Referral and Evaluation Processes

Introduction

In very general terms, the nature of a student’s AAC support depends on how intelligible they are when using their natural voice, because that affects the intensity of the compensatory system that they will need for school (as described on Lane ESD’s general AAC page).

While all such systems (see Note 1) are forms of AAC, not all of them require the formal involvement of an AAC Specialist; in fact, the classroom SLP supports those students who are developing early assisted communication skills, which includes informal consultation with the AAC Specialist.

Note 1: While a few signs might be adopted from a visuomanual language as part of an AAC system (such as ‘more’, ‘help’, and so on), the visuomanual language itself is not AAC (as in ASL).

That collaboration starts to involve more specialized AAC support (see Note 2) when: a) the student’s skills become reliable enough to move beyond the training process; and/or b) the classroom SLP’s support for the student’s training system is approaching about an hour’s worth of dedicated time every week. Those factors both suggest that the level of support might be growing to require the expertise of an AAC specialist, at which point the SLP will submit a request for a formal AAC evaluation.

Note 2: While some people use the term ‘AAC’ to refer only to higher-tech systems, others apply it to any form of assistive technology for communication. There is also a useful distinction to be made between (a) AAC that involves language structural design, which should be a protected scope for SLPs, and (b) such materials as choice boards and simple voice-output devices, which should be more broadly accessible to a student’s partners as Assistive Communication. It can be helpful, then, to distinguish AC from AAC.

If you have questions, then, about whether AAC might benefit your student at school (or whether it might be of benefit more generally), start by having a conversation with their SLP, because that specialist’s therapy monitors whether a student:

1. would benefit from further training with their existing supports,
2. is ready to try a change in their current supports for communication, or
3. is ready for a formal AAC evaluation.

The following material discusses the factors that influence those recommendations.

“What is a reliable skills checklist?”

To begin with, a reliable skills checklist is not a means to deny any student access to communication supports; on the contrary, it is intended to help an SLP to initiate timely modifications to therapy, including referrals.

Such tools represent a system of fundamental skills that are engaged during communication. The more reliable those skills are, the greater the likelihood that communication will be effective. The greater their overall reliability, the greater the likelihood that a formal AAC evaluation will render recommendations that are immediately useful.

When an AAC system cannot rely on these skills, it is a training tool, and actual AAC systems (i.e., those that go beyond AT supports for communication) do not make good trainers for these fundamental skills. While room to grow is a necessity, and stretch is good, strain is bad. An appropriate system will scaffold these in balance. So, if these essential skills are not reliably in place (~90%), then there are other assistive communication materials whose sophistication would better match the user’s projected capabilities and growth opportunities.

“The classrooom SLP says my student is not ready for an AAC evaluation. What do we do?”

The classroom SLP will work with the IEP team to target the skills that the student needs to prepare for a possible AAC evaluation in the future.

“The classroom SLP says my student is ready for an AAC evaluation. What next?”

The student’s case manager will give the parents a “Prior Notice of Consent for Evaluation.” If the parents sign that document, then the classroom SLP will complete the AAC referral form (which includes the reliable skills checklist) and submit that paperwork to the AAC specialist.

“What does the AAC specialist do after they get the referral paperwork?”

First, the AAC Specialist gets that document to the district for a signature acknowledging the AAC evaluation (because there is an addtional fee for service to the district).

Then, the AAC Specialist will perform a SETT Analysis. (This article provides a nice summary of the SETT process.) In short, the Student’s strengths and challenges are evaluated across the many Environments in which communication is required for access to participation in various Tasks (e.g., academic, social, and so on). That provides us with the information that we need to select the Tools that we want to put on trial.

In some cases, one specific system might stand out as the best candidate (particularly if the student has previously developed some familiarity), but in others we might need to try out more combinations of devices and programs. System trials typically last 6-12 weeks, during which time data is gathered.

After the trials have been completed, the AAC Specialist will present their recommendations to the IEP team in a formal, written report. That report will be discussed at an IEP meeting, and AAC services will be determined. It is important for all team members to maintain a SETT perspective, namely prioritizing the needs of the student over the glow of a given device.

“What happens if the AAC Specialist doesn’t recommend a device?”

The AAC Specialist’s recommendations are based on the information they have collected during the trials. If a device is not recommended at that time (or formal AAC services), then their report will include recommendations for subsequent steps and alternatives that anticipate future AAC evaluations (such as lower-tech AAC supports with which to communicate, and materials with which to improve reliability with specific communication skills).

“Can the student take their system home?”

Yes. That is the law, and the right thing to do.

School systems go home with the student because that continuous access to communication is necessary for FAPE, whether the events are for academics, social interaction, or other functional activities.

When a device is assigned, you will be asked to sign an equipment assignment form that describes the expectations for care of the system.

Crucially, the system must be available for use during all school activities, which means returning it charged and on time every school day.

“The student already has a device that they use at home. Can the student just use their home device at school?”

Under specific circumstances, yes. Systems are adopted into the school environment only when an AAC evaluation determines that they are appropriate. That also applies to devices that would be used for Assistive Communication (or other AT), in that an evaluation is necessary.

There are occasions where a student enters our schools after they already have developed proficiency elsewhere with an AAC system, in which case the likelihood of adoption is much greater, but it still requires an evaluation. Please see the draft of the Unified Approach to AT/AAC for details regarding equipment selection.