AAC 101: Building an AAC Library from Scratch

By Brianna Hughes, MA, CCC-SLP for aaccessible.org (Check out their website for great AAC resources and information)

So you’ve got your AAC assessment skills down, but you have no clue how on earth you’re going to get equipment to try with your students! If this hits a little too close to home, then this is the AAC 101 post for you! Read on for a stepwise framework to get your district’ or center’s AAC toolkit out of the dust and into action for your learners! We’ll start with a tasty and oh so true, cookie analogy.

The Cookie Conundrum: Picture this—you’ve been hired to bake a hundred cookies. But all you’ve got is a dusty kitchen cupboard, and inside there is just an empty flour bag, an open jar of clumpy salt, and a can of pumpkin puree that expired before you were born. Yuck. Also, your cookie client doesn’t know yet what kind of cookies they like, and you’re expected to find the best recipe for them. What would you do? When I started as AAC/AT Specialist for my district, we had some materials for individual students, but barely any additional inventory. What we had was a bit like that dusty cupboard I: some empty boxes, some old VOCAs that were too sticky to be useful (with open battery compartments, yikes!), and some devices older than I was. How old was that, you ask? Let’s just say I’m no Doogie Howser, and anything older than 10 years is probably “too old” in technology terms anyway!

I knew that one of my first priorities would be to convince my district that it was time to buy some new AAC devices. This was not a small task. For one, AAC “ingredients” are a lot more expensive than cookie ingredients. But, lucky for me (and you!) there are some great ways to access AAC and AT trial equipment for free, such as:

• Your state’s AT resource center, which will likely have a lending library
• AAC device companies typically offer trials of their equipment
• If you are an SLP and you already have an iPad, you can often get copies of AAC apps for free from the developers

Is it time to give your AAC tech an edit?

However, getting these free resources takes time—sometimes a lot longer than the 60-day deadline of an IEP assessment. To provide a valid AAC assessment, you know

that you really need to have the person try some potential AAC devices during the 60 days, not after! For this reason, it is essential to fill your cupboard – let’s explore how.

You’re likely here because you’d like to know more about how to set up your own AAC lending library. But before we begin, let’s make a few things clear. This article will assume two things:

1. That you work for an organization that has an existing method of funding dedicated AAC devices for clients and
2. That you’re planning to request additional materials on top of that.

It will not address those basics of funding for dedicated devices, since there are other resources available for that purpose. I’ll share everything I wish I had known when I was trying to set up my district’s AAC lending library. Even if the specifics don’t apply to your setting or your population of clients, I hope that you’ll find something of value here. Without further ado, here is what I wanted to know, and had to learn as I went…

How many devices should I order? To decide this, start by taking a look at your pantry (hopefully it’s bigger than my “kitchen cupboard” was…). Count up the devices you already have and the number of kids on your caseload. I would suggest that you request enough “lending library” devices for about 10-30% of your current caseload. It’s okay to start a bit smaller, if you have a plan to add on over time. Keep in mind, it’s very likely that not all your potential AAC users have been identified yet, and your current caseload may be smaller than what it will be. According to Beukelman & Mirenda (2013), the estimated percent of the population that needs AAC is 1.3%, but that statistic includes all ages. To find out how many students you will eventually have, let’s take a rough guess that about 1% of children will need AAC. For instance, my district currently has about 9,000 students, so statistically speaking, there should be about 90 of them who need AAC.

For me, counting up the “lending” devices I had on Day 1 was simple. There were no high-tech devices for students to try, and very few options for mid-tech or low-tech either. I started with a caseload of 28 AAC users, many of whom did not have appropriate devices for their needs. I knew there were dozens more out there who would need an initial assessment. Five years later, my caseload is now 80 AAC users, and still growing!

How do I pay for all of this? Find out your district’s rules around funding assistive technology for students. As far as our funding process: My district follows the letter of the law (that’s IDEA), which states that if a student requires assistive technology to meet their educational needs, we must provide it. So every time I write an assessment and IEP for a student, I explain why they need AAC, and the district finds funding for that dedicated device. However, additional devices (e.g. our “lending library” devices) would be considered a special request and beyond what the district is strictly required to include in their budget.

