Pros From Dover . . . Using "Experts" to Justify an Technology Need.
Frequently technology for people w/disabilities disagreements boil down to a battle of opinions; one side believes device A will best meet a person's need, the other side says device B or C or even D will work. Typically one option is far more costly than the other. What are the parties to do? How do the parties actually determine what will work for a potential technology user?
In cases like this, the opinions of "experts" usually decide. Obviously, it helps tremendously if you use the best expertise available to justify your position. However, how does one determine just who is and is not an "expert." This TECHNOTE offers some questions that consumers, service providers and funding agents can use to decide if an evaluator can be considered an expert in his or her field.
Who conducts evaluations?
Generally, evaluators (or, people who conduct technology assessments) fall into four categories: rehab Engineers/Technologist, Vendors, Therapists and Consultants. People conducting evaluations vary widely in their skill level. Some are licensed, others are not.
Rehabilitation engineers/technologists use the principles of engineering design, and application of technology for people with disabilities. Generally they problem solve by using engineering disciplines, mathematics, physical sciences, life sciences and analysis. If you use a rehab engineer, ask about his or her range of training and experience.
A vendor sells equipment for a company or companies. Unless you ask about credentials, you will not know. If a vendor conducting an evaluation represents only one company, be wary. It is in their interest to sell their particular product whether it works for you or not. It is better to use vendors that represent a range of products.
Therapists are professionally trained in a specific medical discipline. Those disciplines may include, speech, physical, occupational or rehabilitation therapy to name a few. Therapists in Illinois must pass a test to receive their license to practice.
A consultant can be a licensed therapist, a rehab engineer, a really creative person or just about anyone. There are no licensure or educational requirements to hang out a shingle and declare yourself a consultant. Most consultants have a background in disability or health services. It is up to the person purchasing services to decide if the consultant is qualified to conduct an evaluation.
Just having a license or degree does not guarantee that a person is a technology expert. Nor does the fact someone is a vendor or consultant preclude them from being a technology expert. It is important to ask about a person's credentials before an assessment. Nevertheless, do not stop there.
Beyond those traditional questions, consider asking the following more specific questions. We designed these questions to help you decide if the evaluator is likely to project the credibility needed to get the nod to purchase a device.
How long as the evaluator been recommending this type of AT? How many devices of this type has the evaluator recommended?
Evaluators have more credibility when they have been in the field a few years and have recommended many devices within a general technology area. Beware of individuals who have recommended technology for limited numbers of individuals in the last year. Remember that for many providers, like physical therapists, occupational therapists, speech/language pathologists and rehabilitation counselors, technology is a very small part of their overall position or practice. Many of these providers have limited experience with technology and have only a handful of cases where they actually recommend devices. It pays to ask for references from evaluators whether they appear to have a lot of experience or not.
What age range and/or disability type does the person primarily assess?
Some evaluators specialize within a specific age range or disability type. Such focused expertise can help your case if the consumer falls within those limiting characteristics. However, if you are an adult and the person conducting the assessment has only seen children up to this point, someone could seriously question their opinion. Likewise, if you have a cognitive disability and the evaluator primarily sees people with physical disabilities, someone could call into question his/her opinion.
What is the evaluator's track record? Do the recommendations represent a variety of manufacturers and devices?
It is beneficial for experts to have a proven track record of recommending devices that were actually procured and successfully used over time. If an evaluator has cases where they recommended devices that were not used successfully, you should anticipate that those cases will call into question his/her credibility.
Beware of evaluators who recommend the same device for many or most individuals. How can the evaluator address individual differences if he/she recommends the same device for everyone? Were all of the individuals really that much alike? Recommending the same device repeatedly again implies a disregard for individual differences. One could also argue that recommending the same device reflects limited knowledge of the full range of devices available. Look for evaluators who have current knowledge of the myriad of device options available. Also look for those 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.
You can also check out the range of devices on your own, prior to an evaluation, to have firsthand knowledge of what is available.
What assessment procedures does the evaluator use to arrive at a recommendation?
Beware of evaluators 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. There is no denying that standardized testing in traditional areas are helpful. However, in technology assessments, it should not form the sole basis for a recommendation. Best practice would include consideration of many other factors. These would include assessing the environments where the person will use the device, the user's expectations in those environments, the necessary supports for device use, and individual preference in device use. The evaluator should also compare the unique features of a variety of devices to decide which device(s) might meet the individual's needs.
Will the user actually try the device? For how long? What outcomes or behaviors were observed during the device usage?
The best procedure any evaluator can use to find out if a device will work is to actually have the user perform the desired activity using the device in their natural environment. The evaluator should carefully document the degree to which the device provides the desired outcomes. It makes for an almost irrefutable justification for the device recommendation. While evaluators can yield some information from a structured evaluation setting, typically the fact that the user has so little time with a device and in an unnatural environment makes the data less than optimal.
Using a loaned or rented device over a longer time, like a few weeks, in a natural environment, provides powerful data to support a particular device. An evaluator who presents "real-life" observations in a recommendation is far more persuasive than one who presents only a theoretical rationale.
What standard does the evaluator user for his/her recommendation? Is it consistent with the legal standard in question?
Evaluators need to be 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. This is not as complicated as it sounds.
For example, say an evaluator recommends a particular communication device for an individual. He/she may do so because in his/her opinion it represents the "best" standard of client service. However, if a school district is going to pay for a device, "best" is not the standard by which they measure. IDEA, the federal law that governs special education, only requires schools to provide what is "appropriate." Likewise, in an ADA case, the legal standard is to achieve "effective communication." In vocational rehabilitation the legal standard is "necessary for employment."
For Medicaid to cover the device it must be "medically necessary." Make sure that your evaluator understands the legal standard upon which his/her device recommendation must be based.
Finding any person to conduct a technology evaluation is often a difficult task. Ensuring that the person conducting the evaluation is a technology "expert" is even more difficult. We hope this TECHNOTE gives you new questions you can ask evaluators to decide if they really are "the pro from Dover."
While Tech Connect cannot recommend and endorse evaluators, we can help you as you go through this process. We have a list of assessment centers across the state. Our hope is that with this new knowledge you will be better able to pick the professionals whose job it is to make your life better.
The material in this TECHNOTE comes primarily from Issues in Assistive Technology: Use of Experts, written by the Missouri Assistive Technology Project, 4731 South Cochise, Suite 114, Independence, Missouri 64055-6975, 800/647-8557 (V) 800/647-8558 (TTY).