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Quality Indicators forAssistive Technology Services as drafted in 1998 by The QIAT Consortium In the summer of 1998, a group of assistive technology specialists from across the country began discussions regarding the need for the development of quality indicators which can guide professionals in the development and provision of technology services for students with disabilities. Such indicators might be used to promote education gains for students with disabilities and serve as a guide for preservice education and program development. Subsequently, over two hundred assistive technology service providers and consumers met at the 1998 Closing the Gap Conference to take a first step toward considering the need for a common understanding and national alignment of assistive technology services in school settings. A focus of the conversation was the possible usefulness of a set of quality indicators which could guide school districts in the development and provision of assistive technology services which are aligned to federal, state and local mandates and promote widespread educational gains for students with disabilities. The Closing the Gap session provided a clear sense of the complexity of identifying quality indicators that could be useful across a wide variety of educational environments and service provision options. Feedback from that conversation clearly pointed to the need for the widespread participation of people with a variety of perspectives and experiences as providers or consumers of assistive technology services. The following is a summary of the initial work begun by the Consortium for Quality Indicators in Assistive Technology (QIAT). You are invited to comment on the concept and on specific quality indicators. We want to stress that this is a work in progress. There is much yet to be done with this project. It is the intention of the Consortium to solicit additional feedback, complete additional edits and present the document for field review.

Quality Indicators during Consideration of Student's Need for AT IEP Team has the knowledge and skills to make informed decisions A continuum of AT devices and services is explored. IEP Team uses good team process to make decisions. Decisions are made based on IEP/IFSP goals and objectives. Team decisions are made in compliance with federal and state statutes. Determination of need is based on data about student, environments, tasks Decisions and supporting data are documented. Illustrative Case for AT Consideration: Ron was in the fifth grade last year. He is a gifted student who also has learning disabilities. He has a great deal of trouble with visual figure/ground and visual tracking. Because of these disabilities, Ron reads at the second grade level. Ron has tried using a computer with a standard word processing program in his fifth grade class but it was not useful to him because he could not read well enough to tell if the words he was typing made any sense to him. His teachers and his family agreed that his visual perception problems are so great that it was almost as if he were blind when it comes to reading. This fall, Ron's IEP team met to consider his needs for specially designed instruction for the following school year. The team was using the new requirements of IDEA '97 for the first time so there were many changes from the previous year's IEP. When the team came to the "special considerations" section of the new IEP form the district had adopted, they were able to agree that Ron did not need behavioral supports, alternative language instruction, Braille, alternative communication, or transition planning services. When the team came to the place on the IEP form which asked whether assistive technology should be addressed in the IEP or whether it was "not a concern", some of the members of Ron's team were puzzled. Ron's mother and his sixth grade teacher asked someone to explain what assistive technology was. The resource room teacher was able to explain that assistive technology was "any item, piece of equipment or product system, whether acquired commercially off the shelf, modified or customized that is used to enhance, improve or maintain the functional capabilities of a child with a disability. She further explained that in Ron's case, common assistive technology tools were computers with a variety of supportive software and portable word processors. Once Ron's mother understood the words, she was excited about the possibilities for her son. She had seen a television show that demonstrated a computer which wrote down the words that the user said. She remembered thinking how wonderful a computer like that would be for Ron but she did not know that the school might be able to provide him with one. Some people on the team had heard about computers like the one Ron's mother had seen but no one was knowledgeable about them. Use of Quality Indicators in AT Consideration: The team discussion lasted for some time before the district representative remembered to provide a a copy of the district's quality indicators for consideration of assistive technology. She made copies for the others present at the meeting and they decided to look at the seven items to see if the list would help them determine a direction. The first quality indicator stated "The IEP team has the knowledge and skills to make informed assistive technology decisions". As soon as the team read this item on the list, members realized that they would need to learn more before they could make an informed decision. They agreed that they ought to contact someone who knew about voice input computers and find out what skills were needed to operate one. Item number two was "The continuum of assistive technology devices and services is explored (considered). Team members discussed this item and agreed that Ron's trial with a standard word processing program had been rather limited. The resource room teacher knew about several other software solutions that students with learning disabilities use but had never thought to let Ron try them. There were items on the quality indicators list list that the team felt they had accomplished. They were discussing assistive technology in relation to Ron's IEP goals. They felt that they had good data about Ron's abilities and difficulties and about the tasks and environments where he needed to write. The last three quality indicators were related to team decisions. They included the use of a decision making process, decisions made in compliance with statutes and documentation of decisions. Ron's team felt that they did not have enough data to make a decision at the IEP meeting but did not want to hold up development of the rest of Ron's IEP in order to gather the information they needed. Ron's resource room teacher knew that one of the assistive technology services listed in the law was the assessment of need for assistive technology. The team agreed to check the box on their IEP form which indicated that there was a "concern addressed in IEP." Rather than develop goals and a plan for Ron's assistive technology use, the team listed an extended assistive technology assessment as a related service in Ron's IEP. Ron's mother signed a permission to evaluate form right away so that the assessment could be conducted as soon as possible. The assessment question on the form stated, "Ron has visual perception difficulties which make it very difficult for him to read and to write. Are there accommodations or modifications which might help with this problem? Is there assistive technology which Ron might use in order to access and produce print materials?" Ron's team agreed to meet again in two months to review the results of the assessment. If at that time, assistive technology had been identified that was useful to Ron, it would be included in the IEP. Everyone agreed that the district's quality indicators had been a valuable tool in considering assistive technology for Ron. The team finished developing Ron's IEP in thirty minutes and each team member left with a clear understanding of the role they would play in future considerations of Ron's need for assistive technology.

