How to prescribe Assistive Technology

How to Prescribe Assistive Technology

Do you feel pressured to "just write a letter" for equipment funding without doing a proper assessment? Or are you worried your prescribed equipment will end up abandoned in a corner? Discover the comprehensive step-by-step process for prescribing Assistive Technology (AT) that ensures your clients get exactly what they need.

Episode Summary: In this episode of the How to Be a Better OT podcast, host Clare Batkin tackles the essential core skill of prescribing Assistive Technology (AT). Whether it is a simple shower chair or a more complex mobility scooter, Clare breaks down an 8-step framework inspired by the best practices recommendations of Australian OT researcher Dr. Natasha Layton. She walks you through everything from identifying the true functional goal using the HAAT model, to managing equipment trials, navigating complex funding applications, and preventing AT abandonment through proper follow-up and evaluation.

Key Takeaways:

• Identifying the Goal: Learn why you must focus on the functional issue rather than jumping straight to the equipment. Discover how to use the HAAT model to thoroughly map out a client's needs and environment.
• AT Features: How to establish a clear list of required AT features before contacting suppliers, using a simple shower chair as a practical example to consider size, safe working loads, and environmental constraints.
• Trialling and Compromising: Discover the logistics of planning successful AT trials, working collaboratively with equipment suppliers, and helping your clients weigh up the pros and cons to make empowered decisions.
• Navigating Funding: Tips for writing complex funding applications (like the NDIS) by meticulously reviewing quotes and using your trial data to justify cost-effective choices.
• Preventing AT Abandonment: Why your job isn't done after approval. Learn how to use the "Who, What, How" framework for implementation and training, and conduct long-term evaluation using tools like the Quest 2.0 or PIADS.

Links & Resources Mentioned:

• Freebie: Download the PDF mapping out the AT process for an electric riser recliner chair, plus access free webinars on various AT, in the Free Learning Library.
• Deep Dive: Watch the "Just write me a letter" conference presentation on the Learning Library or YouTube.
• Tool: Access the PoMoDATT (Powered Mobility Device Assessment Training Tool) assessment tool for mobility scooter or powered wheelchair trials.
• Deep Dive: Get full webinars on the AT process and the "Who, What, How" training framework by joining the Connector or Alliance Membership.
• Course: Access the Community AT Series (created with Lauren Hart from Otuition) on wheelchairs, commodes, scooters, beds, and recliners, available as a bundle or individual purchases.
• Advanced Learning: Join the Your OT Tutor Journal Club to access a library of recordings discussing topics like end-of-life AT prescription, 24-hour positioning, AT outcome measures and overcoming barriers to AT use.
• Resource: Read more about the 8 steps in the textbook chapter by Dr. Natasha Layton: Layton, N. (2017). Assistive Technology. In M. Curtin, M. Egan, & J. Adams (Eds.), Occupational therapy for people experiencing illness, injury or impairment : promoting occupation and participation (7th ed., pp. 648-670). Elsevier. 

If you found this step-by-step guide to AT prescription helpful, please subscribe, leave a review, and share this episode with a fellow OT! Be sure to tune in next time when we will be covering how to complete functional cognitive assessments.

