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Your UCP: National October 13, 2003
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Assistive Technology

Assistive Technology Assessments: A Team Approach is Best

An Interview with Dr. Roger O. Smith

In assistive technology (AT), an army of one is often not enough.

Throughout the decades, numerous coaches of all sports at all levels have told their charges, “There is no “I” in team.” Though not an athletics coach, Dr. Roger O. Smith, Director of the Center for Rehabilitation Sciences and Technology at the University of Wisconsin-Milwaukee, is also a strong proponent of the team approach to assistive technology assessments and evaluations.

Dr. Smith believes that four functional perspectives are essential in an assessment and evaluation:

  1. The prospective AT user
  2. The family and/or professionals who work with the child on a day to day basis
  3. The diagnostic professional
  4. The AT expert, i.e. speech pathologist, occupational therapist (OT) or physical therapist

An Augmentative Communications Team

Using augmentative communication as an example, Dr. Smith explains, “If one person does an evaluation, he or she may not have the depth and breadth of background to be able to hit all the critical areas.” In order for augmentative communication to work, he declares, “the user has to have good seating, positioning and mobility.” In addition, he cautions, “Somebody who needs augmentative communications may have other physical problems as well.”

A prospective user of augmentative communications “usually needs a wheelchair system, which requires an expert in that specialty to be an assessment team member.” Then, he explains, “there’s the whole interface piece involving how a user is going to control the technology – will it be by a multiple switch, a keyboard or an expanded keyboard? There’s a wide array of inputs and outputs when you add the human interface to these devices.” The human interface, he notes, “usually requires someone with a little more background in aspects of physical disability.” A communication interaction and language skills professional, preferably with a speech/language pathology background, is often needed to complete the augmentative communications assessment and evaluation team.

In order to perform a comprehensive evaluation for a child with a severe need, impairment or set of impairments that require augmentative communications, a single assessor/evaluator is insufficient, Dr. Smith asserts. “You often need a speech/language pathologist, an occupational therapist (OT) or a rehabilitation engineering professional.” In the application phases of the assessment, a special education or general education teacher ought to be included. If the augmentative communication device is also to be utilized at the prospective user’s home as well as at school, the child’s parents and entire family become part of the team.

Getting the Whole Picture – Despite Funding Constraints

“You have to have all these different perspectives and experts at the table during the evaluation or you fail to get the whole picture,” Dr. Smith observes. Unfortunately, he adds, “that concept too often runs in opposition to funding, because the more people you have at the table the more an assessment or evaluation costs.” Funding imperatives, he insists, should not deter educators and AT professionals from pressing school districts to employ adequate resources in performing assessments.

Declares Dr. Smith, “It’s our responsibility to persist in explaining to administrators that if the objective is to perform a sufficient assessment in a complex situation, the appropriate participants must be included.”

Obviously, he explains, not every assessment is complex, “but there is a point at which many assessments become too complex for one or two individuals and others need to be invited.” Therefore, he concludes, “it makes sense for those additional services to be funded.”

The Team Concept: Its Use is Piecemeal

The willingness and ability to employ assessment teams varies by school district. “Many districts who choose not to employ assessment teams actually have no choice,” Dr. Smith claims. “Often, in remote or poor districts, the expertise is just not available.” For example, he adds, “a research-laden district usually has an assessment team available, but a rural district simply doesn’t have the capability.” In fact, he notes, “many rural districts consider themselves fortunate if they have even one person who even knows what AT is.” Other poor or rural districts, he explains, “may have a team that visits just once a month.”

Is More Funding the First and Last Solution?

Funding is not the sole reason why school districts do not utilize the team concept for assessments. For administrative purposes, Dr. Smith notes, some districts choose not to utilize assessments. “If an administrator does not understand how essential a team is for AT assessments, he or she may try to achieve the same results with consultants by bringing in one or two people who can do parts of an evaluation. The administrator announces, ‘They’re expert consultants; they can do it! The local team can follow up.’”

Sometimes, Dr. Smith claims, “the consultant approach can work.” Ironically, however, the occasional success of that approach is “unfortunate.” According to Dr. Smith, administrators experience a little success, see an easy, less expensive solution to a problem and then announce, “it worked once or twice so let’s do it that way all the time!”

Achieving a Nimble Approach

Part of the solution to employing an effective team approach, he asserts, lies in “creating a system that can be very quick-footed in terms of how many people need to be involved in an assessment and then be able to pull in those people very fast as soon as their expertise is required. “But don’t begin the process with them,” he cautions. Instead of a full team complement, he advises, “start with just one or two people.” For a “complex” situation, “you can’t start with just one or two.” Automatically, “you begin with two or three team members, each with different perspectives, but be prepared to ramp up fast and add more to the team” when and if needed. Using this approach, “means that you can’t wait two weeks or another month or longer to get someone involved. You have to have these individuals at your fingertips, and that’s difficult in many environments.”

The “M” Team: IDEA Set the Stage

Across the nation, there appears to be no systemized, mandated approach to team AT assessments, nor is one likely, short of additional federal legislation. The absence of that legislation does not deter Roger Smith’s enthusiasm for the team concept and its practicability, however.

“What’s great is that IDEA and its predecessors really set the stage for the multidisciplinary (“M”) team.” Since IDEA, he explains, the team philosophy has become ingrained in children’s AT assessments, particularly in special education, even more so than in medical or vocational areas. “I think people generally understand that [the team approach] is a good thing.”

The credit, he insists, goes to the framers of IDEA who stated their intent to emphasize the team approach.

The Assessment Information: What to Do with It?

AT professional training programs “should spend more time on the information we get from these assessments and evaluations,” Dr. Smith declares. “We’re moving now from the status quo, where we stress intuition, experience and personal judgment, to determining how we collect the data and figuring out what the data means and how it can best be used.”