In trying to answer this question, here are some other things I considered:

• Timing: An AAC assessment takes 60 days, and then our purchasing process takes a minimum of another 60 days after that. Add it up, and that’s an awfully long time to go without a voice. With this in mind, I wanted my lending library to include enough devices to cover students during their assessment and while they wait for their dedicated device to be purchased.
• Contingency devices: It’s really helpful to have back-up devices for students if their dedicated device gets broken, to tide them over until we can get a replacement.
• Demos and “Buddy” Devices: In the best case scenario, I wanted enough devices to provide extras for SLPs and teachers to use for modeling, but I knew that was probably a little too ambitious at the time.

When I wrote my initial proposal, I only requested enough high-tech devices for about 6 assessments at a time (20% of my then-caseload). As my caseload has grown, each time a child “outgrows” their AAC (for example, kids with apraxia of speech whose articulation improves), moves out of district, or needs a different device (e.g. a child who previously had a larger screen, but now they need something smaller and more portable), that old AAC device goes into my library. This means that my library has grown incrementally over time, without my having to ask the district to set aside “extra” funding for it as they did with my initial lending library request.

What types of devices and supplies should I get?: To answer this question, you’ll have to make some guesses based on what you know about the population you serve. For example, my district has a small number of AAC users in general education or mild/moderate special day classes, and a larger number of AAC users in our moderate and moderate-severe classes. This includes students from ages 3 to 22 with a variety of disabilities. The supplies I need for my lending library look different than, for example, someone who works at a school where all of the kids have complex communication needs. That said, having spoken to other AAC Specialists in local districts, I am going to tell you something I wish I had known sooner: about 90% of kids who need AAC will likely be able to directly access a high-tech device. If you’re in a similar position to mine, it’s likely that you’ll need to focus primarily on getting iPads, and robust AAC apps to go with them. Folks who use high-tech AAC should always have a low-tech back-up option, and there may be a few who use low-tech exclusively. For a smaller number of students, you may need various options for indirect access, including mid-tech VOCAs, switches, switch interfaces, mounting, keyguards, and so on.

Here is a list of supplies that have made their way into my library over the years, that you may wish to consider adding to yours. You can download a PDF of this list for free on the AACcessible Tools page.

Starter Supply List for Your AAC & AT Library

     High-tech devices and Accessories

• iPads (or other high-tech tablets, but iPads are a popular and reliable option).
• iPad cases (I like Otterbox, Attainment Company, Lifeproof, and Unicorn Beetle, but there are lots of others out there to try!)
• Variety of AAC apps to trial
• I recommend focusing on those with a robust, preprogrammed vocabulary.
• If you’re ordering 20 or more licenses of a given app, ask your IT department about getting discounts through Apple’s Volume Purchase Program
• Screen protectors (only for cases that don’t come with one already)
• Extra supply of chargers (10-pin, USB-C and/or Lightning – make sure you check which kind you need!)
• Options to add straps to cases (e.g. Otterbox Latch cases, Attainment company GoNow case packages, and/or materials for DIY solutions)

      Access options for high tech devices

• Flexible mount (e.g. gooseneck) with attachment for iPad (remember to consider the size of the iPad with the case on it before purchasing)
• Inflexible mount with attachment for iPad
• Variety of switches including smaller buttons, larger buttons, wobble switch, pinch switch, etc. May also include switches that come pre-attached to a mount, or have options for attachment.
• Keyguard(s) to add onto loaner iPad(s)
• Switch interface(s) for iPad such as Blue2, Hook+, or Tapio
• Styluses
• Adapted toys that can be used to assess switch access in a fun way, and/or to help develop motor skills to use a switch.
• Switch-accessible game apps for iPad (serves the same purpose as adapted toys).
• Mid-Tech Devices
• VOCAs such as Step-by-Step
• VOCAs such as Learning Resources buttons (yes, you may want a few of the cheap ones, too!)
• GoTalk, TechTalk, or QuickTalker mid-tech devices—these come in a variety of sizes and you may want to have more than one style on hand.
• Low-Tech AAC
• Access to a color printer, and lots of ink!
• Regular printer paper
• Heavy-duty waterproof, tearproof paper (excellent for making PODD books or core boards without having to laminate everything)
• Binders (great for DIY stands)
• Metal binder rings
• Duct tape (for DIY PODD books, but in a pinch it can also hold together a broken device case until you can get a new one!)
• Zip ties
• Hook & Loop (you don’t necessarily need brand name Velcro, but you’ll want to have a range of options including “dots”, “tape”, and “industrial strength”).
• Laminating pockets and a laminator. Even if your office has a big laminator, I still highly suggest getting one of these! It usually produces a more durable finished product compared to the large machines.