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Transcript

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We're on the home straight now with two more steps to go, and I'll admit you may not even be aware that these steps exist because traditionally they're not well-funded and busy clinicians may feel that they're not as important as getting the equipment scripted and funded and out there in the first place. But trust me, they are crucial. Going back to the AT abandonment rates, many reasons for non-use of prescribed AT could be avoided if we do a formal follow-up and evaluation Welcome to the How to Be a Better OT podcast. I'm Claire Batkin, an OT and clinical educator who is on a mission to make professional development simple, practical, and worth it for OTs. If you're ready to step back from the overwhelm and bring core frameworks to life, join me for step-by-step guides and practical solutions that will build your confidence and competence so you can deliver the best outcomes for your clients and truly love what you do. Hi again. Welcome to the podcast. Today, we are tackling an important topic: how to prescribe assistive technology, or AT. Now, it doesn't matter whether it's a simple shower chair or adaptive cutlery or a complex power wheelchair with a customized seating system, the actual steps that we need to go through are the same. We start with identifying the functional issue, considering the possible options, doing trials, ensuring the client receives the training they need to use the AT effectively, and then we need to evaluate whether it worked or not. All this needs to be done in a collaborative, evidence-based way, and every step is important. Cutting corners increases the chance of AT abandonment or, in the worst case scenarios, prescribing equipment that actually causes harm. Now, we don't want this, so in this episode, I'm going to take you through a step-by-step process for AT prescription that you can apply to any piece of assistive technology. Now, as always, there are some freebies to go along with this. If you sign up for my free learning library, the link will be in the show notes, you'll be able to access a downloadable PDF that will take you through this process using the prescription of an electric riser recliner chair as an example, and I've also done loads of collaborations with others working in the AT space, so you can access free webinar recordings on AT such as pressure care mattresses, electric profiling beds, AAC, wheelchairs, and commodes. And also, if you do find this episode helpful, you can also access full webinars on the AT process and how to provide education regarding AT as part of my Connector membership. But for now, let's dive into the episode. So the framework that I'll be using today is inspired by the best practice steps proposed by Australian OT researcher Dr. Natasha Layton. Now, in true OT nerd fashion, I found these steps described in a textbook, so I'll drop the details about that textbook into the show notes too. Now, the disclaimer is that this is my interpretation of the steps, and it's influenced by my own personal experiences of prescribing AT in both a hospital and community private practice setting. But hopefully, I still cover the key points that Dr. Layton described in her textbook chapter, Even if exactly when things happen in the process differ from what others maybe might suggest. But let's get into it. So step one of this process is all about identifying the need or the goal. Now, even though referrals often come to us with a piece of equipment already identified, things like Mary is having difficulty with showering and she needs a shower chair upon discharge, or Don needs an OT support letter so that he can get funding for a mobility scooter. The actual goal that we start with isn't get a shower chair or get a mobility scooter. The goal is to address the functional issue. Now, in Mary's case, we focus on the first part of the referral, the difficulty with showering part. Now, while the shower chair may be part of the solution to Mary's showering difficulty, it's not the only thing that we should be considering. And keeping the focus on the functional task rather than the equipment itself is an easy way to remember this. In Don's case, yes, we might decide that a mobility scooter is a good choice, but we need to go through a few more steps before getting to this point. A nice way to explore this is with a model like the PEO model or the HAAT model. Now, most OTs will be very familiar with the PEO model, so instead we'll chat through the HAAT model. The HAAT model stands for Human Activity Assistive Technology Model. If we start with human factors, we think about Don's age and prognosis. So does he have a condition that's likely to progress quickly? What are his physical and cognitive abilities and impairments? Decreased mobility and endurance are maybe creating the need for something like a mobility scooter so that he can access the community. But will he have the upper limb strength and dexterity to steer it, the visual and hearing ability to use it in a busy suburban area, or the cognitive ability to remember to charge it and keep it locked away safely when he's not using it? In terms of the A for activity, what activity is Don having difficulty with now that he thinks a scooter might help with? Does he only want it for going to the local shopping center for groceries? Does it need to go further than that or to be portable enough to be taken with him when he next visits his daughter and grandchildren, so something that fits on public transport or that can be folded up into a car boot? And how often will he be using it for all of these things? Which type of activity is most important if there ends up being a compromise that needs to be made? The HAAT model also includes consideration of the context or, like the PEO, the environment in which the equipment will be used. So this goes beyond just what terrain Don will be driving the mobility scooter in to also include his social environment, such as how much support will he have from family to learn how to use or store the scooter or to problem solve if issues arise after the prescription. And what is the broader funding source that could dictate whether or not a scooter is even financially possible? Finally, in the HAAT model is the assistive technology itself. What