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Consideration of alternatives: As part of an SGD evaluation, the SLP must discuss other device alternatives that could be used to treat the client’s condition. Consideration of alternatives, first for appropriateness and then for cost, is a required element of all SGD evaluation and reporting guidelines (Lewis Golinker, Esq., Public School Students: Who Can Pay for SGDs?,

Funding sources have different guideline requirements for what constitutes an adequate “consideration of alternatives." Some funding sources require that you consider and rule out (for the client’s use), other device alternatives. Some require that you show that other device alternatives were tried. And yet, some funding sources require an extended trial of a certain length. The following is a discussion of how to know what the difference is between consider, try, and trial as those terms relate to consideration of device alternatives in an SGD evaluation.

The difference between Consider, Try, and Trial:

  • To CONSIDER an AAC method implies that you used your own professional awareness of and clinical understanding of that method, its characteristics, and features, to either rule it in as a match or rule it out for the client’s needs. When “considering” an AAC method, you don’t actually try it with the client or do an extended trial with it. For example, “I considered ASL but ruled it out due to the patient having minimal use and dexterity of the upper extremities. Limitations in his fine motor abilities will not allow him to express through manual signs and thus, ASL was ruled out.” Or, “I considered low-tech and mid-tech E2500-E2506 devices, including but not limited to the Amdi Smart 128 for my clients use. However, due to his fine motor limitations, he is unable to independently access and change the overlays and operate the small toggle switches to change levels on the Amdi Smart 128 to access more vocabulary and messages. This would severely limit his access to vocabulary and messages and require him to be always reliant on a communication partner to change overlays and device levels.”
  • To TRY an AAC method implies that you presented the client with it at least once to try it but then ruled it out quickly based on observations of that brief encounter along with your own professional judgement and clinical knowledge. For example, “During the client’s 45-minute evaluation session, she tried an Accent 1400 but it became very obvious that this device was not going to meet her needs due to the large size of the device display screen and her inability to reach the upper quadrants to activate targets. It was determined that the client needs a device with a smaller screen size due to her limited mobility in her arms and reduced capacity to reach targets on a large display.”
  • To TRIAL an AAC method implies that the device was used over an extended period, with various communication partners and across various communication environments, to rule it in or out for the client’s long-term use. A trial is typically 4 weeks, but can be shorter or longer, and is often dependent on the SGD policy guidelines of the client’s funding source. Some things to note: A trial does not have to stay in the possession of the client during the entire 4 weeks – it could just be used at each session in the clinic over 4 weeks when they come for therapy. Also, environments can be in one location (therapy room, PT gym, outside playground, front lobby, secretary’s desk, etc.) or many locations (home, school, therapy, church, karate practice, etc.). Same for communication partners – could be in one location (SLP, OT, PT, secretary, random stranger in the waiting room) or many locations (teacher, private therapist, minister, waiter at restaurant, etc.) For example, “The client completed a 4-week trial, from 10/1/2021 to 11/2/2021, with the NovaChat 8D+. The client used the device to make requests, ask questions, comment, protest, and direct others in various environments and with several communication partners.”

Funding source guidelines differ in what is required to satisfactorily rule out device alternatives for a client. Some state Medicaid plans require that all other lower cost alternatives must be “considered” and ruled out for the client’s use, AND that an extended “trial” of the recommended device must be completed prior to purchase. Conversely, Medicare only requires that the SGD evaluation report documents the other forms of treatment (other SGD’s) that were “considered” and ruled out for the client’s use. Medicare does not require documentation of an extended device trial of any length. Given that there are these differences among the various funding sources, it is important that SLPs reference SGD policy guidelines for their client’s funding source to assure that the SGD alternatives for their client are satisfactorily considered, tried, or trialed, based on the requirements in the policy guidelines.

PRC-Saltillo will accommodate a trial request, from the SLP or family, even if the funding source doesn’t require it. Check out for options!

Beth Studdiford, M.S., CCC-SLP, and Beth Browning, M.A., CCC-SLP.

AAC Funding