According to Dr. Smith, many professionals in the field “come out of disciplines where we mainly use the data collected for documentation purposes in order to defend our decisions.” That data “may not affect our decisions” because those decisions are based on the evaluator’s best judgment and intuition. “That’s a valid purpose for data use, but you’re really not putting the data to its optimum use.”

As evaluators move toward evidence-based practice, the data collected “ought to be compared with evidence gleaned from previous research and from other individuals in the same circumstances.” Evaluators need to answer the question, “Do we want to simply do what was done before in similar situations, or does our team want to do something different based on the new data we have?”

As a field, “we are just beginning to become acquainted with evidence-based practice.” A positive sign of things to come, he notes, is that this summer, for the first time, “a conference focusing on evidenced-based practice took place, in Pittsburgh.”

Advice to Parents: Get Information from Anyone Who Knows Something

Parents considering an AT assessment should begin by obtaining information from “anyone who knows something about assistive technology.” Parents, he advises, “can go to a rehab center or a special ed team, both of which are good places to start.” From that initial point of contact, “the referral process should be kicked off.”

Next, parents must understand that during the early process of exploration that they may encounter an individual or a team “that may not know very much.” In fact, he adds, “the team may not know who to refer a family to.” Should that occur, “families then have to investigate alternatives and learn who are the true AT experts in their community.” The setting in which parents find the best service delivery referral may be either educational or medical or perhaps an independent living facility. Dr. Smith warns that it is important for a family not to become locked into any one specific setting for referrals “because in any given district, one setting may be in tune with AT but the other two service delivery systems may not be.”

At first glance, it might appear that families are on their own, that there is no shortcut to seat-of-the-pants exploration. “Wrong!” exclaims Dr. Smith. “There is a shortcut. If the first person contacted by the family either is knowledgeable or provides good referral sources, the family may have stepped into a really good situation.”

One-stop referrals are not unusual nationwide, he insists. “There are cities, districts and states that are much better apprised and prepared to help families just beginning the assessment process. Family members need to ask themselves, “Are we in once of those venues or not?”

Advice to Organizations: Know Your Local AT Experts

Organizations assisting families embarking on the assessment process should feel obliged to research and seek out strong potential referral sources. Says Dr. Smith, “It’s really important for these organizations to know where the AT experts are in their communities, or outside their communities, because some communities don’t have many – or any.”

The expert, he explains, “may be a supplier down at the local medical equipment facility who has a certain level of expertise.” He adds, “It might be a special ed teacher in a specific school or a team at a nearby rehab center.”

The occasionally haphazard family referral process could be made smoother, he asserts, “if local AT people could get together once a year or every six months” to meet each other, to build a network.

“I’m a strong advocate for the network building approach to help families,” Dr. Smith declares. “Some leadership may be required in this area to begin maintaining contact list or a resource list” that can be easily accessed.

Ideally, he says, “you’d like a way to rate the AT professionals in the area, maybe giving them one to five stars.” For a variety of reasons, such a ratings plan is not feasible. Still, however, “if a parent calls a facility, the professional to whom a parent is speaking can strongly recommend someone. That’s probably the best rating system around, but you can’t incorporate it into a formal list.”

More AT Specialists: A Blessing and a Curse

There will be more AT generalists in the years ahead who will be able to direct families toward the best referrals, Dr. Smith predicts. Yet the trend toward specialization that has fragmented and changed many professions, such as medicine and engineering, will also impact the AT field, he warns. In the future, he says, the team assessment maybe be blessed by, and sometimes cursed by, the accelerating trend among AT professionals toward specialization. “The augmentative communications profession, for example, has already begun to tighten up; there will be mobility specialists, computer access specialists, job accommodation specialists” and others.

AT “is becoming so big that in order to become an expert, you can’t be an expert in AT anymore – you have to be an expert in some subset of AT.” The evolution of specialization, he predicts, “is going to cause a problem – because AT is already seen as a specialty by the outside world. Can you have specialties within a specialty?”

Will specialization negatively impact the configuration of assessment teams? Perhaps, he predicts, it will create the need for still more team members to acquire seats around the assessment table, thereby causing some cost-conscious districts to constrict team membership.

Dr. Smith is not fearful that specialization will make assistive technology a field in itself. “It’s really a second field for most people who already have a profession.”

Through the Looking Glass

Using IDEA to guide their assessment efforts, families, educators, AT professionals, diagnosticians and administrators are usually on their own as to how to assess the need for assistive technology for specific children. Will that change? Will the process be made more systematic? Gazing into his crystal ball, Dr. Smith sees a solution forged in the national political realm along partisan lines.

From a partisan standpoint, he explains, the Republican side will likely stick to its laissez-faire guns. “Republicans may say, ‘Let’s not get involved, let’s let the consumer decide, let’s not mandate an M team or the inclusion of anyone on a team with any specific credentials.’” They may say, “Here’s the money; you go find whomever you need.”

He predicts that Democrats are more apt to say, “We don’t think an individual is able to find the right [AT] person. We need to provide some guidance. Let’s just say that these [assessment and evaluation] teams must be made available and, yes, administrators must provide the requisite assessment services.”

That said, he adds, “AT and rehab services have been very bipartisan” in the support they have garnered, whereas special education, special services and special professions have been very partisan. “AT has been enamored by both sides of the aisle, which love nifty technology.”

If AT becomes closely associated with special ed services, however, “we may see a partisan effect.” On the other hand, he concludes, if AT becomes associated more closely with rehab engineering, “which is outside the educational model and more closely aligned with the medical and vocational models,” the case for AT and the team assessment concept “will continue to strengthen regardless of which party is in power.”

Source: Family Center on Technology and Disability

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