Family Guide to Assistive Technology
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Family Guide to Assistive Technology |
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Introduction
Assistive technology is redefining what is possible for people with a wide range of cognitive and physical disabilities. In the home, classroom, workplace, and community, assistive technology is enabling individuals with disabilities to be more independent, self-confident, productive, and better integrated into the mainstream.
Beginning early in life, technology is making it possible for children with disabilities to do more for themselves. A child who cannot use her hands can operate a computer with a switch and an on-screen keyboard. A child with speech problems can communicate using a portable electronic device that "speaks." A child who is unable to get in and out of the bathtub can be safely and easily lifted using a mechanical device. These are just a few examples of the wide variety of equipment, called assistive technology, that is available today.
Assistive technology can mean anything from simple, homemade devices to highly sophisticated environmental control systems. It can be adapted toys, computers, powered mobility, augmentative communication devices, special switches, and thousands of commercially available or adapted tools to assist an individual with learning, working, and interacting socially.
As wonderful as assistive technology can be, it is not always easy to acquire. It takes expertise and persistence to find the correct devices and figure out ways to pay for them. For example, children with disabilities who are eligible for special education have a legal right to technology to assist them with learning. Both the Individualized Family Service Plan (IFSP) and the Individualized Education Program (IEP) which are required by tthe Individuals with Disabilities Education Act (IDEA) are potentially powerful tools for incorporating assistive technology into the education of students with disabilities. But assistive technology does not become part of a student's special education plan unless parents are knowledgeable about technology and know what to do to ensure that assistive technology becomes an integral part of their child's program.
This Guide is intended to help parents learn more about assistive technology and how it can help their children. The Guide includes tips for getting started, ideas about where to look for money, and suggestions for what to do when applying for funding. Places to contact for more information or to find software and equipment are listed in the Appendix at the end of the Guide.
Finding and paying for the right technology requires commitment and energy. Professionals in education and medicine can help, but parents cannot rely on professionals to do everything that is necessary to get the equipment. As a parent, you have a much better chance of getting what is needed if you and your child are involved in selecting the technology and planning for its use. This Guide should help you to understand the processes for acquiring assistive technology and provide you with the tools to advocate for your child's special technology needs.
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Defining Assistive Technology
Assistive technology devices are mechanical aids which substitute for or enhance the function of some physical or mental ability that is impaired. Assistive technology can be anything homemade, purchased off the shelf, modified, or commercially available which is used to help an individual perform some task of daily living. The term assistive technology encompasses a broad range of devices from "low tech" (e.g., pencil grips, splints, paper stabilizers) to "high tech" (e.g., computers, voice synthesizers, braille readers). These devices include the entire range of supportive tools and equipment from adapted spoons to wheelchairs and computer systems for environmental control.
The Individuals with Disabilities Education Act (IDEA), the federal special education law, provides the following legal definition of an assistive technology device: "any item, piece of equipment, or product system... that is used to increase, maintain, or improve functional capabilities of individuals with disabilities." Under IDEA, assistive technology devices can be used in the educational setting to provide a variety of accommodations or adaptations for people with disabilities.
The IDEA also lists the services a school district may need to provide in order to ensure that assistive technology is useful to a student in the school setting. The law defines assistive technology service as: "any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device." This service includes all of the following possibilities:
The intention of the special education law is that, if a student with disabilities needs technology in order to be able to learn, the school district will (a) evaluate the student's technology needs, (b) acquire the necessary technology, (c) coordinate technology use with other therapies and interventions, and (d) provide training for the individual, the individual's family, and the school staff in the effective use of the technology.
During the time that students with disabilities are in school, they can have the opportunity to learn to use technology at the same time that they are learning academic subjects and social skills. The efficient and effective use of assistive technology can be as basic a skill for students with disabilities as reading, writing, and arithmetic since the use of technology can go a long way toward circumventing the limitations of disability and providing students with disabilities with a "level playing field" in every area of life accomplishment.
What is an accommodation?
Accommodations are reasonable modifications that are made to compensate for skills or abilities that an individual lacks. For example, if a person does not digest spicy foods well, we might accommodate this individual by adjusting his or her diet so that the person was eating only bland foods.
When the word accommodation is used in connection with disability issues, it refers to a way of modifying a task or assignment so that a person with a disability can participate in spite of whatever challenges the disability may pose. For example, when a student who is unable to remember math facts is allowed to do math problems with a calculator, the use of the calculator is an accommodation which allows the student to work around his or her disability. With an accommodation, the student can still perform math problems, but the student does so using a different method.
In the school setting, sometimes it is necessary to make accommodations for individuals with disabilities in order to compensate for skills or abilities that they do not have. For example, for some students with learning disabilities learning to spell words correctly may be a skill they never acquire or never acquire with a high enough degree of fluency to do them any good in written expression. To compensate for this inability to spell, such students may be encouraged to use alternative methods for spelling like a spell check software program on the computer or a hand-held spelling device.
What is an adaptation? How does adaptation differ from accommodation?
Adaptation means developing unique devices or methods designed specifically to assist persons with disabilities to perform daily tasks. An adaptation is something specially designed which is not normally used by other people. An accommodation, on the other hand, is simply a change in routine, method, or approach which may be used by people with or without disabilities. Examples of adaptations include special grips to turn stove knobs or specially designed keyboards to operate computers.
What are common types of assistive technology? Does assistive technology just mean computers?
Assistive technology certainly includes computers, but it also refers to a number of other types of accommodations and adaptations which enable individuals with disabilities to function more independently. Computers are an important type of assistive technology because they open up so many exciting possibilities for writing, speaking, finding information, or controlling an individual's environment. But computers are not the only avenues to solving problems through technology. There are many low tech (and low cost) solutions for problems that disabilities pose. Examples of inexpensive, low tech solutions include wrist splints, clip boards for holding papers steady, or velcro tabs to keep positioning pads in place.
The following is a list of common assistive technology applications:
Positioning. In the classroom, individuals with physical disabilities may need assistance with their positions for seating so that they can participate effectively in school work. Generally, therapists try to achieve an upright, forward facing position by using padding, structured chairs, straps, supports, or restraints to hold the body in a stable and comfortable manner. Also considered is the student's position in relation to peers and the teacher. Often, it is necessary to design positioning systems for a variety of settings so that the student can participate in multiple activities at school. Examples of equipment used for positioning are side lying frames, walkers, crawling assists, floor sitters, chair inserts, wheelchairs, straps, trays, standing aids, bean bag chairs, sand bags and so forth.
Access. In order to participate in school tasks, some students require special devices that provide access to computers or environmental controls. The first step in providing access is to determine which body parts can be used to indicate the student's intentions. Controllable, anatomical sites like eye blinks, head or neck movements, mouth movements may be used to operate equipment which provides access to the computer. Once a controllable, anatomical site has been determined, then decisions can be made about input devices, selection techniques (direct, scanning), and acceleration strategies (coding, prediction). Input devices include such things as switches, alternative keyboards, mouse, trackball, touch window, speech recognition, and head pointers. Once computer access has been established, it should be coordinated with other systems that the student is using including powered mobility, communication or listening devices, and environmental control systems.
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figure 1: Alternative and Processing Computer Access Methods |
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Access can also refer to physical entrance and exit of buildings or facilities. This kind of assistive technology includes modifications to buildings, rooms and other facilities that let people with physical impairments use ramps and door openers to enter, allow people with visual disabilities to follow braille directions and move more freely within a facility, and people of short stature or people who use wheelchairs to reach pay phones or operate elevators. Accessibility to shopping centers, places of business, schools, recreation, transportation is possible because of assistive technology modifications.
Environmental Control. Independent use of equipment in the classroom can be achieved for students with physical disabilities through various types of environmental controls, including remote control switches and special adaptations of on/off switches to make them accessible (e.g. velcro attachments, pointer sticks).
Robotic arms and other environmental control systems turn lights on and off, open doors, operate appliances. Locational and orientation systems give people with vision impairments information about where they are, what the ground nearby is like, and whether or not there is a curb close by.
