After hearing a little buzz about Therapy Box's new AAC app, Chatable, I was excited to get a chance to try it out this month. It has some nifty features that give it a lot of potential for our AAC users.

Features I like:

• There is an integration of grid based pages and scene based pages. You can choose one or the other or make a hybrid page with both. I found the modification to be easy and user friendly.
• Users can create messages and share these by speaking, posting to text messages, Facebook, Twitter or through email. I love that this company gets the importance of these social options!
• Multimedia options include the ability to add your own photos, link to your own videos, link to YouTube videos, link to websites or play your own music within the app.
• Scanning features: touch anywhere or switch scanning; auditory cues; scan color options
• Text to Speech or Handwriting Input- an unusual input method that gives users who can write the ability to speak outloud
• Navigation by folders, hotspot selection on scenes or by left-right swiping.
• Schedule the appearance of boards by setting a time to have the board open- a nice feature to cue AAC users and assist in navigation
• Set a specific page to open when the AAC user arrives at a designated place (recognized by GPS).

Wish List:

• An organized set of vocabulary and messaging options to help families get started
• Customizable auditory cues and linear scanning options for scanning
• Qwerty keyboard option
• Slightly larger navigation buttons to the keyboard and back for ease of access
• An option to automatically open scheduled pages without requiring a yes/no response

All in all Chatable is an AAC app with robust options. A great place to start with AAC and, with the help of an SLP to develop a relevant vocabulary set, a system which can meet the needs of many beginning communicators.

I was given a copy of Chatable to review. We are given access to many AAC apps but only discuss ones we believe have therapeutic value for our families.

Features video from Therapy Box

http://youtu.be/kNSGQHlJp0w

I'm writing this in hopes that someone at ASHA is paying attention. I'm writing in the hopes that our voices together may add some sense to a situation which is hurting children.

When the government's NCCI (National "Correct" Coding Initiative) edits came out in 2011 they only allowed us to do SGD services on the same day as speech/language services IF we billed the codes with a modifier. Our state Medicaid program didn't restrict these two codes together and didn't give us the ability to add the modifier when we billed. Now the state Medicaid program is coming back and asking for their money back saying we shouldn't have billed the codes together without a modifier, despite the fact that their provider manual stated we could bill the codes together and, the fact that they didn't have a way for us to put a modifier into our billing with them. We are an AAC specialty clinic so this impacts 100s of thousands of dollars of payment. So far they asked for $50,000. They gave us a way to go back on EACH claim and add the modifier. There are thousands of claims. They will graciously pay us once these are done. In the meantime they won't pay their bill with us. This week they decided that they are going to review every claim since January 2011.

There are so many things wrong with this situation. Most importantly , what sense does it make that a therapist with an AAC user would NOT also need to work on receptive language? Anyone working with an AAC user knows that they are at a very high risk for receptive language delays and oral motor/feeding and speech needs. The vast majority of these children need to be seen for receptive/expressive language, speech generating device modification/treatment, oral-motor/feeding and behavioral intervention. Why in the world would we force these already overworked parents to drive to therapy 2-3 times a week simply to have these services on a different day? What is the empirical evidence that providing these service on different days benefits the patient? On the contrary, we have patients traveling up to 1 1/2 hours to see us. Making them come twice places an undue burden on their physical health and their emotional well being. To say that this is the "same service" shows ignorance about the distinction between receptive language and expressive modes of communication. To ask these already incredibly challenged patients to learn all that they need to learn in a 30 minute session is beyond ludicrous. I cannot fathom that anyone with any real experience working with AAC patients had any input into the decision to disallow this code pairing.

The NCCI edits are just incorrect in not allowing these codes to be billed together. The only purpose this is serving is to give insurance and a Medicaid/Medicare an excuse to deny services that these children really need. I hope that the purpose of the NCCI edits is not to simply save government money on the backs of handicapped children. It is utterly wrong.

I have no confidence that our voices here in our clinic in Georgia will be heard by the NCCI editors but I would hope ASHA and our community of AAC families and professionals has the ability to add some reason into this terrible oversight that is hurting ACTUAL handicapped children.

At the same time, I sincerely hope that the service we are providing these children in our private practice can continue.

Thanks for any input you can offer or in helping us spread the word about the effect the NCCI edits are having on our children.

Vicki

• Increase motivation! Some of our apps are simply fun to play. Once a child loves a particular app, just adding the images of the app into another more, eh hem, educational app, makes the app more motivating.  All you have to do to get a screen shot is click your Home Button and the Power Button on top of the iPad at the same time and it will snap an image of whatever is on the screen.  Like these...

• Slow down the images so that you and the child have more time to talk specifically about the picture without the app charging ahead to the next action/picture/direction.  There are some really nice images in apps that deserve a second or so to process and discuss before moving on to the next "clickable" option.  At times, as quick as we therapists are, we're not faster than those little student fingers.   Kids are great at changing pages before the pesky SLP can, good grief, talk about it.

• Reinforce a concept introduced in one app by elaborating on it with another app