September 2010 - AT Assessments: The Right Device Is the Best Device
According to Leonard Trujillo Ph.D., an occupational therapist and AT assessment expert who chairs the occupational therapy department at East Carolina University and heads the university’s graduate OT assistive technology certification program, the best assistive technology device for a child is the device that enables a child to achieve at least some degree of independence.
The selection of that AT device, however, is the final step in an AT assessment process that should begin, Dr. Trujillo says, by discovering a child’s highest priority needs. “Children will communicate their needs if they are asked,” he declares. From that point to product selection many individuals are involved in the AT decision-making process, including parents, teachers, school administrators, AT providers and others who comprise a student’s IEP team, plus experts like Dr. Trujillo who provide even-handed AT assessment advice and information to families and schools. Explains Dr. Trujillo, “Every step of the way, despite the various normal complicated agendas and imperatives of all adult participants, there is really only one objective: to find the right device that best meets the needs of a child.”
This issue focuses on AT assessment, the process, the essentials and the final result.
Leonard Trujillo, Ph.D., OTR/L, Speaks
He learned quickly “that technology could make a difference in terms of my own ability to develop tools. But when I let the kids use the computer I recognized immediately that computer use and accessibility enabled them to learn much faster as a treatment modality. Since then I’ve always sought ways to use technology to make people’s lives better.”
His appreciation for assistive technology blossomed after he left the DoDDS UK occupational therapy program and moved to a major stateside USAF medical center. “On staff with me were several optometrists and ophthalmologists specializing in caring for adults with low vision. They distributed a notice stating that they were interested in making contact with anyone in the hospital who could help them develop the tools they needed to work with their patients and would train the appropriate individuals in the use of those tools.”
The tools, Dr. Trujillo says, were low-vision magnifying devices appropriate for older adults with tunnel vision and macular degeneration, among other low-vision issues. The objective was to develop strategies and technologies patients could implement in their daily lives to enable them to travel, to write checks in order to pay their bills as well as to perform other daily tasks.
“I raided the hospital’s x-ray department, gathering up older x-ray films to create templates so that users could perform tasks like reading their electric bill.” The template, he adds, could be laid over the bill to highlight informational items like the user’s name and the amount due.
By the early 1990s, “I was using computers to find ways to develop AT devices for use by older adults. This type of technology back then was still very new.”
He learned during his career “as I moved from children to adults and back that all of my work with AT could be transitioned for implementation in one form or another by children.” Even in an era of specialization, he insists, “the needs of anyone with disabilities can be met by employing thought and careful consideration about the approach. Flexibility and the willingness to change perceptions and approaches are keys to the AT assessment process, he notes. “I think Einstein said it best, “Insanity is doing the same thing over and over again expecting different results.”
His daughter is employed by a university in South Korea. “She is very independent. Each time I see her I want to film her typing. She uses just two fingers on one hand while the other hand is more functional. Her typing is much faster than mine with nearly100% accuracy. In the beginning the goal was for her to be able to type with one hand. She said, ‘Dad, my way works better.’ That was one of my first lessons in listening to what a client has to say; he or she will show you what they are able to do as opposed to what they are unable to do.”
His son, a senior in high school, turns 18 this month. “Although each day is a challenge for him he’ll graduate on time and with a regular diploma, not a certificate. He evolved from a child who was non-communicative to one who is in an honors English class and is completing his senior research project.”
According to Dr. Trujillo, AT has always been a part of his son’s life. “When he was much younger he’d use the mouse, not a keyboard. He refused to use a keyboard. He was OK with an on-screen keyboard, however. Along the way we added software that helps with predictive typing.” Today, Dr. Trujillo adds, “he uses a Pulse pen for taking notes in class. In the spring at the ATIA conference I’ll do a presentation on the use of Pulse pens by children with autism.”
Prior to his arrival at ECU Dr. Trujillo was an associate professor and associate dean at Texas Women’s University’s School of Occupational Therapy in Dallas. He earned his undergraduate degree in occupational therapy from Colorado State University and his Ph.D. in educational administration from Texas A&M University.
Supporting our interview with Dr. Trujillo are resources related to AT assessment. We also feature members of our Knowledge Net¬work. We invite you to contact these mem¬bers for further information. Please share this newsletter with other organizations, families and professionals who may benefit from it. We invite you to visit us at http://www.fctd.info. We welcome feedback, new members and all who contribute to our growing knowledge base.
