AAC Screening Checklist



AAC Assessment Checklist

*** To be completed by & signed by both SLP and AAC Specialist

Student Name: ________________________ Today’s Date:__________________

Assessment Plan signed date:______________ 60 day deadline: _____________

|SLP or AAC |Date |Tasks |

| |Completed | |

| | |Video Release form signed by parent (if applicable) |

| | |AAC Assessment Checklist completed by AAC & SLP and signed |

| | |Cumulative file review inserted into the ‘Student Info’ form |

| | |History: (birth, medical, family, education) |

| | |Sensory: (Hearing, Vision, T-K) |

| | |Previous testing: (SLP, Academic, Psych) |

| | |Consult with Teacher |

| | |Consult with classroom staff |

| | |Parent interview ( home visit & CSA if possible/necessary) |

| | |Consult with SLP |

| | |(should be directly involved with assessment including Speech and Language assessment portion) (SLP required to do |

| | |testing as part of AAC Assessment if last tested over 1 year) |

| | |Consult with OT & PT |

| | |Consult with BT |

| | |Consult with AT Specialist |

| | |Inventory of Current Communication System |

| | |Observations - Communication Sample Analysis (CSA) |

| | |CSA analyzed with team members– ‘Language Needs based on the CSA’ form completed |

| | |Motor - Access |

| | | Physical status |

| | |Cognitive (abilities that affect communication and language) |

| | |Oral Motor / Speech Production inventory |

| | |Receptive Language Testing |

| | |Expressive Language Testing |

| | |Communication & Symbol assessment (TASP, etc) |

| | |Social Language |

| | |Daily Communication Needs |

| | |- Fringe Vocabulary List- completed by all team members |

| | |Limitations to current system |

| | |Features Needed (device, system) |

| | | No tech |

| | | Low tech |

| | | High Tech needed – see “SGD Assessment and Trial” page below |

| | |- *Medi-Cal application process – complete ASAP if applicable |

| | |AAC Treatment Plan: Participation Plan. Goals, Action Plan |

| | |AAC Training and Transition binder (if necessary) & documents created by team |

| | |AAC Assessment Report - completed and staff reviewed before IEP |

Signatures ___________________________________________________________________________ (pg 1 only)

SGD Assessment and Trial

|(Date Completed |Task |

| |Funding documents completed - with parent |

| |Authorization for Release of Information – signed by parent |

| |Feature Matching documents – completed |

| |SGD trial data collection forms - prepared and discussed with team |

| |Obtain 2-3 devices to trial |

| |SGD trial data documents – completed & reviewed for each device |

| |Medically based SGD Report – completed & submitted to team if necessary |

| |Medically based SGD report submitted to funding source / vendor |

| |Educational Addendum– completed, request equipment / software for school |

| |Follow up with vendor every 3 weeks – mark in calendar, update team |

| |Device arrival – |

| |Train AAC team - contact regional rep for appts |

| |Provide team with resources, online websites, etc |

Signatures ___________________________________________________________________________

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MT. DIABLO UNIFIED SCHOOL DISTRICT SPECIAL EDUCATION

AT/AAC Department, Willow Creek Center

1026 Mohr Lane, Concord, CA 94518

(925) 682-8000, ext 6241

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