Augmentative Communication. Every student in school needs some method of communication in order to interact with others and learn from social contact. Students who are nonverbal or whose speech is not fluent or understandable enough to communicate effectively may benefit from using some type of communication device or devices. Communication devices include such things as symbol systems, communication boards and wallets, programmable switches, electronic communication devices, speech synthesizers, recorded speech devices, communication enhancement software, and voiced word processing.
Assistive Listening. Much of the time in school, students are expected to learn through listening. Students who have hearing impairments or auditory processing problems can be at a distinct disadvantage unless they learn to use the hearing they have, or they develop alternative means for getting information. Hearing problems may be progressive, permanent, or intermittent. Any of these impairments may interfere significantly with learning to speak, read, and follow directions. Assistive devices to help with hearing and auditory processing problems include: hearing aids, personal FM units, sound field FM systems, Phonic Ear, TDDs, or closed caption TV.
Visual Aids. Vision is also a major learning mode. General methods for assisting with vision problems include increasing contrast, enlarging stimuli and making use of tactile and auditory models. Devices that assist with vision include screen readers, screen enlargers, magnifiers, large-type books, taped books, Braillers, light boxes, high contrast materials, thermoform graphics, synthesizers, and scanners.
Mobility. Individuals whose physical impairments limit their mobility may need any of a number of devices to help them get around in the school building and participate in student activities. Mobility devices include such things as self-propelled walkers, manual or powered wheelchairs, and powered recreational vehicles like bikes and scooters.
Computer-Based Instruction. Computer-based instruction can make possible independent participation in activities related to the curriculum. Software can be selected which mirrors the conceptual framework of the regular curriculum, but offers an alternative way of responding to exercises and learning activities. Software can provide the tools for written expression, spelling, calculation, reading, basic reasoning, and higher level thinking skills. The computer can also be used to access a wide variety of databases.
Social Interaction and Recreation. Students with disabilities want to have fun and interact socially with their peers. Assistive technology can help them to participate in all sorts of recreational activities which can be interactive with friends. Some adapted recreational activities include drawing software, computer games, computer simulations, painting with a head or mouth wand, interactive laser disks, and adapted puzzles.
Self Care. In order to benefit from education, some students require assistance with self care activities like feeding, dressing, and toileting. Assistive devices which assist with self care include such things as robotics, electric feeders, adapted utensils, specially designed toilet seats, and aids for tooth brushing, washing, dressing, and grooming.
What sort of students might use assistive technology?
Students who require assistive technology are those with mental or physical impairments that interfere with learning or other life functions. The technology helps the student to overcome or compensate for the impairment and be more independent in participating at school. Students who benefit from assistive technology may have mild learning problems like learning disabilities or they may have physical or cognitive disabilities that range from mild to severe. Assistive technology is not necessary or helpful for every student in special education, but it is an important part of the support system for many students with identified disabilities.
Isn't assistive technology appropriate only for students with more severe disabilities?
Assistive technology is simply a set of tools that can be used to compensate for some deficit that a person may have. For individuals with severe mental or physical disabilities, the technological solutions can help to solve multiple and complex problems. But individuals with less involved problems also can benefit from assistive technology. For example, individuals with learning disabilities who have difficulty with reading or writing can benefit educationally from using the word processing and voiced reading capabilities of computers.
Isn't assistive technology just a crutch? Won't students become too dependent on technology and not learn to use the skills they have?
Assistive technology should be used as support for access, learning and performing daily tasks. In general, assistive technology is appropriate when it compensates for disabilities so that the individual can function as normally as possible. If assistive technology is necessary for a student to have access to educational opportunities or to benefit from education, then it is not a "crutch," but a legitimate support.
Some skills are too laborious or taxing to accomplish at a rate or with degree of proficiency to allow for participation in the least restrictive environment. With assistive technology, the student can participate more fully and more closely approximate the levels of achievement and interaction of his or her peers.
The use of assistive technology enhances function and increases skills and opportunities. Though a student may be dependent upon a particular device in order to perform skillfully, denying the device denies the student an opportunity ever to achieve success at the level of his or her potential.
When is using assistive technology appropriate?
Assistive technology may be considered appropriate when it does any or all of the following things:
Summary
Assistive technology means any device which helps an individual with an impairment to perform tasks of daily living. There is a wide range of types of devices in assistive technology from low tech, homemade aids to computers and sophisticated electronic equipment. Assistive technology is one of the services which can be provided in a special education program under the Individuals with Disabilities Education Act (IDEA). The requirements of IDEA say that students who need assistive technology are entitled to the aids and devices and the assistive technology services (e.g., evaluation for assistive technology and modification and maintenance of equipment) that are necessary for the student to benefit from a free, appropriate public education.
Hints for Parents
It is never too soon to consider using assistive technology. Some infants with physical disabilities, for example, really benefit from early interaction with toys that operate by switch. Here are suggestions for times to evaluate a child for assistive technology:
Assistive technology can be used to provide physical access to the environment (e.g., switch toys, floor scooters, touch window)
Assistive technology can assist with expression through the use of programmable switches, electronic communication devices, voiced word processing, braille embossing and so forth.
If an individual's handwriting, for example, is very slow, laborious and difficult to read, use of a word processing device can be substituted for handwriting; thus allowing the individual to keep up with others in terms of written expression.
Assistive technology can provide access to the workplace, for example, by allowing an individual who is blind to learn to use a screen reader and voiced word processing to do clerical tasks that would otherwise be impossible.
Sometimes assistive technology can be used to allow a person with a disability to function more independently. For example, having a power wheelchair allows an individual to travel independently without the necessity of having someone to push the wheelchair.
Sara
Sara, who has Down syndrome, is eight years-old. Her language and speech skills are three years delayed, but she has age appropriate social skills. Sara has spent part of her school day in a regular classroom ever since kindergarten, but this year her third grade teacher is suggesting that Sara really cannot keep up with her classmates. The teacher thinks that Sara would be better off in a self-contained class with students who work at her pace. Sara has some fine motor coordination problems, and she has had difficulty learning to write in cursive. Her oral reading is hampered by her speech difficulties. However, Sara has learned to do addition and subtraction problems well and has mastered adding with carrying and subtraction with borrowing. She reads at about a second grade level with reasonably good comprehension. Sara's parents would like to see her continue in the regular classroom for as much time as possible, but they recognize that Sara's writing and speaking problems are keeping her from doing her best work.
What are Sara's needs?What kinds of technology should go in Sara's IEP?
How would you make a case for putting assistive technology into her IEP?
Sara's Solution
Sara's IEP Team met to discuss her needs and concluded that she is doing well in a regular classroom setting; she is making adequate progress in academic skills and has learned how to interact socially with her peers. It is to be expected that Sara will have difficulty keeping up with the pace in a third grade, but as long as she is making progress toward her individual goals, the regular classroom is a good setting for her. However, some simple accommodations and technology may help Sara to work faster and more efficiently.
At this point Sara may need some assistance with handwriting and speaking, but the solutions to her problems in these areas need not be complex ones. The team decided that Sara should continue to practice cursive until she has mastered all the letters and can be more facile in using script. However, while she is still learning cursive, she needs other means for responding in writing. For short written responses, the team agreed that Sara should be encouraged to use manuscript printing. When speed is important or when writing assignments are longer, Sara should have access to a computer with an adaptive keyboard (e.g., IntelliKeys). The adaptive keyboard is helpful for Sara because the "keys" are larger and easier to see. Using the keyboard requires only a very light touch so Sara finds it easier to use than a standard computer keyboard.
In terms of oral reading, the team decided to have Sara practice reading into a tape recorder. Her speech therapist will work with her on slowing down her rate of speech and reading with expression. When Sara has a good tape of her oral reading, she will submit it to her teacher for review.
Solution Summary
Making Assistive Technology Decisions
When parents learn about assistive technology and the wonderful opportunities it can provide, they want to jump right in and get the latest in technology for their children. Who wouldn't want an augmentative communication device for a child who cannot talk? What parents wouldn't want to buy a computer if it would help their child learn?
