AT to Promote EmploymentSoS Symposium 2012

Walter Reed Medical Center

Allen Lewis, PhDUniversity of Pittsburgh

(alewis1@pitt.edu)

Overview

• Background on AT• Definition of AT• AT must target all disabilities• AT must target all cultural groups• Barriers to AT • Role of AT in promoting employment• Framework for measuring success of AT in the

workplace

Background

• The reality is that unless one is born wealthy, work has been and still is the path to the American Dream for most individuals, and not just people with disabilities.

• Not since the Great Depression has the importance of gainful employment been as essential to all Americans as it is today given the austere economic times.

• Therefore, it stands to reason that the importance of employment for people with disabilities in current times cannot be overemphasized.

Background (cont’d)

• The vocational rehabilitation profession in the US has existed for almost a century with a focus on improving vocational functioning toward employment for persons with disabilities.

• Technology is one of the keys to future success in all

disciplines and vocational rehabilitation is no exception.

• Full utilization of assistive technology (AT) by persons with disabilities in the future is an emerging frontier in the field of VR.

Background (cont’d)

• Let’s face it technology helps all of us in 2012.

• The VR community acknowledged the integral role of technology in assisting persons with disabilities almost 25 years ago as evidenced by the passage of the first specific AT legislation, the Technology-related Assistance for Individuals with Disabilities Act of 1988, Public Law (PL) 100-407.

• Subsequent re-authorizations of this legislation in 1994, 1998, 2004, and 2010 represent a sustained commitment to the increasingly important role of technology in VR.

Background (cont’d)

• Policy that addresses AT can be found in three categories of legislation: Civil Rights law (e.g., the Americans with Disabilities Act), Education law (e.g., the Individuals with Disabilities Education Act), and Technology law (e.g., the Telecommunications Act) (Fecich, n.d.).

Definition of AT

• AT can have varied meanings, including the one defined in the 2004 re-authorization of the AT Act (PL 108-364) that defines AT as follows: Any item, piece of equipment, or system, whether acquired commercially, modified, or customized, that is commonly used to increase, maintain, or improve functional capabilities of individuals with disabilities.

AT Must Target All Disabilities

• AT needs to target all types of disabilities (mobility, sensory, cognitive, developmental, psychiatric, neurological, physical, etc.) in order to have a mainstreamed effect on improving quality of life for all going forward.

• There is some evidence that people experiencing mental disabilities are at a slight disadvantage in accessing and using AT when compared to those individuals experiencing physical and sensory impairments (Kaye, Yeager, & Reed, 2008).

AT Must Target All Cultural Groups

• The literature on overall usage of AT by European-American and Non-European-American persons with disabilities is mixed.

• African Americans have been found to use smaller and portable AT devices, while European Americans tend to use larger devices associated with home modification (Rubin & White-Means, 2001).

AT Must Target All Cultural Groups (cont’d)

• These differences are thought to be attributable to such factors as, for example, income disparities and discrimination.

• Income tends to be a larger factor for African Americans than European Americans in purchasing AT devices (Rubin & White-Means, 2001).

AT Must Target All Cultural Groups (cont’d)

• The population of elderly individuals with disabilities in the nation will double between the years of 1999 and 2030 (McBride, 1989).

• Advanced age is positively related with AT usage (Agee, Freedman, & Cornman, 2005).

• AT will also have relevance amid the current trend of an aging U.S. workforce where older workers with disabilities comprise an increasing proportion of the overall working population (Zwerling, Whitten, Sprince, Davis, Wallace, Blanck, & Heeringa, 2003).

AT Must Target All Cultural Groups (cont’d)

• This trend combined with the bleak economy, high unemployment rates, and changing general population demographics all contribute to an aging workforce in the U.S. that is increasingly made up of workers aged 55+ years (Silverstein, 2008).

• Workers with disabilities experience a greater decline in employment rates in their elderly years when compared to workers without disabilities (Mitchell, Adkins, & Kemp, 2006), and perhaps AT could help to even out this trend across these two groups.

