assistive technology - beyond boundaries:therapy...

Assistive Technology

Overview and Process: A Provider’s Perspective

www.pcghumanservices.com

Overview: Definitions & Abbreviations:• Assistive technology (AT) is defined as any item, piece of equipment, or product,

whether acquired commercially, off the shelf, modified, or customized, that is used to

increase, maintain, or improve the functional capabilities of individuals with disabilities.

(P.L. 101-407, The Technology Related Assistance Act of 1988).

• An Assistive technology device (ATD) means any item, piece of equipment, or

product system, whether acquired commercially off the shelf, modified, or customized,

that is used to increase, maintain, or improve the functional capabilities of children

with disabilities. (10 NYCRR §69-4.1 (I) (2)(i)).

• Assistive Technology Service is a service that directly assists a child with a disability

in the selection, acquisition or use of an assistive technology device. E.g. installing,

customizing or adapting equipment; assisting children benefiting from these devices,

and training of parents and other caregivers (including child care providers) in using

assistive technology devices to improve children's functional capabilities.

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Definitions & Abbreviations Continued:

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• Assistive Technology Coordinator (ATC) a member of the SFA charged with

managing the AT process from service authorization to final payment.

• Assistive Technology Device (ATD) Vendor is a contracted provider of Assistive

Technology Device

• Municipality a county outside of the City of New York, or the City of New York in the

case of a county contained within the city of New York. Municipality, here, also means

the Municipality in which the Vendor renders evaluations, service coordination or

early intervention services to children residing in such Municipality.

• Purchase Authorization is the authorization given by the ATC to the vendor once

the service authorization has been issued.

• Service Authorization is the approval granted by the municipality as evidenced on

the Individual Family Service Plan (IFSP) that authorizes the assigned provider of

record to deliver a specific service.

• SFA is the State Fiscal Agent

Overview: Types of AT

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High technology (high tech) and low technology (low or light tech) are

general terms that are used by researchers and educators.

High technology usually refers to complex electrical and

electronic devices and augmentative communication systems.

Low technology refers to more simple devices, supports,

systems, and adaptations such as custom-designed hand tools,

positioning devices, and other simple, inexpensive, easy-to-use

devices (Galvin & Scherer, 1996).

Overview:

Recommended Practices

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Recommended practice on Assistive Technology focuses on multiple

outcomes, which include, but are not limited to:

• enhancing development and functional abilities within the

context of everyday routines

• increasing independence and access

• enhancing individualized child and family interaction/instruction

• supporting professionals and families to ensure successful use of

technology

• increasing family and professional access to information and

networking.

- The Division for Early Childhood (DEC)

Overview: AT Considerations

Technology applications should be considered to enhance child development

and access to natural learning opportunities across the following areas

(Lesar, 1998):

• Motor, Cognitive/perceptual, Communication/language, Social interactions,

Adaptive, Daily life skills and Play

Cultural and family preferences must be incorporated into decision making

about assessment, funding, implementation, and evaluation processes

related to assistive technology services.

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Consideration must be given to settings in which the child will need to

access and use the device.

Consideration must be given to the potential for interaction with other

devices of systems

Overview: AT Considerations

Considerations for the use of low technology applications should be equal

to high technology applications. Both technologies have the potential to

assist infants, toddlers, and young children to be successful in natural

environments, typical settings, and in the general education curriculum.

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“Technology applications can be important vehicles to improve teaching

and learning for children, families, and professionals”. – The Division for Early Childhood (DEC).

It is important to emphasize that technology is only a tool, not a solution.

Decisions for selection of AT should not be made based on the funding

source

Best Practices:

Use of AT in Early Intervention

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Professionals match assistive technology tools/devices to intervention and

instructional objectives and evaluate to determine the effectiveness of the specific

assistive technology tool/device.

Devices should be used to enhance the child’s current development and functioning

within the context of daily routines, addressing immediate needs and the

appropriateness of the equipment in attaining desired child and family outcomes.

