1999 Conference Proceedings

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SERVICE DELIVERY ISSUES FOR AAC/AT USERS IN THE SCHOOLS

Marilyn Jean Buzolich, Ph.D., CCC-SLP
Augmentative Communication and Technology Services
350 Santa Ana Avenue
San Francisco, CA 94127
(415) 333-7739 (phone)
(415) 333-3456 (fax)
MJBuz@aol.com

Jillian S. King, M.A., CCC-SLP
The Bridge School
545 Eucalyptus Avenue
Hillsborough, CA 94010
(916) 988-4142 (phone)
(916) 988-2798 (fax)
jking@bridgeschool.org 
www.bridgeschool.org

According to a survey conducted by Shewan and Blake in 1991, 45% of schools offer augmentative/alternative communication and assistive technology (AAC/AT) services. This represented an increase in AAC/AT intervention in educational settings from previous years, which could be partly attributed to the amendments made to the Individuals with Disabilities Education Act (IDEA) in 1990.

In essence, these amendments made local school districts responsible for providing assistive technology to appropriate students. Recent revisions to IDEA (1997), as well as components of the Technology-Related Assistance for Individuals with Disabilities Act (Tech. Act), the American with Disabilities Act (ADA), Goals 2000: Educate America ACT (Goals 2000), and the Improving America's Schools Act all have implications for the delivery of AAC/AT services in the schools. The first section of this presentation will address these current legislative acts by attempting to summarize what is critical for service providers to know in addressing AAC/AT in the schools.

AAC/AT is a highly transdisciplinary field where teaming is an essential process for successful evaluation and intervention. Potential contributors to this process include: administrators, AAC/AT consultants, educators, hearing consultants, manufacturer's representatives, occupational therapists, paraeducators, parents and family members, personal attendants, physical therapists, physicians/nurses, psychologists, rehabilitation engineers, speech-language pathologists, vision consultants, and vocational counselors. No one discipline can successfully address the communication and access needs of any individual student.

Given the transdiscipnary nature of the AAC/AT team, role definition becomes a critical issue for the team to address. Individuals who provide either AAC or AT services (or a combination of both) need to consider the qualifications expected and required to perform various functions of the process. This includes the critical components of assessment and equipment recommendation or prescription. Particularly in the United States, the attempts of related organizations (e.g. ASHA, RESNA, USSAAC) to define competencies and/or to credential specialists has been at best confusing for those who provide services on a day-to-day basis. In this next part of the presentation, we will attempt to define some of the issues related specifically to roles, as well as relate them to regulations that impact the funding of services and equipment.

The next section of the presentation will provide a framework for building, developing and monitoring an AAC/AT program in the public schools. The framework proposed includes the components of: Structures, Processes, and Outcomes. The population of students who need AAC/AT remains vastly heterogenous ranging from children with orthopedic and motor impairments (with normal language and learning abilities) to those with multiple motor, sensory and cognitive impairments. This requires that service delivery models be prepared to address a wide range of needs and abilities. Student's needs for service and support also change as they move through the educational process and transition to new educational settings.

The structure of the AAC/AT program, often provided or add least guided from a level or administration, includes the components of team management and coordination of services; caseload expectations and requirements; staff development; educational program and classroom development; resources (i.e. space, equipment, materials); and setting in place policies and practices for accessing services and procuring equipment. Without this structure, programs often fail.

Processes are the key to success at the service delivery level. In this presentation we will discuss the development of a variety of procedures that will make for a successful AAC/AT program. They include developing screening, assessment and intervention guidelines; determining how device recommendations are made; figuring out what to do when a new device is received with respect to customization; and determining how we place students who use AAC/AT in programs or classrooms, and what to consider when transitioning from one setting to another.

Outcomes are our indices of success/failure. Every program must have a pre-determined set of evaluation tools for measuring the effectiveness of the program. Cost must also be a consideration; a program that is too expensive to operate will be difficult to maintain. While it may often be a parent or small group of parents that get a district going in terms of setting up an AAC/AT program or model, reducing the likelihood of mediations, fair hearings and legal battles with parents by setting up good structures, processes and measures of success is an effective outcome.

In the final section of this presentation, we will discuss some of the current trends as well as pros/cons regarding components of service delivery:

AAC/AT programs as statewide or regional networks versus district-or county-wide teams versus center or school based teams versus teams brought together around the needs of one individual child.

The educational placement of children who use AAC/AT, ranging from the heterogenous grouping of children to educating children in inclusive regular education settings.

Creative and flexible ways that staff can provide the range and intensity of services required to support a child who uses AAC/AT, including mentoring less experience professionals on the team; co-treatment and partnership across disciplines; looking at the big picture in terms of allocating particular staff resources/time (particularly consultants); engineering the educational environment to support communication and use of technology for participation; training communication partners; and empowering families and AAC/AT users to take responsibility for components of the plan.

Reference:

Shewan, C., & Blake, A (1991). 1990 Omnibus survey: Augmentative and alternative communication. ASHA 31, 46.


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