AAC Assessment March 12 & 19, 2018

Reality Check There are a lot of models/frameworks about how to do AAC evaluations and we’ll discuss a few. In practice, it’s very challenging to get everyone on the team to sit down and discuss and come to consensus on much of anything. Most of the time, you use the information you can gather, from the people who will talk to you, try a few things, and come to the best decision you can with the information you have available, all before the deadline. Use the principles of the model as a guide, may look differently in practice

Traditional SLP Evaluations (Helling & Minga) Describe the nature and extent of the communication disability Estimate prognosis for treatment and recovery Design the initial framework for intervention

AAC Evaluations (Helling & Minga) Describe the nature and extent of the communication disability Estimate prognosis for treatment and recovery Design the initial framework for intervention Determine current communication capabilities Identify a symbol system for an external means of language representation Evaluate assistive devices to aid in the access and operation of the AAC system

AAC Evaluations My conceptualization: Traditional SLP evaluations are looking to find and clearly describe what the individual is NOT able to do, in order to direct therapy AAC evaluations are looking to figure out what the individual CAN do and problem solve to figure out which combination of supports will allow him/her to communicate most effectively and efficiently

Historical Perspective Candidacy Models: Potential AAC users had to: have a gap between higher cognitive scores than language scores be a certain age (which age varied) have (or not have) a specific diagnosis meet certain prerequisites have the financial resources to access a device and services Unfortunately these myths can be persistent.

Participation Model (Beukelman & Mirenda) Identify participation patterns and communication needs Assess Opportunity Barriers (Extrinsic Factors from Light’s CC model) policy & practice, knowledge & attitudes of team members/Environment Assess Access Barriers (Intrinsic Factors from Light’s CC model) knowledge/skills, attitudes, access potential of individual with CCN Plan and Implement Interventions select AAC and provide instruction to individual and team Evaluate Intervention Effectiveness Is the person with CCN participating? ---> start over or continue follow-up

SETT Model (Joy Zabala) Student, Environment, Task, Tools, (Trials) Commonly used in school systems for AAC and Assistive Technology evaluations. What are the student’s strengths to build on and team concerns? What supports/barriers are present in the environment? What tasks is the student expected to accomplish in the environment? Are there tools- high or low tech- that could enable the student to accomplish the expected tasks in the environment? Big Question: Is this technology REQUIRED in order for the student to make academic progress? Model can be adapted to use with non-students in non-school environments

AAC Chicks Evaluation (Clarke & Coyer) AAC Skills and Communication Direct Assessment Structured Observation Interviewing parents, teachers, and other communication partners Vicki Clarke has written up her protocols and collected a variety of assessment materials within a number of posts for PrAACtical AAC: http://praacticalaac.org/?s=vicki+clarke

Assessing the Individual with CCN

Discovering the Capabilities of the Individual with CCN There are no standardized assessments for this There are some criterion based assessments There are many checklists You can adapt some standardized tests to gather information, even though you can’t determine a standard score with a non-standardized administration Be careful if you use a test designed for a lower age that you look for other communication skills not captured in a test designed for early communicators- most older kids will have developed some scattered functional skills Don’t report age equivalents! Describe skills!

Considering Commercially Available Tests: What does this test assess and how does it assess that area? How is it useful to use with individuals with CCN? How is the information gained useful when determining appropriate AAC?

Tests Functional Communication Profile Every Move Counts, Clicks & Chats WATI- online Aphasia AAC Assessment- online Communication Matrix- online TASP AAC Profile AAC Evaluation Genie (iPad)

Functional Communication Profile from 3 years to adults informal assessment- checklist format adaptable to a wide range of abilities/level of communication

Every Move Counts, Clicks and Chats dynamic assessment across sessions determine sensory responses, which leads to how to access a switch, which leads to potential voice output helps to define a consistent motor pattern that allows for purposeful activation of a switch

WATI - Wisconsin Assistive Tech Initiative Technically called the ASNAT- Assessing Student Need for AT http://www.wati.org/?pageLoad=content/supports/free/index.php goes through many domains: visual, communication, motor, sensory issues paper checklist continuum of AAC considerations team approach

Aphasia AAC Assessment http://cehs.unl.edu/aac/aphasia-assessment-materials/ 8 tasks, selecting 1or more targets of pictorial symbols looks at accuracy, attempts and level of independence partner dependent or independent, determine most successful strategies includes a self-rating checklist and type of aphasia communicator screener for visual fields

Communication Matrix https://www.communicationmatrix.org/ checklist for any chronological age that is in the language development 0-2 years available in several languages Lots of helpful videos of early communication skills Has a message board/community where you can ask questions and get advice on therapy

TASP- Test of Aided-Communication Symbol Performance 4 subtests: symbol size/number grammatical encoding categorization syntactic performance

AAC Profile http://www.linguisystems.com/products/product/display?itemid=10547 I’ve found this most helpful to use as ongoing assessment/tracking progress for kids who already have a system; not as useful for initial assessment

Other Options TACL-3 Test for Auditory Comprehension of Language CELF- with adaptations CASL- with adaptations EASIC May or may not be able to use standardized scores, but can be useful to show what can be done with and without AAC support

CELF Adaptations

CASL Adaptations

EASIC- Evaluating Acquired Skills in Communication

IASCC- Index of Augmented Speech Comprehensibility in Children http://praacticalaac.org/praactical/say-what-aac-assessment-for-children-who-speak-with-dr-jill-senner-and-matthew-baud/

AAC Evaluation Genie iPad App 14 subtests with full or screener version differential reinforcement for right/wrong choices has a scanning option collects data in a one page summary http://www.humpsoftware.com/aacevaluationgenie.html

Quick Assess by Linguisystems Brief “Physical Assessment” looks at touch and vision Phrase completion task Categorization task Device use simulation task at restaurant

Quick Assess by Linguisystems

Quick Assess by Linguisystems

Assessing the Environment

Opportunities and Barriers in the Environment No standardized tests here, either handout from SET-BC https://www.setbc.org/ Communication Supports Inventory, based on ICF-CY Framework from the Praactically Speaking book When observing, make sure to note what peers are doing Interviews of caregivers, family and AAC user for adults to determine communication breakdowns- may be less observable

Making a Choice of AAC Systems

Participation Model (Beukelman & Mirenda) Identify participation patterns and communication needs Assess Opportunity Barriers (Extrinsic Factors from Light’s CC model) policy & practice, knowledge & attitudes of team members/Environment Assess Access Barriers (Intrinsic Factors from Light’s CC model) knowledge/skills, attitudes, access potential of individual with CCN Plan and Implement Interventions select AAC and provide instruction to individual and team Evaluate Intervention Effectiveness Is the person with CCN participating? ---> start over or continue follow-up

What to pick? No substitute for clinical experience Need to know about the choices- keep up with your options Traditionally: Pull together information about client and environment, and match features of devices to client characteristics Feature Matching has been the main component of AAC evaluations for some time As differences between devices/apps have shrunk, this is less important BUT providing AAC users and their families with choices is important! Present options with appropriate features and make a collective choice to trial

Working with Vendors

Working with Vendors http://praacticalaac.org/praactical/praactical-questions-can-i-work-with-device-manufacturers-and-vendors-in-an-aac-evaluation/