Programs and professionals should consider the family’s daily routines and least

intrusive yet effective low-tech devices in discussing ATD options with families.

Families and professionals should collaborate in planning and implementing the use

of assistive technology.

Best Practices: General AT

Considerations

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Addressing Child Outcomes: Listed child outcomes on the IFSP should reflect the child’s

ability to participate and learn within activities and routines. When creating outcomes, the

team should consider how AT could help the child do these things. Once the child’s

outcome(s) have been determined, the team should discuss how AT might help the child

achieve these goal(s). Assistive technology should support the outcomes on the IFSP,

it should not be its own separate outcome.

Assistive Technology Devices: The definition of AT devices leaves room for the team to

decide the specific device the child will use. Devices may include high tech equipment as

well as low tech, homemade solutions. When providers are interacting with the family

in their natural environment they should make observations about items already in

the home that could be adapted to serve the same purpose as the ATD.

General Considerations (continued…)

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Device trials: The child should be allowed to try different devices (ideally,

borrowed through a lending library) within their daily activities and routines. The

team should observe the child during these activities/routines to see what works

and what doesn’t. If a device does not help the child participate and learn it should

be returned to the lending library and a new device should be tried. Repeat this

process until an appropriate device is found.

Where/When: The team should specify where and when the device will be used

(even if the answer is everywhere). Keep these answers in mind when selecting a

device for the child.

- National Dissemination Center for Children with Disabilities (2013)

Overview: IDEA and State Requirements

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IDEA Requirement Including discussions of AT into the IFSP

process & document

A statement of the present levels of

development; initial and child’s annual

evaluation

If the child already uses AT to assist with any developmental area,

include descriptions here (e.g. communicates words and phrases

using a picture exchange system)

A statement of the family‘s resources If the child uses AT, talk with the family about how they obtained

the devices and any training they received or are receiving. List

these as resources

A statement of the family’s priorities and

concerns

Ask about AT as it relates to the family’s priorities and concerns. If

the child is already using AT, ask how it plays a role in their daily

routines

A statement of measurable outcomes

expected to be achieved for the child and

family

AT is not the outcome itself but is a way of helping a child/ family

achieve an outcome (e.g., _______ will participate during meal or

snack preparation by using a switch to turn on the blender or

toaster)

A statement of specific EI services

necessary to meet the unique needs of the

child and family

Often, PTs, OTs, SLPs, or EIs are providing or utilizing AT

services. Include a discussion of how AT is being used in

conjunction with their service(s).

Early Intervention Memorandum

99-1: Assistive Technology

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In determining whether an assistive technology device should be

provided, it is important to consider whether the device is needed to

increase, maintain, or improve the child's functional abilities due to a

chronic condition affecting the child's development and resulting from a

diagnosis with a high probability of developmental delay; or, significant

and continuing developmental delay, as specified at 10 NYCRR Section

69-4.1

All devices loaned through TRAID Centers must be returned to TRAID

Centers according to the terms of the loan. If the assistive technology

device has not been loaned, leased, or rented, the assistive technology

device is the property of the child and family, and the family may choose

to keep the device when moving or transitioning out of the Early

Intervention Program. However, early intervention officials should

encourage families to donate devices to the Regional TRAID Centers

when the items are no longer needed or being used by the child and

family, or the child outgrows the device.

Overview: Guidance from Memorandum 99-1 Items considered EI ATD include:

• Devices to increase, maintain, or improve self-help skills and functional abilities related

to daily living activities and routines. Examples include adapted feeding utensils and devices

that assist with seating and positioning, such as side lyers and prone standers, and insertions

and adaptations necessary to correctly position or support an infant or toddler in a seating

position.

• Devices to increase, maintain, or improve functional mobility. Examples include orthotics,

prosthetics, scooter boards, walkers, therapeutic strollers and wheel chairs.

• Vision and hearing devices for children with diagnosed visual impairments and hearing

impairments. Examples include eyeglasses, external contact lenses, and magnifiers for

children with diagnosed visual impairments; and assistive listening devices, such as hearing

aids or other forms of amplification, for a child with a diagnosed hearing impairment.

