Issues In Assistive Technology: Use of "Experts"
Issues in Assistive Technology: Education
Issue: Use of "Experts"
Frequently assistive technology (AT) disagreements boil down to a battle of opinions; one side says device A is needed, the other side says device B or another alternative will meet the individuals needs. Typically one option is far more costly than the other; and the question remains, what is actually required?
In cases like this, the opinions of "experts" are usually significant in making a final determination. Obviously, it helps tremendously if you use the best expertise available to justify your position. In addition to the traditional questions regarding an expert's education and training, the following are more specific questions designed to help you decide if your experts are likely to project credibility when providing opinions on assistive technology issues.
How long has the expert been recommending this type of AT and how many devices of this type has the expert recommended in the last year?
Experts have more credibility when they have been in the field a few years and have recommended a number of devices within a general AT area. Beware of individuals who have recommended assistive technology for limited numbers of individuals in the last year. Remember that for many providers, such as physical therapists, occupational therapists, speech/language pathologists, special education teachers and rehabilitation counselors, AT is a very small part of their overall position or practice. Many of these providers have limited experience with AT and have very few cases for which they have recommended devices in the past. The experience of some experts will also be limited to individuals within a specific age range, disability type, etc. Such focused expertise can help your case if the individual falls within those limiting characteristics. However, if your case is the only adult the expert has ever evaluated, or the first person with cognitive disabilities for whom they have recommended a device, their opinion may be seriously questioned.
What is the expert's track record in device recommendations? Do the recommendations represent a variety of manufacturers and devices?
It is most advantageous for an expert to have a proven track record of recommending devices that were actually procured and used successfully over time. If the expert has cases in which they recommended devices that were not used successfully, you should anticipate those cases being used to question their credibility. Beware of experts who recommend the same device for many or most individuals. How can the expert address individual differences if he/she is recommending the same device for everyone? Were all of the individuals really that much alike? Recommending the same device over and over again will likely be used to imply a disregard for individual differences. It could also be argued that recommendation of the same device reflects limited knowledge of the full range of devices available. Look for experts who have current knowledge of the myriad of device options available, who have access to a variety of devices to use during their assessment process, and have a track record of recommending a variety of devices.
What assessment procedures did the expert use to arrive at the recommendation?
Beware of experts who use volumes of standardized testing data in areas such as cognition, visual acuity, auditory acuity, range of motion, fine and gross motor, receptive and expressive language, etc. as the basis for their device recommendation. While standardized testing in traditional areas may be helpful in AT assessments, it should not form the sole basis for a device recommendation. Best practice would include consideration of many other factors in the development of a device recommendation. These would include the environments in which the device is to be used, the expectations for the individual in those environments, the supports needed for device use, and individual preference in device use. The features of a variety of devices should be compared to these factors to ascertain which device(s) might meet the individuals needs.
- Did the person actually try the device recommended? For how long? What outcomes or behaviors were observed during the device usage?
By far the best procedure for determining if a device will work for an individual is actual use of the device, in a natural environment, to perform the activities desired. Careful documentation of the degree to which the device provides the desired outcomes provides almost irrefutable justification for the device recommendation. While some trial device usage data can be collected in a structured evaluation setting, typically the limited device usage time and the unnatural environment of a structured evaluation makes such trial data less than optimal. Trial usage of a loaned or rented device over a longer time period, such as a few weeks, in the environments of actual use, provides powerful data to support a device recommendation. An expert who is able to present "real-life" observations of the individual using the recommended device is far more persuasive than one who presents only a theoretical rationale for their recommendation.
- What standard is the expert using for their recommendation? Is it consistent with the legal standard in question?
Experts sometimes are not aware of the difference between their professional opinion as a medical, rehabilitation, or education provider and the legal standard in question. Many providers will recommend devices designed to maximize an individual's function which is appropriate based on the professional standard of "best" client services. However, such a recommendation may not be consistent with the legal standard applicable to the case. For example, a device that maximizes client function may not be consistent with the "appropriate" standard of IDEA, the "effective communication" standard of ADA, the "necessary for employment" standard of VR, the "medically necessary" standard of Medicaid, and so on. Make sure that your expert understands the legal standard upon which their device recommendation must be based.