Resource Limits Disclosure Statement

 

______________________________
(name service delivery organization)

is providing services to

______________________________
(name of individual being served)

who relies on augmentative and alternative communication (AAC). We acknowledge that future achievement and quality of life are influenced by an individual's communication effectiveness.

It is the policy of this organization to provide services that are in compliance with legal mandates. However, we hereby acknowledge that limitations to services may result in less than the most effective communication being achieved. This disclosure is being provided to clarify that supplemental resources could be applied to increase the possibility of achieving the desired outcomes. Below is a list of those acknowledged resource limitations:

(Choose from the following list and/or create additional items.)

Our staff does not have the knowledge and skills to provide the services needed for achieving more effective communication.

More frequent therapy could result in more effective communication.

Other AAC interventions related to how language is represented and generated using a voice output AAC system could result in more effective communication. (For example, there are three basic methods of representing language in AAC systems: single meaning pictures, alphabet-based methods, and semantic compaction. Our staff does not understand and are not able to support all of these methods.)

Others.

 

Our professional staff feels obligated to disclose the limits of our resources and recommend that supplemental resources be pursued. Signatures below indicate that this disclosure has been communicated.

______________________________ Name of individual, parent, or guardian

______________________________ Signature

______________________________ Date

 

______________________________ Name and position of organization agent

______________________________ Signature

______________________________ Date