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Overview: Guidance from Memorandum 99-1 Items considered EI ATD include:

• Devices to increase, maintain, or improve communication skills and development,

consistent with expectations for age-appropriate development. Examples include

communication boards, augmentative and alternative communication aids, and more complex

communication systems

• Devices to increase, maintain, or improve cognitive development. Examples include

adapted toys, switches, and necessary connections to toys to enable an infant or toddler with

disabilities to become more independent in their interactions with the physical environment

(e.g., adapted toys with auditory signals for infants and toddlers with visual impairments).

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Overview: Guidance from Memorandum 99-1 Items not considered EI ATD include:

• Equipment or medical supplies solely related to a medical condition or chronic illness

unrelated to the child's disability and developmental status, or that are life-sustaining in

nature. Examples include feeding pumps, nebulizers, ventilators, etc…

• Toys that are not adapted. Examples include items such as building blocks, puzzles, and other

common play materials that are used by all children and are not specifically designed or

adapted to increase, maintain, or improve the functional capabilities of children with disabilities.

• Generic items typically needed by all children. Common child items such as car seats, high

chairs, youth beds, play tables, bath seats, infant swings, or potty chairs, which are typically

needed by all children are not considered reimbursable assistive technology devices.

• Standard equipment used in the provision of early intervention services (regardless of

the service delivery setting). Examples include tables, desks, chairs, therapy mats, tumble

forms, therapy balls, vestibular swings, gait ladders, etc. The cost of these types of supplies is

included in the prices established by the department for early intervention services.

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Process: At a Glance

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ATD is not placed

on the IFSP

ATD is placed in the IFSP and the SC

incorporates updates in the child’s record

at various points along the way

Is it feasible for SC/therapist to obtain

ATD on loan through municipality or

Technology Related Assistance for

Individuals with Disabilities (TRAID)

Center

The SC/therapist assists the family to

obtain services

Will the ATD be used to increase, maintain, or

improve the functional capabilities of children

with disabilities?

YESNO

YES

NO

The ATD vendor receives a purchase

authorization from the ATC and places the order

or fabricates the device.

ATD vendor will collaborate with therapist

and/or child/family for selection/measurements;

revise bid if necessary

ATC obtains competitive pricing, location,

availability and delivery timelines, selects the

ATD vendor & communicates that information to

the Municipality

Forward request with the physician’s orders

and medical necessity form to the PCG

Assistive Technology Coordinator (ATC)

The request/need for ATD is discussed during

the IFSP meeting within the context of present

level of development, goals, priorities, concerns

and outcomes.

Assistive Technology Device

(ATD) Process

B

AThe need for an ATD is

identified during the IFSP

meeting

Service coordinator (SC)

receives the request for

the ATD

Process: At a Glance, continued

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The ATC will forward delivery confirmation to the

Municipality for inclusion in the child’s record

Concerns regarding the quality of the device or

services should be directed to the

SC/Municipality who will communicate the

concerns to the ATC.

Routine adjustments or questions should be

directed to the ATD Vendor by the family in

consultation with the treating therapist.

During the next visit, the SC should discuss

with the family any questions or concerns

regarding the device

Assistive Technology Device

(ATD) Process

B

During the next visit, the treating therapist

should discuss with the family any questions or

concerns regarding the device and that the

device is providing the desired benefit for the

child.

The ATD Vendor and treating therapist will

collaborate and coordinate on the delivery date.

Municipality receives a copy of the purchase

authorization & delivery/dispensing

information for inclusion in child’s record. The

SC will notify parent/treating therapist of

estimated delivery/dispensing date

Process: A Narrative

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An assistive technology device (ATD) is requested for a child

The service coordinator receives the request for the ATD or the need is

identified or discussed at an IFSP meeting. The therapeutic need, goals and

outcomes are discussed at the IFSP meeting (initial, six months review or

amendment)

If the IFSP team agrees the device will assist the child in achieving his/her

goal(s) and if the device is allowable by policy, the ATD is placed on the IFSP

and the service authorization is entered in the New York Early Intervention

System (NYEIS) or KIDS by the SC/EIO(D) (vendor or source of the device to

be determined at a later time).

