Augmentative and Alternative Communication (aac) Assessment for Philadelphia ids consumers



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Augmentative and Alternative Communication (AAC) Assessment
for Philadelphia IDS Consumers


The Institute on Disabilities at Temple University is available to conduct Augmentative and Alternative Communication (AAC) assessments, using qualified, licensed speech-language pathologists (SLPs). Assessments may be completed for individuals with disabilities and communication needs who are served by Philadelphia IDS.

Please note: This service is only available to Philadelphia IDS consumers aged 21+

As a result of this service, recommendations will be provided to individuals with disabilities, their families, and other team members. Recommendations may include:



  • Strategies to increase opportunities for communication and increase the likelihood of successful communication

  • Supports for the implementation of AAC strategies

  • Ways in which AAC may help establish functional communication

(including, but not limited to, speech-generating devices)

  • Identification of related assistive technologies (e.g. for telephone communication)

  • Assistance with acquiring AAC devices or other assistive technology devices and services.

To submit your request for Augmentative and Alternative Communication (AAC) assessment Complete and return this form (along with relevant ISP pages) using fax, regular mail or via an encrypted email/file sharing, such as https://tusafesend.temple.edu/



Kathryn Helland, MS, CCC-SLP
Augmentative Communication Services Coordinator

Encrypted: https://tusafesend.temple.edu/ Email: augcom@temple.edu


Fax: 215-204-6336 (Attn: Kathryn Helland)

Institute on Disabilities at Temple University


Attn: Kathryn Helland /1755 N 13th St, Student Center, Rm 411 S / Philadelphia, PA 19122


Please contact your agency’s Communication Champion or Kathryn Helland by e-mail (augcom@temple.edu) or phone (215-204-3032) if you have questions about this process.

AUGMENTATIVE AND ALTERNATIVE COMMUNICATION
EVALUATION REQUEST


Philadelphia County IDS Consumers ONLY

General Information


Consumer’s Name

Today’s date







Birthdate:

Gender

Language(s) Spoken



 Male  Female




Street Address

Telephone







City, State, Zip




Email




Type of Residence  Family Home  Community Living Arrangement  Other________________

Residential Agency

Contact’s Phone




Residential Contact

Contact’s Email




Supports Coordinator (SC)

SCO’s Phone




SCO/Agency

SCO’s Email







*All scheduling will be done through the SC. Please star the best way to reach the SC.

Present Vocational or Day Program Setting


Work/Day Program Agency

Contact Person







Street Address

Contact’s Phone







City, State, Zip




Contact’s Email










Activities/Duties

Hours attended







Please attach a copy of all relevant pages of the ISP. ~ Include Plan Summary, Individual Preference (Know & Do), Behavioral Support Plan (if applicable), and Functional Information (Communication, Understanding Communication), etc.

Referral made by

Relationship to consumer







Reason for referral




Please check any that apply:

 Recent change in communication status

 Family or advocate request

 Needs updated evaluation

 Change in behavioral profile

 Recent transition

 Past history of device use (no longer used/ working)

Additional relevant information






Medical Information


Medical Diagnosis/es

Speech Diagnosis/es







Date of last Vision test/screen

Results







Date of last Hearing test/screen

Results






Communication Information


Estimate the frequency of each communication method used
along with how frequent any prompts/cues are needed with it.
Please enter R (Regularly), S (Sometimes) or N (Never)

COMPREHENSION

Frequency

Prompts/Cues Needed

Frequency

Responds to speakers







Understands what is said to him/her







Follows routine, 1-step directions







Follows simple, multi-step directions










Please enter R (Regularly), S (Sometimes) or N (Never) then describe.

Expression

Frequency with Familiar Listeners

Frequency with Unfamiliar Listeners

How?/What?

(Please describe)






Makes needs and wants known










Initiates communication










Speaks in words, phrases or sentences







How many words?

Speech is easily understood
(if applicable










Writes or types










Uses gestures to communicate










Uses facial expressions, body language or other behaviors










Uses a communication board/book










Uses speech-generating /communication device







What?

Client can recognize (check all that apply):  objects  photos  pictures  line drawings

Make choices between  2 items  more than 2 items  pictures  activities

What does the client communicate about?




What are the most important communication needs at home?




What are the most important communication needs in the vocational/work setting?




What has already been tried to improve communication? And, how did it go?




What results/information do you hope to gain as a result of this consultation or evaluation?




What are the consumer’s favorite topics and activities?




Is there anything else I should know about your consumer?





Complete and return this form (with relevant ISP pages, as described above)
to Kathryn Helland or encrypted: https://tusafesend.temple.edu/
Email: Kathryn.Helland@temple.edu) or Fax (215-204-6336)


Revised 1/2016


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