  AAC communicative aids include no-tech tools such as signs and gestures, low-tech tools such as picture and symbol boards, and high-tech electronic devices.

Although AT practitioners typically have some knowledge of AAC, they are not experts in the area of communication and therefore are not highly qualified to conduct AAC assessments and make recommendations regarding AAC implementation. This actually falls under the scope of practice of a Speech-Language Pathologist (SLP).  In fact, a SLP is required to conduct all assessments for equipment funded by Medicare, Medicaid and most private insurance companies. Unfortunately, there is a critical shortage of SLPs who are qualified to conduct these assessments.  Because of this, ASHA’s Special Interest Group (SIG) 12 – Augmentative and Alternative Communication (AAC), is exploring the possibility of a establishing a specialty certification that recognizes speech-language pathologists with specialized skills and knowledge to provide assessment and treatment to children and adults in need of AAC.

Here at the Diagnostic Center, Northern California (DCN), we have addressed this need by offering an AAC Assessment and Services Certificate course. This is offered as a semester - long “project” between our center and Special Education Local Plan Areas (SELPAs) in Northern California. The focus of this project is to train selected speech-language pathologists who are serving students with AAC needs so they can provide AAC assessment and implementation services for students in their special education programs; the goal is to greatly enhance a school district’s capacity and sustainability for serving students with complex communication needs. This AAC Assessment and Services Certificate course at DCN, which I teach, includes six full day trainings, required research and reading, as well the completion of an AAC assessment/consultation report and implementation plan.  Individual hands-on coaching is provided at the school site for all participants.  Since 2011, fifteen County Offices of Education have participated in the project, with over 160 SLPs earning certificates. After completing the course, many of the SLPs form AAC Professional Learning Communities in their area to foster ongoing collaborative learning.  

For now, I would encourage you to attend trainings and seminars which focus on AAC to increase your knowledge.  There are also several conferences which you may be interested in, including:

Betsy


  • Implementing AAC in the Classroom

Question:

Hi Betsy, 

Hope you are doing well.  I seem to remember you showing us a video illustrating the importance of not taking away the AAC system from a user, even if they are talking out of turn.  I have several staff members that are having a very difficult time understanding this concept. Is there any way I can access the clip? 

Thanks so much! 

Katrina


Answer:

Hi Katrina!

Good to hear from you!

Unfortunately I no longer use the video you are referring to – it was a bit outdated! However I can give you some guidelines to share with your co-workers regarding AAC classroom implementation and the role of communication partners.

When communicating with AAC users it’s important to keep these key factors in mind:

  • AAC is a slow process which requires patience on the part of the communicator and the communication partners.
  • A variety of AAC tools and strategies must be provided for the user, allowing him or her the ability to communicate as quickly and efficiently as possible across settings and environments.
  • AAC users need time and frequent practice to learn how to use any AAC system, whether it is low-tech or high-tech.
  • All communicators, including those who use AAC, need to learn the concept of communicative turn-taking. It is not intuitive!

It sounds as if your co-workers are frustrated with AAC users who activate speech-generating devices (SGDs) inappropriately or in a disruptive manner. When this happens, it’s important to determine whether the behavior is actually communicative in nature, or if the device is being activated for another purpose, such as gaining attention or fulfilling sensory needs. If students do not have the skills sets to use a SGD independently and purposefully, they should not have unlimited access to it, as it becomes a distraction rather than a useful tool. If, on the other hand, the student is clearly trying to communicate something with the device but is speaking out of turn, offer a gentle reminder to wait until being called upon, or until someone else has finished speaking. Taking the device away would be like putting duct tape over a verbal student’s mouth to prevent them from speaking, as was depicted in the video you referred to. This would clearly be both punitive and unethical!

As you know, implementing AAC in the classroom is not an easy task. It takes careful planning and collaboration on the part of all IEP team members. Staff and peers must also be taught how to communicate with the AAC user employing a variety of methods. The speech-language pathologist plays a key role in both the AAC training and implementation processes, although implementation is shared by everyone who works with the student.