Barriers to AT

• AwarenessSolutions?

• MoneySolutions?

• AttitudesSolutions?

• FearSolutions?

Role of AT in Promoting Employment

AT can assist with major steps in employment:1. Job Seeking and Acquisition2. Maintaining the Job

a. Making work accessibleb. On-the-job trainingc. Interpersonal relationsd. Organization and time managemente. Ergonomicsf. Optimal job performance

Role of AT in Promoting Employment (cont’d)

Devices that Assist in Job Seeking/Acquisition:

• Online tools:

-LinkedIn

-Internet job sites

-Monster.com

-Face Time and Skype

Role of AT in Promoting Employment (cont’d)

Maintaining the Job…Devices that Render Work Accessible:

• Telecommuting• Customized vehicles• Screen readers (JAWS or Supernova)• Screen magnification (ZoomText or Magic• Text to speech programs (Kurzweil, Read, Write Gold)• Hearing assistance (Computer assisted real time

captioning/CART, captioning, amplified or video phones)• Voice to text telephones (Captel)• Environmental adjustments (ramps, lifts, positioning, lighting)

Role of AT in Promoting Employment (cont’d)

Devices that Assist with On-the-Job Training:

• Remote desktop assistance via computer from another location

• Visual assistant (Ablelink)

• Note taking software

Role of AT in Promoting Employment (cont’d)

Devices that Assist with Interpersonal Relations:

• Personal assistance dogs as ice breakers

Role of AT in Promoting Employment (cont’d)

Devices that Assist with Organization/Time Mgt:

• There are literally a plethora of options

• Example of low tech = sticky notes, data planners, alarms and timers

• Example of higher tech = PDAs/cell phones, computer reminders, paging systems like Isaac

Role of AT in Promoting Employment (cont’d)

Devices that Assist with Ergonomics:

• Numerous options for ergonomic keyboards (one hand or decreased movement keyboards)

• Various mouse options (Brainfingers-mind controlled mouse)

• Positioning• Mounting• Work envelope (customized workstation based on region of

space within which a person works: arch of reach and most common tasks closest)

Role of AT in Promoting Employment (cont’d)

Devices that Assist with Optimizing Job Performance:

• Telecommuting• Work envelope• Voice recognition software for dictation (Dragon

Naturally Speaking)• Job coaching using telerehabilitation• Scanning devices (ScanBuddy)• Visual concept mapping tools to help organize thoughts

(Inspiration)

RE-AIM Framework for Evaluating AT Use and Impact

• To effectively evaluate AT usage and positive impact, use of the RE-AIM framework.

• RE-AIM is an acronym that stands for the dimensions of reach, efficacy, adoption, implementation, and maintenance (Glasgow, Vogt, & Boles, 1999).

• Each dimension of the framework has an associated level or target group along with an accompanying question(s) that can be used to measure usage and impact of AT.

RE-AIM Framework for Evaluating AT Use and Impact (cont’d)

1. Reach (targets individuals) and answers the questions of what proportion of persons eligible to use the AT will attempt to use it and how representative of the larger potential user group are they?

2. Efficacy (targets individuals) and answers the question of what impact did the AT application have on individuals with disabilities exposed to it in terms of process and positive benefit?

3. Adoption (targets a particular setting or context) and addresses the questions of what proportion of settings will the AT be effective in and how representative are they of the range of potential settings?

RE-AIM Framework for Evaluating AT Use and Impact (cont’d)

4. Implementation (targets a setting and/or population) and responds to the question of to what extent did the AT get delivered in the appropriate setting and with the correct population of persons with disabilities?

5. Maintenance (targets individuals and settings) and addresses the questions of what are the long-term impacts of the AT as implemented on individuals six to 12 months down the road AND to what extent can the impacts that appeared to be long-term in scope be sustained into a particular setting?

Questions, Comments and Discussion

• ???????