are the key features the AT solution will need to have? And we'll go into this in more detail in the next step of the process. Hopefully that quick example was enough to highlight just how important this step of exploring the functional issue is. If we skip this and jump straight to organizing some trials of mobility scooters because that's what the referral asked for, we could be setting up Don for disappointment when we realize that he doesn't have the vision to drive it safely or he doesn't have anywhere safe or weatherproof to store it and instead we need to look at other options that could have achieved the same goal, which was to increase his ability to access his community. You'll also find it's much more difficult to write a report that justifies the need for a scooter for Don and how we know it will be a safe, cost-effective option unless we think through the functional goal and Don's abilities first. Now, just a little side note before we move on to the next step. This just write me a letter type scenario is one that comes up a lot for OTs and we can feel like we are only really valued as people who fill in forms or who write letters to get people stuff and often this is because the referrers or our clients don't really understand the clinical reasoning process that we need to go through before we fill in the form or write the letter if we're doing our job correctly. Now, one way to try to change this narrative is to make sure that we aren't skipping over the proper process ourselves and that even if we get a referral where the AT solution has already been identified, we still go back to the start of the AT prescription process and explicitly tell our clients this is what we're doing. Something like, "Don, we can definitely explore whether a mobility scooter might be a good option for you, but before we jump into booking in a showroom visit so you can do some test drives, we just need to go back a bit and make sure that we're both really clear on exactly what activity is difficult for you now and what you're hoping a scooter will be able to make easier for you. So let's talk about how you currently get out into the community and what part of that is hard, and it will help us make sure that we test the best options if we do decide a scooter may be helpful. Or if we decide a scooter isn't going to be a good option, then my job will be to help you find other ways to be able to get out into the community and to do the activities that you want to do." So something like that maybe. If you would like to hear more about how to deal with this just write me a letter scenario though, um, I actually did a conference presentation on this topic last year, and I've recorded a version that you can view in my learning library and on my YouTube channel. So I'll drop the details in the show notes Okay, now we're up to step two. This one is all about really getting into the nitty-gritty of what type of assistive technology we need. So in step one, we decide that there's a functional need that a piece of AT will solve. Now we need to find out exactly what that AT is. We evaluate the options that are available, and we put together a list of features that the AT will need to have. Now, if you haven't already started mapping out the scenario using the PEO or the HAAT model yet, either explicitly on paper or in your head, then now is definitely the good time to pull it out. You can work through the model piece by piece and think about what features are essential based on person, environment, or activity considerations the use of models is something we do a deeper dive into in the Community AT series that I created with Lauren Hart from Otuition. In this five-part course bundle, we use the PEO or HAAT models to map out the features required for manual wheelchairs, mobile commodes, mobility scooters, beds and mattresses, and electric riser recliners. And again, I'll drop some details in the show notes. But for now, let's go back to the simple shower chair example with Mary to work through this step. Although at this point, we may have only decided that a piece of AT that Mary can sit on in the shower is needed, we may not have a hundred percent decided what that is yet. So to do this, we need to consider things like Mary's size and weight. So how big will the shower chair need to be, and what safe working load specs will it need to have? How does Mary normally transfer, and what does her shower environment look like? Will she need a chair with armrests because she's reliant on those to do a safe sit to stand transfer? Or does she prefer to pull herself into standing and there's a grab rail on the wall in her shower for this, so having a chair with no armrests actually could make it easier for her to wash herself or to reach certain body parts. Does she have a very sloped shower recess floor where each leg of the shower chair will need to be able to be adjusted separately to keep it level? And how big is her shower recess in the first place? Will she be able to fit a shower chair or will something smaller like a stool be needed? In terms of her sitting balance and endurance, will she need something with a backrest so she can safely sit back and have a rest? Or would, again, a backless stool maybe give her more space and freedom for washing? How long do Mary's showers take, and is she at any significant increased risk of developing a pressure injury? Now, this may not be something we usually need to worry about when prescribing a shower chair for hospital discharge, but it can be really crucial when considering AT for the same task of showering if the person actually needs a mobile shower commode instead. And finally, what about the cost or funding source? Is Mary self-purchasing and working to a particular budget, or is she funded by a particular funding source that only allows us to choose between three different shower chair or stall options, or is she borrowing from the hospital equipment loan pool, and we may be limited by what's actually available. Sometimes you won't know exactly what features will be required until you have a chance to trial them, but ideally what we want to have is a mapped out list of features before that trial stage. We can then provide these details to the equipment supplier, and they will hopefully be able to narrow down the options to make the process easier. Next, we'll move on to