 

• Other Supplies
• Batteries as needed for all of your VOCAs, switches, adapted toys, etc.
• Label maker
• Baby wipes (for regular cleaning of devices)
• Goo Gone (for more intense cleaning of devices)
• Bag of dry rice (for device emergencies if they get wet)
• Set of small screwdrivers
• Optional – set of allen keys, may be needed if you plan to be adjusting mounts
• X-acto knife
• Cutting board
• Sharp scissors, and velcro scissors (if you know, you know)
• Hole punch (preferably one of the large ones that can do lots of pages at once!)
• Posters of AAC core boards – you can have these printed by various companies, or your organization may already have the ability to print poster-sized things.
• PVC pipe and pipe cutters if you plan to make DIY PODD books

Once I have these devices, how will I keep them organized? It was important to me that after spending all this money on devices, we had to be able to keep track of them! If you’re in a large organization, or setting up a large library, it may be worth researching software that can keep track of the inventory for you. If yours is a smaller program, then you can likely keep track using a spreadsheet, or set of spreadsheets. For my district, I use one spreadsheet for the iPads (since it is shared with other departments), and a different one for all other AAC and AT devices. The iPad spreadsheet includes the serial number, apps on that device, and student or teacher it is assigned to. All of our iPads are labeled with the district’s name and their Apple serial number.

However, other devices don’t typically come with a serial number, and in that case, it’s helpful to make one. This is pretty easy to do, and the web has many helpful articles describing general principles of creating serial numbers from scratch. When labeling AAC devices (other than iPads), I use the following system that I came up with:

1. Two letters identify what category of device this is. HT (high tech), MT (mid-tech), LT (low-tech), or AT (for miscellaneous, not easily categorized things such as adaptive toys).
2. Three numbers identify what type of device this is. For example, my Little Step-by-Steps might be MT-001, but Big Step-by-Steps would be MT-002.
3. A final two-digit number identifies how many of that type and category of device we have. So for example, my first Little Step-by-Step might be MT-001-01, and then when I get another one, I would call it MT-001-02.

In my spreadsheet, next to the serial number is an item description. I learned that it’s important to write these with the nouns first, and the adjectives later. So for example, a description for the little Step-by-Step might be, “VOCA, Step-by-Step, Little, 3-levels, Ablenet.”When visually scanning through your list of items, this allows you to find things more easily because you’ve put the thing first, and the description after.

Next, I have a yes/no column to show whether the device is available. If an item is checked out, I list the school site, teacher, and student it is checked out to, as well as an anticipated return date, if applicable.

Download a a free PDF version of this Supply List on our Tools page

If it is checked in, then the location in my office is listed. This may seem excessive, but in the unlikely event that I was struck by lightning and a new AAC Specialist was hired, I would want her to know where to find everything! So I have labeled my cabinets by letters, and the drawers or shelves by numbers. For instance, if the little Step-by-Step is stored in cabinet “D,” in the 3rd drawer, I would list the location as “D3.”

Putting this all together is a lot of work upfront, but saves many headaches later. Plus, it demonstrates to your administrator that you value the investment your organization has made, and that you plan to keep track of these items with care.

How will I convince my administrator to spend all this money? Knowing how to persuade someone generally starts with knowing the person. So in crafting your proposal, consider the following questions:

• What is your administrator’s vision for your organization? What are their top priorities?
• How will your work (and this purchase in particular) support that vision/those priorities?
• What are the counterarguments the administrator may make to your proposal?

My then-administrator and I sat down early on in my AAC journey and she explained to me that her top priorities included (1) legal compliance, (2) staff training, and (3) reducing the severity of behaviors in the classroom.