 

Quality Indicators for AT Assessment AT assessments are conducted by a team of individuals who are knowledgeable about assistive technology devices and services and procedures to utilize in conducting assistive technology assessments. At least one individual conducting the AT assessment is competent and knowledgeable in the specific area of technology that they are assessing. Information gathered through the assessment addresses questions and areas of need targeted by the student's IEP team. The student, his/her teachers, and family/care givers and any other appropriate stake holders are actively involved in the assessment process. Communication between all team members, including the student, his/her family, and the student's teachers is on-going. AT assessment procedures are clearly outlined and follow school district and state guidelines for conducting assistive technology assessments. AT assessments are completed within acceptable time lines as identified by the student's IEP team.. AT assessments are conducted in the student's customary environment. The AT assessment results in recommendations for assistive technology devices and services which are feature based and based on the student's needs/abilities, environments, and tasks. Recommendations for AT devices and services are clearly documented in a report that is provided to the student's IEP team. Illustrative Care for AT Assessment: John's IEP team has requested an assistive technology assessment in the area of augmentative communication. They have determined that he does not have an efficient means of communicating with peers and adults within his environment. The IEP team would like for him to be able to use an augmentative communication device, but due to their limited experience in this area, they have requested assistance from the district's assistive technology team. The IEP team completed all of the necessary referral information and provided background information to the district team regarding John's abilities/needs, his environments, and the tasks within each of the environments. The IEP team was especially concerned about John's limited motor skills and how they would impact his ability to use an augmentative communication device. Due to limited time and a large number of referrals that were received by the district assessment team, they often sent a single person out to complete assessments. In this case they assigned a speech-language pathologist with experience in augmentative communication. However, this individual did not have experience in working with students like John who required a microswitch in order to effectively access an augmentative communication device. Use of Quality Indicators In AT Assessment: Reading the quality indicators, the speech language pathologist recognized that she did not have the necessary expertise about physical access to complete the assessment by herself. She reviewed the information presented by the IEP team and asked an occupational therapist to accompany her to John's school. They scheduled a day to come to John's school to conduct the assessment. Using the school district's Augmentative Communication Assessment Protocol, they completed the assessment which included observing John in several settings, talking with his mother and the staff that worked with him on daily basis and trying out several devices and access options. Because John was very cooperative and had some clear preferences during the process, they were able to make recommendations for an augmentative communication device. The recommendations included the type of device that was required as well as the most appropriate access technique (visual scanning via a microswitch) and symbol set. They also made recommendations for vocabulary selection and organization. The recommendations were provided to the IEP team in a written report.

Quality Indicators during AT Intervention Assessment/evaluation data is utilized in planning the intervention. AT intervention is directly related to the implementation of the IEP (including goals and objective, related services, and/or supplementary aids and services). AT intervention is integrated into curricular and environmental activities and occurs appropriately in multiple environments. Training for the student, family, and all staff is an integral part of the intervention. AT intervention proceeds according to a collaboratively developed plan and is provided by multiple implementers. Management and maintenance of the technology is part of the intervention. AT intervention involves on-going/dynamic assessment which is adjusted based on student performance data. Illustrative Case for AT Intervention: Sam is six year old boy with autism, included in a general education first grade with approximately one and a half hours of resource support daily. He also receives speech/language and occupational therapy services twice weekly. Sam has no oral speech and has recently acquired a powerful voice output communication aid (VOCA). Sam's IEP includes goals and objectives that integrate the use of the VOCA into various instructional activities. He also has a behavior management plan that includes communication behaviors involving the use of the VOCA to supplement other communication strategies and assist in decreasing acting-out behavior which has been determined to worsen when he is required to complete work tasks. Both the IEP and the behavior management plan were developed collaboratively by members of the IEP team and used to guide implementation of the IEP. The team felt it unnecessary to develop an additional action plan. Sam's general education teacher and classroom assistant were very concerned about his behavior and its effects on Sam's learning and that of the other children . They consistently used all of the strategies in the behavior management plan and were anxious to learn to use the VOCA. The SLP demonstrated the use of the device to them, but they were not able to implement the specific one- to-one instructional strategies she suggested in the classroom. They were unclear about what they were expected to do with the device and what they could expect Sam to do with it. They made sure that it was always available to him, but only requested that he use it to tell them what he needed when he displayed signs of agitation which generally predicted the onset of acting-out behavior. They asked for additional training with the device. Other team members had different ideas about the value of the VOCA. Sam's resource teacher did not have to use any of the strategies in the behavior management plan because neither she nor the other children in the classroom were bothered by Sam's acting-out behavior. The SLP used the VOCA in pull-out therapy sessions twice weekly. During that time, Sam was an active participant in language activities and used the VOCA with increasing independence. The occupational therapist did not use the VOCA at all. Progress reports sent home indicated erratic progress with both behavior and use of the communication aid at school. At home, Sam's parents attempted to work on the IEP by using both the strategies in the behavior management plan and the VOCA. They saw increases in the Sam's communication and decreases in acting-out behavior. They were puzzled by the reports from school and requested a meeting with school staff to review Sam's program. Use of the Quality Indicators for AT Intervention: Without a collaboratively developed action plan for integrating the communication aid (VOCA) and behavior management strategies into the activities which took place in Sam's customary instructional environments, interpretation of when and how implementation should take place was left to the individual interpretation of each staff member. Though the IEP included all required information, it lacked the specifies required for consistent implementation by various people across instructional environments In this illustration, the staff did not have a set of quality indicators from which to work. Failure to develop an action plan which identified tasks which occurred in Sam's natural instructional environments and specified instructional strategies, expectations, responsibilities and time lines resulted in the lack of several AT intervention quality indicators. Sam's communication and behavioral needs were not met.

