AT personnel, the Reflective Practitioner and Ethics

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AT personnel, the Reflective Practitioner and
Ethics
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Assistive Technology Service(from Assistive
Technology Act of 1998-PL 105-394)

• "Any service that directly assists an individual
  with a disability in the selection, acquisition,
  or use of an assistive technology device.
• This may include
• evaluation of the needs of an individual with a
  disability, including a functional evaluation of
  the individual in his/her customary environment
  (evaluating their needs in their usual
  surroundings)
• purchasing, leasing, or otherwise providing for
  the acquisition of assistive technology devices
  by individuals with disabilities
• purchasing, selecting, or borrowing AT devices
• selecting, designing, fitting, customizing,
  adapting, applying, maintaining, repairing, or
  replacing of assistive technology devices

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Assistive Technology Service cont

• coordinating and using other therapies,
  interventions, or services with assistive
  technology devices, such as those associated with
  existing education and rehabilitation plans and
  programs
• providing training or technical assistance for an
  individual with a disability, or where
  appropriate, the family of an individual with a
  disability
• providing training or technical assistance for
  professionals (including individuals providing
  education and rehabilitation services),
  employers, or other individuals who provide
  services to, employ, or are otherwise
  substantially involved in the major life
  functions of individuals with disabilities.

4
Assistive Technology Device(from Assistive
Technology Act of 1998-PL 105-394)

• "Any item, piece of equipment, or product system,
  whether acquired commercially off the shelf,
  modified or customized, that is used to increase,
  maintain, or improve functional capabilities of
  individuals with disabilities."

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Definition of AT

• The International ISO-9999 standard defines AT
  as
• Any product, instrument, equipment or technical
  system used by a disabled or elderly person, made
  specially or existing on the market, aimed to
  prevent, compensate, relive or neutralize the
  deficiency, the inability of the handicap. 2007
• "Any product (including devices, equipment,
  instruments and software), especially produced or
  generally available, used by or for persons with
  disability
• for participation
• to protect, support, train, measure or substitute
  for body functions / structures and activities
  or
• to prevent impairments, activity limitations or
  participation restrictions." 2011
• http//cirrie.buffalo.edu/encyclopedia/en/article/
  265/
• http//www.abledata.com/abledata.cfm?pageid194670
  ksectionid19327

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ISO 9999 defines 12 functional areas called
"classes," each of which is subdivided into
"subclasses." Within most subclasses, more
specific categories called "divisions" are
listed

• 04 ASSISTIVE PRODUCTS FOR PERSONAL MEDICAL
  TREATMENT
• Included are those assistive products which are
  intended to improve, monitor or maintain the
  medical condition of a person. Excluded are
  assistive products used exclusively by
  health-care professionals.
• 05 ASSISTIVE PRODUCTS FOR TRAINING IN SKILLS
• Included are, e.g., devices intended to improve a
  person's physical, mental and social abilities.
  Devices that have a function other than training,
  but which may also be used for training, should
  be included in the class covering its principal
  function.

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ISO 9999

• 06 ORTHOSES AND PROSTHESES
• Orthoses are externally applied devices used to
  modify the structural and functional
  characteristics of the neuromuscular and skeletal
  systems.Prostheses are externally applied
  devices used to replace, wholly or in part, an
  absent or deficient body part.Included are,
  e.g., body powered and externally powered
  external orthoses, prostheses, cosmetic
  prostheses, and orthopedic footwear.Excluded are
  endoprostheses, which are not part of this
  International Standard.
• 09 ASSISTIVE PRODUCTS FOR PERSONAL CARE AND
  PROTECTION
• Included are, e.g., assistive products for
  dressing and undressing for body protection for
  personal hygiene for tracheostomy, ostomy and
  incontinence care and for sexual activities.
• Assistive products for eating and drinking,
• 12 ASSISTIVE PRODUCTS FOR PERSONAL MOBILITY
• ORTHOSES AND PROSTHESES,
• Assistive products for carrying and transporting,
  
• Assistive products for transporting objects in
  the workplace,.

