Assistive Technology Assessment
What is an Assistive Technology (AT) assessment?
An AT assessment answers the question: Which technologies and strategies can I use to improve my functioning? A formal AT assessment is provided by someone who is recognized as a provider of AT services by public and private funding agencies.
Do I Need a Formal AT Assessment?
You may need a formal AT assessment if one is required by your funding or procurement source. If you are unsure, ask your case manager, funding agent, or counselor. State agencies, such as the SC Vocational Rehabilitation Department, educational agencies (school districts), and medical insurers (private companies, Medicaid, Medicare) often require an assessment. They want to see that an AT service provider verifies your need for AT to maintain or improve functioning, and that the selected AT will meet your needs.
Who Can Help You Select AT?
More and more people are learning about what a powerful difference AT can make. As new equipment and devices are developed at a rapid rate, choosing the AT that best matches the needs of an individual can be intimidating.
Whether looking for a simple gadget to help arthritic hands open a jar, a speech output communication device to speak out in class, or a sophisticated computerized system to compete in the workplace, most people seek some help in selecting AT. Who you choose to help you make an AT decision depends primarily on four factors:
- Type of equipment/device (simple over the counter, individually fitted or prescriptive):
Generally speaking, if a device does not require "fitting" or prescription, and is not at risk for causing injury, it can be bought "off the shelf" or selected from disability product catalogs. Such products include magnifiers, large print playing cards, adapted eating utensils, flashing smoke alarms etc. Other devices need careful personal fitting such as adapted seating systems, adapted skis, etc. and some need prescriptions. Prescriptive devices are usually medically necessary devices such as power wheelchairs or communication devices that will be paid for by an insurance funding source. Fitted and prescriptive devices need to be reviewed and recommended by experienced, and in some cases, licensed, professionals. Devices that do not need personalized fitting or prescription are often chosen by matching the features of the device to the specific needs of the person. Providing an opportunity for trial use of the AT during naturally occurring daily routines can provide valuable feedback about the appropriateness of the AT.
- Complexity of the system involved (single item or complex integrated system):
The complexity of the device or system you need often makes a difference in your choice of who can help you find the right device to meet your needs. Some AT devices are single, “stand alone” items, such as a closed circuit TV (CCTV) that enlarges print, a switch-operated toy, or a talking calculator, etc. Often AT systems consist of several components (such as a computer that speaks scanned text), or they need to be compatible with other AT devices (such as an environmental control unit that operates using a wheelchair driving mechanism). The more complex the system, the more you will probably need experienced help.
- Your knowledge, experience, and comfort level with AT
("new user" or "old pro”):
If you have experience with other pieces of AT, you feel comfortable asking questions and getting information, and have some experience working with vendors and health professionals, you may be able to make decisions on your own or with very little help. If you are new to technology (possibly even technophobic), you probably need the help of experienced people to start the selection process.
- Requirements of the procurement/funding source:
Specific funding sources may require that you have an "AT Evaluation or Assessment" done by a professional before they will pay for an AT device or service. The funding or procurement source is a very important consideration in determining who should assist you. Educational (school districts), vocational rehabilitation, and medical (insurance companies, Medicaid, Medicare) funding sources usually require verification of need and assurance that the AT selected will meet that need in the form of an "evaluation" or "assessment." Other funding sources (low interest loans, private grants, self pay, gifts) do not require assessments.
Who can do an AT Evaluation or Assessment?
Assessment providers are most often licensed and or certified in related fields such as Physical Therapy, Occupational Therapy, Speech-Language Pathology or Rehabilitation Engineering. AT Specialists/Professionals have experience and knowledge in AT and may have a certification.
Occupational Therapists, Physical Therapists, and Speech-Language Pathologists are professionals who have training and expertise in clinically-recognized areas. All practicing therapists or pathologists must pass standardized tests and be certified or licensed in their respective fields. However, a therapist may or may not have experience and expertise in assessment and recommendation for AT. You will need to ask if your therapist has a working knowledge of AT devices, applications, and other AT supports and can complete a formal AT assessment which may be required by your funding source. Standards for formal AT assessments vary, but a good assessment should verify a need for AT and verify that the recommended AT will meet that need. There is almost always a charge for AT services provided by therapists. Depending on the service, it may or may not be covered by insurance, or other funding sources such as Medicare or Medicaid.
