By: Kelly Connor, CCC-SLP

So, your child’s speech language pathologist (SLP) is suggesting AAC for your child and talking about a trial. What does this even mean? An SGD trial is an involved and complicated process. Here are some of the basics about AAC trials to help parents have a better grasp on the process.

What is AAC?

Augmentative and Alternative Communication (AAC) are tools that supplement or replace speech. Some types of AAC we use every day: writing, pointing, signing, and more. For some people with more complex communication needs, systems replace speech such as communication boards, picture symbols, or Speech Generating Devices (SGDs). This will be our focus. SGDs are communication systems that have a screen and produce vocal output when buttons are pressed. They can be handheld or attached to different equipment.

These SGDs can greatly improve a person’s quality of life and allow them to learn and use language spontaneously to improve their quality of life. These devices are very expensive and are often not feasible to pay out of pocket. Insurance will often fund a device with a trial and proper documentation. This trial process has many components. Here is a basic outline of the process.

Step 1: Obtain Necessary Information.

The first step to an SGD trial is to gather all of the client information needed before submitting for a device. This includes insurance information, medical diagnoses, and client information (i.e. date of birth, address, etc.) There are several forms that need to be submitted and it’s important that the SLP has all of the background information to make filling out these forms more efficient.

Step 2: Gather the Team and Evaluate

The next part of the process is a comprehensive evaluation. Professionals involved can include the SLP, OT, PT, pediatrician, and specialists involved in the child’s care. The SLP will assess your child’s expressive language (what they can produce), receptive language (what they understand) and current means of communication. Motor abilities, cognitive abilities, visual abilities, and literacy abilities. A huge part of a justification is showing that your child has the capabilities to learn and use a device.

Step 3: Trial Device

The clinician will try to get a device on loan to trial with your child. For the loan, a device will be sent to the clinician, who will set it up for your child to trial and practice with. Goals will be written and target words will be selected to help your child learn how to use the device, find vocabulary, etc. Most trials last 2-4 weeks. During this time the client will attend therapy and work with the clinician to learn how to use the device. Data will be collected to show that your child can learn and use the device effectively to communicate. It is important that the family works with the SLP to learn about the device, practice modeling words for their child, and show support and commitment to helping their child learn how to use the device. Family support is one of the keys to a successful AAC device. If the device is sent home with the child during the trial, the family will also collect data on how their child uses the device at home and what vocabulary they are using.

Step 4: Determine Appropriate Device and Software

One of the most important aspects of the AAC process is selecting the right device for your child. There are a variety of SGD’s available with different layouts, colors, voices, and button options. The SLP will work with the family and client to figure out what device is best suited to help your child communicate. While writing the justification, the clinician will outline why the aspects of the device are necessary for your child. The justification will also outline your child’s success with the device to show insurance that the device is medically necessary. Medical necessity means that your child needs the device to communicate their wants, needs, and medical information. Determining medical necessity is important in a justification.

Step 5: Determine Access and Positioning

For individuals who have motor impairments, such as a child in a wheelchair, a child who cannot isolate their fingers, or a child with Cerebral Palsy (CP) who have spastic movements, alternative access will be necessary. Access is the way an individual controls their device. Some kids use direct selection, where they can select a button with their finger. For other children, they may use their hand or other body part to activate a switch to control their devices. Some children with limited body movement or control use eye gaze to control their SGD. Different access methods required requires equipment, such as a wheelchair mount, a switch button, or a key guard. This additional equipment also is requested in the justification. Your SLP will work with other professionals to determine the best equipment for your child to help them have success with their SGD.

Step 6: Write the Justification/Finish Trial

At the end of the trial, the loaner device will be sent back, and the clinician will write the justification. A justification is a report that is sent to the insurance company that outlines and describes the SGD trial and your child’s success. Data will be used to show that the client was able to learn and use the device to make their needs met. This report outlines your child’s communication deficits, their needs, and justifies that a device is needed for your child. The justification can also request required accessories.

Step 7: Wait Time

The time after the justification is submitted is the longest part… waiting. It can take several weeks to months for the insurance company to respond to the justification. Insurance can approve or deny a request, or ask for more information.

Step 8: Receive Your Device

If the device is approved, a personally owned device will be sent to you for your child to use to communicate. Typically a therapist will continue to work with the child on their own device to continue to grow their communication skills.

That was a ton of information! While it may seem overwhelming, remember that you will be supported through the process. We SLPs encourage you to ask questions and take part in the process. We will facilitate the process and do everything we can to help your child be successful during his/her trial. There is no better feeling than watching your little one get the power to communicate through a device.