Friday, March 9, 2012

Decisions, decisions. . .

So lately I've been seeing more people than usual who want to get someone some assistive technology.

That's a  very good thing.

At the same time, I'm seeing more people than usual who want to start with the "stuff" part instead of the assessment part.

That's not so good.

What does that mean--start with the stuff? People are thinking that they need some sort of assistive technology, and they want to see lots of it so they'll be able to find what they need. Unfortunately, this doesn't usually lead to successful AT interventions.

I'm reminded of an old saying from Pokemon Mark Twain, "To a man with a hammer, everything looks like a nail."

So what should I do if I want AT? Do I just do nothing? Do I stay away from AT all together? Of course not. That's far from what I'm suggesting. I do think we can proceed in a thoughtful manner and find AT that actually helps the user. So what does that look like? Well, I like to proceed using the SETT framework. SETT stands for Student, Environment, Tasks, Tools. The frameworks was created by Dr. Joy Zabala, and the particulars regarding it as well as some supporting documentation are available on her website  One of the things I like about the SETT is that it starts with the student or the individual instead of the technology or tool.

I know that jumping right in and having a lot of tools to choose from seems like the best way to find AT. I mean if you know what all of the options available are, you can choose the best one right? But how do you solve a problem that hasn't been defined? You can know that you need assistive technology, but do you really know why you need it? Do you know what it will do? Do you know how it will be used? Starting with a "tool-centered" approach can be confusing if you have a lot of tools to go through. It can also be frustrating if you don't. Taking person-centered approach and using a framework like the SETT can help you find the right tools without simply going through everything at hand and disqualifying it without really taking into consideration what the person really needs and often what the tool can really do.

Previously on. . . 

In an earlier series of posts entitled, "Understanding The Process," I went over how to get AT outside of the educational system (for non-students or for students needing to get equipment outside of the school system). In Parts 1 and 2 ,I talked about talking to your doctor and clinician (physical or occupational therapist or speech language pathologist). That's important to make sure that you don't have a change in your condition that needs to be dealt with using something other than AT. It's also important to make sure that you are looking at the right AT device. Similarly, the clinicians need to make sure that if they're considering AT for you, they're looking at the right stuff. I think an example would help here, and I just can't take my mind off of the number one thing people keep asking me about-- The iPad.

Ever since 60 Minutes aired their piece "Apps for Autism," I've been answering lots and lots of questions regarding iPads and their use as communication devices. I won't begin to go into all of my problems with the 60 Minutes story, but suffice it to say, it did not paint an accurate picture of the world of AAC (Alternative and Augmented Communication). So after the piece airs, I start getting calls from people wanting to try the iPad as a communication device. Nothing wrong with that, but the vast majority of those calls were coming from people who have never tried any device of any kind. A pretty alarming number were coming from people who arent working with a clinician at all (no speech language pathologist (SLP) involvement at all). While some of these calls were coming from parents, caregivers, and teachers, a lot were coming from SLP's who hadn't worked with other electronic AAC devices before.

I'm not sure about your state, but here in Delaware, iPads are not currently purchased by Medicaid or some private insurances. Reason being, it's a consumer electronic device. Trying to get it covered, you run into the same problem you run into trying to get Medicaid to cover computers--They are consumer electronic devices and can be used for purposes other than the requested medical purpose. I know, I know. I don't make the rules. Still, I can understand this one. Communication is absolutely of medical necessity. Is Facebook? Twitter? YouTube? I do enjoy Angry Birds, but is it really medically necessary for me to get my daily fix of it? Not likely. This gets us into the dedicated vs. non-dedicated device wars. I'm going to attempt to keep us out of that battleground (for now) and say this is the big concern over having entities who pay for medical goods and services paying for goods that aren't necessarily medical. So that means I'm "stuck" with other communication devices. The boring old ones that have been around for ages that funding sources will cover.

It's not that bad. It really isn't. The devices are getting better and better. The DynaVox Maestro has a very "iPad-ish" look to it that's different from it's predecessors. One of the best parts about it is I can get the device "unlocked" for $55. What does that mean? That means for $55, you can have DynaVox open the operating system for the device to you. That will open your device as a Windows 7 touchscreen computer with your communication software running on it. Prentke Romich offers something similar with their ECO2 device.

Now, I don't want to lose focus, which can certainly be easy when talking about this stuff, but it's knowing that these devices, which are most often covered by Medicaid and other funding sources, offer the ability to have their "computer-ness" unlocked that brings you a very powerful tool. If indeed you want that, it's available as well as the ability to run other Windows software on the device. When I start with the tool, I'm greatly limiting myself because I'm forcing myself to only consider one possible solution no matter how difficult or even impossible that solution may be. When I think about what the individual's needs and wants, I can think in terms of  general device properties. When I add in things like thinking about where the individual's going to be using "something" and what they're going to be using the "something" to do, I can refine that list more and more. It's like the wish list the kids from Mary Poppins made up of qualities they want in an nanny. Here's a little video clip of that scene.

Once I have my wish list of device properties, I can move on to finding what tool can do all of the things I need that "something" to do. If I have those properties, it's easier to sort the devices from the larger field of AT. It might also lead me to a very simple, readily available solution. Still, if I don't know what those properties are and I'm thinking about tools first, it can take me a long time to get there if I get there at all.

Drawing on another movie analogy, it's like when James Bond goes to see his gadget guy, "Q." Before Bond goes on a mission, he sees Q and gets the equipment he may need given the dangers he may face. Need something to take down someone following you? Q's got the thing. Need something to disable video cameras watching you? Q's got something. Here's a little video clip of Q giving James Bond a little toy.

In this clip, we see Bond getting a very special briefcase. Now, what we're not seeing here is that the stuff in the briefcase was chosen to be most helpful to Double-0 agents in the field. So a little bit of thought actually went into the choice of equipment, and equipment was chosen that would benefit agents in the field based on that information.

See where I'm going with this? If you have an idea as to what an individual's needs are and what they're being asked to do, getting them set up with AT to try, and hopefully be successful with, becomes much, much easier. 

The main thing to remember about any assistive technology is that the device isn't the end. Having AT doesn't mean it will work. We need to know what the person using the AT needs to do before we can set about finding them the tool for the job. If we do that, we stop seeing the world as full of nails just because we have a hammer. Instead, we start looking through the toolbox for exactly what our need may be.

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