Proposal for Think-and-Link Assessment Model

1. Proposal for Think-and-Link Assessment Model Comprehensive Overview of Requisite Email Skills (CORE)

2. Guiding Assumptions • Useful to build on existing theoretical frameworks available in AT & AAC literatures • Assessment process should capture information potentially relevant to: • determining how to maximize the likelihood of successful email use by user & partners; • measuring change resulting from email facilitation.

3. What is “Assistive Technology” (AT)? From 1998 Assistive Technology Act: “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 functional capabilities of individuals with disabilities” (Scherer, 2000, pg. 37)

4. What is “Augmentative/Alternative Communication” (AAC)? “Augmentative and alternative communication is an area of clinical practice that attempts to compensate (either temporarily or permanently) for the impairment and disability patterns of individuals with severe expressive communication disorders (i.e., the severely speech-language and writing impaired.”(ASHA, 1989, p. 107) “An AAC system is “an integrated group of components, including symbols, aids, strategies, and techniques used by individuals to enhance communication.”(ASHA, 1991, p. 10) Involves multiple modes of communication: Examples- gestures, eye gaze, alphabet or picture boards, communication books, speech generating devices

5. Models for Assessment & Outcomes Measurement:ATOM (AT) & Participation Model (AAC) ATOM (Assistive Technology Outcomes Measurement) • State-of-the-art model for assessing AT user needs across a broad range of domains/contexts • Integrates three major components, two of which stem from previous AT/AAC research (components 1 & 3) and the other from the WHO classification of disablement (component 2) Lambrou-Weiss, R. (2002). Satisfaction and comfort. In M. J. Scherer (Ed.), Assistive Technology: Matching Device and Consumer for Successful Rehabilitation (pp. 77-94). Washington, DC: APA.

6. ATOM Model 1) MPT (Matching Person to Technology) model: characteristics of a) person, b) milieu, and c) technology considered together; underscores importance of consumer experience and opinion as foundation for assessing AT outcomes (Scherer, 1997). 2) WHO International classification system: integration of a) activity (everyday activities; written communication via computer), b) participation (engagement in life situations/roles; social relationships with families/peers), and c) environment/context(physical, social, and attitudinal environment in which people live)(WHO, 2001) Note: “Impairment” has been left out, but we want to include this. 3) Outcomes: a) clinical results, b) functional status, c) quality of life, d) cost, e) satisfaction and f) comfort(DeRuyter, 1995)

7. Participation Model “Provides a systematic process for conducting AAC assessments and designing interventions based on functional participation requirements of nondisabled peers of the same chronological age as the potential AAC user”(Beukelman & Mirenda, 1992 edition, pg. 101). (See handout for diagram of Participation Model.) Includes assessment of opportunity barriers (imposed by persons other than the individual with the communication disorder; can’t be fixed by simply providing AAC system or intervention) and access barriers (present due to current user capabilities or his/her immediate support system)

8. What will we assess to determine “best fit”? What will our outcome measures be?How will we maximize outcomes? The next several slides highlight some potential answers to these questions, borrowing from the fields of AT & AAC. Themes include: • Social validity • Best practice assessment guidelines • Communication purposes • Communication patterns • Linguistic measures • Assessment variables to maximize outcomes

9. Social validity outcomes (AAC) Schlosser, R. W. (1999). Social validation of interventions in augmentative and alternative communication. AAC, 15, 234-246. AAC Social Validation Framework: • Who?: Stakeholders---direct, indirect, intermediate, extended community • What?: Goals validation--goal topography & levels; methods; outcomes • How?: subjective evaluation & social comparison Application: we will include e-mail buddies & careproviders as stakeholders; establish “who” & “what” before intervention (Light, 1999)

10. Communication Purposes (AAC) Light, J. (1988). Interaction involving individuals using augmentative and alternative communication systems: State of the art and future directions. AAC, 4, 66-82 • expression of wants/needs • information transfer • social closeness • social etiquette • discourse patterns ? (Togher, Hand, & Code, 1995) Application: study analyzing “sent mail” with CI and non CI users to develop potential code categories for analysis; observe trends between partners; relative proportion of each purpose etc.

11. Communication Interaction Patterns (AAC) Calculator, S. (1999). AAC outcomes for children and youths with severe disabilities: When seeing is believing. AAC, 15, 4-12. Example items: increased frequency and success of initiations, increased # of messages directed to partner, increased variety of partners “Variables to gauge impact of AAC for students with Severe Disabilities in Inclusive Classrooms”

12. Linguistic measures (AAC):Augmentative Communication Quantitative Analysis ACQUA • Used for analyzing multiple-field logfiles produced by AAC device • Windows-based package provides an intuitive graphical interface, facilitating rapid statistical analysis of logfiles. • ACQUA Features: (Ex. # words in a message; # of characters generated but deleted; time units to produce message) Windows version only--can be downloaded at: www.enkidu.net/downloads/ACQUA_Setup.exe. General information: www.enkidu.net/acqua.html.

13. Linguistic Measures (AAC):Hill, K. & Romich, B. (2000). AAC best practice using automated language activity monitoring. Paper presented at the Biennial Conference of the International Society of Augmentative and Altnerative Communication. Language Activity Monitor (LAM) • Monitor the language activity of individuals with communication disabilities who use alternative and augmentative communication devices. • Collection and analysis of language samples and records content and a time code for each language event • Information transferred to a computer and analyzed for text generation methods, communication rates, and other language parameters. • Software & hardware available Manufacturer's Website http://www.prentrom.com

14. 9 CORE Assessment Products • Milieu Domain Sheet • Impairment Domain Sheet • Practice Sheet • Careprovider Training Plan • Environmental Plan • Expectations Sheet • Email Buddy List • Technology Fit Sheet • Field Note Interest Sheet

15. Milieu Domain Sheet Catalogue of environmental and support variables that potentially a person’s ability to use email. The protocol provides person generated examples (“constructs”) of milieu obstacles and their relative level of impediment as well as opportunity resources.