Rehabilitation Engineers are providers who have engineering and/or technology backgrounds and may be familiar with AT devices. They may or may not have the clinical experience of working with individuals with disabilities and AT. You will need to ask about their experience and expertise to determine if they are able to meet your needs for assessment or recommendation. Rehab engineers may also provide services in non-medical related areas such as home modification, work site accommodations, and computer adaptations.
AT Specialists/Professionals may have clinical backgrounds in working with persons with disabilities and have specialized in AT applications. Most provide complete assessments and training on device use. You will need to ask about the individual's experience and expertise to determine if the provider is appropriate for your needs.
Who else can help you select AT devices or services?
If your funding source does not require an evaluation or assessment or if you are using private funds, who are the people that can help you select AT devices or services?
Experienced peer users may be helpful, but their advice almost always reflects personal experience. This personal experience may be very useful when considering durability of a product or actual usage issues. Many times, AT requires personal fitting, so what is appropriate for one person may not be appropriate for someone else, even if that person has the same disability. Peer users can be good sources of information about vendor services such as technical support or vendor responsiveness. A successful user may also act as a motivator for "hanging in" during the training time that most technology requires.
Product company representatives are employed and salaried by companies to represent devices or product lines. Company reps are well informed about their products and will often demonstrate a device for a customer at no charge. Some have had clinical experience and may be able to help you decide if a device is best for you; others are primarily sales people. Company reps believe in their products and want to sell them, but should not sell you a product that is not appropriate for you. Reps usually provide follow-up and post installation support for the devices they sell, usually at no additional charge.
Rehabilitation Counselors often help people with AT for vocational purposes. While some counselors may have knowledge of specific technologies or areas of technology application, consumers need to inquire about their counselor’s level of experience and expertise in AT. Most often, counselors will refer you to qualified providers or rehabilitation engineers and then work with you to interpret the assessment results and obtain the appropriate equipment.
Friends are always willing to offer advice and assistance. These opinions almost always reflect only personal experience and prejudices which may not be true for you! Friends may be good resources for simple, inexpensive solutions, but you will need more objective assistance for complex technology decisions.
How Do I try AT Before I Buy It?
Many vendors offer their products for loan. You may be able to borrow some products from friends or family members. The SC Assistive Technology Program (SCATP) offers a device loan program that allows the user to borrow AT devices for 2-4 two to four weeks at a time. This allows time for “test-driving” the equipment in natural environments and allows the AT assessment provider an opportunity to collect data from your AT use to support the request for funding.
Selecting the AT that will work for you is important. If you are not happy or completely satisfied with the assistance you have received (no matter the source), you should ask for further help or seek a second opinion from another source.
You are the one who needs to be satisfied, and you are the only one who can determine if the assistive technology selected is right for you. No matter what the cost, no matter who prescribed it for you, if your goal of increased functioning has not been reached, you haven't found the right solution and your assessment is not finished! Contact your assessment team, and discuss the next steps to take.
Who Pays for the Assessment?
BabyNet provides early intervention services prior to age three. An assistive technology assessment must be performed if the IFSP team, including the parent and appropriate professionals feels that a device may be needed to achieve an IFSP outcome or goal.
Federal law requires local school districts to consider AT for all children who have a disability. Because schools provide assessments and education-related AT devices and services for children from ages 3 to 21 years, the school district is the first entity to contact. Finding and funding devices or services may ultimately involve a number of agencies and organizations. AT assessments for children whose AT needs are related to medical factors can be funded through private insurance, Medicaid, Children’s Rehabilitative Services, or agencies which serve people with specific disabilities.
Adults who are beginning the AT assessment and acquisition process should look into many options. Local and national support groups or foundations should be investigated as well as Medicaid, Medicare, VA and agencies that serve people with specific disabilities, including the Vocational Rehabilitation Department. Preauthorization from the primary care physician is a typical requirement prior to assessment.Medicaid and Medicare assessment services are reimbursed if the healthcare professional is an enrolled Medicaid or Medicare provider. When an individual with a disability has Medicare and Medicaid, Medicare is considered to be the primary payer. Services rendered to persons who are certified dually eligible for Medicare/Medicaid must be billed to Medicare first. All claims not paid in full by Medicare must be filed directly to Medicaid as claims no longer cross over for automatic payment review.
This information was adapted, in part, from TechACCESS of Rhode Island