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ISO 9999

• 15 ASSISTIVE PRODUCTS FOR HOUSEKEEPING
• Included are, e.g., assistive products for eating
  and drinking.
• 18 FURNISHINGS AND ADAPTATIONS TO HOMES AND OTHER
  PREMISES
• Sets of castors,
• Assistive products for environmental improvement,
• Workplace furniture and furnishing elements,
• 22 ASSISTIVE PRODUCTS FOR COMMUNICATION AND
  INFORMATION
• Devices for helping a person to receive, send,
  produce and process information in different
  forms.Included are, e.g., devices for seeing,
  hearing, reading, writing, telephoning,
  signalling, and alarming and information
  technology.
• Assistive products for office administration,
  information storage and management at work,
• 24 ASSISTIVE PRODUCTS FOR HANDLING OBJECTS AND
  DEVICES
• Assistive products for transporting objects in
  the workplace
• Assistive products for hoisting and repositioning
  objects in the workplace,

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ISO 9999

• 27 ASSISTIVE PRODUCTS FOR ENVIRONMENTAL
  IMPROVEMENT AND ASSESSMENT
• Devices and equipment to enhance and measure the
  environment.
• ASSISTIVE PRODUCTS FOR EMPLOYMENT AND VOCATIONAL
  TRAINING,
• 28 ASSISTIVE PRODUCTS FOR EMPLOYMENT AND
  VOCATIONAL TRAINING
• Devices which exclusively fulfill the
  requirements of the workplace and for vocational
  training.Included are, e.g., machines, devices,
  vehicles, tools, computer hardware and software,
  production and office equipment, furniture and
  facilities, and materials for vocational
  assessment and vocational training.Excluded are
  products that are mainly used outside of the work
  environment.
• ASSISTIVE PRODUCTS FOR TRAINING IN SKILLS,
• ASSISTIVE PRODUCTS FOR PERSONAL MOBILITY,
• FURNISHINGS AND ADAPTATIONS TO HOMES AND OTHER
  PREMISES,
• ASSISTIVE PRODUCTS FOR COMMUNICATION AND
  INFORMATION,
• 30 ASSISTIVE PRODUCTS FOR RECREATION
• Devices intended for games, hobbies, sports and
  other leisure activities.

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Definition of AT

• The European TIDE/HEART study (1994) looked at
  AT from the perspective of its outcomes, bringing
  in the human dimension and concluded that
• The ultimate objective of AT is to contribute
  to the effective enhancement of the lives of
  people with disabilities and elderly people
  helping to overcome and solve their functional
  problems, reducing dependence on others and
  contributing to the integration into their
  families and society.

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AT Service Ireland?

• Nine recommendations were made by the Commission
  of the Status of People with Disabilities (1996)
  on technology and telecommunications for people
  with disabilities,
• In particular three recommendations referred to
  the provision of AT services.
• http//www.nda.ie/cntmgmtnew.nsf/0/9007E317368ADA6
  38025718D00372224/File/strategy_for_equality_04.h
  tm

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Strategy for Equality 96

• The Department of Social Welfare and the
  Department of Transport, Energy and
  Communications should introduce legislation to
  ensure access to assistive technology and
  telecommunications in line with the UN standard
  rules. Access to this technology should include
  financial access.
• - Recommendation 271

13
Strategy for Equality 96

• A single existing agency should be responsible
  for all assistive technology and for
  dissemination of information about new
  technological developments. Services should
  continue to be provided by a mixture of state and
  voluntary organisation but voluntary sector
  services must be properly funded and regulated.
  This agency should also provide an adequate
  assessment service of the most appropriate
  technical aids for people with disabilities.
• - Recommendation 272

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Strategy for Equality 96

• One agency should be responsible for all
  technology and for giving out information about
  new kinds of equipment. This overall agency
  should set up nominated assessment centres and
  support them with appropriate funding for
  equipment, staff and training. There should also
  be a county network of feeder or outreach
  centres to provide primary assessments and
  training. All assessment must be based on a
  person centred approach.
• - Recommendation 273

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Implementation?

• None of the recommendations have been fully
  implemented to date
• it was reported that Neither the Department of
  Public Enterprise nor the Department of Social
  Community and Family Affairs see the
  recommendations as falling with their brief
• This leaves the provision of AT in the remit of
  Department of Health and Children through which
  it is largely considered aids and appliances.