step three, which is trialing the AT options. This could include trialing various models of the same type of AT, such as trialing a few recliner chair options or a couple of manual wheelchair options, but it could also include trial of, or at least consideration of, lower cost alternatives too. Now, in the case of an electric recliner chair, did we consider replacing the current lounge cushion with something firmer? Or mady-- maybe adding some chair raisers or blocks to make it a little higher? Or did we review the transfer technique and make sure that just some better positioning and a rocking technique would have actually solved the difficulty and delayed the need for AT a little bit longer? Let's chat through the logistics you need to consider when planning and conducting the trials. First, think about where it will happen. So is it a piece of AT that will be fine to try in an equipment showroom, something like a recliner chair? Or is it something that will need to be trialed at the home to ensure it would definitely fit, something like a mobile commode or a wheelchair maybe. How long does the trial need to go for? Can they do a few quick transfers in and out and sit on it for a few minutes, and that'll be fine, or do we need to have it for a few weeks to make sure that it's actually comfortable and works in all the scenarios the person will need to use it for? So something like a pressure care mattress is just one example where a try before you buy extended trial can be really crucial for making sure it will actually be suitable long term rather than trying to make a decision based on lying on a mattress in a showroom for five minutes with some random strangers looking at you. Next, who needs to be present at the trials? Is it the client only, or will they be reliant on carer support to operate the AT during manual handling movements or during moments when their cognitive ability fluctuates? What activities do you actually need to test out during the trial? So something like a forty thousand dollar powered wheelchair should be tested in a range of activities, not just sitting on it for a few minutes in the showroom. Does it go up and down their driveway so they can make it out of the house? Does the seat raise high enough to be able to allow the person to reach into their kitchen cupboards? And then how will you record the results of the trial? What outcomes are you looking for in the first place? Is it that your client will now be independent with the task, or that their carers can complete it without manual handling injuries, or that their comfort levels are significantly increased? A big key thing that can help you collect this information is photos. So if you can get some consent from your client to take photos throughout the trial process, That will really help with your clinical reasoning and also can be included in the final funding application if you're needing to put one through Let's go back to Don and his mobility scooter trial to chat through these things. Now, in Don's case, we could do the trial at a showroom, or we could also search to see if there are any local suppliers who offer mobile showrooms who could bring some options to Don if that would actually make it easier for him. How long do we need? Now, if Don's a quick learner, a short one-off trial could be fine to get the process started, especially if we know that we'll be able to come back and reinforce any education once the scooter is actually provided Does anyone else need to be there? Now, in Don's case, we know that he wants to take his scooter with him when he goes away with his daughter on holidays, so it would make sense to have her there if possible, especially if we're looking at a portable or foldable option that she'll need to be lifting in and out of her own car. If we do it in a showroom or his home, we still need to make sure that we're performing or simulating the activities that Don wants to use it for. Now, this includes taking it outside, going up and down footpaths and other terrain, doing tight turns or fitting it through narrow doorways. For some pieces of AT, there could even be freely available guides or assessments to help you know exactly what to test. Now, in the case for Don, we could use the POMADAT, which I'll link in the show notes, which is a helpful tool for doing things like mobility scooter trials or powered wheelchair trials. We can use that to make sure that we aren't missing any important tasks that Don may need to perform on his scooter The final things to discuss when it comes to trials is what is the OT or clinician's role? How does our role fit with the supplier's role, especially if the AT rep happens to be a clinician themselves? Now, this is something that has become a bit of an issue in the private sector in Australia, where clinicians come along to trials but essentially let the supplier run the show and come up with the full script that they then hand to the OT to write the funding application for. The problem with this is if the OT isn't actively participating in that AT trial, that script may not make sense to them. They may not fully understand what the features are in the script for and why they are essential versus optional. Now, this isn't to say that the OT always needs to completely run the show and ask the supplier to sit quietly and watch. It needs to be a collaborative effort where the supplier is the product expert. You as the prescribing clinician are the expert on your client's functional capacity and requirements, but also that the client or the family are also recognised as experts of their own lived experience Okay, now once we've done the trials and we think we may have a winning option, we need to do some double-checking. Often this involves prioritising and compromising on AT features, as it is quite rare that we'll find a unicorn piece of AT that will do everything the client needs it to do. We'll stick with Don for this step as the example. So say you've narrowed it down to two options. Both are safe options, but one has a seat and suspension that gives a much smoother ride over bumpy terrain, but the other is much more compact and easy for his daughter to fold down and pack into the boot of her car. Which do you recommend? Now, this is where it can be helpful to actually map it out. So get a piece of paper, draw up a table with two columns for pros