Exceptional
Education: Getting Parents Involved
The Coping.org Assistive Technology
& Educational Adaptation Survey
If you are not fully aware of the
scope and breadth of Assistive Technology or Augmentative and Alternative
Communication Systems please first review the Assistive
Technology section of the Tools
for Parents of Children with Special Needs Book on this website.
Prior
to your child's next IEP meeting, to better prepare to educate your
child, take
the time to respond to this survey so as to help
staff, working with your child, to prepare for
Assistive Technology (AT)
modifications or educational
Adaptations (EA) you would like to see incorporated
in your child’s educational and/or therapeutic program
through your child's IEP.
There
are many types of Assistive Technology (AT) modifications and Educational
Adaptations (EA), which your child may be able to benefit from, or is already
currently using. Just a few of the
AT areas include:
-
Communications
(symbol-picture boards, electronic communication devices, etc.)
-
Mobility
and Seating (power and manual wheelchairs and seating systems)
-
Fine
Motor Control (adaptive writing instruments, hand positioning splints,
adaptive utensils, etc.)
-
Computing
(trackballs, word prediction software, laptops, etc.)
-
Receptive
Hearing (FM units, hearing aids, etc.)
-
Reading
(books on tapes, computer software, etc.)
-
Auditory
Training (FastForward, Earobics, etc.)
-
Cognition
(training software products)
-
Hearing augmentation (fm unit,
hearing aids, etc.)
These
are a few of the Educational Adaptations (EA), which may benefit your child in
the academic arena:
-
Mathematical calculations
(calculator)
-
Handwriting adaptations
(computer, laptops with portable printer)
-
Reading (books on tapes)
-
Test Taking (tests on tape)
To
Download a Word Document of this Form Click Here
Fill out this information first:
-
Name
of Parent or Guardian responding
-
Relationship
to the target child for whom you are responding
-
Address:
City: State: Zip:
-
Telephone:
Work Phone: Fax:
-
Email:
Please indicate
your target child’s:
My target child
currently attends a school which is:
-
Public
and its name is:
-
Private
and its name is:
- Home Schooled:
1. My target child currently has assistive technology
equipment and related therapy expenses paid for by (put an x in front of the
insurance or third party payors for the medical and technology supports your
child has):
-
Family Health Insurance Plan
-
Medicaid
-
Medicaid Waiver
-
State Developmental Services Purchase of Materials
-
Assistive Technology Grant from Public School under the
IDEA
-
Grant from a Civic Organization or National Charity
(Please Specify):
-
Other source (Please Specify):
2. The amount of support and time available to implement
Assistive Technology or Educational Adaptation services in the classroom may be
different depending on the classroom environment. Please put an x in front of what best describes your
child’s classroom environment.
-
Self-contained classroom
-
Resource room support (2-3 hours a day) and in regular
classes rest of day
-
Fully included in a regular classroom all day with an
attendant
-
Fully included in a regular classroom all day with no
attendant
-
Other (Please describe):
3. Put a check in front of which therapies or services
your child currently receives and indicate where and degree of frequency when
asked:
-
Physical Therapy (frequency and location [school,
private]):
-
Occupational Therapy (frequency and location [school,
private]):
-
Speech Therapy (frequency and location [school,
private]):
-
Sensory Integration Therapy (frequency):
-
Auditory Integrattion Therapy (frequency):
-
Visually Impaired Services (frequency):
-
Auditory Impaired Services (frequency):
-
Specific Learning Disability Services (frequency):
-
Recreation Therapy (frequency):
4. Please rate the perceived comfort level of the
professionals who are currently working with your child concerning utilizing
Assistive Technology (AT) to assist your child to be more functional in everyday
activities.
-
Extremely
supportive and currently implementing AT services for your child at this
time
-
Very supportive
and offer many AT suggestions and alternatives for use now
-
Supportive
offered information about AT as a possibility some day but not now
-
Rarely
supportive has slightly mentioned AT but never as a possibility for my
child
-
Non supportive
refuses to consider an AT alternative for my child or has never mentioned AT
to me
5. Please rate the perceived comfort level of the
professionals who are currently working with your child concerning utilizing
Educational Adaptations (EA) to assist your child to be more functional in
school and everyday activities.
-
Extremely
supportive and currently implementing EA services for your child at this
time
-
Very supportive
and offer many EA suggestions and alternatives for use now
-
Supportive
offered information about EA as a possibility some day but not now
-
Rarely
supportive has slightly mentioned EA but never as a possibility for my
child
-
Non supportive
refuses to consider an EA alternative for my child or has never mentioned AT
to me
6. Place an X
next to each specific functional difficulties your child currently experiences
which impairs full functional performance at school, in the community, or at
home.