When the world of assistive technology opens up for parents, it can be like entering a great toy store--everything looks so wonderful that it makes it hard to know what to select. Choosing the right device to meet an individual's needs requires technical knowledge and indepth understanding of the individual's functional capabilities. Not only is the selection of a device made difficult by the complexity of the equipment and the demands of the individual's impairment, assistive technology devices can be very expensive. Making such purchases is a major financial commitment for most families, one that takes a great deal of soul searching and sometimes significant sacrifice.
Families invest more than money in their children's assistive technology. Practical investments of time and effort and emotional investments of hope and enthusiasm are made with every assistive technology purchase. Because of the high level of financial, personal and emotional commitment, family disappointment is great when equipment fails to perform as expected.
Buying and then not using a device because of dissatisfaction can be a devastating experience for all concerned. That is why it is so important for parents to proceed cautiously into the world of assistive technology and make purchases only after careful evaluation and trials with the new device. Following is a summary of some suggestions for parents to consider before making any assistive technology purchase: be realistic about your child's capabilities and needs; get a multidisciplinary evaluation; examine available technology with a critical eye; match the child's needs to specific equipment features; do not make a purchase until you have used the device for a trial period; identify next steps; and determine what needs to be done for follow-up after purchase.
Guidelines for Making Assistive Technology Decisions
Assistive technology can open up exciting new opportunities for a child, but it is not magic. There are certain basic requirements for any individual to be successful with technology, and it is important to face these requirements squarely. There is nothing more disappointing or discouraging than purchasing expensive equipment for a child which is beyond his or her capabilities to use.
Prerequisites for Computer Use. Physical or sensory impairments do not limit access to computers, but cognition is a factor in computer operation. The major prerequisite for using a computer (with or without adaptations) is the cognitive ability to understand cause and effect. The child must be able to understand that the computer operates (e.g., changes, does something) because the child has activated the equipment through some volitional movement or activity (e.g., eyebeam, speaking, puffing into a straw, hitting a switch). Some children enjoy playing with switches by hitting them randomly but may not be able to connect their own behavior to the response their movement activates. In order to be successful in interacting with a computer, the user must be able to control some volitional activity and to do so consistently. For example, the child would have to be able to activate the computer in response to a visual, tactile, or auditory prompt.
Another prerequisite to computer use is the ability to make conscious, meaningful choices between alternatives like yes and no. The choices can be very simple ones, but there has to be evidence that the child has made an actual decision and not merely acted randomly.
If a child does not have the concept of cause and effect or cannot make consistent choices, using a computer is probably not a worthwhile next step at this point in the child's development. Other types of activities may be more appropriate, less expensive, and just as rewarding developmentally and personally.
Prerequisites for Augmentative Communication. Augmentative communication devices can literally give voice to the thoughts of individuals who cannot speak or cannot speak clearly, but--again--these devices are not magic. Electronic communication devices are of no value unless the user has some communicative intent. That is, for a communication device to be helpful, the user has to have some basic understanding of the communication process and must be intentional in expressing choices, desires, or needs.
For example, Maggie is a four-year-old who is nonverbal. She communicates her wants and needs by using eyeblinks as responses to yes or no questions. When Maggie's dad asks her if she would like another glass of milk, she indicates her choice by raising her eyes up vertically for yes or moving her eyes down for no. Maggie clearly knows what she wants to communicate, she has a consistent method for making her wishes known, and she expects that her dad will understand her communication and act on it.
Dan, who is also nonverbal, communicates in a different way. He points to objects and makes gestures to show what he wants or needs. His gestures are clear and used consistently so that family members and even people who do not know Dan well can understand most of the time what he is communicating.
Shelley communicates very basic information about how she feels by crying when she is uncomfortable or wants attention and by laughing when she enjoys something like music, bright lights, or water running. Shelley does not, however, respond to yes or no questions. She does not make choices, even when objects are presented to her individually or in pairs. She cannot respond to a question like "Do you want some ice cream now?" Or "Would you like the teddy bear or the doll?"
Maggie and Dan may benefit from using some communication device because they are already using communication systems meaningfully and consistently. Shelley, however, may need to develop greater ability to communicate meaningfully before moving on to electronic communication.
Communication skills fall along a continuum. At one end of the continuum are very simple communications like expressing preferences by indicating yes or no, pointing or gesturing toward objects, or pointing to pictures. Use of sign is a more complex form of communication because it requires that the user understand that the signs are symbols for meaningful communications. When an individual is able to string together signs or words into meaningful phrases, this is an additional step toward more complex communication. When a person understands syntax and is aware of typical word order, this is another step forward. Each of these advances along the communication continuum represents a step toward more complex and sophisticated communication. Whatever assistive communication device is chosen should match or just slightly exceed the place on the continuum where the individual is functioning. It makes no sense, for example, to purchase an elaborate electronic communication device that requires understanding symbols and syntax when the individual using the device is just at the point of learning how to express yes and no preferences.
An electronic device does not teach communication; it enhances communication by giving audible expression to thoughts that already exist in the mind of the user. If the thoughts are not there yet or are not completely formed, they cannot be expressed by the device.
Physical and Sensory Impairments Are Not Barriers. Mastery of a few simple prerequisite skills is necessary before computers or electronic communication devices should be considered, but it is not necessary for a child to master every developmental milestone before entering the world of assistive technology. Physical or sensory impairments can often be circumvented by the technology itself, and typical developmental milestones can sometimes be bypassed so that assistive technology can be used. For example, some educators assume that students cannot use computers until they have completely mastered keyboarding skills. This is a false assumption. Many students benefit from using computers, even though they operate the machine using a "hunt and peck" method or only one or two keys. In a similar fashion, students with limited verbal ability who have not mastered oral speech benefit from using augmentative communication devices while they continue to develop oral language.
Overall, the keys to knowing when to try assistive technology are (a) being realistic about the child's cognitive abilities and potential, and (b) being open to trying the level of technology which meets the child where he or she is.
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figure 2: Factors to consider when selecting Assistive Technology |
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Evaluations for assistive technology are not always easy to arrange. In many parts of the United States, there is no convenient center or "place" to go for an assessment. The available centers may be far away in another city or even another state. Since assistive technology is a new field, the systems for disseminating information and providing assistance are in the process of evolving. Parents may have to be "assistive technology detectives" in order to put together the information needed for a complete AT evaluation for their child.
The place to start the evaluation is by considering the functions the child needs to perform and cannot because of impairment. The physicians, teachers, and therapists currently working with the child, as well as family members and friends who are around the child on a daily basis, can provide very valuable information about functional problems and potential solutions.
Finding Functional Solutions. The Alliance for Technology Access (ATA), a national network of assistive technology centers, has developed an informal method for using the functional information available from professionals, family members and friends as a basis for analyzing assistive technology needs. This process, called a Solution Circle, is a means to bring people together in an informal session that allows for creative thinking and is not inhibited by what is "legal," "currently available," or "what has been done before." The individual with a disability and 4-10 family members, professionals, and friends get together to brainstorm ideas about the technology which may help the individual perform functions that are hard, or impossible, to do because of disability. The Circle usually includes a balance between people who know the person who needs the technology and people who have specialized knowledge about technology, education, or work-related issues.
Solution Circle for Tom. To demonstrate how the Solution Circle works, let's take a look at how this process was used in the case of Tom, a high school student with a learning disability. For Tom, the print in textbooks is a significant barrier to learning. Tom is "print disabled"; that is, he cannot read the printed word with much comprehension. Reading is a slow, unproductive process for him, even though he is intelligent and eager to learn. Tom and his parents were hoping that there might be a way that new technology could help Tom overcome or work around his problem with reading so that he could get more out of school and perhaps go on to college.
Tom's Solution Circle included his parents, Betty and Bob; his resource teacher; a friend Darrell; his soccer coach; his 4-H leader; and the owner of a local computer store. This group met together to think about how Tom could participate more fully in school and prepare himself for college, even though he could not read with comprehension past the second or third grade level.
Solution Circles generally take 1 to 1 1/2 hours to complete. The steps include the following:
1. Star Time. The individual for whom the Solution Circle is being held is described in a holistic way. The emphasis is on how the individual is functioning at home and in the community. What does he or she like and dislike? What are his/her goals? Interests? If possible, the individual with a disability speaks for himself or herself or a video or pictures may be presented. The point of this part of the discussion is give a clear picture of the individual as a whole person.