and cons, and write down some dot points. Do you want the option that prioritises comfort or the one that prioritises manual handling for his daughter? In many cases, if there are no clinical deal breakers, it comes back to client preference. But sometimes there are many more factors to consider than just comfort or manual handling, like in this example for Don. So using techniques like this of actually mapping it out, including some photos so they know exactly what features you're talking about, and then giving them a reasonable amount of time to consider those details and discuss it with others, is how we can ensure that we're empowering our clients to be active, collaborative decision makers Okay, so now we're halfway through the steps of the process. We started by identifying the functional issue in step one and deciding that an AT solution was the right choice. In step two, we went deeper into exactly what features the AT needed to have. Then in step three, we ruled out the lower cost alternatives and trialed some different options. And then in step four, we prioritise and compromise to come up with the final choice for what AT we are going for. Now we're up to step five, which is finding the funding source that will supply our chosen piece of AT. This will vary significantly depending on the country someone lives in, their age, and their eligibility to various funding schemes. And this in itself can be the most challenging part of the process. So my strong advice would be to make sure that you're seeking some advice from a clinician who regularly works within the scheme that you're applying to, so that you understand what formal processes you should be following, but also if there are any hidden tips or tricks that you would only really know once you've been working in that scheme for a few years The complexity of what is required can vary significantly. So for someone like Mary, we could just be filling out a one-page form for the local hospital's equipment loan pool so that she can borrow a shower chair for a short time while recovering from an injury or surgery. One form that involves writing down contact details, ticking a box, and no big long justification about exactly what Mary needs the shower chair for. Contrast this with the funding process for Don, who will be applying for funding for his chosen mobility scooter via the NDIS or the National Disability Insurance Scheme, which is a government funded support scheme for people with disability under the age of sixty-five, for any of my overseas listeners. This funding process can be confusing, inconsistent, and time-consuming, and definitely one where I'd be recommending that you have some supervisor input if you're new to it. Now, in these applications, we need to outline Don's function, clearly justify why a mobility scooter is the most cost-effective option to address the functional goal that was linked to his NDIS accepted disability, outline all the other options that we had considered and why they weren't suitable, as well as gather a quote, sometimes two, from an equipment supplier My key tips for this more complex type of funding application are things that you need to think about earlier in the process. Now, I mentioned the importance of comprehensive data collection and exploring person, environment, and occupation factors. So go back to these notes now, because you'll need to cover all these bases when writing up your justification. During the trial phase, you needed to keep detailed notes, take some photos, not just about the piece of AT that you selected, but about any other models that you tried or considered, because you'll need to explain why they weren't suitable, especially if they were a cheaper option that on the surface seems like a plausible solution. You'll really need to justify why the insurer should pay a little bit more to get the better option, such as because maybe it has more features that the client will need as their condition progresses, So you're future-proofing it so that the AT won't need to be replaced quite as quickly As I mentioned, for this more complex or expensive AT, you'll generally submit your application with a quote that the supplier provides. It's important that you don't just look at the bottom line and copy that final quoted amount into your application. You need to go over that quote in detail. You need to make sure that it a hundred percent accurately reflects the script that you came up with during the trial. Even with the best equipment supplier, human error can happen, so you want to make sure that all the details are correct, including what size seat, what type of hand control, and other special customizations that were requested. It's vital that the details are correct now because if everything gets approved and it comes to delivery day, only to realize that the incorrect seat size was listed on the paperwork all along, then there's a high possibility that the supplier won't correct it free of charge, and it could come out of your own professional indemnity insurance as a clinician. Now, I'm not putting that in there to scare you, but even mistakes that don't result in a safety issue can still be financially costly. So attention to detail and even just having a second set of eyes run over your report and the quote can be well worth it One final important part of this process is to keep your client in the loop and to manage expectations. Make sure they know how detailed your report will need to be and how long it will take to write rather than surprising them with your bill at the end. Make sure they know what time frame of waiting is expected before they'll hear a funding decision outcome. Also explain what the likelihood is that the funding will be approved and what plan B will be if the funding gets rejected. So yes, we can hope for the best, but even the most foolproof prescription can sometimes have interesting funding decisions made about it Okay, now we're up to step six. Let's leave the stress of the paperwork and skip forward to delivery day. The AT funding has been approved and the arrangements are being made to deliver the AT. The first thing you need to do is to make sure that you don't miss this happening. Now, while in the hospital setting, you may be hand-delivering the loan equipment to the ward for the family to collect or leaving it in place during a home