Published on October 19, 2008
Factors that Influence Assistive Technology Decision Making : Factors that Influence Assistive Technology Decision Making Elizabeth A. LahmUniversity of Kentucky Leslie SizemoreClay County Board of Education, Manchester, KY Abstract : Abstract With technological advances and growth in the availability of assistive technology, infants and toddlers with disabilities have many more options than they had previously. Professionals that serve this population are required by law to consider assistive technology for each child with a disability that they serve. This study examines the factors that impact the decisions made about assistive technology by the professionals that serve them through the Kentucky First Steps Program. Fifteen of 16 professionals approved to provide assistive technology services in Kentucky were interviewed. An analysis of the differences in experience, philosophy, and beliefs of the participants by discipline provide insight into the process of decision making and the implications they have on the implementation of assistive technology. Parents and professionals need to be aware of the differences between disciplines and delivery strategies to assure a complete and balanced look at the whole child. Assistive Technology Decision Making Process : Assistive Technology Decision Making Process Teaming and family-centered assessments are dominant philosophies today in assistive technology service delivery Regardless, there are differing values and priorities among professionals. There are differences of opinion among professionals as to who should take the lead role in the assistive technology team. The role of the environment during assessment and implementation varies across disciplines. Purpose of the Study : Purpose of the Study Examine characteristics of the individuals that provide assistive technology services in the Kentucky Early Intervention System – First Steps. Explore differences in the decision making approaches of these disciplines. Note the implications these differences may have on delivering assistive technology services to infants and toddlers with disabilities. Methods: Participants : Methods: Participants Assistive technology service providers approved by the Kentucky First Steps program (n=16; 15 participated) Disciplines represented: Educators (2); Occupational therapists (1); Speech-language pathologists (6); Assistive technology suppliers (4); Assistive technology practitioners (2) Methods: Instruments : Methods: Instruments Researcher design telephone interview survey 26 items organized into 4 sections: Interview logistics notes Background information Educational background Role of teaming Methods: Procedures : Methods: Procedures Survey research using semi-structured phone interviews Mailed request to participate – returned card noted a good time for a phone interview Phone interviews lasting 25-30 minutes Responses summarized and confirmed by the participant at the end of the interview Data analysis Responses were organized into categories generated by the responses Categorical responses were quantified Results: Experiential and Educational Background : Results: Experiential and Educational Background Disciplines represented: educators, occupational therapists, speech-language pathologists, assistive technology suppliers (RESNA certified), assistive technology practitioners (RESNA certified) Close to 75% had 5 or more years of experience in assistive technology About half had a Master’s degree or above; three had no degree; the degrees were not necessarily in assistive technology or disability related fields Most agreed (83%) that their professional training did not prepare them for assistive technology service delivery Results: Factors of Decision Making : Results: Factors of Decision Making Factors that were rated extremely important: Client goals (14); environmental demands (14); family/client demands (10); funding (4); client diagnosis (4) Conducting assessments in clinical settings did not provide enough information Geographical area and type of agency sometimes constrained the type of assessment conducted Results: Philosophical Underpinnings : Results: Philosophical Underpinnings Functional areas cited as appropriate for assistive technology applications: work, self care, play, learning, communication, goal achievement Educators, occupational therapists, and assistive technology suppliers performed assistive technology services exclusively in the child’s home. Speech-language pathologists worked equally in the home and in a clinic. Assistive technology practitioners worked exclusively in their program centers. The majority of the participants subscribed to a functional approach for decision making. A few used combined functional and clinical approaches. Suppliers followed a clinical model exclusively. Discussion: Experiential and Educational Background : Discussion: Experiential and Educational Background Speech-language pathologists had the most education and years of experience in assistive technology but spent the least amount of their time providing assistive technology services. Suppliers had the least amount of education but spent all of their time providing assistive technology services. Suppliers was the only group that had a specific focus within assistive technology (seating, positioning, and mobility) but provided services outside this area of expertise when requested. Discussion: Factors of Decision Making : Discussion: Factors of Decision Making Differences across disciplines was clearly evident. Occupational therapists and speech-language pathologists focused on goal achievement; assistive technology suppliers focused on work; assistive technology practitioners focused on play; educators balanced their focus across multiple areas. Participants spoke about the constraints of funding availability as a factor in decision making but did not report it as a factors when directly asked. This could indicate that funding as a factor is a given and does not need restating. Discussion: Philosophical Underpinnings : Discussion: Philosophical Underpinnings The preferred settings for conducting assistive technology services did not necessarily match their stated approach to assistive technology. For example, suppliers worked in the home yet they subscribed to a clinical approach to decision making. Several speech-language pathologists agreed that teaming was important but then stated that a team was only pulled together “as needed”. This raises questions about the alignment of beliefs and practice. All believed that the client was an important member of the assistive technology team but no one stated that the client or parent was a part of the team. Again, this raises questions about the alignment of beliefs and practice. Implications : Implications More stringent requirements for approved First Steps assistive technology service providers would help control for the wide variation in quality of services. Two separate types of approval may disallow service providers from providing services that are not within their area of expertise. More stringent requirements for approved First Steps assistive technology services providers would help parents have confidence in the services they are receiving. Additional training and experience requirements for First Steps approval is needed to raise the standard for services. The Kentucky legislature must be made aware of the impact of training, experience, and team approaches on the quality of services so they can legislate appropriate criteria for approval. Limitations : Limitations Small number of participants and focus on a single state. Each discipline was not adequately represented in this study. The study was exploratory and cannot be generalized to other states or systems. Future Research : Future Research Similar study with larger number of participants. More precise questions related to differences between training, philosophy, and practice. References : References Angelo, J., Bunning, M. E., Schmeler, M., & Doster, S. (1997). Identifying best practice in the occupational therapy assistive technology evaluation: An analysis of three focus groups. The American Journal of Occupational Therapy, 51, 916-920. 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