[Athen] Assistive Technology Assessment Sample Forms or Templates?

Alexa Schriempf ats169 at psu.edu
Thu Oct 2 17:25:35 PDT 2014

With apologies for cross-posting, I am putting an urgent plea for resource
sharing out there. I have been asked by my school's rehab counseling
program to give a talk to their classes on the provision of AT services in
disability services.

Part of this talk would ideally include the sharing of sample AT intake and
AT assessment templates. Would any of you interested in sharing please be
so kind as to do so, either on or off list?

FWIW, the assignment that the students for this class need to complete, and
for which I'll be providing partial instruction on, is below.

Thank you!


Develop a 8-10 page (double-spaced, not including cover page or references)
case study in which you apply the principles and practices of
rehabilitation counseling to a population of your choice.

This case study should reflect an integrated personal theory of
rehabilitation counseling in which you incorporate the following components
(a) provide a brief description of the client and their presenting concerns
including information about the client’s cultural identity (socioeconomic
status, ethnicity, abilities, sexual orientation, religion); (b) describe
an model/framework that informs your assessment and development of an
initial treatment plan; (c) reviews potential interventions that you would
consider to address identified needs; (d) reflects that a comprehensive
resource assessment has been completed, including a list of related
community resources that are relevant to your client’s needs, (e) documents
that an assistive technology assessment has been completed, including
appropriate recommendations, and (f) identifies relevant disability
policies and regulations that may help to support your client’s goals. In
conclusion, discuss contextual aspects of the client’s experience that have
contributed to their presenting problems and represent opportunities and/or
need for advocacy. Include a preliminary advocacy plan and also discuss how
consultation with and possibly referrals to other professionals and/or
rehabilitation team members may be needed to effectively assist your
<end assignment>
Alexa Schriempf, PhD
Access Tech Consultant
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