Incomplete requests or those that have not been reviewed by the
school district liaison will be returned
The Assistive Technology (AT) Process
· Team meets and identifies areas of student need and considers possible assistive technology devices or services
· AT Consideration checklists (available at http://wiu.k12.pa.us ) are used to review past and potential interventions
o Past or current tools and interventions are noted and described in terms of their outcomes
o Potential AT tools and interventions are identified for trial or implementation – the Assistive Technology Action Plan is used to document targeted tools and strategies, individual responsibilities, and AT trial results
· If the team determines that the further assistance of a WIU Assistive Technology Coordinator is required, a Request for Assistive Technology Consultation packet is completed by the team and forwarded to the school district’s special education liaison for review
o AT Coordinator reviews information from the liaison, communicates with various team members, and makes site visits (as appropriate)
o Recommendations are shared with the team using the Assistive Technology Action Plan
· Team members meet to review the recommendations, identify available resources, clarify needed supports, outline action steps, and agree to responsibilities for action steps
· Team members meet to discuss the outcomes of trials and update the IEP/IFSP, if warranted
Estimated Timelines when a Request for Assistive Technology Consultation is UsedDistrict / Intermediate Unit / District
· Request for Support completed by team and forwarded to liaison
· Request reviewed by the special education liaison/LEA
· Signed Request for AT Consultation and supporting documentation are sent to the WIU Assistive Tech Coordinator / · Request received and reviewed
· Consultation occurs via phone, email, or onsite visit / · Recommendations are made and forwarded to the team via the Assistive Technology Action Plan / · Assistive Technology Action Plan is reviewed and completed by district team members / · Trials and training conducted, as needed
· District team meets to review outcomes of trial or discuss recommendations
· IEP developed or revised, as needed
10 days / 30 days / 10 days / 10 days
Please mail this completed form and supporting documentation to:
Candice Hite –AT Coordinator
Natalie Panaia-Audiologist
Westmoreland Intermediate Unit #7
102 Equity Drive
Greensburg, PA 15601-7190
This packet must be completed in print/type by the Building Team Contact and reviewed by the District Liaison/LEA upon packet completion.
Date of Birth (Age): / K-Age (Kindergarten/EI only):
District/School/Grade/Support Type:
District of Residence (if different):
Building Team Contact Name:
Contact’s Email: / Contact’s Phone: / Contact’s Fax:
Student & Team Availability:
Please indicate the days and time periods that the student and team members are available for onsite visits (Check all that apply)
Monday AM PM / Tuesday AM PM / Wednesday AM PM / Thursday AM PM / Friday AM PMSpecial scheduling concerns:
Reviewed by (REQUIRED):
Incomplete requests or those that have not been reviewed by the school district liaison will be returned.Signed, completed requests will only be processed by the AT Coordinator after all documentation has been received.
Liaison/LEA Signature / Date of Review
For electronic submission only: Checking this box in lieu of a signature indicates that this request has been approved by the designated school district liaison.
The reviewer’s name and review date must be indicated on the appropriate lines above.
Areas of Concern (Check all that apply):
Expressive Communication / Mobility / X Sensory Needs – HearingReceptive Communication / Organization / Sensory Needs – Vision
Computer Access / Reading / Writing – Composition
Mathematics / Seating & Positioning / Writing – Fine Motor
Please print or type:
Based on the collaborative review, what educational concerns does the team hope to have addressed by this assistive technology consultation? What are the desired outcomes?What supports are currently available to the student and team in terms of assistive technology? Describe pertinent strategies, devices, and personnel. Which strategies from the Assistive Technology Considerations checklists have been considered or attempted?
Additional information or comments:
/ Assistive Technology Considerations for Sensory Needs (Hearing)
Student Name: / Grade & Age:
Observed Needs: / Hearing
Y / N / AT Intervention / Independence with Technology / Frequency/Duration of Use / Outcomes
Use classroom infrared/sound field system / Complete
With Initial Setup
Assisted
Use personal to table FM system / Complete
With Initial Setup
Assisted
Use personal FM system / Complete
With Initial Setup
Assisted
Use hearing aids / Complete
With Initial Setup
Assisted
Use cochlear implants
***Surgically implanted MEDICAL DEVICE / Complete
With Initial Setup
Assisted
Use BAHA (Bone anchored hearing aid)
*** Surgically implanted MEDICAL DEVICE / Complete
With Initial Setup
Assisted
Complete
With Initial Setup
Assisted
Complete
With Initial Setup
Assisted
Complete
With Initial Setup
Assisted
Complete
With Initial Setup
Assisted
***A MEDICAL DEVICE that is surgically implanted or the replacement of such a device is not classified as an assistive technology device as per IDEA 2004 Sec. 300.5.
Adapted from Technology and Media Division of the Council for Exceptional Children & Wisconsin Assistive Technology Initiative (n.d.) Assistive Technology Quick Wheel, available at http://www.ideapractices.org/ or http://www.cec.sped.org/ and from Beukelman, D. R. & Mirenda, P. (1998). Augmentative and alternative communication: Management of severe communication disorders in children and adults. Baltimore: Paul H. Brookes.
Assistive Technology Roles and Responsibilities Matrix
Team Role / Name / Email / PhoneStudent
Parent
Special Educator
General Educator
Paraeducator
Audiologist / Natalie Panaia / / 724-836-2460 x2322
Speech Language Therapist
Occupational Therapist
Physical Therapist
AT Coordinator / Candice Hite / / 724-836-2460 x2123
Building Principal
Psychologist
Building Tech Staff
District Tech Staff
LEA
Assistive Technology Product / Website / Vendor Address & Phone / Notes
Assistive Technology Roles and Responsibilities Matrix
Responsibilities(A) Assigned (B) Back-up
List all actions that must be done for this student. For each item, agree on a team member who is (A) Assigned for responsibility and one who is (B) Back-up. Team members should speak for themselves rather than be assigned to items. No one person should serve as Assigned for all items. Each team member should assume Assigned or Back-up responsibility for at least one item. / Student / Parent / Special Educator / General Educator / Paraeducator / Audiologist / Speech Language Therapist / Occupational Therapist / Physical Therapist / AT Coordinator / Administrator / Psychologist / Building Tech Staff / District Tech Staff / Hearing Therreapist
Selecting appropriate equipment / A
Ordering Equipment / A
Receiving and Checking in Equipment / A / B
Training student and staff on care and use of equipment / A / B
Charging unit nightly / A / B
Preparing unit daily / A / B
Troubleshooting Equipment / A / B
Repairs/Returns / A / B
Adapted by Kelly Fonner, http://www.kellyfonner.com/, , Modified by Allegheny Intermediate Unit #3
Westmoreland Intermediate Unit #7 Audiology AT Request for Support April 2014
Westmoreland Intermediate Unit #7 Audiology AT Request for Support April 2014