Telling The Story Behind The Trial Data

Several funding sources including many private insurance plans and state Medicaid programs, require a device trial to objectively show the client’s ability to use the recommended SGD as part of their funding process. The device trial can be viewed as a welcome opportunity to gather data that proves the medical need for the device, and takes away the burden of relying solely on the SLP’s professional judgement.

Lew Golinker, Esq., founder of the Assistive Technology Law Center in Ithaca, New York, stated the following about device trials in, “Best practice for device trials?”, 08-19-2019:

Device “trials deserve to be seen as an ‘asset’ because they allow SLPs to change the justification for their recommendations from their ‘professional judgment’ to ‘objective data and facts’." …. To the funding source, the SLP can say: the medical need – the appropriateness – of the device being recommended is established by the facts right before your eyes.”

Using Data to Prove a Medical Need

However, in many cases the data does not tell the whole story. So there remains a burden on the SLP to adequately explain the data and connect the dots for the funding source. This narrative should explain how the data proves that the client has a medical need for the communication device being recommended. It is important not to let the data speak for itself, but rather to find the story within the data to help the funding source to see the importance of continued access to a communication device in order to allow the client’s emerging skills, as demonstrated in the trial, to continue to grow and develop.

Finding the narrative within the data:

• Use the data to tell a story that illustrates that continued language growth is only possible if the client is given access to the recommended device, which provides the necessary language and abilities to grow the client’s spontaneous novel utterance generation, allowing for continued development and progression of language (i.e. progressive development through Brown’s Language Stages).
• Point out that the client has demonstrated that he/she possesses the necessary skills and abilities to achieve competency if not mastery in these areas given adequate time with the device and additional support and training.
• AAC interventions address the development of adequate, functional communication skills to support individuals with complex communication needs in developing, rebuilding, or sustaining communicative competence to express needs and wants, develop social closeness, exchange information, and participate in social etiquette routines as required (Drager et al., 2010; Light & McNaughton, 2014). Show that the client demonstrated, throughout the length of the device trial, evidence of his/her continued growth and independent use of single words, and additionally demonstrated emergent use of word/symbol combinations. These are examples of progress in development of communicative competence and are all indicators that he/she can achieve competence or mastery of these with the necessary time, support and training. However, this continued language growth is only possible if given access to the (recommended device), which provides the necessary language and abilities to grow his/her spontaneous novel utterance generation, allowing for continued development and progression of language (i.e. progressive development through Brown’s Language Stages).
• Show a reduction or improvement in negative or self-injurious behaviors associated with inability to communicate. Conversely highlight any positive behaviors that are correlated with increased communication ability through SGD use.
• Extrapolate single word use, showing how use of these single words are currently allowing the client to meet daily and medical communication needs, and provide discussion about their necessity as building blocks for more complex communication that is anticipated to follow.
• Whether a school-based SLP or a clinic/hospital-based SLP, it is necessary to establish the case for the medical necessity of the device for the client. Keep in mind these medically necessary communicative functions and how they relate to what the client was able to demonstrate during the trial:
  • Call for help
  • Ask questions about care
  • Express feelings or state of being
  • Direct caregivers on care requirements (transfers, bathing, nutrition, mobility)
  • Make requests regarding health & hygiene
  • Participate in family planning decisions
  • Provide information about health status
  • Tell personal stories or anecdotes
  • Express physical needs
  • Describe physical symptoms

Merging Data + Narrative to Tell a Story

Examples of merging the data with a narrative to tell a story about your client’s communication to prove the medical necessity of the device:

1. Emerging language skills were evidenced by the client using the device to generate the following single words “more, stop, go, want, help” – a handful of single core words, when playing. This has allowed the client to participate/interact in meaningful play with siblings and peers at home and at school, which is developmentally appropriate at this time. Through play, the client will learn to control his/her environment and advocate for his/her needs. While these words seem simple, their use can be extended beyond play to communicating medical needs such as “more water”, “stop suctioning”, “go dentist”, “want medication”, “help reposition”, or to indicate “help” in daily tasks such help to zip up his coat.
2. Client identified colors, “red, blue, yellow, orange, green, purple, white, black.” This allows the client to pick out colors of clothing when getting dressed in the morning and reduce frustration and self-injurious behaviors when the client cannot communicate and participate in self-care routines such as dressing and making clothing choices. Being able to make choices is important for independence and medical self-advocacy.
3. Client selected ‘mouth’ to indicate need for suctioning for swallow precautions. Identifying body parts and symptoms is important for proper medical diagnosis and treatment.
4. The client used the following body part vocabulary functionally and intentionally allowing client to begin to direct care/indicate need for repositioning, etc.: “eye, arm, leg, nose, hand, foot, back, head”. Instead of just answering yes/no questions, he can now indicate where he has pain or discomfort in his body by naming a body part. This has decreased the time it takes for his parent/caregiver to understand his needs for repositioning and has decreased his crying/outbursts that result from being unable to communicate this.
5. Client used the device to identify himself, his address, and his mother’s phone number. This is an important life skill that the client might be required to communicate to first responders, health care providers, or others in case of an emergency.
6. Client used the device to express feelings “sad, mad, happy, frustrated” during activities and story recall. This is an important skill when discussing personal state of being. In light of the recent quarantine due to COVID-19, the client shared with us that he was feeling sad and mad. Because he could express these feelings, we were able to talk about it and ease his anxiety and concern. We were also able to monitor his need for mental health counseling.

Conclusion

The challenge of the trial does not end with collection of the data, but rather, it just begins there for the SLP, who must find the story emerging from the trial data. Connecting the dots between the trial data gathered and the story they contain is often crucial to the funding source realizing the medical necessity and appropriateness of the device for the client, and can be the key to a funding source approval!

– Beth Studdiford, M.S., CCC-SLP. Read additional articles by Beth.