Sample Adult AAC Evaluation

Sample Adult AAC Evaluation
Here you will find a sample adult AAC evaluation report/funding request for a client with a diagnosis of Cerebral Palsy. This report is based on an actual report that resulted in Medicaid funding for the purchase of the recommended voice output device. This report may provide assistance for your own report writing. However, it is strongly advised that you check the guide lines for funding with each insurance company you are submitting funding requests to. This report follows the suggested guidelines for Florida Medicaid funding as of Fall 2009.

The device manufacturer’s funding department is the best resource for ensuring your report and funding packet will contain the most up to date requirements. Speech Generating Device (SGD) manufacturers such as DynaVox and Prentke Romich Company provide report writing tools and funding advice.

SGD funding requests must be submitted by a qualified speech-language pathologist and must be accompanied by a complete funding packet including but not limited to: a physician’s prescription for the SGD, copies of ALL the client’s insurance cards, a current list of medications, client information form, assignment of medical benefits form, client bill of rights, written concurrence from school if client is a student in the public schools, signed trial evaluation contract (if applicable), statement of non-conflict of interest. All of these forms can be obtained through the funding department of the device manufacturer (check the manufacturer’s website). Funding packets must be submitted to the funding department of the device manufacturer.

Sample Adult AAC Eval approved by Florida Medicaid




Augmentative-Alternative Communication Assessment

Name: Jane Doe DOB: XX/XX/XX
Address: 111 Pretend Lane DOE: XX/XX/XX
Ft. Lauderdale, FL 33305
Medical Diagnosis: Cerebral Palsy
Telephone: XXX-XXX-XXXX
Medicaid ID#: XXXXXXXXXX ICD 9 Code: 343.9
Contact Person: Janette Doe (Mother)
Speech-Language Pathologist:
Nicole Lilienthal, M.S., CCC-SLP
Florida License #: SAXXXX

The purpose of this evaluation was to determine, based on Ms. Doe's physical, cognitive and language skills which augmentative/alternative communication (AAC) system or speech generating device (SGD) would be most appropriate for her. A variety of assessment strategies were used to evaluate her motor, cognitive, oral-motor and language skills. In addition, a variety of communication devices were shown to Ms. Doe to allow her the opportunity to explore each communication device.

I. Medical Information:
Significant Medical Diagnosis - Ms. Doe is a 25-year-old nonverbal female with medical diagnosis of Cerebral Palsy, which is the significant medical diagnosis that results in her needing an augmentative/alternative communication (AAC) system.

Significant Treatment Information - Ms. Doe has a history of past speech therapy that has not helped improve her speech so that she can functionally verbally communicate. Ms. Doe is not on any medications that would influence her use of an AAC system.

Medical Prognosis - The medical prognosis for improvement in Ms. Doe's Cerebral Palsy is limited. The prognosis for speech improvement is limited.

II. AAC Related Skills:
Motor and Accessing Skills - Ms. Doe is primarily seated in a power wheelchair. She is able to use direct selection to access a communication device with her middle finger of her left hand with a key guard in place to increase her accuracy. Ms. Doe requires a mounting system to mount the communication device to her power wheelchair in order to access the device. The device should be mounted on her right side but positioned directly in front of her left hand, as her power chair's joy stick is on her left side.

Language and Cognition - Receptive language skills were formally assessed using the Peabody Picture Vocabulary Test-III (PPVT-III). Results from testing indicate a receptive language standard score of 52, age equivalent 7 years 11 months. When communicating using the Vanguard Plus with Unity 45 Sequenced Language System, Ms. Doe was able to spell out single words and phrases/sentences with some spelling and grammatical errors, utilize the word prediction feature of the device and demonstrate the ability to sequence 2-3 icons using the Unity 45 Sequenced Language System. Ms. Doe has prior experience using the DeltaTalker with the Unity 128 Language System. She expressed that she is familiar with some of the Unity Language System from her experience using the DeltaTalker.

Ms. Doe began using the DeltaTalker in 1995 when she received the device through the public school system in Pleasantville, NC. She expressed that she did not receive speech therapy services long enough for her to learn to use the Unity 128 Language System proficiently. Thus, Ms. Doe primarily uses the DeltaTalker to spell out her messages. The DeltaTalker (produced by Prentke Romich Company) has been discontinued by the company and thus, is unable to be repaired when it breaks down. While Ms. Doe presents with mild cognitive/language difficulties, these disabilities did not affect her ability to access the Vanguard Plus.

Sensory/Perceptual Skills - Ms. Doe wears glasses but has no significant visual or hearing limitations that would influence use of an AAC device. She showed sufficient visual skills to use pictures printed smaller than 1" X 1" and was able to discriminate the synthetic speech of the various devices tried.

Oral Motor Skills - Ms. Doe does not have the oral-motor skills to depend on speech as a primary means of communication. She lacks the coordination of her lips, tongue, palette and respiratory system to produce speech sounds that could be used functionally for communication.

