This last month I was reminded how important receiving a quality AAC evaluation can be, even for existing users. Although many adult users don't need a lot of changes or updates to their communication systems as many have their vocabularies (apps) set, it is imperative that we remember that their needs do change when we are re-evaluating them for an updated communication system (typically every five years). I have been working with an individual who is in his mid 20's. Back when he was in high school the school team met his AAC evaluation needs. After graduating, getting a quality evaluation was more difficult, especially one that looked at an individual's needs as an adult and was multi-disciplinary. Where I live there are very few options for receiving an AAC evaluation through insurance, and the options that do exist include long waiting lists. It's frustrating and due to a lack of expertise and poor reimbursement for AAC evaluations it has forced clinics and hospitals to stop offering AAC evaluations throughout the state that I live in (Wisconsin).
One thing that I love about my private practice is being able to go into an individual's home as it gives a clearer picture of what day-to-day life looks like as opposed to the outpatient/clinic setting. I quickly found out that when this individual is at home he is often seated in a chair in the living room or in his bed, and had no access to his communication device. His entire communication system was built around his wheelchair, which made sense when he was evaluated by school as he spent the majority of his day in his wheelchair. However, for most individuals who use a wheelchair, changing positions is necessary to avoid things like pressure sores, and we don't all just stay seated in one position in our home (and even at school). With all evaluations we should be looking at and thinking about the entire environment, and as a school SLP doing evaluations for speech generating devices (SGDs) you should be asking the caregivers questions about what the child's day looks like beyond the school day and planning for more than one way to access the device.
So, how do I do this? I often think about Joy Zabala's SETT framework during my evaluations. SETT stands for Student (or Adult), Environments, Tasks, and Tools. Notice that most of these words end with a plural -s. We have to look at all of the environments where an individual may need to communicate. The tasks may look different than in a school environment, but are no less important. What do individuals need to communicate in the living room? Change the channel, turn up the volume, that play stunk, Go Pack Go (if you're from Wisconsin), when is dinner going to be ready, come here Scooby, and so many more. When my family is in the living room we are playing board games, talking about our day, my kids are fighting over who gets to sit by Mom or what to watching on TV. So much social language is communicated in the living room on the couch or in the recliner. But do the individual's you're working with have access to their communication system in this environment? If it's a multi-modal system, what do they need to have in place to communicate? Some individuals prefer to use speech because their family can understand them or maybe a low-tech communication board is more their style, while some may prefer to access their device-the important part is having the conversation and learning what is needed in the various environments! Have you thought about what communicative "Tasks" happen in the individual's bedroom? We're often discussing what to wear, some individuals have a television or gaming system in their room, with my children we are reading and discussing bedtime stories, talking about the day's events, and just think about all of the memorabilia that is in a bedroom. We often decorate rooms with trophies or medals, favorite sports teams, pictures from events, and items or figurines that have been handed down through generations. My 20 year old niece keeps jewelry and bath and body products on her dresser. Do the individuals that we are working with have access to the "Tools" they need to communicate about some of those things in their bedroom? I'm not just talking about vocabulary, although it's also important, can they physically access their communication device when they are laying in bed or playing with toys on the floor?
Hopefully this gets you thinking about seating and positioning in a more comprehensive way. If you're an individual who uses AAC or a parent or caregiver advocating for your child or the individual, please bring up communicating in various environments. Don't let access become a barrier to communication! If you're a Speech/Language Pathologist or other service provider, use the SETT framework during the evaluation so that we don't create a system that is limited and full of barriers!