If the Team determines an AT evaluation is needed, the evaluation will be

authorized as a part of the IFSP.

Process: A Narrative (continued…)

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The service coordinator/EIO/treating therapist will attempt to obtain the device

from the municipality/county loan closet where available and/or the regional

Technology Related Assistance for Individual with Disabilities (TRAID) Center.

• If the short term loan available through TRAID Centers does not meet

the child’s long term need, the SC will pursue the municipal request

process simultaneously.

If the device is available through a loan program, the service

coordinator/EIO/treating therapist will communicate with the family how and

where to obtain the device and assist the family in obtaining the device.

If the treating therapist coordinated the acquisition of a device from the

TRAID Center, he/she will communicate the information to the SC/EIO


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If the device is not available or not feasible to obtain by loan, the service

coordinator will forward the request, including the physician’s orders,

Medical Necessity Justification form (completed by the treating

therapist) and therapist’s most recent service log to the municipality for

approval. Once approved, the municipality will forward all the information to

the PCG Assistive Technology Coordinator (ATC) by secure e-mail

([email protected]) or secure fax (1-518-935-9258). Any third party

payer authorization will be obtained by the selected vendor in collaboration

with the ATC. In the event, the ATC is unavailable, a member of the PCG

Customer Service Support team will process the request.

Within two working days of receipt of request, the ATC will seek competitive

pricing information when needed from vendors having agreements with the

State. The process of locating a suitable ATD Vendor, obtaining pricing and

availability of device could take one to two weeks.


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The ATC will select the ATD Vendor with the technical expertise, best pricing,

delivery terms, insurance in-network status, and convenience for the family

and communicate the selection, via secure method, to the municipality

(EIO(D))/service coordinator for inclusion in the child’s record where needed.

The ATD Vendor will collaborate with the treating therapist and child/family to

determine the best AT device, accessories and to obtain measurements or

castings. A revised bid may need to be submitted after collaboration.

The selected ATD Vendor will receive a purchase authorization from the ATC

containing the specifications of the device, demographic information and

insurance information for the child. The ATD Vendor will obtain any required

third party liability authorizations. The ATD Vendor will place the order for or

fabricate the device.


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The ATC will forward to the municipality/SC a copy of the purchase

authorization and delivery or dispensing timeline information to the

municipality/SC for inclusion in the child’s record. The service coordinator will

notify the parent and the treating therapist of the estimated delivery date of

the device.

The ATC will monitor the transaction until delivery to the child as evidenced

by the vendor’s delivery confirmation signed by the parent/guardian or

designee and will update the service coordinator/municipality of any

anticipated delays and will communicate with the municipality regarding the

delivery schedule and any questions or concerns.


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The AT Vendor will collaborate with the authorized treating therapist

regarding delivery scheduling when appropriate or necessary depending on

the nature of the device. When needed, the treating therapist should be

present when the device is delivered to the child/family to ensure the device

is still appropriate and the family is adequately instructed on the operation of

the device. The treating therapist will complete the Notification of Item

Delivery, Condition and Status form and forward to the service

coordinator/municipality if needed. The municipality will send the form to the

ATC.

The ATC will forward delivery confirmation to the EIO(D)/service coordinator

for inclusion in the child’s record where needed.

During the next visit/service session, the service coordinator and treating

therapist should discuss with the family the receipt of the device and any

questions or concerns the family may have.


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During the next visit/service session, the treating therapist should discuss

with the family any questions or concerns regarding the device and that the

device is providing the desired benefit for the child.

Routine adjustments or questions regarding the function of the device should

be directed to the ATD Vendor by the parent after consultation with the

treating therapist. Many times the therapist can assist the parent.

Parent or therapist concerns regarding the quality of the device or service

should be directed to the service coordinator/municipality who in turn will

communicate the concerns to the ATC via secure email/fax. The ATC will

address those concerns with the ATD vendor.