At Tom's Solution Circle, he explained his dream of going to college and becoming an agricultural botanist. Tom loves plants; he is interested in breeding new strains of wheat and perfecting various types of grain crops. Tom's 4-H leader agreed that Tom had real gifts in understanding plant growth and physiology, and that he already had sophisticated knowledge about botany which would prepare him well for college study.
2. Strengths. With a complete picture of the individual in mind, the group then makes an exhaustive list of the individual's strengths, particularly noting any technological accommodations which the individual is already using. What does the individual do well? What are his or her unimpaired functions? Often this discussion reveals an incredible number of adaptations that the individual has already achieved.
Tom's Solution Circle discovered that he had many strengths, including keen intelligence, perseverance, and thoroughness when approaching a task. Tom already had some effective learning strategies for remembering material that he heard. He had also learned to use a small tape recorder for keeping track of information provided in class.
3. Obstacles. With the individual's strengths in mind, the group then turns its attention to a consideration of the environment in which the individual is functioning and the activities in which the individual wants to participate but cannot at this time. The group considers what the obstacles and barriers might be for the individual in his or her environment and makes a list of these impediments.
For Tom, reading was a serious obstacle. He could not keep up with homework assignments because it took him so long to read his textbooks. In addition, he had difficulty reading directions on tests and often misread assignments on the blackboard.
4. The Enemy Within. Physical and cognitive impairments may pose difficult obstacles for an individual, but often the feelings that people have about the individual's disability or about assistive technology pose greater problems than the disabilities themselves. The Solution Circle process recognizes that human fears, concerns, reservations, and prejudices might stand in the way of a person's success as much as other types of limitations. Getting these fears and concerns out on the table often helps the group to deal more constructively with what is possible and what needs to be done.
One of the serious issues in Tom's situation was that his resource teacher felt he should continue to try to read for himself instead of using a "crutch" like assistive technology. The teacher thought that if Tom did not have to read all the material, he would lose what little reading skill he had. In some ways, the teacher's opposition to considering assistive technology actually posed a greater barrier than the reading problem itself.
5. Solutions. The exciting part of a Solution Circle occurs when the group takes each obstacle or concern and turns it into a possible solution through the use of technology or some other type of adaptation. Not all solutions suggested eventually prove to be feasible, but the point of the discussion is to produce many possible solutions so that the individual and his or her family have an array of options from which to choose. With good minds puzzling over the problems and a spirit of cooperation and collaboration, seemingly impossible barriers can be removed or conquered. The process recognizes the expertise and contributions of all participants, including the individual with disabilities and his or her family members. The freewheeling format of the discussion promotes ingenuity and innovation. All involved come away from a Solution Circle energized by the new possibilities.
Tom's Solution Circle became excited about the possibility of solving his reading problem by using computerized texts. The computer store operator mentioned he had heard that Recordings for the Blind (RFB) offered textbooks on disk. Tom's parents got in touch with Recordings for the Blind and ordered texts for Tom to try on his computer at school. Soon Tom found that he could keep up with his classmates and study exactly the same material that they were covering. Because Tom had good strategies for memorizing information that he heard, he learned quickly from the texts that were read aloud to him by the computer. When given oral tests by his classroom teachers, he was able to recite appropriate answers which would have eluded him if he had had to read the tests for himself.
Technology has made all the difference for Tom; he has every reason to think that he will be able to go to college and pursue his intellectual interests. His resource teacher is now completely sold on the idea of assistive technology and using computerized books and wants to use the technique with other students. More than that, Tom's teacher also appreciates the process of the Solution Circle which allowed professionals and nonprofessionals to work together to find practical solutions without being too concerned about the formalities of the special education process. The informal nature of the Solution Circle validated the expertise of all the participants and gave everyone a chance to offer suggestions. The combination of a new process for planning and new technology made Tom a winner. This same combination holds potential for many students like Tom who benefit from technologies which eliminate barriers and open up new possibilities for learning.
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f igure 3: ASSISTIVE TECHNOLOGY EVALUATION |
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Name: |
Date: |
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COGNITIVE FACTORS |
MOTOR FACTORS |
Cognitive Ability Documented below average ability Documented significant overall delay Does not appear age appropriate Lacks understanding of cause & effect |
Mobility Needs help to be mobile Needs motorized help to be independent Needs help boarding transportation Unable to transfer independently Cannot climb stairs Cannot open doors independently Cannot carry materials in hands or arms Cannot lift weight |
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FINE MOTOR |
SELF CARE |
Dexterity
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COMMUNICATION |
SENSORY |
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Receptive Language
Expressive Language
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Vision
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From Function to Technology Solution. It happened that a participant in Tom's Solution Circle hit on a great idea for a solution to his functional problem with reading. This was a fortunate connection to make. At the suggestions of his Solution Circle, Tom began to use computerized books which he "reads" by having the computer speak the words as he follows along with the text. For Tom, computerized books proved to be a successful solution to his reading problem because they help him to get the information he needs without struggling with the reading process.
Not every Solution Circle will be like Tom's and identify the exact technology that the individual needs. But if a Solution Circle has worked well, the end result will be a clear analysis of the functions that need to be performed. This functional information can then be brought to technicians who can make suggestions for possible assistive technology solutions. There are over 50 assistive technology centers in the United States where knowledgeable individuals can assist people with disabilities and their families with making a match between functions that need to be performed and the technology that is available to perform those tasks. A list of assistive technology centers is available in the Appendix to this Guide.
Formal Assessment. Solution Circles are an effective, informal way to identify functional needs that can be met through technology. However, in the school setting, it is also necessary to establish a student's needs for technology in a more formal way. Formal evaluations for assistive technology must be multi-disciplinary, involving educators and therapists who are knowledgeable about the school curriculum and the particular types of impairments that the student being assessed may have. For example, for a student with cerebral palsy the assistive technology evaluation might involve a teacher, a physical therapist, a speech and language clinician, and an occupational therapist. The teacher would assist the therapists in determining what skills the student needed to learn and how technology might assist the student in acquiring those skills. Some assistive technology evaluations might require the additional services of an A-V technician, adaptive physical education teacher, a rehabilitation counselor, or speech and language pathologist with specialized training in augmentative communication. In school districts where there is no specialized expertise in technology and its applications, it may be necessary to contract for evaluations with special education cooperatives, medical centers, or centers that focus on technology assessment.
Individuals conducting an assistive technology evaluation should:
Because the assistive technology field is so new, there are no particular licenses or credentialing processes to identify a professional as qualified to do assistive technology evaluations. Generally speaking, individuals with professional licenses as occupational or physical therapists, special educators, speech pathologists, or rehabilitative counselors may have the expertise to conduct an AT evaluation. When considering an evaluator, it is wise to ask about the evaluator's specific experience with assistive technology. It is also important to recognize that no one person or discipline will know everything about assistive technology; therefore, access to knowledgeable people at the local level and through other agencies, programs or services is essential.
Conducting the AT Evaluation. The assistive technology evaluation must be tailored to the unique needs of the student. In some cases, the evaluation may be conducted by at team of individuals; in other cases, the evaluation may be conducted by a single individual (e.g., the speech pathologist). Questions to be addressed during the assessment should be related to the specific tasks the student needs to be able to perform and what, if any, assistive technology would help. The following questions may be considered during the assessment:
The above are only a few of the considerations which need to be addressed as part of the evaluation process. There is no specific "test" for evaluating the need for assistive technology. Therefore, prior to conducting the evaluation, the individuals doing the assessment need to have a well planned process in mind.
The formal written assistive technology evaluation report should address, but not be limited to, the following points:
In the end, an assistive technology evaluation should provide recommendations for accommodations, adaptations, devices, and services based on the individual's strengths, needs, and preferred lifestyle. The evaluation should indicate (a) whether devices and services have potential for improving function, and (b) what training may be necessary in order to use the technology equipment safely and effectively.