III. Functional Communication Skills:
Present Communication Abilities - Ms. Doe's primary means of communicating at this time includes spelling out messages using the DeltaTalker, verbal approximations, facial expressions, gestures and physical manipulation of her environment. Ms. Doe's ability to verbally approximate words is extremely limited and speech intelligibility is very poor for unfamiliar as well as familiar listeners. Communication must be supplemented with the use of a voice output device to be reliably understood by care givers.

Ms. Doe is able to spell out sentences with minor spelling and grammatical errors with her left hand using the DeltaTalker. This method of communicating is extremely time consuming. The Unity 128 Language System available on the DeltaTalker is not an appropriate system for
Ms. Doe given her level of cognitive and language functioning. This patient requires the use of an AAC device which meets her current level of language skills to communicate in an effective and efficient manner with care givers, medical professionals, within a school/work setting and in the community.

Daily Communication Needs - Ms. Doe needs a system that:
1.promotes independent conversation and interactive communication;
2.provides a language system that is efficient and easy to access;
3.allows for communication through less key strokes than typing;
4.allows for word prediction when typing;
5.has voice output for more normalized interaction;
6.can be used to signal emergencies;
7.has a display that is easy to see under a variety of lighting conditions;
8.is durable and able to tolerate normal wear and tear;
9.has sufficient battery capacity to run for a full day without charging or changing batteries;
10.is useful across all the environments in which she participates; and
11.is learnable with structured teaching.


Written Communication - Ms. Doe is able to spell out sentences with minor spelling and grammatical errors using the DeltaTalker. Ms. Doe demonstrates the ability to utilize word prediction software to improve her spelling and increase the accuracy of communication.

Communication Environments and Barriers - Ms. Doe's communication needs include: communicating to participate in family decision-making, communicating to participate in family leisure activities, communicating by telephone, participating within the community, reporting medical status and complaints, asking questions of medical providers, responding to medical provider's questions and in the near future to communicate on the job site as she is seeking employment at this time. In many community settings, people are not trained in the use of AAC strategies; therefore, Ms. Doe needs a system that does not depend on the skills of others to communicate. In addition, most of these settings have the normal barrier of time limitations; therefore Ms. Doe needs a system that promotes fast and efficient communication. Using an AAC device will increase her speed of communication by allowing her to store pre-made messages that she needs to say frequently. An AAC device would also enable her to speak independently in a work environment and over the telephone. Finally, there are also natural human nature barriers, such as impatience, negative attitudes/stereotypes, and lack of knowledge/skills that must be overcome.

IV. Speech Generating Device Recommended:
Ms. Doe was shown three different AAC devices including: the Vanguard Plus, Pathfinder and DV4. Of these devices, the Vanguard Plus is recommended as the AAC device which best meets Ms. Doe's needs and skills.


V. Rational for Device Selection:
Device - The Pathfinder (produced by Prentke Romich Company) was not considered an appropriate device for Ms. Doe because of the complexity of the Unity 128 Language System. Ms. Doe was most effective using the Unity 45 Sequenced Language System that is available on the Vanguard Plus (also produced by Prentke Romich Company). The DV4 (produced by DynaVox Systems, Inc.) did not appeal to Ms. Doe because she is most comfortable and familiar using the Unity Language System which is only available through Prentke Romich Company products.

Vocabulary Selection or Program - The Vanguard Plus comes with Unity Sequenced 45 Language System already loaded in the memory of the device. This program can serve to meet most of
Ms. Doe's communication needs as well as provide a foundation for a customized program.

Vocabulary Management - The Vanguard Plus uses the Unity Language System as the primary means of vocabulary organization. The program in the Vanguard already has all the vocabulary organized. Any personalization of the program is done within the architecture of the program.

Selection Technique Used - Ms. Doe will use the device via direct selection with the aide of a key guard.

Output - Ms. Doe will use the device with a synthesized female voice in English.

Purchase Information - The Vanguard Plus is manufactured by the Prentke Romich Company. The following chart shows the address of the company and a listing of all device components that should be ordered.

(Present in chart format the SKU #, Item Description, Cost per unit and Total Cost)

SKU Item Description Cost per Unit
XXXXXX Vanguard Plus
XXXXX Daessy Folding Mount
XXXX-X Quick Release Mount Clamp
XX-XXX Vanguard Plus Carrying Case
XXX-XXX Vanguard Plus 45 Location Key Guard



Justification for Accessories - The Daessy Folding Mount allows for the device to be mounted to Ms. Doe's power wheelchair and will position the device high enough for her to be able to access it. The Quick Release Mount Clip provides a safe and durable way to attach the device to the mounting system that is user friendly. The key guard is necessary for Ms. Doe to accurately make selections on the device. A carrying case is recommended to protect the device from damage while transporting it.

