This month I’ve shared lots of content on Assistive Technology (AT) prescription as I’ve been in the midst of launching a brand-new collaborative initiative with Lauren Hart from Otuition called the Community AT series. These courses cover a fantastic step-by-step process for prescribing common pieces of AT in the community (find out more here), but in this newsletter, we'll go to the next level and tackle some of the real-world challenges we face in the prescription process.

Even when you know the standard practice framework inside out, roadblocks inevitably pop up. Here are 5 common challenges you might encounter during the AT prescription journey, along with some practical tips on how to overcome them.

1. The client just wants you to "write a letter." It’s a scenario we all dread: you arrive for an initial assessment, and the client already has a specific AT item in mind and simply wants you to "write a letter" so they can get it funded. Often, they have lived with their disability for a long time and feel they know exactly what they need. Because of this, our comprehensive assessment processes can sometimes feel like an unnecessary hurdle to them.

Try this: Take a breath and consciously acknowledge their request and their lived expertise. It is vital to manage their expectations about our clinical responsibilities, safety considerations, and the specific requirements of their funding body, but don’t just shut their idea down. Try to invite them to start the process with you collaboratively from the beginning. Take the time to observe them in their current setup and listen deeply to their perspective. If you focus on building rapport first, you can earn their trust to complete a proper, holistic assessment rather than just acting as a rubber stamp.

2. You don’t even know what AT options are possible! You've completed your assessment, mapped out the person, environment, and occupation (PEO), and know exactly what the client's goals and needs are. But when it comes to the "feature matching" stage, you draw a blank. With technology constantly evolving, it can feel overwhelming when you don't actually know what options, modifications, or accessories are out there on the current market.

Try this: Remember – you don't have to know everything! It is impossible to hold every product specification in your head. Lean heavily on resource databases like the National Equipment Database (NED) and tap into your communities of practice. Bring these complex cases up in supervision, or register for some supplier webinars or workshops to build your foundational knowledge. Most importantly, don't be afraid to lean on the expertise of equipment suppliers. You know the client's capabilities and therapeutic needs, but the supplier knows their product range inside out. Together, you can find the perfect match.

3. The AT item isn’t available to trial. You’ve done your thorough research, collaborated with the client, and found what looks like the perfect AT solution. But when you go to organise the physical trial, the supplier tells you they don't have a floor model available in the correct size or specification for you to actually test with the client in their home environment. Or logistics like living in a rural or remote location mean that distance is the barrier to facilitating a trial.

Try this: First, don't rely solely on supplier websites, pick up the phone and speak with them directly to explore all options – sometimes they do runs out to regional areas and that trial is possible with a bit of waiting and planning. Ask if there is a way the client can safely travel to a showroom or clinic, or if certain key features can be simulated using different pieces of equipment they do have in stock. If a direct trial remains completely impossible, it comes down to rigorous clinical reasoning. You must document exactly why a physical trial isn't possible, what the specific risks of an incorrect prescription are in this case, and what modifications or adjustments can be made if the item arrives and isn't quite right. Then weigh up those considerations – is it still safe and worth it to request funding without a trial?

4. One AT item can’t tick all the boxes. Sometimes, despite your best feature-matching efforts, the "unicorn" piece of AT simply doesn't exist. You might find an item that has the perfect cushions and fabrics your client needs, but it doesn’t come in the dimensions that are right for them. Or perhaps a lightweight wheelchair is ideal for lifting into the car boot independently, but it lacks the necessary postural support for long days out.

Try this: When this happens, create a comprehensive list of all the required features and work with the client to rate their priority. Have an honest, transparent conversation about the pros and cons of including or sacrificing certain features. Use visuals, lists, or rating scales to clearly outline how each compromise will impact their daily life. By providing clear education in an accessible way, you facilitate a supported decision-making process, empowering the client to work with you to choose the compromise that ultimately works best for their unique lifestyle and goals.

5. There’s no funding available for proper follow-up. It is incredibly frustrating when you dedicate hours to an AT prescription, but there's simply no money left in the client's plan to pay for your time to return and complete a proper follow-up, fitting, or training session. It can leave you wondering if the equipment is even being used safely, or if it has been abandoned in the corner of a room.

Try this: First of all, don't make "no funding" your autopilot assumption. We can often fall into the trap of assuming follow-up isn't possible and cross it off our list by default. Always try to proactively identify the need for follow-up hours when submitting your initial funding application. But if the funding truly isn't there, you need to facilitate a strong self-management approach right from the start. Educate the client and their carers so they can be proactive. Ensure they know exactly what to expect from the equipment and the prescription process, what warning signs to look out for, and exactly who to call based on the specific issue that arises (e.g., calling the supplier for mechanical faults, or calling the funder/OT for functional decline). If your training time is severely cut short, lean into the supplier's resources! Ask the supplier what video tutorials or comprehensive user manuals they have available that you could use as your starting point, instead of developing your own resources from scratch. Hot tip: If you want to dive deeper into this specific hurdle, check out my previous LinkedIn newsletter on Why clinicians aren’t tracking outcomes, where I cover more strategies for overcoming barriers to follow-up and outcome measurement in general).

My final thoughts… Yes, prescribing AT can be more complex than it looks. And there will often be things that will go wrong that are completely out of your control. But knowing how to pivot and manage these challenges is what makes you a great clinician! Choose one of these tips that resonated the most with you and keep it in mind for your next AT assessment.

If you found this newsletter helpful, make sure you subscribe and ring the bell on my profile so you’ll be notified whenever I put up a new post. Also check out the Your OT Tutor website and subscribe to the mailing list or sign-up for the Learning Library – there are heaps of resources, courses, and CPD opportunities, with more being added regularly.

#OccupationalTherapy #NDIS #YourOTTutor