Download Proposal for Think-and-Link Assessment model

Proposal for Think-and-Link
Assessment Model
Comprehensive Overview of Requisite Email Skills
(CORE)
Guiding Assumptions
Useful to build on existing theoretical
frameworks available in AT & AAC literatures
Assessment process should capture information
potentially relevant to:
1) determining how to maximize the likelihood
of successful email use by user & partners;
2) measuring change resulting from email
facilitation.
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)
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
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.
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)
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)
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
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)
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.
Communication Interaction Patterns (AAC)
Calculator, S. (1999). AAC outcomes for children and youths with severe
disabilities: When seeing is believing. AAC, 15, 4-12.
“Variables to gauge impact of AAC for students
with Severe Disabilities in Inclusive Classrooms”
Example items: increased frequency and
success of initiations, increased # of messages
directed to partner, increased variety of partners
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.
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
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
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.
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.
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.
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.
Environmental Plan
Lists any modifications or needs specific to
arranging or organizing user’s physical
space.
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.
Email Buddy List
Lists contact and email information relative
to potential email buddies.
Technology Fit Sheet
Details interface/software features and
hardware adaptations that would be
important for an individual user. It also
describes the installation plan.
Field Note Interest Sheet
Summarizes any areas revealed through the
assessment process that we are interested in
tracking.
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
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)
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)
Personal History / Demographics
Initial information is solicited via in person, mail
and/or phone contact using Computer User Profile
w/supplementary questions.
Milieu Domain
Structured 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
Impairment Domain
Structured 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
Task Domain
Direct 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
Community Domain
Direct 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
Supplementary Testing
Standardized Assessments
Supplementary cognitive and psychosocial
assessment will occur as indicated by the Impairment
and Milieu Domains.
PROPOSED CORE PROCESS
Personal History/Demographics
Milieu Domain
Impairment Domain
Task Domain
Community Domain
Supplementary Testing
Background Theory for
Impairment & 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
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
QOLAS Process Modified
Scoring
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
QOLAS Process Modified
Serial 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”.
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
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.)