It is easy to be dazzled by the possibilities in new assistive technology, but it is important for parents to be wise consumers and ask probing questions about the features and quality of an assistive technology device. The following is a list of questions to consider when evaluating a particular assistive technology device:
Performance
Does it work efficiently and effectively? Is it easy to learn to use this device? Is it compatible with other devices? Does this device serve only one purpose or is it flexible?"Elegance"
Does this device represent the simplest, most efficient way to accomplish the task? Or is this device too elaborate, too complicated to be worthwhile?Ergonomics
Does it fit the individual? Is it convenient to use in the environment? Is the equipment portable enough to go where the user goes? Are different devices needed in different environments?Reliability
What is the manufacturer's reputation for reliability? Does it stand up well to normal use? Is it durable?Safety
Is it safe to use? What is the power source for the device? Is it safe? Is a margin built in for foreseeable misuse?Practicality
Do company sales people seem knowledgeable and helpful? Are the company's service people knowledgeable and helpful? Does the device have a warranty? How long is the device guaranteed to function? How available are repair services? At what cost? Can this device be leased? Is this device available for a trial period before purchase? Will this device soon be outdated? Is something better on the horizon? Will the company update the device? Does the manufacturer provide training in using the device?Aesthetics
Is this device attractive to the eye? Does the device fit well into the user's lifestyle?Normalization
Does the device assist the user with more normalized living? Can the user operate the device independently or with a minimum of assistance? Or does the device "stick out" too much and advertise the disability of the user? Does the equipment minimize difference or exaggerate difference? Does the device have the potential to increase the quantity and quality of time spent with nondisabled peers? Or does the device separate the user from others?Cost effectiveness
Do the benefits the device provides justify the cost? Are there less expensive devices or models that serve the purpose as well?Personal acceptance
Is this device the user's own choice? Does the potential user like this device and want to use it? Does the potential user view this device as life-enhancing? Would the user have preferred some other device or means to perform the task? Will using the device always be a chore or can using it become a habit?There are several ways that consumers can find answers to their specific questions about assistive technology devices. Most vendors will provide good basic information about the product. Call the vendor and ask for brochures, product specifications, price list and any other written information. This is a place to start. A second step is to read reviews of the product in trade magazines or Closing the Gap, a widely respected publication that reviews new assistive technology products. If possible, it is very helpful to talk to other consumers who are already using the product. Ask them about the pros and cons of using the device. Then visit a preview center, if there is one nearby, and try out several types of devices. Ask for general recommendations from the preview center's staff. After identifying a device that appears to meet the potential user's needs, try the device out for a month to six weeks to make sure that it performs as advertised and fits in well with the user's lifestyle. During the trial period, it will be possible to identify training needs for the user, family members and school staff. The trial period will also be a time for the user to test the device in several settings to determine its portability and flexibility.
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figure 4: ASSISTIVE TECHNOLOGY EVALUATION |
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When considering an assistive technology device, it is very important to consider how a device matches up with the particular individual's needs and habits. In some ways, an assistive device becomes an extension of the user's mind and body. As such, it is a highly personal item. A device may work as advertised, but still not meet an individual's needs because the individual just does not feel "comfortable" in using it. For example, Cindy, a fourteen-year-old who is totally blind and has mild cerebral palsy affecting her hands and arms, was being taught Morse Code as a means to speed up her writing. She had difficulty using a Brailler because her arm strength was so limited so her teacher thought Morse Code would be an easier method of writing for Cindy. The only problem was that Cindy did not like using Morse Code. To her, it seemed like she was having to learn another complicated language when she already knew braille and liked to use it. Cindy admitted that writing in braille was slow for her but she was more comfortable with it. Cindy and her teacher were at an impasse until a friend suggested to Cindy that she try writing on a voice-output computer. Cindy loved the computer! With a headset attached to the sound system, she could listen carefully to the computer as it read aloud the letters and words she was typing on a light touch, tactile-marked keyboard. This computer also had a feature of printing out text in either standard print or braille. Cindy was delighted--she could write copy for herself to read in braille and for her sighted teachers to read in regular print. This solution worked because it met Cindy's learning needs and responded to her own ideas about herself. She did not want to use Morse Code because it was a separate type of communication known only to a few. With her computer, voiced software, and dual printer, she had the best of two worlds--she could "hear" her writing as she typed, she could read it over in braille, and her sighted teachers could read her finished product. This solution helped Cindy to improve her composition skills, speed up her writing time, and communicate more easily with sighted people.
Cindy was fortunate because her assistive technology solution met her needs almost perfectly. Such a close match is not, however, always possible. Nonetheless, every effort should be made to have the match be as close as it can be. In general, when assistive technology solutions are individualized, simple to use, and responsive to the whole person, they are more likely to be used by the individual. When the device performs a task well, but does not "fit" the individual, the technology is likely to be abandoned by the user in favor of something else which meets the need more exactly. Too often devices are purchased because of their technical potential without thought to their relationship to the individual and his or her lifestyle. These mismatched devices are the ones that end up languishing in their packing boxes--a sad reminder of time and money spent to no avail.
It cannot be emphasized enough how vital it is to try out assistive technology devices and equipment before buying. Trying out a device for several weeks provides the user with an opportunity to learn how to use the device and how to adapt to its features while at the same time testing the device in the various environments where it will be used. For example, Mike tried out a communication device which attached nicely to his wheelchair tray and was compatible with his computer that he used for doing school work. Though the communication device worked well and was relatively easy to program, Mike found out quickly that the device was just too bulky to be useful for him. When he traveled around the school, the communication device blocked his view of the terrain and of people passing by. He found he missed opportunities to communicate because he could not see who was coming his way. Mike also discovered that the communication device did not serve him well in crowds like at pep rallies or basketball games. After a month of working with this communication device, Mike decided it was not for him and selected instead a device that was less complicated, smaller, and more portable. The second device was not as sophisticated as the first, but it better met his needs for quick communication with friends in social settings. If he had not had the opportunity to try out both devices for an extended period of time, Mike might not have realized the value of the second device and may have been stuck with a communication device that was too large and too sophisticated to match his lifestyle.
Similarly, Marilyn benefited from a trial period with her communication device. She found out the first week that the particular device she had chosen would not work for her because it broke too easily and it was difficult to get repaired. During the first week that Marilyn had the device for trial, her teacher broke one of the buttons during a programming session. It took two weeks to contact the manufacturer and then the device had to be mailed back to the factory for repairs. The device was gone for over six weeks, and the manufacturer would not supply a "loaner" while Marilyn waited for repairs to the first device. This experience taught Marilyn the importance of having a responsive manufacturer who is willing to repair devices quickly and to supply substitutes for the user while repairs are being made. Marilyn decided on a different device with similar features and a great helpline to provide assistance with the maintenance of the machine.
The information that can be learned during a trial period with a device is invaluable to the user. It is discouraging to find out during the trial that a device is not all it is purported to be or that it does not work as well as advertised, but it is far better to learn before purchase that a device does not meet the user's needs than to learn after purchase and be stuck with an expensive, unusable machine. For the consumer, it is daunting to think about starting over again with the process of selecting a device. Nonetheless, it is worthwhile to seek more information and look again. Having been through a trial, even when the outcome is not successful, provides the user with greater clarity about what an appropriate device will have to be able to do. The second time around the search is likely to go faster and come out with a better result.
Once a device has been selected, the consumer becomes impatient to have one and begin using it right away. But at this point, important work still needs to be done. Funding the device is a major consideration. Sometimes families will pay for the device themselves, but under other circumstances, the device will be purchased by a school district, through Medicaid or private insurance, or through some other means. Parents need to become familiar with the various funding options and determine which one will work for them (See Funding Assistive Technology for additional information about funding sources).
Also when considering funding, families should think about costs beyond the price of the device itself. For example, a computer set-up with a keyboard, monitor and printer might cost $3,500. This equipment is basically useless unless other equipment is purchased as well: software, adaptive devices, paper, manuals, upgrades. Prices for these additions can raise the actual cost of the device by hundreds of dollars.