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Current State of Practice

• Still many of the EU countries have adopted, in
  principle, or in practice, the Medical Model
  where advice and decision making is largely
  dependent on the professionals in the field
  (medical doctors and therapists / advisors).
• These professionals play a crucial role in
  bringing together the needs and available
  assistive technology, however in reality, these
  professionals all too often have insufficient
  knowledge as to the latest technology advances
  and available solutions
• Analysing Federating

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National Physical and Sensory Disability Database

• This is well illustrated in the report of the
  National Physical and Sensory Disability Database
  Development Committee (Gallagher 2001).
• report contains no reference to the provision of
  AT services.
• The intention of the database is to gather
  information on technical aids and appliances
  currently being used by people with disabilities.
  The areas covered are aids to mobility, orthotics
  and prosthetics, vision aids, aids to hearing,
  communication aids, incontinence aids, special
  furniture and other aids to personal care.
• For each technical aid and appliance identified,
  there are three subsequent fields to identify up
  to three individuals who assessed/authorised that
  particular aid and appliance,
• http//www.hrb.ie/health-information-in-house-rese
  arch/disability/npsdd/

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National Physical and Sensory Disability Database

• The list of professionals involved includes,
  audiologists, audiometricians, community resource
  workers, continence advisors, G.Ps, information
  technology specialists, nurses, occupational
  therapists, ophthalmologists, optometrists,
  orthotists, physiotherapists, prosthetists,
  mobility specialists, seating technicians, speech
  therapists and suppliers.
• It would appear from this listing that AT is
  still considered a rehabilitative tool viewed
  solely as helping in the eventual rehabilitation
  of the patient rather than as an enabling tool
  to support people with disabilities to achieve a
  better quality of life.

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Education for People with Disabilities Act 2004

• The Education for People with Disabilities Act,
  eligibility both for support and technology
  service hinges on the assessment of the
  individual, an assessment carried out by two or
  more of the following
• An educational psychologist
• A medical practitioner
• A teacher nominated by the principal of the
  school where the child is attending
• A social worker
• A therapist

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Education for People with Disabilities Act 2004

• It is evident from the medical background of the
  personnel involved that the emphasis is on the
  diagnostic factors of the persons special needs.
  
• A broader view of the person needs to be to be
  considered and in particular the persons
  abilities and how enabling technology can
  have a positive impact on both the behaviours and
  quality of life of the person

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EU Research 2009
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The AT ICT value chain in Europe
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EU Telemate Project

• The assistive technology (AT) provision cycle
  involves, by its nature, a heterogeneous group of
  disciplines.
• Skills are needed in design, manufacture, user
  assessment, delivery, maintenance, disposal and,
  use
• http//www.fernunihagen.de/FTB/telemate/database/i
  sced.htm

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Earlier Research

• The TIDE HEART project (report E.3.2)
  identified three areas of education and training
  in Assistive Technology for specialists
• Human
• Socio-economic, and
• Technical.

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HEART area Human

• Basic profession
• Clinical
• with underpinning disciplines
• Anatomy
• Physiology
• Biomechanics
• Disabilities
• Psychology
• Sociology
• Knowledge transfer, and
• Ethics

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HEART area Socio-economic

• Basic profession
• Administration
• with underpinning disciplines
• Management
• Service delivery
• Standards, testing
• Legislation
• Economics

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HEART area Technical

• Basic profession
• Engineering
• with underpinning disciplines
• Mechanics
• Electronics
• Physics
• Information Technology
• etc.,

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Knowledge of Assistive Technology
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International Standard Classification of
Education (ISCED) UNESCO

• ISCO skill Level
• First skill level
• Second skill level

• ISCED Categories
• ISCED category 1, comprising primary education
  which generally begins at ages 5-7 years and
  lasts about 5 years.
• ISCED categories 2 and 3, comprising the first
  and second stages of secondary education. The
  first stage begins at the age of 11 or 12 and
  lasts about three years, while the second stage
  begins at the age of 14 of 15 and also lasts
  about three years. A period of on-the-job
  training or experience may be necessary,
  sometimes formalised in apprenticeships. This
  period may supplement the formal training or may
  replace it partly or, in some cases, wholly.