AT Assessment: “What Do You Want to Do?”
An Interview with Leonard Trujillo Ph.D., OTR/L, Department Chair, Occupational Therapy and Director, OT Assistive Technology Certification Program, College of Allied Health Services,
According to Dr. Trujillo, AT assessment for a child in a school setting “is all about the team and about every member of that team, especially in middle and high school when children have multiple teachers.” Each of a child’s teachers, he adds, “is vital to the success of the AT assessment process and therefore should be involved from beginning to end.”
He continues, “I have found that every teacher responds differently to a child, just as the child responds differently to each teacher, which is why it is so important to track how mutual perceptions and responses regarding a child’s needs fluctuate in a variety of school settings. These fluctuations are grist for the assessment.” Yet the most significant aspect of any AT assessment, he notes, “is how closely team members listen to the child when the child is asked, ‘What do you want to do?’”
Heeding the child’s response, he emphasizes, can spell the difference between a successful and unsuccessful assessment, the right AT device or, in some instances, no AT device at because you have found the right connection with the child.
“Use the Children’s Method of Communication”
A true team approach, he says, can transform the top-down medical model into a child-centered assessment model, but only if the child is an active assessment participant. Often, however, it is not until high school that children are advised – and invited -- to attend assessment meetings. According to Dr. Trujillo, however, “The truth is that the child needs to be involved in the AT assessment process long before a meeting. Without his or her direct input, an assessment can revert to the medical model, which provides little real help for the child.”
Nevertheless, a child’s current expressed needs are not engraved in granite, he cautions. “Needs and desires change and evolve,” he comments. “Given that that change and evolution are a permanent ingredient of human nature, we as AT assessors must be sufficiently flexible to ask children, ‘What is it that you want today?’ or ‘What do you expect to learn in this class?’ Using this timely approach requires both time and effort, but it is time and effort well-spent.”
Currently, he notes, “we are learning how beneficial this approach can be for children on the autism spectrum, defying the conventional wisdom which alleges that these children lack the ability to communicate their needs. My response to that claim is, ‘They are not able to communicate because you are trying to make them communicate using your method of communication.’ My advice: Instead, use the children’s method of communication. Stop, listen, observe and learn from the child. The needs will often present themselves, but we need to be patient and give the child a chance to give us insight into their world.”
Input should be expected from everybody on the AT team, he says. “Therefore, every team member also must have a high level of respect for all others on the team. In addition, during the assessment process all team members need to know where their particular expertise and insight is most important and appropriate.” He cites the example of a school aide who transports a child with disabilities between classes. “Sometimes what a child says to an aide during transit can change an IEP – if the team listens to the aide.”
IEP Team Best Practices: Avoiding a Failure to Communicate
The teacher’s complaint, he asserts, is not unusual: It was not specified in the child’s IEP that the device could be used in “her classroom.” When such a scenario occurs, he adds, parents must intervene. “That’s when parents need to advocate for another IEP meeting to incorporate that special sentence in their child’s IEP specifying that the equipment is approved for use in that teacher’s class. When the meeting is held, the teacher in question must attend, he notes.
Fortunately, Dr. Trujillo sees the opposite classroom scenario as well. “There are teachers who see a child using AT in their class and exclaim, ‘That is cool! I like the way you’re using that device.’ In such a positive environment, he explains, “other kids in the class will want to use the device, or they’ll ask the child to demonstrate the device and then ask how the equipment helps.”
He advises parents, teachers, principals and other IEP members to keep an open mind about AT even in those instances where budget constraints are especially acute and impact most educational decisions. “I am certainly and continuously aware of the financial imperatives of schools in this very difficult economic environment,” he says, “but AT not only impacts a school’s bottom line, it also impacts the futures of young people who desperately need these devices as equalizers to help them keep up with their fellow students in inclusion classes.”
Preparing for an IEP Meeting
“I know many AT providers who become so focused on what they do for specific categories of children that at the IEP meeting they fail to listen to a teacher who offers a different strategy which incorporates new elements but that still meets the child’s needs. A strategy that achieves the same desired result in providing a ‘least intrusive’ – as opposed to ‘least restrictive’ – environment is a strategy that is viable and should be paid attention to.”