Devices often require training for the user, family members, and others to ensure effective and safe use. How much does training cost? Who will provide it? Repair and maintenance are other costs usually additional to the price of the equipment. Sometimes families will also want to insure the assistive device so insurance payments become part of the overall cost.
Since making an assistive technology purchase is such an important personal and financial decision, it is wise to have a realistic budget in mind that includes all of the equipment and services that are necessary to make the assistive technology work effectively. With this budget in mind, it becomes easier to plan the purchase, seek out funding sources, and make a compelling case for financial assistance.
After the assistive technology device has been purchased and put to use, there are additional follow-up activities that need to take place. The original assistive technology evaluation should include a way to monitor the use of the device. Periodic scheduled reviews the by evaluator, follow-up calls to and from the family are some ways to help assure effective, safe use. Families who travel great distances for evaluation need to be certain that services like maintenance, repair and replacement of devices are available within a reasonable distance from home.
Assistive technology devices are used best when all the people in the life of the individual with disabilities understand the devices in the same way. At first, devices may seem to exaggerate differences between a person and the rest of the world. Care should be taken to explain that assistive equipment is a difference equalizer, not a difference maker. Classmates and friends need to understand that the adapted seating or adapted keyboard helps the individual do what other students do. Adults in a child's life need to understand that devices work to make life easier, better, and more functional. People need to know that ramps help keep individuals with mobility disabilities from being separated from peers; that communication technology allows people to "speak" their thoughts.
Close communication between parents and their child's helpers--teachers, therapists, day care workers and others--is essential to make sure devices and services are being used safely and effectively. If the device is working well, but the child is not being integrated into the classroom or other environments, then there may be a need for additional training for the children and adults who interact with the child.
Besides keeping track of how the device is working and being used, it is important to observe progress in the areas of technology which are useful to the individual with the assistive technology device. As upgrades of equipment occur or more sophisticated models come on the market, the user may want to consider modifying or replacing the equipment that is currently in use. Also as the individual becomes more skilled at using technology, the individual may outgrow the current device and need to look for more advanced equipment. It can be assumed with most high tech items that in three to five years there will be a need for upgrade or replacement. The wise consumer begins early to plan for the next step in technology, including saving money for a new device and staying alert to the new options that become available.
What kinds of training are important to occur when a child has a new assistive technology device?
Because assistive technology of the high tech variety is so new, it is particularly important that training be provided to all those who may need it. In the school setting, it is helpful for all educators and administrators to have some awareness training so that they have a general idea of what assistive technology is. Areas to be covered in inservice training might include:
Beyond these awareness activities, those members of the school staff who work directly with a student who uses technology, need to have training on the specifics of using the device and how it is maintained and serviced. Training should include, but not be limited to, the following:
Depending on the type of assistive technology used by the student and the student's needs, it may be advantageous for assistive technology information to be shared with the student's peers. Such training will help fellow students to gain an understanding of the student's assistive device, foster acceptance in the social environment, and reduce fears other students may have about socializing with the student who uses technology. In some cases, parents and the student may want to be involved in the peer training.
Parents may require training, too, in order for the device to be used at home for the student to complete homework assignments or participate in extended school year services. Once trained, the parents can become a resource to the student for proper care and maintenance of the device.
Most importantly, the student himself or herself, will need training in how to use the device as independently as possible. Training for the student may be written into the IEP as a separate goal or may be included as a related service that supports the student's special education program.
Summary
Purchasing a high tech assistive technology device is a major life decision because of the potential impact on the individual and because such devices can be costly. When considering an assistive technology device, it is important to do the following: be realistic about the consumer's capabilities and needs; get a multidisciplinary evaluation; examine available technology with a critical eye; match the individual's needs to specific equipment features; test the device for a trial period; identify next steps; and determine what needs to be done for follow-up after purchase. Evaluations for assistive technology, both informal and formal, should consider first of all the functions that the consumer wishes to perform using technology. When evaluating a particular piece of equipment, consideration should be given to the following features: performance, simplicity of design, ergonomics, reliability, safety, practicality, aesthetics, normalization, cost effectiveness, and personal acceptance. Good sources of information about assistive devices are manufacturers publications, trade journals, preview centers, and consumers who are already using the device. Once a device is selected, the consumer will need to secure funding for the purchase and be aware of additional costs for related equipment, insurance and training.
Hints for Parents
Don't let the cost of assistive technology deter you from considering it for your child. High tech assistive technology can be quite costly, but it can also make the difference for your child in terms of becoming well educated, employable, and a fully-included member of the community. Don't leave any stone unturned when looking for funding sources. Consider any or all of the following for funding or assistance:
Sierra
Sierra wants to play with dolls like other children her age, but she has a muscle disease that has caused her to lose muscle tone except in one hand. What could be done to allow Sierra to dress and undress her dolls, comb their hair, and bathe them?
Sierra's Solution
The assistive technology solution for Sierra involved her whole family. While vacationing in Mexico, Sierra's grandmother found her a fashion doll that was a bit larger than the typical "Barbie doll." The larger doll was easier for Sierra to manipulate. Sierra's mother sewed several outfits for the doll using velcro instead of snaps or buttons as fasteners.
Sierra's dad bought doll stands at a toy store and fastened several stands with clamps to Sierra's wheelchair tray. He also fastened a plastic pouch to the tray. Sierra puts the small doll accessories in the pouch. When Sierra wants to dress her doll, she puts the doll in one of the stands. In this way, the doll is held securely and Sierra can dress and undress the doll with one hand.
Sierra's friends also use the doll stands for their dolls. With this arrangement, two or three girls can play together.
Solution Summary
Larger dollVelcro fasteners
Plastic pouch
Doll stands
Clamps
Funding Assistive Technology
Funding for assistive technology is available from a variety of public and private sources. To receive public or private funding, the individual must meet eligibility criteria for the specific program and provide sufficient documentation of the need for assistive technology.
The following list includes some of the programs which may pay for equipment if the individual needing the device meets their requirements. Many of these programs are run by different agencies in different states, making them hard to find. In general, the state's Tech Act office can assist consumers and family members in finding and using these programs (See Appendix under Resources).
Early Intervention Programs (Individuals with Disabilities Education Act, Part H)
Young children (0-3) and their families may receive help through early intervention programs in evaluating what the child needs, in getting assistive technology, and in learning how to use it. Equipment and services must be included in a written plan, called an Individualized Family Service Plan (IFSP). To find the program for a particular state, call National Early Childhood Technical Assistance System (NEC*TAS) at 919-962-2001 or 919-966-4041 (TDD).
Head Start
This child development program provides comprehensive educational and health services for eligible children ages 3-5. Since 1982, federal law has required that at least 10 percent of the total number of placements must be available to children who are disabled and require special services. Head Start is a mainstream placement option for children whose IEP calls for placement with nondisabled children. The January 1993 Head Start regulations specifically require the consideration of assistive technology services and devices. For more information, contact National Head Start Association, 201 N. Union St., Suite 320, Alexandria, VA 22314; 703-739-0875.
Schools (IDEA, Part B)
This program mandates a free, appropriate public education for preschoolers, children and youth with disabilities. An Individualized Education Program (IEP) is required for all children with a disability. These children are entitled to special education, related services or supplementary aids. If the IEP team determines that assistive technology is required for a free, appropriate public education, then it must be provided at no cost to the child. The technology must be included in the child's Individualized Education Program (IEP). Parents have a right to be involved and should help to develop the IEP goals which may include technology. For help in getting assistive technology in the IEP, call the TAPP Focus Center on Assistive Technology at 1-800-222-7585.
State Operated and Supported Schools (Chapter I)
This program provides federal assistance to help educate children with disabilities who are enrolled in state-operated and state-supported programs. Federal funds must be used to pay for services that supplement a child's basic special education program, such as construction and the purchase of equipment. For more information, contact your State Department of Education.
Section 504 of the Rehabilitation Act of 1973
Section 504 provides a civil-rights mandate that requires accommodations for students who have disabilities such as orthopedic impairments, but who do not qualify for special education services. It denies federal funds to any institution, including a school, whose practices or policies discriminate against individuals with disabilities. This legislation has resulted in a number of outcomes, including various actions to remove physical barriers to education, which may incorporate assistive technology. For more information, contact the nearest regional Office of Civil Rights or the State Vocational Rehabilitation Agency.