Recording ATD in KIDS-EIOs/SCs only

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• For children enrolled in KIDS, ATD Service Authorizations (SA) will be

created in KIDS

• Municipalities and, perhaps, Service Coordinators have access to add

the SA

• Begin from the EI Authorization Screen

(Main Menu>EarlyInt.>Service)

• Select “Add” from the Options menu

to enter the Provider Selection


(continued…)

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• Select “GoTo STATE FISCAL AGENT” from the Provider option menu to

bring up the State Fiscal Agent provider


(continued…)

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• Select “Select and Exit” from the option menu to select the State Fiscal

Agent.


(continued…)

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• The Category will default to “I” for Assistive Tech Device and the Max Est.

cost will default to 0.01. These values cannot be changed for this

provider/service combination. Enter the remainder of the authorization, then

select “OK” to save and generate the Service Authorization.


(continued…)

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• Please note that you may not select a different provider for ATD or choose a

different Category for provider State Fiscal Agent. Otherwise, you may

Edit/Update as usual.

Recording ATD in NYEIS-EIOs/SCs only

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• For children enrolled in NYEIS, ATD Service Authorizations (SA) will be

created in NYEIS

• Municipalities and, perhaps, Service Coordinators have access to add

the SA

• Select the Category “ATD”


(continued…)

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• Search for and Select the Vendor record “State Fiscal Agent (SFA)”

• Note: This Vendor record has already been added to NYEIS so please do

not register


(continued…)

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(continued…)

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• The following data must be entered in the Create AT Device SA page for the information to be transmitted to PCG• For ATD authorized on or after December 1, January 1

or February 1 (depending on your region)- Dates should reflect actual effective start and end date of the IFSP/SA

• Do not enter a DME code

• Quantity must be “1” (even if multiple devices approved)

• Enter the following text in the Non-DME Device and Non-DME Description Fields: “Request sent to SFA”

• The Authorized up to Amount should equal “$.01”

• Then select Create Service Authorization

Recording ATD in KIDS/NYEIS-EIOs/SCs

only (continued…)

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• For new ATD SAs created in NYEIS on or after December 1st, January 1st or

February 1st depending on your region, the ATD SA data will be transmitted

to the SFA during the weekly transfer, and must include SFA as vendor.

• If an ATD SA with an December 1st, January 1st or February 1st or after start

date has any vendor other than State Fiscal Agent, then the municipality will

need to correct the ATD SA.

• There should be no ATD claims entered into KIDS or NYEIS for these

ATD SAs by the vendor or municipality.

• If a claim for ATD is entered in KIDS or NYEIS for ATD SAs with a start

date on or after December 1st, January 1st or February 1s, the

municipality must void the claim.

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Assistive Technology Medical Necessity

Justification Form, Page 1

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Justification Form, Page 1, cont.

37



38



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Name, EI#, DOB—ensure all information is correct and agrees with

NYEIS/KIDS

Indicate the service type and service location

Indicate the child’s diagnosed medical and/or developmental condition.

ICD-9 codes are required to correspond to diagnosed condition.

Provide the name & credentials of the current rendering therapist

completing this form and recommending the device.

1. Complete the information pertaining to contact with the TRAID Center

and/or Municipality Lending Closet

2. Indicate the ATD requested for the child (to the best of the therapist’s

ability)

2a. List any accessory needed for the requested device. Justify why each

accessory is required to support the attainment of IFSP functional

outcomes. If the therapist is unsure of the specific item(s) needed, the

therapist should describe the child’s functional capabilities and what the

therapist believes needs to be supported or enhanced.

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3. The requested ATD should facilitate the attainment of the IFSP

functional outcomes included in the child’s and family’s IFSP

4. Document how the requested assistive technology category meets the

child’s current and specific developmental needs, functional abilities, and

family priorities.

5. Document all confirmed & prospective contraindications for use of the

selected device & how the child’s medical conditions & developmental

status will affect how the device is used and/or how often it is used.