16. Impairment Domain Sheet Catalogue of impairment areas that potentially affect a person’s ability to use email. The protocol provides person generated examples (“constructs”) of impairments and their relative level of disruption.

17. Practice Sheet Lists specific skills related to the ability to use email that are important for the user to learn. The skills are listed in the sequence which they should be mastered. Each skill has an associated practice plan and criterion.

18. Careprovider Training Plan Lists specific skills and activities critical for helping the careprovider to assist the user. The skills are listed in a sequence of importance and each has an associated implementation plan and criterion.

19. Environmental Plan Lists any modifications or needs specific to arranging or organizing user’s physical space.

20. Expectations Sheet Lists goals and/or expecations that users, careproviders and partners have related to the user implementing email. This protocol will use a goal attainment scaling format.

21. Email Buddy List Lists contact and email information relative to potential email buddies.

22. Technology Fit Sheet Details interface/software features and hardware adaptations that would be important for an individual user. It also describes the installation plan.

23. Field Note Interest Sheet Summarizes any areas revealed through the assessment process that we are interested in tracking.

24. 9 CORE Assessment Products • Milieu Domain Sheet • Impairment Domain Sheet • Practice Sheet • Careprovider Training Plan • Environmental Plan • Expectations Sheet • Email Buddy List • Technology Fit Sheet • Field Note Interest Sheet

25. PROPOSED CORE PROCESS • Personal History/Demographics (via phone or mail) • Milieu Domain (Structured Interview;Direct Observation) • Impairment Domain (Structured Interview; Direct Observation) • Task Domain (Direct Observation at computer station) (Two 1 ½ hour session with examiner)

26. PROPOSED CORE PROCESS • Community Domain (Direct Observation & Structured Interview over time) • Supplementary Testing (completed during the initial two weeks following scheduled session with the examiner)

27. Personal History / Demographics Initial information is solicited via in person, mail and/or phone contact using Computer User Profile w/supplementary questions.

28. Milieu DomainStructured Interview & Direct Observation Structured interview (and direct observation in the community as described below will be used to generate milieu constructs and identify opportunity barriers and resources. Responses will contribute to the development of: 1) Initial Careprovider Training Plan, 2) Technology Fit Sheet, 3) Field Note Interest Sheet, 4) Environmental Plan, and 5) Expectations Sheet

29. Impairment DomainStructured Interview & Direct Observation Structured interview (and direct observation on tasks described below) is used to generate impairment constructs and identify access barriers. Responses to interview & will contribute to the development of: 1) Initial Practice Sheet, 2) Technology Fit Sheet, 3) Field Note Interest Sheet, and 4) Environmental Plan

30. Task DomainDirect Observation Series of discrete, standardized email tasks requiring user to manage inbox, compose and send email. Tasks are set up to evaluate declarative knowledge, motoric execution, procedural learning, and response to prompting. Performance will contribute to the completion of the Impairment Domain and the development of: 1) Initial Practice Sheet, 2) Technology Fit Sheet, 3) Field Note Interest Sheet, and 4) Environmental Plan

31. Community DomainDirect Observation & Structured Interview Users/careproviders will be observed and interviewed in natural settings three times over the course of one week. The responses will contribute to the completion of the Impairment and Milieu Domains as well as the development of: 1) Weekly Activity Log, 2) Weekly Social Communication Log, 3) Technology Fit Sheet, 4) Field Note Interest Sheet, and 5) Environmental Plan

32. Supplementary Testing Standardized Assessments Supplementary cognitive and psychosocial assessment will occur as indicated by the Impairment and Milieu Domains.

33. PROPOSED CORE PROCESS • Personal History/Demographics • Milieu Domain • Impairment Domain • Task Domain • Community Domain • Supplementary Testing

34. Background Theory forImpairment & Milieu Domains • QOL is uniquely personal and subjective by nature making it difficult to use standardized instruments (Joyce, O’Boyle, & McGee, 1999) • No gold standard—one method is to have individuals “nominate” items of importance but may sacrifice internal validity/psychometric base

35. QOLAS Process Modified Step 1: Rapport Building Step 2: Users invited to talk about a number of areas that are affected by having a brain injury. Main topic domain (e.g., physical issues) is raised and subtopics are mentioned to prompt responding Step 3: A construct (user example) is elicited for all identified impairment area

36. QOLAS Process ModifiedScoring • The users rates how much of a problem each construct is now [0=no problem; 1=very slight; 2=mild problem; 3=moderate problem; 4=big problem; 5=it could not be worse] • Scores are summed to yield construct scores out of 20 for Impairment Domain and out of 15 for Milieu Domain. Totals for each are summed

37. QOLAS Process ModifiedSerial Measurement • Follow up interviews are conducted • Users are read their individual constructs out loud • They re-rate each on the 0-5 scale for how much of a problem there is with each “now”.

38. QOLAS(Quality of Life Assessment Schedule) (Selai et al, 2001) • Developed to assess QOL in patients with neuropsychological disorders • QOL is in part of function of levels of expectation (discrepancy between current life and expectations drives QOL) • QOL is also a comparative phenomenon - people compare their situation to others

39. Starter List of Outcome Measures • Repeated CORE • User email behavior (who, when, content, and nature of support) • Partner email behavior (who, when, content) • Satisfaction ratings by user, careprovider, and partners • Computer Data???? • Field Note Info (time till comfortable, maintenance, training needs, etc.)