Team members, he says, “don’t need to come to the IEP meeting with only one solution. Instead, they come with an end goal in mind and some possible paths to reach that goal.”
IEP Team Best Practices: the Parental Role
He urges parent team members to be present for a child’s trial and error experience during the AT evaluation stage. “I certainly acknowledge that parents’ work days are longer than ever, but their presence can be very beneficial.”
For example, he adds, “If there is a device that is proving to be effective for a child and the parents, who are witnessing the device’s effectiveness first hand, insist that this is the device they want and need, then the parents’ wishes should be listened to.”
Sometimes, however, parents advocate for a device that is not yet in general use. “Often this is a device parents have seen and read about on the web while conducting their research. In those instances we have to help parents understand that the product information they have cited is part of a manufacturer’s online marketing strategy aimed at influencing consumers’ device selection decisions. In such cases I advise parents to consider other options that will be at least as effective for their child as the equipment they’ve read about on a product website.”
“I am a strong advocate for parents,” he declares. “I want to make certain they get all that they can for their children.” Nevertheless, he cautions, “the parental goal should not be to get all that they think they are entitled to; their goal should be to get the equipment that works best for the child.”
“Today’s new specialized technologies will become commonplace everyday tools for us in the near future. The time frame encompassing early development and introduction of technologies that allow us to communicate, interface with our environment and implement in classrooms and the equipment’s ubiquity becomes ever more compressed.” As a result, he continues, more and more individuals who might have been reluctant technology adopters just a few years ago are increasingly willing to incorporate new technologies into their daily routines. For example, he says, “five years ago many aging adults were less likely to use a cell phone, now it’s commonplace see older adults not only using cellphones for voice communication but also for texting!”
The same willingness to adopt and adapt is taking hold in classrooms among teachers and students. “I know of an instance in which a teacher needed an AlphaSmart battery-operated word processing keyboard for one child. The child received and used the device. However, as the semester proceeded, other students in the class saw how easy the AlphaSmart was to operate and wanted one. The teacher wrote a successful grant proposal that enabled her to acquire AlphaSmarts for all her students. That’s how fast the unusual and the specialized can become commonplace and universal, thereby providing learning opportunities for the entire class.”
Teachers, not just the digital natives but also veteran digital immigrant teachers, perceive the new technologies’ ease of use and benefits, he says. “Teachers are no longer blackboard bound. Instead, they are often PowerPoint presenters. Lectures can be recorded when permissible. Media can be captured in multiple ways. This information can then be reviewed, transformed and shared. Options for use exist that until recently were unimaginable in the education realm.”
For instance, he continues, “a teacher of children with communication challenges can set up a Big Mack button with a recorded sound of an animal to accompany the singing of ‘Old MacDonald Had a Farm,’ and a child is able to hit the button when his turn comes around. Without skipping a beat the button emits a ‘quack, quack’ to match the song’s lyrics. The child is instantly included in a social exchange. As a bonus the child is envied by classmates for his device.”
“Education professionals are becoming less and less fearful of technology in classrooms. Technology continues to advance for everyone, not just those with disabilities; which is something that we in education need to remind ourselves of occasionally.”
The Checkbox Dilemma: To Check or Not to Check Is Not the Question
“The checkbox is a reality,” Dr. Trujillo declares. “I’ve worked in overseas Department of Defense schools as well with public schools in Texas, North Carolina, Tennessee, Wisconsin and Delaware. I’ve dealt with this issue at every stop. In each of those jurisdictions there is an IEP form with a box that asks, ‘Has AT been considered for this child?’ Yes or no. And, ‘Does this child require AT or Special Services?’ Again, yes or no are the only possible responses. Administrators ask, ‘As soon as you check yes for AT or Special Services, does that open the door for the child to receive every conceivable special needs service?’
“Rather than ask the question, ‘Does this child need AT?’ there ought to be a box that instead asks, ‘Has every need been addressed?’ That’s the real question, the only question that matters.”
He recommends that when IDEA is next revamped that a revision of the checkbox format be considered.