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International Standard Classification of
Education (ISCED) UNESCO

• Third Skill Level
• Fourth Skill Level

• ISCED category 5 (category 4 has been
  deliberately left without content) comprising
  education which begins at the age of 17 or 18,
  last about four year, and leads to an award not
  equivalent to a first university degree.
• SCED categories 6 and 7, comprising education
  which begins at the age of 17 or 18, lasts about
  three, four or more years, and lead to a
  university or postgraduate university degree or
  the equivalent.

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ISCED is UNESCOs International Standard
Classification of Education
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AT accreditation USA - Resna

• The rising expectations of end-users are forcing
  accreditation away from qualifications based on
  knowledge to demonstrate competence in practice
• Competence applied to whole services in which a
  skill mix can be provided in a number of ways
  depending on the needs of the user

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RESNA Rehabilitation Engineering Society of
North America

• In the US RESNA have developed a package of
  qualifications for AT professionals
• Assistive Technology Practitioner
• Assistive Technology Supplier
• Rehabilitation Engineering Technologist

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Aspects of Assistive Technology Education in a
European context

• Evert-Jan Hoogerwerf

Keeping Pace with Assistive Technology,
Guidelines for Lifelong Learning in Assistive
Technology http//www.at4inclusion.org/kpt/kpt_pr
oject.php
38
Professionals involved in AT
135 responses

• Majority (79) of professionals reported working
  in two or more settings and in two or more teams

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Training Needs Analysis
AT as part of formal pre-qualification education

• Only 20 of 135 professionals interviewed

Post-qualification AT training
38 didnt receive training 62 did receive
training
Nb The mean number of years post qualification
was 12.1 years
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Professions studying aspects of AT as part of
formal pre-qualification education
Frequency
Physiotherapist 1
Doctor 2
Teacher, Educationalist 4
OT 7
SLT 13
Total 27
Nb The mean number of years post qualification
was 12.1 years (N 125, range 1-35, SD8.65)
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Factors that influence Assistive Technology
decision making

• Elizabeth A Lahm Leslie Sizemore
• Journal of Special Education Technology Winter
  2002 17, 1 ProQuest Nursing Allied Health
  Source
• pg. 15

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Factors that influence Assistive Technology
decision making
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Factors that influence Assistive Technology
decision making
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Factors that influence Assistive Technology
decision making
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Factors that influence Assistive Technology
decision making

• AT training programmes at universities and
  colleges were highly multidisciplinary.
• Almost three-quarters (18 of 25) were sponsored
  by more than one department within the university
  or college.

46
Assistive technology training Diverse audiences
and multidisciplinarycontent, Lita Jans Marcia
Scherer in Disability and Rehabilitation
Assistive Technology, January-June 2006 1(1-2)
69 77
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Areas of AT

• Biomedical Engineering,
• . Child Development,
• . Communication,
• . Disability and Human Development,
• . Education,
• . Engineering,
• . Health and Human Development,
• . Health and Rehabilitation Sciences,
• . Gerontology,

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Areas of AT

• Industrial Design,
• . Occupational Therapy,
• . Psychology,
• . Physical Therapy,
• . Rehabilitation Engineering,
• . Rehabilitation Medicine,
• . Rehabilitation Science and Technology,
• . Speech and Hearing Sciences, and
• . Vocational Rehabilitation.

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AT Professionals

• Professionals in the counseling field have an
  ethical responsibility to be aware of the
  technology available,
• Must be comfortable with deploying AT.
• Studies have shown like consumers of AT services,
  providers of AT services likely demonstrate a
  wide range of emotions from being
  techno-centered to extraordinarily
  techno-anxious.

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Reflective Practitioners
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But firston 2 slips of paper

• On one slip of paperlegibly write down your
  definition of reflection in 60 seconds.
• On the second slip of paperBRIEFLY jot down
  thoughts about how our culture society views
  and practices reflection in 60 seconds.

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Then second

• Share your ideas with the people beside you for 2
  minutes
• Now share with the class

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The Reflective Practitioner

• Reflective practice is a continuous process and
  involves the learner considering critical
  incidents in his or her life's experiences.
• It was introduced by Donald Schön in his book The
  Reflective Practitioner in 1983.
• As defined by Schön, reflective practice involves
  thoughtfully considering one's own experiences in
  applying knowledge to practice while being
  coached by professionals in the discipline.
• described as an unstructured approach directing
  understanding and learning, a self regulated
  process, commonly used in Health and Teaching
  professions, though applicable to all.