Shipping Address: The device should be shipped directly to Ms. Doe's caregiver, Janette Doe.
This therapist is available to provide follow-up therapy, assist in device set up and training.
The device should be shipped to: Janette Doe, 111 Pretend Lane, Fort Lauderdale, FL 33305.

Prentke Romich Company (PRC)
1022 Heyl Road
Wooster, OH 44691
General Phone Number: 800-262-1984
Sales Phone Number: 800-262-1933
Fax Number: 330-262-4829

Recommended Individual Action Plan
Limits of Current Communication System - Ms. Doe is extremely limited by her current use of the Delta Talker as a primary communication strategy as she primarily uses the device to spell out her messages. Additionally, the device is not able to be repaired because the company has discontinued producing it. Without the use of an AAC device, she cannot independently and functionally communicate to caregivers, teachers, therapists and medical professionals. What follows is a therapy plan for Ms. Doe's use of the Vanguard Plus.

Intervention Schedule:
The maximum number of therapy sessions (eight 30-minute sessions per year) that Medicaid will reimburse is required for Ms. Doe's training. Therapy sessions will focus on teaching Ms. Doe the Unity 45 Sequenced Language System, to train her and her family on the features of the device and how to trouble shoot problems that may arise. This therapist will provide additional training twice weekly for 45 minute sessions for a period of 52 weeks through the Medwaiver program. Ms. Doe will be re-evaluated for continued need for services following 52 weeks of therapy.



Functional Communication Goals:

Immediate Goal: To be achieved following three, 30 minute sessions, training on the features of the device.

1. Ms. Doe will participate in customizing the vocabulary on her communication device and learn to retrieve frequently used messages on her device to increase the speed of communication.


Short Term Goals: To be achieved following 3 months of therapy sessions.

1. Ms. Doe will learn a minimum of 2 new icon sequences per week and will demonstrate the use previously learned sequences with 80% accuracy.

2. When verbally presented with a 4-5 word sentence, Ms. Doe will construct the sentence using Unity 45 sequenced icons with 80% accuracy.

Long Term Goal: To be achieved following 6 months of therapy sessions.

1. Ms. Doe will decrease her use of spelling to no more than 60% usage when using her device.


Recommended Device and Trial Period (if applicable) - Ms. Doe performed well with the Vanguard Plus during this evaluation and based on her prior experience using the DeltaTalker, it is felt that an additional trial period is not warranted.

Description of Past AAC Systems - In 1995, Ms. Doe began using the DeltaTalker, a SGD produced by the Prentke Romich Company. The Delta Talker utilizes the Unity 128 Language System. Similar icon sequences are used in Unity 45 which is available on the Vanguard Plus. The Unity 128 Language System is too advanced for Ms. Doe so she primarily uses the device to spell out her messages. Additionally, the DeltaTalker has been discontinued by Prentke Romich Company and the company will not perform repairs as they arise.

Benefits of Recommended SGD - The primary benefit of Ms. Doe's use of the Vanguard Plus is that it will give her a reliable, functional and time efficient means of communication. This will greatly increase her independence at home, school/work and within the community.


Plan for Mounting, Repairing and Maintaining - Ms. Doe will transport the device in the carrying case when it is not in use. The device will be mounted securely to her wheelchair when it is in use via the main frame clamp. Daily maintenance, such as cleaning the device, will be done on a monthly basis by caregivers.

Plan for Delivery and Programming of the AAC System - The device will be shipped to Ms. Doe's caregiver, Janette Doe. For the most part, the device will be programmed by the manufacturer and ready for immediate use. The device comes with a manual and tutorial guide that provides start-up information. In addition, this therapist will be providing additional training for the recipient and caregivers on the following training topics: proper cleaning and charging of the device, basic programming, vocabulary training and interactive use of the device.


This report was forwarded to Ms. Doe's primary care physician (Dr. Nice Guy, Best Medical Group Inc., 1000 NE 10th Street, Suite 101, Ft. Lauderdale, FL 33305, 954-999-0000) on 03/21/07.


If you have any questions or concerns about this report, please contact Nicole Lilienthal for clarification or more information at 954-XXX-XXXX.


_____________________________
Nicole Lilienthal,MS,CCC SLP
Speech-Language Pathologist
Augmentative/Alternative Communication Specialist


_________________________________
Primary Care Physician's Signature




Statement of Non-Conflict of Interest

I hereby certify that I, Nicole Lilienthal, am a speech-language pathologist that adheres to all the standards of the American Speech-Language-Hearing Association and all other associations that support the field of Augmentative and Alternative Communication. I have a private practice in the state of Florida and work as a speech-language pathologist. As part of my ethical standards of practice, I hereby certify that all recommendations in this report were made for the best interest of Ms. Jane Doe. I have no financial interest nor receive any monetary compensation from any manufacturer for the sale of the recommended AAC technology. My only professional interest is in the communication success of Ms. Jane Doe.


____________________________________
Nicole Lilienthal, MS, CCC-SLP
Speech-Language Pathologist
Augmentative/Alternative Communication Specialist

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