In communications your child needs:
-
Total assistance: has
extremely limited communications skills
-
Maximal assistance: frequent
interpretations of child’s communications are needed
-
Moderate assistance: uses
simple language to tell about own needs and activities
-
Minimal assistance: expresses
self clearly almost all of the time
-
Prompting/setup: caregiver or
other adult may need to give some prompting or cueing when the child is
communicating with less familiar people
-
No assistance and is
Independent: can be readily understood by others all of the time
Other needs:
-
problem hearing – severe hearing deficit or loss
-
problem seeing – severe visual deficit or loss
-
problem with long distance mobility (walking long
distances)
-
problems with fine motor control (please specify):
-
other physical movement problems (please specify):
-
problem with mathematical computations
-
problem with handwriting
-
problem with reading comprehension
-
problem with reading books or stories
-
problem spelling words
-
other cognitive problems (please specify):
-
problem paying attention to directions
-
problem with remembering directions
-
inability to follow or understand geographical
directions
-
problem behaviors interfere with conduct in a classroom
or social setting
-
problem with relating to peer group in a social setting
-
other (please specify):
7. Is your child aware of Assistive Technology?
yes no
8. Is your child aware of Educational Adaptations?
yes no
9. What does your child
think about Assistive Technology (AT):
-
Extremely
motivated and currently implementing AT services at this time
-
Very motivated
and openly participates in the search for AT alternatives for use now
-
Motivated has
shown openness to information about AT as a possibility
-
Poorly motivated
has never shown interest in possibility of AT for self
-
Not motivated
refuses to consider or participate in any AT alternative at all
10. What does your child
think about Educational Adaptations (EA)
-
Extremely
motivated and currently implementing EA services at this time
-
Very motivated
and openly participates in the search for EA alternatives for use now
-
Motivated has
shown openness to information about EA as a possibility
-
Poorly motivated
has never shown interest in possibility of EA for self
-
Not motivated
refuses to consider or participate in any EA alternative at all
11. Please list what Assistive Technology and/or
Educational Adaptation products you are currently considering or have considered
using in the past (e.g. Adapted keyboard, electronic communication device,
writing aids, etc)
Assistive Technology
The following questions are for
those parents who have already used
Assistive Technology and/or Educational Adaptations in the past with their
child, or who have had previous
experience attempting to obtain AT/EA in the past.The following questions are for
those parents who have already used
Assistive Technology and/or Educational Adaptations in the past with their
child, or who have had previous
experience attempting to obtain AT/EA in the past.
12. list
all of the Assistive Technology and Educational Adaptations your child is
currently using or has used in the past?
Please rate 1-5 on how successful the AT/EA device has been for your
child? Use the following rating scale:
Assistive Technology Device … Rating
Educational Adaptive Device… Rating
13. List each Assistive Technology and Educational
Adaptation device your child is currently using and fill in the following
information:
How often is AT/EA devise used? D=daily,
F=frequently,
I=infrequently
Where is it used : H=home,
S=school, C=community
1. Assistive Technology Device
2. Assistive Technology
Device
3. Assistive Technology
Device
1. Educational Adaptation Device
2. Educational Adaptation Device
3. Educational Adaptation Device
14. Up until this time how did you obtain funding for
your child’s Assistive Technology and Educational Adaptations?
15. Choose as many of the following statements which
you would use to describe the entire Assistive Technology and Educational
Adaptation process (evaluation, funding, implementation, follow-up):
-
very productive experience
-
worth the time and aggravation
-
waste of time and energy
-
made a world of difference in my child’s life and
that made it worth the effort
-
did little for my child thus it was a waste of energy
and effort
-
lots of red tape, very confusing and took too long to
get what my child needed
-
invaluable learning experience on what to do and not
do for my child
-
hopeful and enlightening because it opened a new
world for my child
-
relieving since it offered a modification which would
enable my child to be better to handle the responsibilities and
requirements facing him in school, at home, and in the community
16. What would you like to change about your child’s
Assistive Technology and Educational Adaptation experience? (please describe):
17. How knowledgeable have the professionals (OT, PT,
SLP, Teacher) been in implementing Assistive Technology and Educational
Adaptations in the past?
-
Experts:
I have complete faith that they know what’s best for my child and will
carry it through in school
-
Very good:
They have carefully thought out the process and identified multiple
solutions. An AT plan should
be in their IEP at this level.
-
Adequate:
They came up with helpful ideas that had a positive impact, but carry over
and implementation was inconsistent.
-
Inadequate:
They were not able to identify AT/EA solutions that were suitable or did
not use the suggested AT appropriately.
-
Poor:
They did not know which types of AT/EA might be available for my child
and/or refused to implement
suggested AT/EA.
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