Community Living

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Community Living Assistive Technology The
Reality and the Promise

• Delawares Path toward a Comprehensive AT Access
  Infrastructure
• Beth Mineo Mollica, Ph.D.
• Delaware Assistive Technology Initiative
• Center for Applied Science and Engineering
• University of Delaware

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Assistive Technology Is Key To...

• Independent and safe community living

Travel
Employment
Homemaking
Mobility
AT
Self-care
Scheduling
Communication
Money management
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What Is Assistive Technology?

• AT Device
• Any item, piece of equipment or product system,
  whether acquired off the shelf, modified or
  customized, that is used to increase, maintain,
  or improve functional capabilities of individuals
  with disabilities.
• 20 U.S.C. Chapter 33, Section 1401 (25)

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What Is Assistive Technology?

• AT Service
• Any service that directly assists an individual
  with a disability in the selection, acquisition,
  or use of an assistive technology device.
• 20 U.S.C. Chapter 33, Section 1401 (25)

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Is AT getting to everyone who might benefit from
it?

• NO!
• Awareness challenges
• Expertise challenges
• Funding/policy challenges
• Population specific challenges

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Awareness Challenges

• Unaware that tools exist to address challenges to
  independence
• Unaware of how to access tools and related
  supports
• Example
• maintaining the checkbook

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Funding/Policy Challenges

• Varied sources of support for AT access
• Be prepared for confusion and complexity
• Denial aint just a river in Egypt
• Devices and services
• Ownership issues

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Expertise Challenges

• May need assistance in
• evaluation of need
• device selection and try out
• device procurement/purchase
• Specialized expertise needed in some situations
• limited number of qualified providers

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Population-Specific Challenges

• Older people may have
• Different perspective on disability
• Technophobia
• Limited contacts and networks

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Population-Specific Challenges

• Individuals with cognitive limitations
• Technology design issues
• Worthiness issues
• Limited self-advocacy/self-determination
• History of learned helplessness

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Delawares Experience

• Precipitating Factor
• Individuals with MR living in community
  residences had communication devices but didnt
  have access to them
• Work group convened to figure out why
• Many factors hypothesized
• Began by assessing nature/extent of the need for
  AT

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Study 1

• Representative sample of Division of Mental
  Retardation caseload (N50)
• AT needs screened? 80 referred for further
  evaluation
• Evaluation driven by screening results
• Consumer, family, provider involvement
• Up to 4 disciplines involved
• Average cost of evaluation 360

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Study 1 Results

• 68 of study population had an immediate need for
  AT devices and services

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Study 1 Results

• Projected cost for addressing needs 2,300 per
  person (n34)
• Costs averaged across entire sample 1,550 per
  person
• Estimates included devices and services to meet
  immediate needs only

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Study 2

• Study 1 participants followed for 15 months to
• examine the extent to which their needs were met
• identify elements that either facilitated or
  hampered AT access

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Study 2 Results

• 74 of those who needed AT had at least some of
  their device/service needs met.
• 91 continued to have unmet needs.

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Study 2 Results

• Many barriers to AT access were identified
• inadequate communication among team members
• uncertainty regarding policies, procedures, and
  resources
• lack of access to equipment for trial use periods
• limited availability of staff qualified to
  support AT implementation

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Study 2 Results

• Contrary to popular belief, lack of funding
  resources was not a primary barrier.
• Confusion about how to access that funding was
  the problem.

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Study 2 Results
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Study 2 Results

• Those residing in the state institution (Stockley
  Center) enjoyed much better AT access than those
  living in the community because of Stockleys
  investment in
• staff development (skill attitudes)
• an equipment inventory
• the development of policies/procedures
  streamlining AT access

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Study 2 Results

• Those with a successful AT outcome had the
  benefit of an advocate concerned with timely and
  appropriate acquisition of devices/services.

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Study 2 Conclusion

• The challenge for Delawares MR/DD system was to
  build a sufficient AT access infrastructure
  combining
• ? qualified providers
• ? technology availability
• ? coordination
• ? responsive and consistent policies and
  practices
• ? enabling attitudes

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Subsequent Initiatives

• Development of the Comprehensive Guide to AT
  Resources for DDDS Clients in Delaware
• Clarification of policies related to AT access
  through Medicaid, DDDS, Medicare, private
  insurance, and other sources
• Establishment of AT Recycling Center
• Incorporation of AT screenings into annual
  planning process
• Commitment from state agency to s of clients
  screened and staff trained

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Gaps in Support Remain

• Private insurance far less responsive to AT
  requests than DE Medicaid
• Many do not have Medicaid coverage
• Many types of AT still not funded routinely by DE
  Medicaid
• home modifications
• vehicle modifications
• aids for hearing and vision
• environmental control systems

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Gaps in Support Remain

• Community service provision still far less
  comprehensive than institutional service
  provision, but that will change with
  implementation of new initiatives

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Recent Developments

• Expansion of infrastructure improvement project
  to include entire state Department of Health and
  Social Services, as well as other key state
  agencies and consumer groups
• Real Choice Systems Change grant awarded to DE to
  support this initiative

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Grant Elements

• Needs analysis
• Comprehensive awareness and training campaign
• Streamlined access process
• Information dissemination
• AT access alternatives
• Capacity building
• Data collection/tracking/evaluation

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Assistive Technology Act of 1998

• Supports states in sustaining and strengthening
  capacity to address AT needs of individuals with
  disabilities
• Support investment in technology across federal
  agencies and departments
• Supports micro-loans programs for individuals
  wishing to purchase AT

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Assistive Technology Act of 1998

• State Programs - focus on capacity building and
  advocacy activities to assist states in
  maintaining permanent, comprehensive, consumer
  responsive, statewide programs of
  technology-related assistance

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Assistive Technology Act of 1998

• State requirements
• Public awareness about availability and benefits
  of AT
• Interagency coordination to improve AT access
• Technical assistance and training
• Outreach to underrepresented populations

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Assistive Technology Act of 1998

• State optional activities
• Alternative financing systems
• Technology demonstrations
• Funding information
• Information-and-referral
• Interstate activity
• Create public-private partnerships

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Assistive Technology Act of 1998

• Broad mandate - target population is all persons
  with disabilities
• all ages
• all disabilities
• all service systems
• All states, DC, Puerto Rico, and outlying areas
  have funded projectsfor now
• 23 states will lose all funding if Congress does
  not act quickly

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For AT Act State Project Information...

• Association of Tech Act Projects (ATAP)
• atap_at_ataporg.org
• [phone]
• RESNA Technical Assistance Project
• www.resna.org/taproject/at/statecontacts.htm(703)
  524-6686

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For more information...

• Beth Mineo Mollica, Ph.D.
• Delaware Assistive Technology Initiative
• University of Delaware
• [phone] (voice)
• [phone] (TDD)
• [phone] (fax)
• mineo_at_asel.udel.edu (email)