State Programs for Children with Special Health Care Needs
These programs provide and pay for services for eligible children. CSHCN programs vary widely from state to state in the services they offer, the number of children served, and the requirements for eligibility. Some CSHCN programs do pay for assistive technology devices when no other funding source is available and the equipment is necessary for health-related reasons. Most CSHCN programs are run by the state health agency. To contact CSHCN, ask information for the telephone number of the state health agency.
School-to-Work Transition Programs
Transition Programs are charged with assisting students with disabilities to receive the job related training and placement services to help them move from school to work. Sometimes assistive technology may be necessary in order for a student to make a successful transition and become employable. If technology is needed for transition purposes, it can be written into the student's Individualized Transition Plan (ITP). To receive more information about transition and technology, call the Parent Training and Information Center (PTI) in your state (See Appendix).
Vocational Rehabilitation Services
State vocational rehabilitation agencies provide information, evaluation services, training and funding for technology and education to help adults go to work or live more independently. If technology is necessary for an individual to work, Vocational Rehabilitation may pay for the equipment as part of an Individualized Work-Related Plan (IWRP). To locate the nearest Vocational Rehabilitation Agency, look in the telephone book under state government.
Plan to Achieve Self-Support (PASS)
One of many Social Security Administration work incentive programs, this program provides an income and resource exclusion that allows a blind or disabled person to set aside income and resources for a work goal such as education, equipment purchase, vocational training and starting a business. It should be considered for all students with vocational goals who are receiving social security benefits.
This program provides a mechanism for people to set aside funds to purchase work-related equipment, such as assistive technology devices and services. In many cases, if an individual is a recipient of SSI and writes a PASS to purchase education or equipment, an additional SSI check will be provided to cover other living expenses. Sometimes if a person receives Social Security Disability Insurance (SSDI) and designs a PASS, it may make the individual eligible for SSI because the SSDI has been allocated for equipment and services.
Impairment-Related Work Expense (IRWE)
Impairment-Related Work Expense (IRWE)--one of the Social Security Administration's work incentive programs--allows an employed individual with a disability who receives or is eligible for SSI or SSDI to deduct work-related expenses from gross reported income.
This deduction allows the person to continue drawing SSDI or SSI and associated benefits (Medicaid or Medicare) if the IRWE deduction reduces earning below the Substantial Gainful Activity (SGA) Test.
Although this method does not provide funding to pay for a device or service, it is a way of allowing the use of the individual's own money to pay for assistive devices and services necessary to return to work. The following is a list of possible work-related expenses: special transportation to and from work, personal assistance on the job, structural modifications, durable medical equipment, prostheses, medical supplies and services, work-related equipment, non-medical appliances and equipment, routine drug and medical costs, and diagnostic procedure costs.
Medicaid
Medicaid is a joint federal and state program which covers some equipment if it is considered medically necessary. For more information about Medicaid and who and what is covered, contact the local Department of Human Services office.
Medicare
Although not a usual source of funds for assistive technology, Part B of Medicare provides coverage for some durable medical equipment if it is considered medically necessary and is for use in the person's home. For more information about Medicare benefits, contact the Social Security Administration Regional Office.
Technology-Related Assistance for Individuals with Disabilities Act of 1988
This federal competitive grants program provides monies for states to establish a statewide, consumer-responsive service delivery system designed to effect systems change regarding assistive technology. In most Tech Act states, a funding specialist or policy analyst is available to assist with accessing assistive technology. Several states operate loan programs to help with the purchase of devices and services. For more information, contact RESNA Technology Assistance Project, 1700 N. Moore ST., Suite 1540, Arlington VA 22209-1903; 703-524-6686.
Private Insurance
Some health insurance plans will buy equipment, but it depends on the specific wording of the policy. Unless the policy says the equipment is not covered, it makes sense to ask the insurance company to pay for it. The equipment must be considered medically necessary and therefore requires a doctor's prescription.
Loans
There are several low or no interest loans available to help buy technology. Call the state Tech Act program or the manufacturer of the equipment may know where to get this type of loan.
Non-Profit Disability Associations
There are many disability organizations, some of which may be able to loan equipment or provide information about other funding sources or support groups. These organizations include: National Easter Seal Society, March of Dimes, Muscular Dystrophy Association, United Way, United Cerebral Palsy Association, and the Braille Institute.
Foundations
Some private foundations have been set up specifically to provide help to people with disabilities. A listing of such foundations can be found at the library or may be available from the state Tech Act program.
Programs Providing Assistive Technology
The state Tech Act programs offer referrals for evaluation and equipment recommendations as well as assistance with identifying funding or equipment lending sources. A therapy department in a local hospital or Disabled Students Center at a local college or university may also offer to help locate technology programs in the area. Alliance for Technology Access Centers (ATA) sometimes have loan programs or information about purchasing used equipment or renting equipment.
Civic Organizations
There are many local civic and service organizations which may provide money to help someone in their community. Lists of these organizations are available from the Chamber of Commerce. Examples of these organizations are: Lions Club, Masons, Grotto, Veterans of Foreign Wars (VFW), Elks Club, Rotary Club, Kiwanis, Knights of Columbus and Soroptomists. Some of these organizations have a national focus on disability or on a particular disability. Others will fund devices for a particular child who is known to the local club.
Charities and Fund-Raisers
Local churches, high school groups, neighborhood organizations, labor unions, or special interest groups (e.g., computer clubs, ham operators) may plan a fund-raiser to help purchase assistive technology. College student organizations (fraternities and sororities) may give money or students' time to help a special cause. Even if money is not available, they may be willing to help organize a fund raiser.
Local media (radio, television, newspapers) sometimes will sponsor fund-raising activities to fund devices. They may not contribute money but will help with organizing the fund-raising activity and publicizing it to the community.
In addition to federal and private funding sources, there are a number of education-related grants, corporate technology donation programs, and funding options that consumers should consider. Information on these alternative options is available through a number of sources, including the following:
Newsletters
Education Grants Alert, Capital Publications Inc., P.O. Box 1453, Alexandria VA 22313-2052; 800-655-5597.
Education Technology News, Business Publishers Inc, 951 Pershing Dr., Silver Spring MD 20910-4464; 301-5878-6300.
Financing Assistive Technology, Smiling Interface, P.O. Box 2792, Church St. Station, New York NY 10008-2792; 415-864-2220.
Special Education Report, Capital Publications Inc., P.O. Box 1453, Alexandria VA 22313-2053; 800-655-5597.
Technology and Learning, Peter Li Inc. Publishing, 330 Progress Rd., Dayton OH 45449; 415-457-4333.
Technology Manufacturers
If it is not possible financially to purchase equipment, consumers can sometimes rent or borrow equipment directly from the manufacturer.
Used Equipment
Used equipment is often advertised for sale in disability-related publications, or the consumer can place a newspaper ad to see if used equipment can be purchased locally. Several companies refurbish old computers and sell them at low prices. Listings of used computer outlets can be obtained from ATA Centers or state Tech Act programs.
Leasing
Many manufacturers of assistive technology devices have equipment which is available for rent or lease. Sometimes the rent or lease payments can be applied toward purchase. Check with the manufacturer to see if this is an option.
Equipment Loan Programs
Many states have equipment loan programs as do some rehabilitation facilities and disability organizations. Information about loan programs is available from Tech Act programs.
There is an art to applying for funding for assistive technology. It is necessary to use just the right words to suit the particular agency that might be the funding source. It is also crucial to document the need for and projected outcome of assistive technology. This documentation should include at minimum:
In summary, the documentation to support an assistive technology funding request should include a physician's prescription, the child's assessment, an explanation of projected benefit from use of the technology or service, and any correspondence obtained from professionals that would support the child's need for technology.
