Zen and the Art of Successful AT Transitions

Marvin Williams, AT Specialist, Kent County ATRC

It’s Susie’s first day at the Xavier School. All of Susie’s teachers and therapists, as well as Susie’s parents, have been working hard for years to get her ready for this day. Her power wheelchair is charged, her Portable Impact Tablet is charged, and the back-up power converter allowing the tablet to run on the power wheelchair batteries is working and connected. Her backpack with medications, ADL equipment, and personal supplies is mounted to the back of the chair. Susie wished that Melanie, her assistant for the past five years, was coming with her, but, unfortunately, that was not possible. Still, Susie was excited about her new school and about making new friends.

Susie’s parents arrived at the principal’s office 30 minutes after they had been called to take Susie home. Their daughter was in the nurse’s office crying, obviously very upset, yet she did not respond to questions. All she could say was "what.” This was odd because she was a pro with her tablet communication device. Her mother noticed that the symbol library on the tablet was gone. Instead, a QWERTY keyboard with a word prediction window was in its place. The low battery light flashed just before the device shut down. Her father reconnected the back-up power converter, which had been unplugged. With power restored, Susie’s father loaded her custom communication symbol set. Her mom filled the portable water pack at the sink and clipped Susie’s sip straw to her shirt so she could easily reach the straw for a much needed drink. After two button pushes, the device’s synthesized voice began to communicate Susie’s tale: “I had a bad day…”

I’m sure that we have all heard similar stories of problematic transitions from one school to another. I’m sure that we’ve even heard of challenging transitions within the same facility due to internal changes. The simple fact is that changes in AT require a transfer of information from one group of service providers and support staff to another. One of the things that makes equipment transitions so important is that there are so many of them. In schools, they occur when a student gets a new teacher or a new paraprofessional. They can also occur when a student is transitioned into a different educational environment, at the end of the school year, or if the student changes schools for any reason. In an institutional setting, they can occur when an individual changes support staff or changes facilities and/or programs. In any case, when new people are involved with an individual, those new people are likely to need instruction on the particulars of an individual’s AT use.

As transitions are inevitable, we can and should prepare for them as best we can. Without such planning, we jeopardize the efficiency of the transition process. The equipment may not be complete or may not be working properly. Problems with equipment ownership may arise if an item’s history has not been documented. The new staff may not know how to operate the equipment or how the particular individual uses the equipment. All of these problems—or even one of them—is enough to cause big headaches for everyone. The key to preventing these problems, or at least minimizing their destructive effects, is the successful transmission of AT information between service teams.

In the beginning. . .

So how can AT be effectively and efficiently transitioned from one service team to another? As with most things, preparation is the key. AT should be an explicit element of transition planning. A transition plan should provide adequate information about the AT and its use. It should also identify those who will facilitate transition of the equipment from one setting/situation to another. The team might include teachers, therapists, paraprofessionals, resource specialists, AT specialists, parents, administrators, and the AT user. Although this list is by no means comprehensive, it suggests several people who are likely to play a part in AT transitions.

The thing to keep in mind when forming the transition team is that each member needs to have a clearly defined role that is understood and accepted by all members. The team should also have a leader or coordinator who will keep the process moving along on schedule and according to the established plan. The leader should also monitor the transition to determine whether the supports following the transition are adequate to meet the AT user’s needs.

Follow the yellow brick road!

The timeline for the transfer of equipment should include all appropriate milestones and deadlines. This way, team members will have a clear sense of how their responsibilities contribute to the overall objectives. Here are some points to keep in mind when developing a timeline:

• Be sure to describe all steps in the transition of equipment from one environment to another. This provides a “heads up” for all involved, and enables revision to the plan in advance if necessary.
  
• Give plenty of time for successful information gathering. Most service providers have a multitude of responsibilities, and cannot ignore other duties just because they receive a last-minute request. With adequate advance notice, team members will be able to compile information enabling the new team to become familiar with the AT and the user’s needs.
  
• Create milestones. Schedule meetings around the milestones to make sure that everything is going as planned. If someone is having a problem gathering information or completing some other task, the group can troubleshoot or revise the plan. Not all meetings need to be conducted face-to-face; email can facilitate effective and efficient “virtual” meetings. The important thing is to keep the team informed.
  

By following a transition plan complete with timelines, even the most complex equipment transfers can be accomplished with minimal disruption for the AT user.

It’s not who you know, but what you know

Because a successful transition depends on accurate transfer of information, the team will need to generate documentation about each device if no previous record exists. Important information might include an item’s purchase history, repair history, and cleaning and maintenance schedule. This will tell the new team who purchased and owns the device as well as who is responsible for its maintenance. Maintenance information should also specify any special procedures that must be followed if the device requires service. For example, does the device need to be returned to the manufacturer for service, or can it go to a local service center? Are there special shipping instructions or a certain department within the manufacturing company that must be consulted? Is there an associated cost for cleaning and repairs? If so, who pays, and what is the payment procedure?

In addition, the team needs to learn the item’s usage history. This describes who initiated the use of the equipment, when and how it is used, and who is trained to use it. It is also important to know if the item is part of an individual’s IEP or treatment plan, as this will provide additional insight into how the equipment is intended to support the user. If the team finds that the item is no longer accomplishing its intended purpose, the treatment plan will need to be updated to reflect any change in implementation.

If an individual’s AT includes software with customized user settings, those need to be documented and sent with the user. Otherwise, the work that went into tailoring a piece of software for a specific user will be lost, and someone will have to undertake the customization process all over again.

An ounce of prevention

A successful equipment transfer is possible with thorough planning and preparation. While it takes work to gather the necessary information, advanced planning saves time and aggravation in the long run. Perhaps the best way to keep transition preparation from becoming overwhelming is to maintain up-to-date documentation on equipment history and use. As a consumer’s equipment is serviced or changed, make sure that the circumstances are documented. Transitions are inevitable; the goal should be to make the transfer of equipment as efficient for all members of the team as possible.