Assistive Technology Decision making

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Information about Assistive Technology Decision making

Published on October 19, 2008

Author: aSGuest1322


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. Armstrong, J., & Jones, K. (1995, June). Using family dreams to develop meaningful goals involving assistive technology. [On-line]. Available: http://www,closingthegap. com/l ibrary/June-3-July95/armstrong.html Behrmann, M. M., & Schepis, M. M. (1994). Assistive Technology assessment: A multiple case study of three approaches with students with physical disabilities during the transition from school to work. Journal of Vocational Rehabilitation, 4(3), 202-210. Slide 18: Blackhurst, A. E., & Berdine, W. H. (Eds.). (1993). An introduction to special education (3rd ed.). New York: HarperCollins. Blackhurst, A. E., Lahm, E. A., Harrison, E. M., & Chandler, W. G. (1999). A framework for aligning technology with transition competencies. Career Development for Exceptional Individuals, 22(2), 153-183. Bowen, R. E. (1996). Should occupational therapy adopt a consumer-based model of service delivery? American Journal of Occupational Therapy, 50, 899-902. Cook, A. M., & Hussey, S. M. (1995). Assistive technologies. Principles and practice. St. Louis, MO: Mosby. Deterding, C., Youngstrom, M. J., & Dunn, W. (1991). Position paper: Occupational therapy and assistive technology. American Journal of Occupational Therapy, 45(12), 1076. Slide 19: Fuhrer, M. J. (1995). An agenda for medical rehabilitation outcomes research. American Journal of Physical Medicine and Rehabilitation, 74, 243-248. Grigley, L. (1998). Tapping the power of assistive technology. OT Week, 12(25), 12-13. Hobson, D., & Trefler, E. (1995). Rehabilitation engineering technologies: Principles of application. Pittsburg, PA: CRC Press. Holder-Brown, L., & Parette, H. (1992). Children with disabilities who use assistive technology: Ethical considerations. Young Children, 47(6), 73-77. Hutinger, P., Johanson, J., & Stoneburner, R. (1996). Assistive technology applications in educational programs of children with multiple disabilities: A case study report on the state of the practice. Journal of Special Education Technology, 13(1), 16-35. Kelligrew, D., & Alien, D.·(1996). Occupational therapy in full-inclusion classrooms: A case study from the Moorpark Model. American Journal of Occupational Therapy, 50, 718-723. Slide 20: Kentucky Department of Mental Health and Mental Retardaton Services. (2001a). First Steps: Kentucky Early Intervention Service: Guide to services. [On-line] Available: Kentucky Department of Mental Health and Mental Retardaton Services. (2001b). First Steps: Kentucky Early Intervention Service: Policy and procedures manual. [On-line] Available: King, T. W. (1999). Assistive technology: Essential human factors. Boston: Allyn and Bacon. Lange, M. L. (1997). Focus on technology. OT Practice, 2(5), 51-52. Melichar, J., & Blackhurst, A. E. (1991). Introduction to a functional approach to assistive technology: A national assistive technology training series (NATTS) module. Lexington, KY: University of Kentucky, Department of Special Education and Rehabilitation Counseling. Slide 21: McGregor, G, & Pachuski, P. (1996). Assistive technology in schools: Are teachers ready, able, and supported? Journal of Special Education Technology, 13, 4-15. Morris, S. (1991). Facilitation of learning. In M. B. Langely, & l. J. Lombardino, (Eds.), Neurodevelopmental strategies for managing communication disorders in children with severe motor dysfunction (pp.251-295). Austin, TX: Pro-ed. Parette, H. P. (1995, November). Culturally sensitive family-focused assistive technology assessment strategies. Paper presented at the DEC Early Childhood Conference on Children with Special Needs, Orlando, FL. Parette, H. P. & Brotherson, M. J. (1996). Family participation in assistive technology assessment for young children with mental retardation and developmental disabilities. Education and Training in Mental Retardation and Developmental Disabilities, 31, 29-43. Slide 22: Proffit, E., & Combs, T. (1998, July). IDEA Reauthorized. Paper presented at the administration meeting of Clay County Board of Education Staff, Manchester, KY. Rainforth, B., York, J., & MacDonald, C. (1992). Collaborative teams for students with severe disabilities: Integrating therapy and educational services. Baltimore: Brookes. Scherer, M. (1994). Matching person and technology: A series of assessments for selecting and evaluating technologies used in rehabilitation, education, the workplace, and other settings. Unpublished manuscript. Scherer, M. J. (2000). Living in the state of stuck (3rd ed.). Cambridge, MA: Brookline Books. Struck, M. (1996). Computer access: A link to classroom learning. OT Practice, 1(8), 18-25. Swinth, Y. (1996). Evaluating toddlers for assistive technology. OT Practice, 1(3), 32-40.

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