The initial funding request should include not only the cost of the device, but also the cost of ongoing support and instruction in the use of the technology. Assistive devices often have "hidden" expenses that are incurred with their purchase, and these expenses are frequently costly over time. Battery-powered devices may require frequent charging or cleaning. Upgrades for computer software may be necessary. Special modifications of the home or school environment may be necessary for the technology to be used. In each of these examples, costs associated with the technology may have to be assumed by the family if they are not considered in the initial application for funding.
It is also helpful to include with the funding request a picture or a descriptive brochure about the device being requested. This is important because often persons who are reviewing the application do not know about the wide range of technologies that might be appropriate.
Appropriate wording on the application is absolutely necessary. Key concepts for Medicaid include "medical necessity" and "restore the patient to his or her best functional level." The term medical necessity means that the device is included in the course of treatment being provided to the child and that a professional, such as a physician or speech therapist, is supervising its use. Medicaid and private insurers alike generally pay for technologies that help restore people to "functioning levels" and take the place of a body part that is not working. Typically, these programs do not pay for technologies or services whose function is educational or life-enhancing rather than health related.
The key for private insurance is "terms of the policy." It must be remembered that coverage by any insurance company does not set a precedent. Just because one child receives needed technology under a particular policy issued by a company does not mean that all other covered children will also have technology paid for by that company. Each application stands on its own based on the expressed terms of the policy.
It is usually under the major medical provisions of a health policy that assistive technology can be provided as "other medical services and supplies." It may, however, be necessary to purchase additional insurance coverage or a "rider" in order for technology costs to be included in the terms of the policy. It is important to remember that heath insurance policies are oriented toward health care, and not toward changes in the environment or rehabilitation.
Both private health insurance policies and Medicaid sometimes impose limits on the number of assistive technology devices over a certain cost that can be purchased within a certain time frame. Sometimes the rule is that the funding source will purchase only one device in the individual's lifetime. With these kinds of restrictions, it is all the more critical to be sure that the technology choice is the right one.
It is not at all unusual for an initial funding request to be denied. Even when family members and professionals have been meticulous in preparing applications requesting funding for needed technology, denials should be anticipated. Making an appeal is worth the effort since many denials are reversed at the appeal level.
To start the appeal process, obtain any documentation or information provided by the funding agency (e.g., Medicaid or the private insurance company) relating to appeal procedures; forms to use, timelines, and filing procedures, for instance. This information will help in the prompt preparation for appeal. The kind of appeal to be made depends on the reason for denial. When developing an appeal, find out the following:
Going to appeal makes sense because generally the appeal places the application before more experienced persons in the decision-making hierarchy. The technology requested is often new, and the initial examiners in the process may be unaware of its usefulness. Also, insufficient documentation may have been provided in the original application, and the problem can be remedied on appeal.
Don't be daunted by the length of the appeal process. Follow it through to its completion. In some states, families may be able to appeal a denial beyond the first level. For example, some states have "unfair claims settlement practices" regulations, which are administered through the insurance commissioner's office.
Always make your appeal in person and take the child and the equipment if possible. If only part of the money is offered by one agency, ask another agency to share costs. If the appeal is denied, try again. Submit the funding request to another agency. Being persistent will nearly always result in success.
When going through the appeal process, turn to the state Protection and Advocacy Program (P & A) for guidance and support. P & A advocates can help make sure that a child's rights to technology and related services are not denied.
Who pays when assistive technology is needed at school?
The party who is responsible for paying for assistive technology depends upon the circumstances under which the technology is purchased. Under the special education law, students with disabilities who are eligible for special education are entitled to a free appropriate public education. Parents do not have to pay for school services, including assistive technology, if that service is part of the student's Individualized Education Program (IEP). If the student is eligible for Medicaid, the school district can request that Medicaid pay for the device. If parents choose to do so, they may agree to use private insurance to pay for a device that is used at school. Parents cannot, however, be forced to use their insurance in this way. If the private insurance requires a co-payment, the school district would have to pay this amount since parents should not have to pay any special education related costs.
Does Section 504 pay for assistive technology?
Section 504, part of the Rehabilitation Act of 1973, is basically a piece of civil rights legislation that is intended to prevent discrimination against individuals with disabilities in any program which receives federal funding. Students who have disabilities, but who do not qualify for special education, may still be eligible for accommodations under Section 504 of the Rehabilitation Act of 1973. Section 504, however, does not provide any funding for accommodations.
Like the special education law, Section 504 requires public schools to provide students with disabilities with a free appropriate public education and, in addition, ensures that students with disabilities are afforded an equal opportunity to participate in school programs. For students with disabilities, this means that schools may need to make special arrangements so that these students have access to the full range of programs and activities offered. For example, a student who needs a wheelchair lift on a school bus to get to school must be provided with this technology. Other modifications which might be required under Section 504 include installing ramps into buildings and modifying bathrooms to provide access for individuals with physical disabilities. Even though required by the law, none of these types of modifications would be funded by Section 504.
Under what circumstances does private health insurance pay for assistive technology?
Some private health insurance policies will pay all or part of the cost for some assistive technology devices. The devices are unlikely to be listed specifically in the policy, but may be included under some generic term like "therapeutic aids." Usually the devices have to be prescribed by a physician in order to be covered by the policy.
When does Medicaid cover assistive technology?
Medicaid (Title XIX) will pay for "prosthetic devices"&endash;that is, replacement, corrective, or supportive devices prescribed by a physician or other licensed person. Each state has some flexibility in determining which prosthetic devices it will include in its list of Medicaid covered expenses. Devices that are frequently covered by Medicaid are canes, crutches, walkers, manual wheelchairs, hospital beds, and hearing aids or eyeglasses for children and youth.
Summary
Assistive technology can be expensive to purchase, but there are a number of public and private sources for funding devices. Common public funding sources include: early childhood intervention programs, schools, Vocational Rehabilitation, and Medicaid. Private sources may involve health insurance, personal loans, charitable donations, or fundraising. It is very important to provide proper documentation and use correct wording and procedures when requesting funding. Initial requests for funding are frequently turned down, but appeals can be successful.
TED
Ted is an active four-year old who lives in a small rural community with his parents and younger sisters. He was identified as speech impaired and has been attending preschool special education classes. Ted has normal mental capabilities, but his mild cerebral palsy impairs his ability to speak. Because of the speech therapy he has received, Ted is able to make some speech sounds but he says no intelligible words. He uses sign to communicate with his special education teacher and his parents. No one else in his community uses sign, so Ted is limited in his ability to communicate with others.
As Ted's IEP Team looks ahead to his entry into elementary school, the Team recognizes that he will need better communication skills in order to participate successfully in the regular classroom. His speech therapist has recommended that Ted begin to use an AlphaTalker.
What funding sources might pay for the AlphaTalker?What case could you make for funding? Are there any obstacles to seeking funding?
TED'S SOLUTION
At this point Ted's ability to communicate is somewhat primitive. Because of his cerebral palsy, he is not able to make conventional signs so the gestures he makes are understood only by those who know him well. A simple electronic communication device may work for Ted but there are some prerequisite communication skills he will have to master first. Augmentative communication devices operate on the principle of choosing icons (abstract symbols) that represent certain basic communications like a cup to indicate "I want a drink."
In order to make a picture/symbol system meaningful and functional for Ted at his young age, his speech therapist began to work on point-to-object and point-to-picture activities. When Ted had mastered point-to-picture activities, his therapist made a picture ring for him. On the ring were picture symbols (icons) for things that Ted might want to say. Ted's family, his teacher, and his classmates began to ask him to use his pictures to explain what he wanted. Soon Ted was using pictures to communicate simple wants and needs effectively. His word ring went with him everywhere and helped him to "talk" to people he did not know as well as to friends and family members.
An unexpected bonus to the picture practice is that Ted is verbalizing more and his speech has become more intelligible. He has even begun to sing! An electronic communication device may be in Ted's future but for now he is learning to communicate well with his picture ring and some spoken words.
Solution Summary
Point-to-picture practiceUse of picture ring.
GLORIA
Gloria, an eighteen year-old with mild cognitive delays and CP, is about to finish high school. She has been using a laptop computer and switch access hardware and software in lieu of a pencil and paper to complete work in high school. The equipment and software were provided by the school district through the I