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Article 3. Equipment Loan Programs: A Rationale

One common misconception is that an AAC assessment is synonymous with the question "What device should we buy." It isn't. While equipment recommendations are appropriately embedded in the AAC assessment process, they are rarely the sole focus of an AAC assessment. Exceptions are:

• A community team asks an AAC team to address specific questions (e.g., best means of access to a device).
• An individual who is computer literate and cognitively intact requests a device recommendation only. Peple with amyotrophic lateral sclerosis sometimes approach AAC assessment in this manner.

While there are no prerequisite skills for communication other than being conscious,^7,8 there are prerequisite skills for using specific communication devices, signs and graphic symbols, and for pointing to letters to spell words, for hitting a switch to select a scanned message, and so on. There are also psychosocial and cultural variables that heavily influence a person's use of assistive technology.9 Just because someone can use a device does not mean he or she will use it to communicate. Studies on the abandonment of technology, and the personal experiences of AAC team members have made many professionals reluctant to recommend purchasing a communication device until after a person has had an opportunity to use it in everyday life. Currently, this is difficult to arrange.

Many AAC manufacturers do rent devices. Equipment loan programs are another option. Since 1987, the Los Angeles Unified School District, the second largest in the U.S., purchased more than 250 AAC devices for students. Many devices had been abandoned or were not being used to the fullest extent possible. Reasons identified were:¹⁰

• Technology selections were often based on what professionals believed was correct. The consumer and family were expected to agree.
• Decisions were based on equipment the clinician knew how to use or favored.
• Lack of attention was paid to psychological and social aspects of assistive device selection and use.

With growing concern, the district implemented a Device Loan Program. Since 1989, 152 students have participated prior to a device being purchased. In her presentation How good is our first guess? Cindy Cottier reported the results of a retrospective study of 76 students for whom devices were recommended during the 1991 and 1992 school years.¹⁰ Recommendations were based on the district's Augmentative Communication Team (ACT) matching the students' capabilities and needs to the features of devices. Devices considered most appropriate were then loaned to students for approximately two months with the Augmentative Communication team (ACT) providing consultative support.

Table III (not included) gives information about the ages and disabilities of the students participating.¹¹ To summarize, students ranged in age from 5 to 22 years and attended both regular education (49) and special education (27) campuses. Disabling conditions included cerebral palsy, autism, mental retardation, severe language impairment (aphasia) and multiple handicaps. In addition to consultative support from the ACT program, nearly half (42) of the students had one-on-one instructional assistants. Seventy (70) received speech therapy at school, and (25) had private speech therapy.

Twenty (20) different AAC devices were ultimately purchased from 10 different manufacturers. Data in Table IV (not included) shows less than one-third (24/76) of the devices originally recommended by the ACT were subsequently purchased for the students. An additional 34 devices were purchased after 2 to 5 devices had been evaluated through the loan program. For 18 students, no device was bought. Closer examination of these data reveals the team's original recommendations were more likely to be confirmed with younger students. For example, original devices were purchased for 63% of elementary school children, compared to only 15% of middle school and 0% of high school students. Devices that were not originally recommended by the ACT were purchased for 56% of the high school, 62% of middle school, and 25% of elementary students. Cottier concludes that during the assessment process we need to pay more attention to determining:

Cottier is currently working on a project to define the needs and resources of a Loan program for L.A.County. Use her data to help advocate for the use of device rentals and loan programs in your area.

This article appears in ACN Volume 7, # 1.

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