“AT is but one modality that can be utilized,” he remarks, “[and] it is one that has a monetary stigma attached to it. Therefore, some administrators remain leery of its use. I’ve been told, ‘AT isn’t needed.’ I then ask, ‘How do you define AT?’ I always revert to the most basic definition of AT: any device or strategy that enables an individual to be independent. If there is continued resistance, I say, ‘Then I guess we can’t use pen or paper here.” The most common retort to that is, ‘That’s ridiculous.’ My reply is, ‘That’s just as ridiculous as asserting that AT should not be considered. After all, the rolling pin or the pearl ink or the Pulse pen and other similar devices are forms of AT, but these devices have become ubiquitous and we no longer regard them as different or exotic.”
The real issue, he stresses, “is not technology per se. The real issue, and the real question is, Have the child’s needs been fully addressed?”
He acknowledges that there should be appreciation for the bureaucratic realities that are endemic to individual schools and districts. “Don’t work against the bureaucracy,” he warns teachers and parents. “Work with the system’s imperatives to obtain what’s best for the child and the child’s family.”
His long military career, he admits, provided him with plentiful opportunities to learn the ways of some of the world’s largest and most complex bureaucracies. “I was loaned by the Air Force to the Army for nine years. I taught at the Academy of Health Sciences which is housed at Fort Sam Houston, an Army facility in San Antonio. The Academy offered a junior college-level course for OT assistants that I taught. I was an Air Force occupational therapist training Army and Air Force and, eventually, Navy OTAs. I had to understand the Air Force bureaucracy, live in an Army bureaucracy and teach Navy students. I had to know the regulations for all three services and the bureaucracies of all – because that was the only way for me to get things accomplished.”
He came to ECU specifically for the AT program, he says.” I didn’t have to explain my background. In fact, the university was seeking individuals with backgrounds similar to mine. In order to come to ECU, I left an administrative position as the associate dean at Texas Women’s University. When I came here I pledged that I’d let go of administrative duties. But it wasn’t long after I arrived that I became department chair.
“Understanding and working efficiently within bureaucracies has its bonuses, as well as its curses, but the experience has certainly proven to be beneficial. Part of my job, in fact, is offering help and advice to teachers who would prefer not to have such an intimate relationship with their respective bureaucracies. Accepting my advice and help does not make administrators of classroom teachers but it can provide them with another level of understanding that they can utilize on behalf of their students.”
From his perspective, he says, “the best strategy is to let the parent know I’m there as their child’s advocate, that the only stake I have in the selection process is my wish for their child’s success.”
With his perspective in mind, he adds, “I identify the pros and cons of a variety of devices, making sure to demonstrate the advantages and disadvantages of each device and then clearly move toward the best solution possible.”
As for AT providers, Dr. Trujillo advises them to offer parents and institutions multiple functional options. “Not all these provider options may offer the perfect solution but presenting a range of options allows both sides to see the plusses and the minuses of devices while aiding them in arriving jointly at the most appropriate choice.”
Selecting AT, he explains, “is about helping a student resolve or overcome a problem in the immediate present, not in the future.” A recent encounter with parents and school administrators typifies his challenge as a mediator, he says. “The parents found a high-cost ‘do-all’ device. My job was to help the parents understand that their child may change once he acquires the ability provided by the device. I urged the parents to determine their child’s specific current need instead of paying a lot of money for a single device that purports to meet all the child’s needs in perpetuity.
“When I saw that the child already had the ability to perform the task he wanted to perform without that expensive device the parents were amazed. To show the parents that I was listening closely to their wishes I stated that their desired device was an excellent piece of equipment but that there might be other and more appropriate devices that were less cumbersome for the child to use. I told them that I was very appreciative of the effort they had put into their search, the result of which provided us with a strong starting point for our investigation into which device would be most effective for their child.” This approach, he insists, “not only diffuses potential frustration and anger on the part of the parents, it also results in a better device selection that’s most advantageous.”
He reminds parents and school administrators about how rapidly consumers graduate from one generation of cellphone or computer to the next. “Within months of a cellphone or computer purchase we are lusting for the next big thing. Why should our preferences for AT devices be any different?”
AT at ECU: A Hands-On Program with a Deep Foundation
The ECU Occupational Therapy department chaired by Dr. Trujillo features a special education section and a large AT lab. “The lab is fully equipped, with a full range of software and hardware that individuals from the community can try out prior to purchasing their equipment. Parents and K-12-age children are frequent users of the lab for hands-on training.”
The online graduate AT certification program he directs covers the fundamentals of various AT devices as well as device competency. Students learn how to conduct AT assessments and discuss funding issues.
