Passion Sparks AAC Innovation When interprofessional partnerships lead to new service delivery methods, clients benefit. In a recent online chat, assistive technology expert Beth Mineo talked about ways clinicians can turn novel augmentative and alternative communication ideas into clinical realities. Overheard
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Overheard  |   October 01, 2014
Passion Sparks AAC Innovation
Author Notes
  • Beth Mineo, PhD, CCC-SLP, is director of the Center for Disabilities Studies and associate professor in the School of Education at the University of Delaware. mineo@udel.edu
    Beth Mineo, PhD, CCC-SLP, is director of the Center for Disabilities Studies and associate professor in the School of Education at the University of Delaware. mineo@udel.edu×
Article Information
Augmentative & Alternative Communication / Overheard
Overheard   |   October 01, 2014
Passion Sparks AAC Innovation
The ASHA Leader, October 2014, Vol. 19, online only. doi:10.1044/leader.OV.19102014.np
The ASHA Leader, October 2014, Vol. 19, online only. doi:10.1044/leader.OV.19102014.np
Kristyn Nunes: Interprofessional collaboration is obviously very important when treating our clients! Have you had difficulty getting other team members to collaborate with you? What are some ways that I could get colleagues who are not very big on collaboration on board?
Beth Mineo: I was hoping someone would ask that question! I’ll answer from the perspective of my experience, and I’m going to make an analogy to dating. Typically, we don’t just jump into a serious, committed relationship with another person. We explore each other’s interests, and seek common ground. Then maybe we do things together that aren’t “goal-directed” just to see how we get along. It has been my experience that those really productive and rewarding collaborations don’t happen on command, and just because we want them to. They work best when you’ve had time to get to know what makes your potential collaborators tick, and then find those areas in common where you have shared passion for an issue.
Mark Turek: It seems that so much of the innovation and research that is going on occurs at the collegiate level. How can the everyday, school-based SLP tap into some of these kinds of projects? Where can we go to learn more about what is happening at that level?
Mineo: There is a lot happening at the college level, because colleges and universities are supposed to be hotbeds of innovation, right? But there are any number of ways that school-based folks can make those connections. In fact, most of the interesting—and important—projects I’ve been involved in have started with issues posed at the school or community level. If you are confronting a challenge in policy, technology or practice, I encourage you to scope out university program websites to see who might be interested in the same issue, or check to see who is publishing in the area, or posting in the Special Interest Group 12 or QIAT [Quality Indicators for Assistive Technology] Listserv.
Joy Cary: You mentioned various funding sources. Which source has been most successful in obtaining your augmentative devices for kids?
Mineo: In general, we find that communication systems are being funded by private insurance, Medicaid and schools when the justifications are really solid. And by that I mean when the features that someone needs are clearly specified and justified, and then several potential products are compared and contrasted so that the one that is recommended, ultimately it is obviously the appropriate option.
Katherine Simmons: Do insurance companies readily provide what their policies are related to approval of communication devices as durable medical equipment? I have had iPads approved for some students and denied for others, based on the argument that it can be used for other things. Are their policies published somewhere for us to review?
Mineo: Information about scope of coverage has to be published, but often it isn’t as specific as we’d like. But that is both a good thing and a bad thing. When it is vague, we have an opportunity to walk right through that open door with a justification. For example, if speech-language pathology services are covered, then augmentative and alternative communication is by association covered, because AAC is within a clinician’s scope of practice. But as you noted, sometimes denials—and even approvals—seem very arbitrary and capricious. That was why we advocated to get our Medicaid policy spelled out in such vivid detail. It was good for the Medicaid folks reviewing applications, but also extremely helpful for clinicians preparing applications. It gives SLPs a framework for their assessment, recommendations and treatment planning.
Katie Samuelson: Are you familiar with any universities at the current time who are researching AAC technology on the same level as Rupal Patel?
Mineo: Do you mean speech technology specifically, or just really out-of-the-box ideas that support people who struggle with communication?
Samuelson: I was thinking speech tech, but I would love to know of other universities who are looking at creative solutions as well if you know of them!
Mineo: Great. A wonderful place to start looking is on the website of federal funding agencies. They list the kinds of projects that they have funded, along with the contact info of those who are doing the work. For many years, the folks associated with the Rehabilitation Engineering Research Center on AAC have been doing innovative things with technology. Some of the universities involved include University of Nebraska, Penn State, and the Oregon Health Sciences University. But if you go to websites like www.ed.gov, and click on links for the National Institute on Disability and Rehabilitation Research, Office of Special Education Programs, and the Institute of Education Sciences, you can see a compendium of innovative projects in the technology, policy and practice realms. I would bet that researchers would be really excited to hear from you about your ideas, or about serving as a test site—that kind of thing.
Nunes: VocalID is such an amazing tool. I saw that the girl on the video used this on her phone. Can this be utilized in any voice output synthesizer?
Mineo: It is amazing! I don’t know about every single device, but I hang out with a young lady in Delaware who uses it on her Dynavox product.
Susan Staaf: Going back to insurance denials—what are the options when the last step in the appeal process is to file in court, which is beyond my scope of practice?
Mineo: If the appeal process has really been exhausted, it typically falls to the consumer or family to seek legal redress. Lots of families may be put off because of cost, or the drain of those kinds of proceedings on the rest of life, but in every state there is a protection and advocacy organization. They receive federal funding to address legal issues related to all different types of disability issues, and they have a specific line of funding for assistive technology advocacy and legal counsel. It would be interesting to hear how many of you have heard of them before.
Megan McCall: I have heard of them, primarily as advocates to families in their dealing with the schools—not related to insurances. Glad to hear that should be part of their mission.