So I said, great! (1) I’m working on identifying all the kids who need AAC, and getting all of the IEPs on my caseload to be legally compliant. That means I need devices for kids to try, so that my assessments will be legally defensible. I can’t really say if a device would work if I can’t offer the kid a trial. I can make a list of items I would need to get started, and we’ll call it the AAC Lending Library. (2) I would love to train the staff members on how to use the devices, so another purpose of this lending library would be to give me real devices that I could bring with me to staff training. And (3) AAC is a fantastic proactive strategy for reducing unsafe behavior, because most of the time, severe noncompliant behavior happens when a person has no other way to communicate their needs.

“But,” she said. “Our funding is very limited.”

PAUSE,

Do you know of a school or district that doesn’t have this problem? Me neither.

I’ve worked in districts that couldn’t even provide their teachers with enough paper, for heaven’s sake, let alone set up an AAC library! IDEA has never been fully funded and that IS a major problem. But there are low-incidence funds, and federal reimbursements, and all kinds of other details we don’t necessarily need to know about. I don’t let this particular counterargument stop me from advocating for kids, and I hope you won’t either. We are AAC specialists, not budget specialists, and it is our job to explain what kids need, and why it matters. All we need to know about the budget is what the law says about it, and that there’s usually some discretionary funding for extra stuff, to be spent only if it’s really, really important.

What I said to my administrator was: the AAC Lending Library will save us money over time in three big ways.

1. It will reduce the amount we have to pay our lawyers, because we’ll have happier kids and families once they have the accommodations they need, and because we’ll have legally compliant assessments and IEPs.,
2. It will help us get the right device for each child the first time. If we blindly buy dedicated AAC devices for a student without being able to try them and assess first, that’s going to result in a huge amount of waste.
3. I’ll be keeping track of every single device so if a kid doesn’t need it, then we’ll save it and potentially reuse it with someone else instead of letting it gather dust in the bottom of a drawer in the classroom.

And then I held my breath to see what she would say next…

What if they say no? I had prepared myself for the possibility that my district might say no to at least some of the materials I was requesting. In that scenario, I had prioritized which ones I absolutely had to have. At the time, that included at least one iPad for myself to do assessments, and all of the less expensive low tech AAC materials that I was asking for. I knew that in the worst case scenario, they still were legally required to provide dedicated devices, so it would have been a lot slower, but kids would still have received their AAC devices eventually. Tenacity is a job requirement for the AAC Specialist, after all!

Thankfully, my district said yes!

They made a big upfront investment in the AAC Lending Library (about $10,000), and have even continued to invest in it over time. Within the first year, I estimate that it actually saved us about $20,000 because we were reusing devices and app licenses instead of having to buy new ones every time. I have no way of knowing how much we saved on bills from the district’s lawyers, but I can tell you that five years later, we haven’t had a single lawsuit related to AAC, and cases involving an advocate are rare (less than 3% of my caseload). Once teachers heard about the AAC Lending Library, they started reaching out and saying things like, “I think I have some extra VOCAs in my classroom, do you want them?” Knowing they could request it back at any time meant they were willing to share. That generosity increased the size of the library and benefited everyone.

But the greatest impact was of course for the students. How do you measure the value for them to finally have access to robust language and communication? It’s priceless!

So Many Cookies, So Little Time

Picture that kitchen cupboard again. It’s been thoroughly dusted and disinfected, filled not to the brim but “just right.” Everything is labeled and categorized, and there’s nothing expired here. You’ll need to shop again every so often, but in the meantime, you’re ready to make some delicious cookies. Your client will get to try as many flavors as they like until they find one they love!

That’s how I feel about my district’s AAC Lending Library today. It’s an awesome resource that I never take for granted. In moments when I’m struggling to figure out how to meet the needs of all these kids, I think about how far we’ve come. That gives me the energy to get creative, make do with what we have now, and keep advocating for what they’ll need next.

References:

Beukelman DR, Mirenda P. Augmentative and alternative communication: Supporting children and adults with complex communication needs. 4th ed. Baltimore, MD: Paul H. Brookes Publishing Co.; 2013

Want to know more? Ask Brianna Your Questions at this month’s LIVE (always FREE) Online AAC Fireside Chat!