Quality Indicators during Evaluation of the Effectiveness of AT Services Information is solicited from and analyzed by all involved stake holders, the user, parents, family and appropriate school personnel. Evaluation is oriented toward goals identified to increase participation, productivity and/or independence. Evaluators are capable of making objective decisions and empowered to do so. Regular evaluations are conducted across natural settings in an appropriate, cost effective manner. Growth towards accomplishing IEP goals is objectively documented through data collection regarding one or more of the following: quantity, speed, accuracy, frequency, or spontaneity of a targeted behavior. Data collection is an ongoing process and provides a means to perform data analysis in order to identify where modifications or revisions in the student's program need to occur. Data that supports recommendations for change is documented reported, and acted upon. Illustrative Care for Evaluation of Effectiveness: Samantha is a twelve year old girl with Osteogenisis Imperfecta (OI). She is very bright and is fully included in her sixth grade classroom. She has multiple physical deformities because her bones break very easily. She uses a power wheelchair and is unable to use her hands for writing tasks. A personal care assistant takes dictation for Samantha when she has written assignments. Any modification to Samantha's educational environment must take into account her safety. Samantha's IEP goals for the last three years have included her need to learn to operate a computer to do written work. While the district's assistive technology team has worked with her several times a year to identify an alternative way for her to operate the computer, they have never been successful at determining a solution to her specific needs. As a result, Samantha has had the same long term goal for computer use for all three years. Each year when the IEP team met, the staff assigned to Samantha's case reported that they were still working on a plan. The specific computer access goal on Samantha's IEP stated "Samantha will learn to operate a computer, using the school's word processing program to complete written assignments of up to 100 words." No assistive technology related services were listed on the IEP In this year's IEP team meeting, Samantha's parents were unwilling to accept this goal for the fourth time. They insisted that the district provide a computer for Samantha on a full time basis and asked that an independent contractor be hired to identify the alternative computer access that Samantha needed. The LEA representative for the district stated that the proposed IEP goal for Samantha was adequate and that the district did not have the funds to hire an outside consultant. Samantha's parents requested mediation in this disagreement and stated their intention to file a due process complaint. Use of the Quality Indicators in Evaluation of Effectiveness: Samantha's team did not have access to Quality Indicators for Evaluation of Effectiveness, nor did the district have a system in place to review effectiveness of annual goals and objectives before developing a new IEP. Because of this lack of criteria and process, the district became embroiled in an adversarial dispute which failed to serve the needs of either party. Samantha's needs for assistive technology were not addressed in any meaningful way and in the long run the district was required to expend many resources and much staff time to participate in the mediation and due process hearing that resulted A more proactive approach could have occurred if the team had quality indicators for evaluation of effectiveness to use to identify the places where the process was breaking down. Had this been done, the team might have decided to collect data on what had already been tried for Samantha, what specific writing tasks she needed to accomplish, what district resources had already been accessed, and what internal or external resources were needed. A more capable and responsive evaluation team might have been identified and data regarding Samantha's performance on options she had already tried might have been analyzed in order to identify and implement other potential solutions.

Conclusion The use of quality indicators is one way educators can have an external, objective measurement to use in assessing their own performance. It is also a tool which might be used in program improvement and capacity building. This tool can have a beneficial impact on the provision of assistive technology services for school districts, preservice education programs and others involved in the development of assistive technology services.