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6. The rendering provider is required to assess and document how the

ATD category will be used within the context of the family’s natural routines

and with respect for the family’s cultural, physical and social environments

(include the settings where the device will be used, the routine activities

and the frequency with which the device will be used). Indicate how any

safety concerns will be addressed

7. The rendering provider must document the process by which the device

range or level was chosen and why a lower technology device wasn’t

chosen.

8. The rendering provider must document any other ATDs the child us

currently using and how the requested device will be used in conjunction

with any existing device(s).

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9. Describe collaboration with other Individual Rendering Providers.

Document what was discussed regarding the child’s use of the device, the

family’s routine activities in which the device will be used, the child’s

functional abilities and skills that the device category is intended to support.

10. List the parents/caregivers that will be trained on the requested device

List all the areas that the training will cover, including precautions to ensure

the safe and effective use of the device.

The parent/caregiver and the Individual Rendering Provider are both

required to sign the form. Include the Individual Rendering Provider’s

license# and direct contact information, such as a cellular phone number.

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Assistive Technology Notification of Item

Delivery, Condition & Status, Page 1

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Delivery, Condition & Status, Page 1, cont.

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Delivery, Condition & Status, Page 1

Name, EI#, DOB—ensure all information is correct and agrees with

NYEIS/KIDS

Print the name, discipline and provider agency of the Individual Rendering

Provider who is completing the form.

Indicate if the device was delivered by an ATD vendor or Hearing

Aid/Vision Dispensary.

Provide the category and full brand name and model of the device

received.

Complete with the date the device was received.

Purchased items must be provided new from vendor. Reconditioned or

refurbished used items are not acceptable.

Section B: Check as many issues as apply

Provide a full explanation for any issue(s) indicated.

The parent/caregiver and the Individual Rendering Provider are required to

date & sign the form.

Process: When to revisit the Need for AT

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Formal times to revisit AT

Plans:

• During the initial IFSP development & the writing of the first IFSP document

• At the 6 month review or the Annual Review

• At any other time where the IFSP is reviewed and amended

Other times to revisit AT

Plans:

• When the team or team members are reviewing the child’s progress

• When child and family routines or activities change

• As the child grows and develops

Resources: Extend your learning

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• Galvin, J. C. & Scherer, M. J. (1996). Evaluating, selecting, and using appropriate

assistive technology. Gaithersburg, MD: Aspen Publishers.

• Individuals with Disabilities Education Act of 1990, Public Law 101-476. (October

30, 1990), Title 20, U.S.C. 1400 et seq.: U.S. Statutes at Large, 104,1103-115.

• Individuals with Disabilities Education Act, Amendments of 1997, Public Law 105-

17. U.S.C. 1401. Available: http://www.ed.gov/offices/OSERS/IDEA/the_law.html

• Lesar, S. (1998). Use of assistive technology with young children with disabilities:

Current status and training needs. Journal of Early Intervention 21, 146-159.

• Division for Early Childhood. (2014) Retrieved from http://www.dec-

sped.org/About_DEC/Recommended_Practices

• Using assistive technology.

Research shows that using assistive technology can help young children with

disabilities learn valuable skills. Find out more about AT for infants and toddlers at

the link below.

www.pacer.org/publications/pdfs/ALL7.pdf

• National Dissemination Center for Children with Disabilities (2014). Retrieved from

http://nichcy.org/babies/effectivepractices#AT

http://www.ed.gov/offices/OSERS/IDEA/the_law.html

http://www.dec-sped.org/About_DEC/Recommended_Practices

http://www.pacer.org/publications/pdfs/ALL7.pdf

http://nichcy.org/babies/effectivepractices#AT

Questions?

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Contact Sheet

Sherree Sinclair

Assistive Technology Coordinator

[email protected]

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mailto:[email protected]

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Public Consulting Group, Inc.

148 State Street, Tenth Floor, Boston, Massachusetts 02109

(617) 426-2026, www.publicconsultinggroup.com

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