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The Reflective Practitioner
Donald Schon Philosopher, researcher, professor
emeritus (MIT), made significant contributions to
the theory and practice of learning. Concerned
with professional learning, learning processes in
organizations, and with developing critical,
self-reflecting practice
The Reflective Practitioner How Professionals
think in Action (1983) Educating the Reflective
Practitioner (1987)
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Reflection

• Latin reflectere To bend back
• Involves shuttling back and forth between
  thinking and action

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Definition
Reflection has been defined as a generic term
for those intellectual and affective activities
in which individuals engage to explore their
experiences in order to lead to a new
understanding and appreciation.
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Definition
Reflection is a basic mental process with
either a purpose, an outcome, or both, applied in
situations in which material is unstructured or
uncertain and where there is no obvious solution.
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Why reflect

• Manage emotions ordering / controlling emotions
  Mindlfulness work to manage anxiety
• Re-processing to discharging emotions
  Pennebakers expressive writing
• Embracing change avoiding burnout reducing
  fear of change, looking for patterns

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• Writing about earlier traumatic experience was
  associated with both short-term increases in
  physiological arousal and long-term decreases in
  health problems
• Pennebaker Beall, 1986 
• Pennebaker, J. W. Beall, S. K. (1986)
  Confronting a traumatic event. Toward an
  understanding of inhibition and disease. Journal
  of Abnormal Psychology, 95, 274281

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Why Reflect

• Manage behaviour maintain motivation
• Demonstrate ethical practice / accountability
• See thoughts feelings behaviour links

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Potential benefits of reflection

• Improved practice
• Development of self regulation
• Facilitation and integration of theory and
  practice
• Development of personal theories of practice

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Retrospective or Real Time

• Reflection after the event
• After the event becoming self aware
• Action orientated
• Should lead to change

• Reflection during the event
• Self monitoring
• Concurrent awareness
• Knowing and doing implicit checklist

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Reflection framework
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Reflection in Action

• The sorts of knowledge we reveal in our
  intelligent action publicly observable,
  physical performances like riding a bicycle and
  private operations like instant analysis of a
  balance sheet. In both cases, the knowing is in
  the action. We reveal it by our spontaneous,
  skillful execution of the performance Schon,
  1987
• Thinking on your feet
• Knowing in action knowing more than we can say,
  the capacity to do the right thing (tacit
  knowledge).

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Reflection in Action

• Pausing after an activity to see how it went
  what went well, what did not, what could be
  changed
• We develop sets of questions and ideas about our
  activities and practice
• Looking back on experience to improve practice
• Learning in the midst of practice
• Making decisions about what to do
• Donald Schon

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Reflection Frameworks - basic

1. Description What happened
2. Evaluation what went well, what didnt
3. Analysis what thoughts, feelings,
   behaviours, contributed to success-
4. Action What next

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Reflection homework

• Attending to emotional responses working more
  skilfully with emotions
• Managing unhelpful feelings
• Working with surprises positive negative
• Notice tendency to avoid recalling experience

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Reflection homework

• Identify attitudes, beliefs, feelings - that
  helped, - that got away
• Consequences for self concept - professional
  identity supported or challenged-Personal
  identity supported or challenged
• Critical reflection challenge the validity of
  our presuppositions

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EIKey components

• Personal competence self awareness self
  management (self confidence, integrity,
  initiative, value base
• Social competence Social awareness
  Relationship management (empathy, supporting
  others, managing conflict, team working group
  dynamics

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Golemans 5 point Framework

• Self awareness understanding own motivation,
  strengths weakness, how one is perceived by
  others
• Empathy ability to see others perspective and
  use it in a helpful way
• Self regulation ability to control ones self
  and think before acting
• Social skills communicating and relating to
  others

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Epstein, R. M., Hundert, M. (2002). Defining
and assessing professionalcompetence. JAMA 287,
226235.
74

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Reflective Cycle - from Gibbs (1988)
Description-What happened?
Feelings-What were you thinking and feeling? What
lead you to that decision or opinion ?
Action Plan-If it arose again what would you do?
Would you do things differently ?
Evaluation-What was good and bad about the
experience?
Conclusion-What else could you have done? What
have you learnt?
Analysis-What sense can you make of the
situation? What have you learnt? What does the
literature say ?
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Reflection is the bridge between thinking and
acting
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EXERCISE 1

• As a group spend 15 minutes answering the
  following two questions
• What have you learned in this MSc in AT so far?
• What have you achieved on this MSc in AT so far?

