I wrote a blog post for PrAACtical AAC on motivating adult clients to utilize AAC systems. You may read it here if you so desire:
AACtual Therapy: On Motivation and AAC
Enjoy! Let me know if you have questions or comments or ideas or suggestions or if you just want to see more pictures of Simon (he is ultra-cute.)
I have not been doing the “AAC” thing long, and I don’t deal with tech-AAC frequently. I make a lot of communication books, gesture dictionaries, and just general working with families on implementing strategies to increase communicative attempts in the natural environment. I have recommended an actual communication device only 3 times so the funding piece of things tends to be a bit over my head. Most companies have someone that will work with you on getting devices to trial, completing the appropriate paperwork, and procuring the device and I worship the ground said person walks on.
I recently recommended a device for a client, contacted the company to find out about funding and was told that they don’t do it. AACK. WHAT? Mind blown. I just assumed that every speech generating device for every client would be funded in some capacity, one way or another (I also live in magical fairy AAC land, did I not mention that?) But the device doesn’t qualify as “durable medical equipment” so the company doesn’t bill insurance.
So now what? The company told me to contact a durable medical equipment company in my area and have them “give them a call.” ABOUT WHAT? GIVE YOU A CALL? I swear some days I feel like I’m losing my mind with these hoops.
Luckily I have my very own AT guru (you may all express your jealousy) who explained that the client’s primary insurance company likely has a DME company they work with for AAC. So the trick is to contact that specific DME company, and work with THEM on funding the device. It’s just more red tape than usual but seriously who knew? In case you didn’t know – now you do!
Learn something new every day I suppose.
(On the AAC-upside, I’m working with a client right now who is actually having success and demonstrating progress with the Tobii I-15 eye-gaze system and I couldn’t be more thrilled. I’ve only ever seen typical adults use eye-gaze systems so it’s a beautiful thing to watch it happen before your very eyes with someone who has disabilities.)
NP: Dime Porque (One of my client’s parents was listening to this during a home visit today and I was like, “This is quite catchy even though I do not understand.)
It has been a really, really long time. SO LONG. MONTHS. I wish I had a valid excuse but basically it is cold and I’m sleepy and I’m busy and I don’t wanna go to the library to blog. I’ve had so many things to share, and I can’t even begin to pick a topic. I think the last thing I blogged about was CFs and swallowing therapy and how I suck at dealing with behaviors. I still suck at dealing with behaviors. I’m working on it OKAY?!
But I’ve been doing so many new things and meeting so many people and I learn something new every day. I think my most challenging area since my last blog has been AAC! Oh yeah my friends. Can I just tell you – in grad school and undergrad I was all, “UGGGGH AAC.” Now I eat-sleep-breathe AAC. And I enjoy it! It still scares me and confuses me and and overwhelms me and I’m still learning an INCREDIBLE amount. It seems so daunting! AAC is changing every day and that stresses me out – how am I supposed to stay on top of it? How can I make sure my clients have the best system for them when I might discharge them and find out about a new system the next day? I DON’T LIKE THAT.
So currently, my caseload is right around 30 plus evals. Which feels kinda crazy-pants some weeks, so I feel really bad for people in schools and hospitals who have more than that. Don’t forget, my friends: ASHA says no more than 40 but I know you all are doing way more than 40. Average is 50ish. Max is 110ish. SCARY.
Anyway, so about half my caseload is adults. I see two adults with acquired disabilities, and the rest have developmental disabilities. I’m not seeing anyone for swallowing currently, and I see one adult for cognitive-communicative tx, and the REST are AAC. So I’m seeing like 12 adults for AAC. It is a LOT of work. My adult clients require way more planning than my kiddos. The kids are challenging, but in a very different way. I’m doing some AAC with a couple of my kiddos but it isn’t the ONLY thing we’re working on. Basically my desk looks like the birthplace of AAC on most days:
DESK EXPLOSION
So what am I doing with these clients? Some I’m working on developing low-tech communication books and wallets. So far I’ve successfully created two functional and effective communication books for clients who use ASL, but have difficulty communicating with hearing individuals (specifically group home staff and workshop employees.) I’m learning a lot about interacting with the Deaf community, and I’m taking a sign language course right now. It’s…interesting. We’ll get there one day once I catch up on this blogging business.
A couple of clients I’m helping to obtain high-tech speech generating devices for. One client my goal is a Dynavox Maestro, the other a NovaChat7. I’m also trialing a Springboard Lite with a client.
Some clients I’m going more mid-tech with – Go Talk 20, 7 Level Communicator, Three Message Platform Communicator etc.
Some devices I’ve trialed include: Dynavox Xpress, Dynavox V+, Dynavox DV4, NovaChat7, Springboard Lite, Alt Chat, Tobii C12, ProxTalker, Go Talk 4, Go Talk 20, 7 Level Communicator, One Message Communicator, Three Message Platform, Four Message Communicator. The DV4 isn’t made anymore, but we have one in a cabinet and I like using it during evaluations because it has a large screen and “exploratory” pages that assist in evaluating category skills, access skills, identification skills etc. Someone today referred to it as a dinosaur, but I think this ol’ dinosaur still has a place.
Also of course, I’ve been working with the iPad and apps. I don’t LOVE the iPad the way everyone else does. Don’t get me wrong: it is awesome and there’s so many things that can be done with it in therapy and in terms of using it for a communication device. My main beef with it is that damn 60 minutes piece that focused on its use with people with autism. I think just about every person I see for AAC has asked if they can get an iPad. I’m like:
WELL, you certainly CAN but I can’t promise that insurance will pay for it or any apps on it (probably not). And I also can’t promise that using it will be successful or that it will be appropriate for the person using it. The iPad IS NOT a be all end all.
I’ve also been downloading free AAC apps for my Android phone and there are SO MANY. I think I want to start reviewing them and sharing what I think here on my blog. So get excited for that. I think it is a great idea especially for home-health therapists to be able to just pull out their phone and try an AAC app with a client.
You may be wondering how I get my hands on all this good stuff. First of all, my workplace has an AWESOME Resource Center that has SO MANY AAC and AT products. It’s great. I just be-bop down there about a million times a week and borrow devices. Also, I utilize DATI a LOT. In fact I’m on their wait list right now to borrow a Dynavox Maestro. DATI is a life-saver! They’re so incredibly knowledgeable and helpful. LOVE. And of course, if I need to I can always contact companies directly and ask them if they know of a device I can borrow in the area (I tweeted at Saltillo and they were so helpful in my hunt for a NovaChat. Thanks Cara at Saltillo!) I think I’m pretty in what is available to me.
I think one of the more frustrating things about AAC is actually GETTING a device. The process is so long. I wrote up an explanation for families for the steps it will take to get a device. I found that families were coming to the evaluation and expecting that their loved one would have a device by the next time I saw them. And while I don’t want to discourage anyone from coming to therapy to get a device, I also don’t want them to be surprised if it takes a long long lonnnnng time.
My letter to families and caregivers
I think overall, the learning curve for AAC is a little intense, but I’m getting there. I tell people that I’m learning just like they are and that it is definitely a trial-and-error process. If you have any questions, ideas, suggestions, stories – WHATEVER – about AAC, please share!
PS – I’m obsessed with the NovaChat7. OBSESSED.