The program, he says, is grounded in a foundational course designed to help students examine the full range of models for decision-making about AT devices and strategies that can serve as a background for assessments. “We also investigate AT devices that can be utilized by multiple populations for solutions in a variety of problem areas.”
The program, he continues, focuses on teaching AT implementation, an area, he alleges, where AT providers sometimes come up short. “Individuals with disabilities and their caregivers, need to be taught to use a device in a variety of settings so that the device becomes fully integrated into their lives.”
In addition, “we examine the workings of the assessment concept – including decision-making processes -- and analyze the impact of assessments on those with disabilities.” He says that his curriculum highlights the role of the individual with disabilities and his or her needs, not the AT device, as the focal point of assessments.
An entire course, he notes, is dedicated to helping new providers understand that concept as well. “Some providers prefer to announce to a family or a school district, ‘Here’s the one device that will solve your problems’ – and walk out.” Leaving users to figure out how to use a device, he says, “is not an effective approach for providers. This is one area where AT providers should improve. It ought to be their responsibility to make sure AT users and their families understand the capabilities of the device, its operation and, ultimately, to become comfortable with the device and skilled in its operation.”
Despite its online setting, the program, Dr. Trujillo points out, provides students with the opportunity to develop a hands-on relationship with AT equipment.
Students utilize the kit’s content to create a mini-lab in their homes. The lab teaches them how to connect the devices to their computer, use switches and set up X10 environmental switches.
In addition to receiving hands-on device experience, students are expected to master established competencies established by Dr. Trujillo and his staff. Students acquire detailed knowledge of each device via training kiosks they are required to develop. These kiosks, he explains, “are developed through PowerPoint which visually walks a user through the connection and operation process.”
Students, he adds, are also required to devise strategies and then demonstrate those strategies via an instructional video. “Some students have asked if they can utilize YouTube for their demos instead of PowerPoint and the door is now open to that approach.”
Currently, he says, “We’re examining the feasibility of transitioning the program from the graduate category to a continuing education program. Our program is already 100% online but moving to an online workshop environment ought to result in an increased enrollment and be less costly than the current model. Many of our students have used our program as part of their specialty study.”
“Some of these patients communicated only by blinking. I recall bringing in an old clock equipped with a button. I replaced the numbers on the clock with letters. The idea was for the user to turn the dial. When the hand settled on the appropriate letter the patient would press the button and the letter would blink. For awhile this was their only way to communicate.
“Finding ways for people to communicate, to tell their story, to eat a meal independently, to express their needs, all these are critically important goals for anyone with disabilities, especially children – and their families.”
The Family Center on Technology and Disability will be shortly releasing
To clear our remaining inventory of current CD’s, we are offering free bulk shipments of the information-rich disk to schools, parent groups, advocacy organizations, and disability conference organizers. The astute among you will note that bulk copies of the CD have always been free (thanks to the Office of Special Education Programs, U.S. Department of Education), but we thought it would make a better promo this way :-)
Consumer Tips for Evaluating Assistive Technology Products
Educational Uses for the Livescribe Pulse Smartpen
General Curriculum Projects: Parent and Teacher Resources
What Is an Assistive Technology Assessment?
Assessments with Assistive Technology
Documenting Assistive Technology in the IEP
Assistive Technology: A Framework for Consideration and Assessment
Assistive Technology and the IEP
Users must register and provide information on each child entered. Once that information is provided, the Communication Matrix generates a graphic representation of 80 areas of communication and a determination of a child’s potential ability. The matrix can be employed by parents to develop a logical order of communication goals for discussion with their child’s speech/language pathologist in order to establish goal achievement priorities.
KNOWLEDGE NETWORK MEMBERS
Assistive Technology Exchange Center (ATEC)
For additional information, contact:
In recent years, CADL has been a partner in the Rehabilitation Engineering Research Center on Communication Enhancement (AAC-RERC). The goal of the partnership’s R&D activities is the establishment of benchmarks and methods/tools to test the performance capabilities of humans interacting with augmentative communication systems. For the consumer, the partnership aims to develop tools that will compare device performance. For the clinician, the partnership plans to provide information and tools to determine the technical performance characteristics of devices. Each of these services will ultimately aid parents and professionals during the AT assessment process in determining the most effective technology for a child’s use.
Funding provided by the US Department of Education under grant number H327F080003
Project Officer: Jo Ann McCann