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How do you define a Profession?
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Profession

• "A profession is a disciplined group of
  individuals who adhere to ethical standards and
  who hold themselves out as,
• are accepted by the public as possessing special
  knowledge and skills in a widely recognised body
  of learning derived from research, education and
  training at a high level
• who apply this knowledge and exercise these
  skills in the interest of others.
• It is inherent in the definition of a profession
  that a code of ethics governs the activities of
  each profession.

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Practice

• Such codes require behaviour and practice beyond
  the personal moral obligations of an individual.
• They define and demand high standards of
  behaviour in respect to the services provided to
  the public and in dealing with professional
  colleagues.
• Further, these codes are enforced by the
  profession and are acknowledged and accepted by
  the community."
•  

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Code of Ethics

• has two aspects 
• The content comprising the requirements, the
  rules, principles, ideals etc
• The commitment of the members of the occupation
  or organisation to conform to, and otherwise
  uphold, these rules and ideals

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Codes of Ethics

• Code Principles
• The most obvious way to recognise professional
  competencies is by a formal qualification
  together with peer recognition or references and
  membership of a professional organisation.A
  professional organisations standards for entry
  should also include a requirement to adhere to an
  enforceable Code of Ethics, the requirement to
  commit to measurable ongoing professional
  development and sanctions for conduct that falls
  below the required standards.

http//www.professions.com.au/Homepage.html
85
RESNA STANDARDS OF PRACTICE for Assistive
Technology Professionals www.resna.org
Standards of Practice set forth fundamental
conceptsand rules considered essential to
promote the highest ethical standards among
individuals who evaluate, assess the need for,
recommend, or provide assistive technology.
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RESNA STANDARDS OF PRACTICE for Assistive
Technology Professionals www.resna.org

• Hold paramount the welfare of persons served
  professionally.
• Practice only in their area(s) of competence and
  maintain high standards.
• Maintain the confidentiality of privileged
  information.
• Engage in no conduct that constitutes a conflict
  of interest or that adversely reflects on the
  association and, more broadly, on professional
  practice.
• Seek deserved and reasonable remuneration for
  services.

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RESNA Standards cont

• Inform and educate the public on
  rehabilitation/assistive technology and its
  applications.
• Issue public statements in an objective and
  truthful manner.
• Comply with the laws and policies that guide
  professional practice.

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Ethics

• ethics as 'a way of living ones life in pursuit
  of excellence.
• Ethics is not just a private matter.  It has its
  public and private sidesbut it cannot be just
  personal.' 
• Ethics is not mere conformity to rules.' Acting
  in a way which breaches the law of the land can
  certainly not be taken to be done in the name of
  ethics.Professionals have an ethical obligation
  to act in the best interest of their
  client/patient. Ethical duties also prohibit
  professionals from acting to promote their own
  self interest. 

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Five Core Concepts in Ethics

• Nonmaleficencenot causing harm to others
• Beneficence..doing good for others
• Autonomy.freedom of action choice
• Fidelity ..faithful, honest behaviour
• Justicefairness

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Ethical GEthical Guidance for Research with
People with Disabilities uidance for Research
with People with Disabilities
Ethical Guidance for Research with People with
Disabilities
91
Core Values for Research with People with
Disabilities
Promote the wellbeing of those participating,
involved in or affected by the research process
Respect the dignity, autonomy,
equality diversity of all
those involved in the research process
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Guidance for Good Practice in Research with
People with Disabilities

• Guidance is provided on six key principles
• Promoting the inclusion and participation of
  people with disabilities in research and research
  dissemination
• Ensuring that research is accessible to people
  with disabilities
• Avoiding harm to research participants
• Ensuring voluntary and informed consent before
  participation in research
• Understanding and fulfilling relevant legal
  responsibilities
• Maintaining the highest professional research
  standards and competencies