visit. It's often a very different story for community therapists. It can be many months between when you submit the paperwork and when you hear the outcome. You may have had no other contact with the client in that time because the AT prescription was the only OT goal they needed you for, and definitely in schemes like the NDIS, the therapist is not automatically kept in the loop by funders. So you need to be proactive and make sure you stay in the loop. Some of my tips are to set some calendar reminders in your diary so you regularly check in to follow up for any updates with the client or referrer. During the trials, make sure that you're clear what the next steps will be. Tell them that they'll need to call you whenever they hear anything so that you can be involved with the next steps, and this applies whether the funding application was successful or not. If it wasn't successful, you'll be the best placed person to provide any additional information that may be needed to get it over the line. If it was successful, you'll need to be clear about whether you need to be present at the delivery or whether the person can start using it without you there and just reach out if there's a problem. This depends on what your evaluation plans will be, and we'll go into more detail about that in the next steps. While the client or referrer may assume that your job is done once the equipment is approved, this is far from the case, and evidence in the literature will a hundred percent back this up. Abandonment of AT is so high, and often this is due to completely avoidable circumstances that we could have avoided if the clinician had just done some follow-up. So things like making some adjustments to the AT setup or reinforcing some education about how to use it because the trial was months ago and the client's forgotten all those things. We've all been out on home visits where we see the very expensive wheelchair parked in the corner with a flat battery because the client decided it was too bulky and hard to drive, so they didn't use it. Or the shower chair that now serves as a glorified holder of dirty washing because the client couldn't work out the best position to place it in the shower so that it didn't get in the way when they were transferring in and out. These are the things we need to be checking for and troubleshooting at step six, which is all about the implementation and training about the AT. Once again, the depth of the training we provide will depend on the complexity of the AT we prescribed. In my connector membership, I have a full webinar on the who, what, how framework for making sure that you cover everything, even when you're doing something as simple as explaining to Mary how to use her shower chair upon hospital discharge. I'll take you through it now. So it involves thinking about the who. So what's Mary's specific learning style or preferences and her ability to recall information? Or how do these things apply if it's a family member who will be helping Mary with that AT setup? The what is about what content we cover, including where she'll be learning it from, how to set it up, how long to use it for, and whether it's safe to wean off using the shower chair or not, how to keep it clean and how to troubleshoot if something doesn't seem quite right. The how is about how you deliver the education. Should you just say it once and give a quick demo, or do you also need to include a written handout or a link to a YouTube video with a demo that they can refer back to later? These same components also need to be covered if the AT is more complex, something like Don's mobility scooter. Now, in this case, it could be months between submitting the application and the scooter being approved and delivered. So even if he mastered it during the trial, we need to revisit this. At this implementation and training step, we double-check it's still suitable for Don's functional capacity, especially if we've noticed any sort of decline in his abilities. We double-check that what was delivered was actually what we requested before he takes it out for the first lap around the block, and we make some time for a refresher training session with his daughter present if needed. We reinforce how the controls work, any safety precautions, how to fold and load it into the car, how to store and charge it. And at that same time, keeping in mind Don's ability to retain all that information. Can we just do some verbal instructions and a practice session, or will he need some written information to refer back to? We're on the home straight now with two more steps to go, and I'll admit you may not even be aware that these steps exist because traditionally they're not well-funded and busy clinicians may feel that they're not as important as getting the equipment scripted and funded and out there in the first place. But trust me, they are crucial. Going back to the AT abandonment rates, many reasons for non-use of prescribed AT could be avoided if we do a formal follow-up and evaluation. Step seven is the follow-up that comes after you've been there for the delivery and implementation of the AT. Now, in the case of Mary and the hospital discharge, we probably won't have any future contact with her unless a problem arises. Due to the nature of the setting, we can't keep track of every discharge client to see if they're using their AT, unless maybe it's someone who we are particularly concerned about. We often rely on the patient or family member being able to contact us for help if something doesn't go to plan, which is why the information we provide in the previous implementation step is so important. But within a community setting with complex AT, we need to be the ones driving follow-up. Before taking on the referral, we need to be flagging with the referrer that our job isn't done once the equipment is delivered, and that we'll need another home visit or another follow-up phone call, depending on your client's needs, to fully complete the job. We need to do this so that we do have funding for our time to do this important follow-up Follow-up includes things like reevaluating whether the training we provided is still making sense, checking that there hasn't been a change in the person's function that would mean the AT is no longer fit for purpose, and ensuring that any maintenance schedule is in place. And as much as