Client assessment for recommending assistive solutions: Protocols and tools

Objective. Individual assessment for assistive technology solutions (AT) is often part of the rehabilitation program; however, it may also be carried out as a specialist consultation in Assistive Technology Centres (ATCs), especially when inter-disciplinary competence and trial equipment are required. Currently, this specialist consultation is not officially recognized by the Italian National Health Service (NHS): thus it is not eligible for reimbursement. For custom-made equipment, this is not a big problem (as the cost of the professional work is embedded in the cost of the device). Conversely, it is critical for the sustainability of Institutions operating ATCs. In view of prospective accreditation and reimbursement, protocols for these consultations have been defined in order to make sure that the same type of consultation, provided by different ATCs, has a similar output at a comparable quality level. Based on economic analyses, tariffs have also been established for negotiation with Regional Authorities. Method. First, the methods used by several ATCs have been analysed; similarities and differences encountered have been extensively discussed until achieving a consensus on a taxonomy of AT Consultations in terms of topics dealt with (mobility, communication etc.) and generated output (recommendation for prescription; assistance during provision; etc.). Armed with these findings, a further analysis was carried out within a subset of ATCs until agreeing a proposal ready for submission to regional authorities as a basis for tariffs negotiation. An economical model was purposely developed to support such tariffs with evidence. Results. Eleven Consultations have been identified: 1) On-Centre Assessment of general AT needs; 2) On-Centre Assessment for mobility/seating; 3) On-Centre Assessment for ADL equipment; 4) On-Centre Assessment for home adaptation; 5) On-Centre Assessment for environmental control; 6) On-Centre Assessment for computer access; 7) On-Centre Assessment for augmentative communication; 8) On-Centre Assessment for educational technologies; 9) Home Assessment for general AT needs; 10) Home verification of the equipment provided and 11) Technical Check-up of the equipment provided. For each Consultation, a protocol has been established, as well as a tariff covering the related costs. Conclusions. The work has led to the first widely-agreed proposal for an Italian quality standard on AT assessment. Currently, the proposal has been submitted to the largest Italian Region (Lombardy) and is waiting for feedback.