2009 Technology Symposium
Natasha Layton
Keynote Address
ILC WA - 24 March

Brought to you by

Independent Living Centre WA

NDS

Aged & Community Services WA

Relating the extent of AT provision to the extent of outcomes

This session takes a societal perspective of assistive technology, exploring the constraints operating for the marketplace, government, service providers and consumers. Real life scenarios are used to explore the interrelationships of these systems and how to achieve good outcomes despite the hurdles.

Why am I here?

Natasha Layton
B App Sc OT; M App Sc OT

My standpoint is informed by:

Equipment knowledge
Honorary Affiliate ILCA
ARATA representative to Standards Australia ME67

Professional standards
OT Australia National Professional Credentialing Group
University Occupational Therapy Academic Advisory Board

Policy in action
Aids and Equipment Action Alliance
DHS Aids and Equipment Redevelopment expert advisory group
Public Sector Residential Aged Care Equipment Review

Research
Member of the AT Collaboration
PhD Candidate Deakin University

My standpoint strives to include:

5

Able Australia Action for Community Living Association for Children with a Disability Australian Orthotic Prosthetic Association Bayview Disability Services Care Connect Carers Victoria CAUS Communication Rights Australia DEAL Communication Centre Disability Advocacy Resource Unit Disability Justice Advocacy Housing Resource and Support Service Isis Primary Care MacKillop Family Services Melbourne Citymission MS Australia National Disability Services Nillumbik Community Health Service Office of the Public Advocate OT Australia ParaQuad Victoria Royal Talbot Victorian Spinal Service Scope VCOSS Vision Australia Yooralla Youth Disability Advocacy Service B Gabe D Humphris Dr E Wilson Dr R McDonald M DeSanto N Layton R Domagalski S Wallace S Whiting

How does the extent of assistive technology provision relate to outcomes?

Clinical practice (PBE)

Research evidence (EBP)

Sociology

Health Economics

PhD Topic

… but is assistive technology the thing that makes the difference?

Ordering food at a restaurant for an individual with cerebral palsy who has severe athetosis and is non-vocal

  1. Reduce the impairment
    Rehabilitate the dysarthria for functional vocalisation

  2. Compensate for the impairment
    Point to the menu or use gestures

  3. Use AT devices
    Use a speech synthesizer

  4. Redesign the activity
    Have a set menu

  5. Redesign the environment
    Go to a cafeteria style restaurant

  6. Use personal assistance
    Have an attendant order or interpret vocalisations

Arizona State University Tots N’ Tech Project
Campbell, P. H., Milbourne, S., & Jeanne Wilcox, M. (2008). Adaptation Interventions to Promote Participation in Natural Settings. Infants & Young Children, 21(2), 94-106

Least
restrictive

Most restrictive

Web to illustrate domains of impact of AT Solution
by Campbell, P. H., Milbourne, S., & Jeanne Wilcox, M. (2008). Adaptation Interventions to Promote Participation in Natural Settings. Infants & Young Children, 21(2), 94-106.

Home made
communication
device

Working Definition

Assistive technology solution

An individually tailored combination of assistive technology devices, environmental interventions and personal care.

Definition developed by
AT Collaboration
www.at.org.au

What is a Societal Perspective of Assistive Technology?

society

society

Solutions hierarchy triangle

Courtesy of
Lloyd Walker NovitaTech
from Symons J and Ross D RESNA 1991

Government & Marketplace
(Audit Commission 2002 UK)

society

Policy Rhetoric:
current tension between old and new paradigms

Victorian Aids & Equipment Program Redevelopment
Service Delivery Model Discussion Paper November 2008

The Victorian Aids & Equipment Program provides people with a permanent or long term disability with subsidised aids, equipment, home and vehicle modifications to enhance independence in their home environment, facilitate community participation and support families and carers in their role

www.disability.wa.gov.au

‘The Community Aids and Equipment Program (CAEP) aims to provide an equitable accessible and consistent statewide scheme for the provision of equipment and home modifications for the benefit of people with a long-term disability, who are eligible for services from the Commission and living in the community.

All equipment and home modifications funded by CAEP are provided not only to enhance the function, independence and safety of the equipment user, but also to assist carers in their caring role. ‘

society

Hierarchy of concerns
(see critique of rehabilitation model de Jonge, Scherer & Roger 2007)

Dependence, Independence and Normality

‘Professionals working in services for disabled people, doctors, nurses, social workers, teachers, therapists and so on, often use the promotion of independence as a central reference point for both theory and practice in their work...although it should be remembered that human service professionals often can, and do, work in alliance with disabled people to achieve emancipatory ends, it is clearly the case that many disabled people experience this professionalized approach to the issue of independence as irrelevant and oppressive’

Colin Goble

Disabling Barriers – Enabling Environments p 42-43

Life Areas or Life Domains

WHO ICF 2001

How to define life domains?

Diagram courtesy of Schraner (2008)

Consider the relationship of ICF Domains to each other

…What do consumers say?

‘Traditionally, key issues usually pursued for service provision or rights are: education, training, housing and health. It is really only in the past decade, particularly with the growth of the disabled people’s and independent living movements, that disabled people are starting to question why social, leisure, relationships and sexual expression have not been addressed’

Selina Bonnie
Disabling Barriers – Enabling Environments p128

Life Domains

SCOPE 2006

An alternate conceptualisation of life domains, honouring meta-domains

society

How do funders support life domains?

What gets funded in Victoria?

Other funders?

society

… back to the practitioner

Clinical reasoning
in constrained contexts

Abandonment &
Non-Use of AT

• Funding delays forcing people to source inappropriate equipment just to try and get by

• Therapists forced to act as fund raisers or funding gate keepers making it difficult to properly focus

on the end user’s needs

• A prescriptive approach to providing equipment that does not properly engage and empower the end user and fails to involve them fully in the selection of equipment

Non-use of provided assistive technology devices (Wessels 2003)

  1. user-related

  2. device-related

  3. related to the device market

  4. related to the environment

Hard and Soft Technologies
(Odor, cited in Cook & Hussey 2008)

1.User-related personal factors

2. Device-related factors

3. Factors related to device market

4. Environmental factors

Does AT use infer satisfaction?

How would this consumer abandon his wheelchair?

Does the fact that he uses his AT mean that these outcomes are optimal:

Articulating optimal outcomes:
Palmer and Seale (2007)

society

How does the extent of assistive technology (AT) provision relate to outcomes?

Stand during
prayers

Reach standard
height voting booth

Get a view at the Grand Prix

No longer requires standing frame
& additional transfer

Lawn bowls
upright with
chute

Able to converse face to face with mother

queue and mingle with
fellow students outside
lectures

interact with bank & Medicare at ‘ordinary’
height counters

The Equipment Survey

1. Equipment Survey

- Things I use

- Other help I get

- Overall, how much difficulty? (1-5)

- Costs aside, what aids and equipment improvement or solution would best meet your needs? (devices, environments, support)

- What could you do as a result of these changes that you can’t do now?

2. AQOL

3. Demographic Questions

Repeat survey questions for each domain:

Research Project
AEAA, Buckland Foundation & Deakin University

Sample: Victorian adults whose impairments necessitate use of assistive technology solutions

Contact : natasha@footy.com.au

AT Economics