Below are several resources to help guide you in educating staff about AAC users and implementing best practices in the educational setting.

 

https://www.spectronics.com.au/conference/2014/timetable/session/1001

http://praacticalaac.org/praactical/boosting-aac-implementation-in-the-classroom-6-things-to-try/

http://praacticalaac.org/praactical/how-i-do-it-classroom-support-for-students-with-aac-needs-by-tina-moreno/

http://praacticalaac.org/praactical/how-i-do-it-encouraging-aac-implementation/

 

Best of luck and keep me posted!

Betsy


  • Providing AAC Support within Natural Settings in the Educational Environment

Question:

I’m a parent of a non-verbal child with multiple special needs.  My son uses a variety of AAC systems.  I’m trying to get an understanding of recommended best practices for AAC Specialists in schools with respect to supporting their students across educational settings.  I have read the ASHA Technical Report “Roles and Responsibilities of Speech-Language Pathologists with Respect to Augmentative and Alternative Communication”, but I am looking for further clarification regarding how AAC specialists should support a child in their “natural settings”.  Does this mean directly observe/work with/support the child in different educational settings the child may be in throughout a school day such as therapies, mainstreaming, lunch, etc.?

Thank you,

Elizabeth B.


Answer:

Hi Elizabeth,

First off I want to commend you for your efforts in learning about best practices for AAC service delivery in the schools.  The ASHA Technical Report is a good place to start, as it provides an excellent overview of an AAC system, its purpose and guiding principles regarding assessment and implementation.  Unfortunately, this document has not been updated since 2005.  Since that time, a wealth of professional journal articles have been published providing important research and evidence based practices regarding AAC.  I highly encourage you to look at one in particular; Calculator and Black (2009). Validation of an Inventory of Best Practices in the Provision of Augmentative and Alternative Communication Services to Students with Severe Disabilities in the General Education Classrooms, American Journal of Speech-Language Pathology, Vol. 18, 329-342.  The authors of this article conducted a comprehensive review of literature published between 1976 and 2009 to develop an inventory of best practices in providing AAC for students with complex communication needs.  The focus was on students with significant needs, including those with severe intellectual disabilities and adaptive behavior challenges.  AAC practices were reviewed by a panel of eight experts in the field of AAC.  Based on the results of their comprehensive review, the authors developed 91 best practices with 8 categories.  These best practice strategies included:

  • Use of a multi-modality approach to communication
  • Close collaboration among staff and IEP team members
  • Provision of staff and peer training
  • Implementation of AAC within relevant, meaningful and motivating activities
  • Use of functional communication strategies across environments
  • Family involvement in the AAC assessment and implementation processes
  • Speech-language pathologist plays a key role, but implementation of AAC is shared by many
  • Consultative role of speech-language pathologist is supported by team and parents

I recommend sharing this article with your son’s IEP team to assist in them in developing an AAC implementation plan.  You should be included in this process.

In response to your question about the role of an AAC Specialist, I first want to clarify the definition of this term.  Many educational professionals have received some kind of “certification” in the area of Assistive Technology (AT).  Because AAC falls under the umbrella of AT, the assumption is often made that an AT Specialist is also an AAC Specialist.   It is crucial that the person serving as an “AAC Specialist” be highly knowledgeable about speech-language development, as well as being familiar with AAC tools and strategies.   Typically, a speech-language pathologist will serve as the case manager for a student who uses AAC; however, the implementation of AAC will be shared by many.  Ideally, AAC support will be provided by all those who interact with your son at school, including his teacher, therapists, special education support providers, and peers!  You are correct in assuming that this support should be offered within “natural settings”, across all environments and activities of the school day.  Your son’s IEP should include an implementation plan which clearly defines the AAC tools and strategies he will be using during each activity of his day, and the person or persons responsible for facilitating the use of those tools and strategies.

I hope this is information is helpful and will assist in guiding your son’s IEP team in supporting his AAC needs.

Betsy