possible, we want to encourage a self-management approach so that the client and their family is an active participant in this. We want to help them put in place strategies such as writing the due date for the mobility scooter maintenance warranty check on their wall calendar along with the supplier contact details, so they can book this in without waiting for an OT reminder. We also need to be very clear what our role will be going forward. Make sure the client or family knows that if there's a general maintenance issue with the AT, they can go straight to the supplier. But if it's something related to a change in the client's function or that if there's been a fall or a pressure injury, this is something they should be telling us about. Make sure that they're aware of how important it is to address issues like this early. And then the final step, step eight, is about reviewing the success of the AT device itself, as well as coming up with a plan for our ongoing involvement with the client. Again, exactly what this looks like will vary depending on the client and the complexity of the AT. For Mary, we may not be able to do a formal evaluation if we never hear from her again because her discharge and recovery went to plan. But I would say it would be a helpful QI or student project to consider to actually do a snapshot follow-up of people who were discharged from hospital with equipment to check in with them a month or so later and find out did they actually use it? Did it work? Were there issues? Was there anything different that could have been done to improve their experience? Now, while we don't often have capacity to follow up individual clients routinely after hospital discharge, a snapshot project like this could be the next best thing to make sure that what we're doing is actually working and worth our time. But for a deeper dive into this step, let's go back to Don and his mobility scooter. First of all, think about timing. If he did well in our implementation session, we may not plan to formally evaluate the scooter until he's had a really good chance to use it multiple times, so that may even be a few months later. Whereas if we had concerns that things could go wrong, we may schedule the follow-up and evaluation for after a few weeks. In terms of format, if there were concerns and funding was available, we would probably find that an in-person visit would be the most helpful. But if funding was limited or if he and his daughter were managing really well, we could maybe do this formal evaluation via a phone call instead. So what are we actually doing at the evaluation? Basically, we want to know, did the AT work? In that, did it solve the functional issue that we identified at the start? For Don, did it allow him to get out and about and do all those activities in the community that he hadn't been able to do due to his fatigue or decreased balance? We can find this out by asking a series of questions just based on a non-standardised checklist that we come up with ourselves, or there are loads of standardised outcome measures specifically designed for measuring the success of AT prescriptions. Some of them, like the Quest two point O, will focus on the logistics of how easy it was to use and did it work well, while others, like the PIADS, will focus more on the impact the AT had on the person's quality of life. You need to decide which outcome is most relevant for your client and then choose a method that will capture that. If you discover there was room for improvement, you might be able to fix it now, or at the very least, it's something that you can keep in mind and change for your next AT prescription. Now, the final thing to do is to evaluate where you're up to in terms of your working relationship with the client. Your options are generally that you will identify a new goal that you can start working on if you haven't already done this simultaneously with this AT process. Or you might decide that all the OT goals have been met for now and you can discharge the client from your service. If this happens, make sure you provide the client with some details about how they can re-refer again if new issues arise in the future. And guess what? That is it. We have reached the end of the process and hopefully prescribed a piece of AT that helped improve our client's function, independence, participation or safety. And hopefully, we're also feeling confident that we did it in a way that was comprehensive, evidence-based, collaborative and with occupation and function at the heart of it. Remember, if you would like a deeper dive into some AT focused learning, there are plenty of options with Your OT Tutor. Within my paid Connector and Alliance memberships, there are webinar recordings on general AT prescription, and the Alliance membership even comes with access to the course on prescribing recliner chairs that is part of the Community AT Series. You can also sign up to access the Community AT Series on wheelchairs, beds, mattresses, commodes, scooters and recliners, either individually or as a five-part bundle that will save you loads of money, and this does come with an example report template for prescribing these types of AT. If you are confident in the steps of AT prescription but you want to talk more about the challenges, the Your OT Tutor Journal Club is a great option. So for a one-off payment, currently less than $50, you can access a full library of recordings for a year that includes topics such as end of life AT prescription, 24-hour positioning, AT outcome measures, and overcoming barriers to AT use. That's all for now, so tune in for my next episode of the How to Be a Better OT podcast soon, where we'll be talking about how to complete functional cognitive assessments. Thanks for listening, and I'll talk to you then The information shared on this podcast is for general educational use only, so please always use your own clinical reasoning and seek appropriate professional supervision for any individual client situations. If you'd like to learn more with Your OT Tutor so that you can be a better OT who loves what you do, check out the Your OT Tutor website. The links will be in the show notes. There are free resources in the learning library, paid CPD memberships, online courses, supervision and mentoring opportunities, and options for your team to all learn together with me.