Gina Capri: I hadn’t heard of them. That is good information!
Judy Price: It is called PAI in California.
Mineo: The way to find out who operates the “P&A” in your state would be to contact their national organization, the National Disabilities Rights Network. I’m sure they would be delighted to put you in touch with folks in your state. In the Medicaid policy advocacy that I discussed in my presentation, we worked very closely with an attorney from the Delaware P&A, which is known as the Disabilities Law Program. They are funded to take on cases, so in many instances there is no cost to the consumer or family. And as I noted, they have one very specific mandate in the area of assistive technology, so they are likely to be very open to collaboration on solving policy challenges. Cultivating a collaborative relationship with your state’s P&A is a smart thing to do. You have information about policy and practice barriers that they really need to hear about, and they can offer a legal lens on some complex matters.
Price: Would the federal agency focused on rehabilitation [Rehabilitation Services Administration in the Office of Special Education and Rehabilitative Services] fund AAC devices for young adults since communication is a barrier to employment? Also, I seem to recall viewing an AAC lab years ago that was funded by the cerebral palsy organization and staffed by Rehabilitation Engineering and Assistive Technology Society of North America engineers. Are those still likely sources?
Mineo: In a word, the answer is absolutely! In fact, there is probably one key piece of info that you should know about vocational rehabilitation. When technology is needed in order for the person to be employed—or to receive training on the way to being employed—VR does have responsibility. What they will often tell you, however, is that they are the payer of “last resort,” which means that they will only consider funding if all other possibilities have been exhausted. And that actually is an incorrect interpretation of the federal law that governs vocational rehabilitation. For services other than assistive tech, VR can do a “comparable benefits” test, which means that they can hold off paying until all other options have been exhausted. But assistive technology is actually exempt from the comparable benefits test, so you don’t need to wade through all the other applications, and wait for denials, before VR will pay. And I’m not VR-bashing here, but I can tell you from experience that a lot of their case managers and employment specialists don’t even understand this aspect of law, so we had to cite “chapter and verse” on more than one occasion. But this is another issue that the P&As are well versed in. There are also some wonderful compendia of policy guidance for education, VR, and public and private insurance that you can access through the National Disabilities Rights Network.
Jody Terry: Is there a website to find out other places who are using VocalID and more information about it?
Mineo: I would encourage you to contact Rupal Patel at Northeastern University or Tim Bunnell at the Nemours Foundation/A.I. DuPont Hospital for Children in Delaware. There is also a great TED Talk that Rupal did.
Simmons: Is there a listserv or publication that we can subscribe to that will keep us “on top” of all the legalities of AAC funding? It seems so overwhelming!
Mineo: There are a few places that I can think of. ASHA’s Special Interest Group on AAC is a great resource. Louis Golinker is an attorney practicing out of New York who has made funding of AAC his life’s work, and he is always eager to learn about the challenges folks are facing and to give helpful tips. Another great resource would be your state’s Assistive Technology Act program. Those entities have federal funding, and are charged by Congress with providing equipment demonstration and loan, training about assistive technology, and information about the “legalities” of accessing it. There are typically sessions at the ASHA convention on funding, and your state association should also be a source of info.
Leigh Deussing: ASHA also has reimbursement resources. Also, reimbursement questions can be directed to reimbursement@asha.org and someone will respond.
Katie Smart: What steps would you take at the district level if you think a related service could be useful to the district? Sometimes devices can be obtained through grant money or organizations. But to hire a consultant, additional therapist, social worker—this seems to be more difficult.
Mineo: Let me make sure I’m understanding you, Katie. Are you asking about the process of figuring out what AAC approach is needed, or how to get it funded?
Smart: I’m asking about how a team can get more support ... not technically an AAC issue.
Mineo: One way is to connect with the state assistive technology program. Another is to grow that support internally ... there are lots of resources, training and people who can be accessed.
[With regard to securing funding,] school districts are required to consider assistive technology—which obviously includes AAC—as a part of every Individualized Education Program deliberation. That is a federal IDEA requirement. What happens very often, however, is that IEP teams zoom right past that “special factors” section of the IEP. But it is there as a prompt for deliberation and consideration. A savvy parent can often be an ally in insisting that that kind of deliberation take place.
Then there’s the whole process of figuring out what approach or approaches are best, and again ... that’s a team process. But the use of a systematic approach, such as Joy Zabala’s SETT Framework, can be very useful for getting folks focused first on the student, environments and tasks before discussion turns to the “tools” part of the acronym. And then there’s acquisition. Interestingly, IDEA does not say that schools have to buy devices for students, but only that they have to make them available. It can often be very productive to explore other funding avenues such as insurance.
There are some interesting legal subtleties that came sometimes compel opponents to come together on a plan. Such as the fact that if school buys a device, the school owns it. But if insurance buys it, the family owns it. That can be a very powerful incentive for families to access their insurance for device purchase. But the law is very clear ... families can never be compelled by districts to access their insurance. It is their choice.
Mallory Buckingham: We have heard Medicare rules are changing, and that they will no longer pay for devices that have Internet access?
Mineo: You’ve just raised an issue that is making lots of people very upset. Medicare appears to be rolling the clock back many, many years. The last news I had, which was on a conference call yesterday, is that they are not responding to the voices of the advocates. This really demands an all-out campaign to inform families impacted, as well as your elected officials. We can’t return to where we were only 15 years ago with very limited support from Medicare, especially because Medicare often sets the benchmark for Medicaid and private insurance on funding practices. This is definitely an issue to watch, and get wound up about. ASHA can be a great voice for us in this debate!
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