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Assistive technology for clients with visual impairments of the Alaska Division of Vocation Rehabilitation: a qualitative evaluation

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Assistive technology for clients with visual impairments of the Alaska Division of Vocation Rehabilitation: a qualitative evaluation

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Content ASSISTIVE TECHNOLOGY FOR CLIENTS
WITH VISUAL IMPAIRMENTS
OF THE ALASKA DIVISION OF VOCATIONAL REHABILITATION
A QUALITATIVE EVALUATION
by
Linda Lee Newman
A Thesis Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
MASTER OF ARTS
(Occupational Therapy)
May 1995
UNIVERSITY O F S O U T H E R N CA LIFO RN IA
THE GRADUATE SC H O O L
UNIVERSITY PARK
LOS A N O ELES, CA LIFO R N IA SOOOT
This thesis, written by
under the direction of h.gAC— .Thesis Committee,
and approved by all its members, has been pre
sented to and accepted by the Dean of The
Graduate School, in partial fulfillment of the
requirements for the degree of
...
MASTER OF ARTS
O l «
Date
J a n u a r y 1 2 , 1995
THESIS COMMITTEE
ACKNOWLEDGEMENTS
Grant # H1299D810X1-90, entitled, SKILLS AND TOOLS:
Occupational Therapy Student Training for Community-Based
Independent Living Skills Using Technological Tools for
Persons with Disabilities, was provided by the Rehabilitation
Service Administration of the United States Department of
Education through the University of Southern California.
Being a recipient of this grant contributed to the focus of
this study. Additional funds were provided by the State of
Alaska Division of Vocational Rehabilitation as well as
support provided by Assistive Technologies of Alaska.
Guidance and support were gratefully provided by my
chairperson, Dr.Gelya Frank, and committee members. Dr.Ruth
Zemke and Dr. Harlan Hahn. Thanks both to Shirley Bennett and
Carol Hooper for their assistance in conducting the focused
group interviews. Special thanks to my parents, Boyd and
Shirley Bennett, and my husband, Anthony Newman, for their
endless support and encouragement. For the readers who
assisted me along the way, and to the participants of this
study: Thanksl My appreciation to you all.
TABLE OF CONTENTS
I. Introduction.......................................................1
II. Literature Review................................................ 9
III. Methodology...................................................... 23
IV. Results............................................................28
V. Discussion........................................................49
References................................... 66
Appendi xes
Cover Letter............................................ Appendix A
informed Consent Form Appendix A
Background Information Form Appendix B
Outline of Interview Questions/Topics........... Appendix C
Summary of Focus Group A ..............................Appendix D
Summary of Focus Group B ..............................Appendix D
Summary of Focus Group C ..............................Appendix D
Tables
Table 1: Background Information on Participants....... 29
Table 2: Clients' Vision, Technology, and Satisfaction
with DVR..........................................30-31
ABSTRACT
This study examines the role of assistive technology and
the effectiveness of the Alaska Division of Vocational
Rehabilitation (DVR) in the lives of individual clients who
have visual impairments. Thirteen men and women clients of
DVR with visual impairments participated in focused group
interviews. These clients varied widely in age and other
demographic variables, severity of visual loss, participation
in disability organizations, and satisfaction with DVR
services in meeting their assistive technology needs. The
participants' discussion covered a vast field of experiences,
and exposed varied attitudes toward technology, access to
information, funding, training and maintenance of equipment,
and views of the DVR system and of their counselors. The
experiences of many clients were marked by frustration, but
several specific and potential solutions--such as having
experienced clients act as mentors or improving counselor
understanding of technology and training in empathy skills--
emerged from the discussion.
iv
CHAPTER I
INTRODUCTION
in the summer of 1985, two women enrolled in the Center
for Blind Adults (CBA) in Anchorage, Alaska were given
equipment from the state's Division of Vocational
Rehabilitation (DVR), Both women had severe visual
impairments, and they had successfully completed high school
and were preparing for their freshman year of college. Both
women also had the same counselor from DVR assigned to them.
Like all DVR counselors, one of this counselor's main duties
is to help provide clients of the Division with the means to
become productive competitive workers in their society.
Assistive technology is one of these means, and this DVR
counselor thought that her young clients could benefit from
i t.
These two young women received their equipment within a
few weeks of each other. The first woman, Sharen, received an
electric typewriter. The second woman received an Apple lie
t
computer adapted with a large print display, speech output,
and braille access to the keyboard.
I was the second woman. I began losing my central vision
in both eyes at the age of 16 due to subretinal neovascular
hemorrhaging of an unknown etiology; I was legally blind by my
eighteenth birthday. Through my mother's efforts, I became
familiar with the Center for Blind Adults, where I met Sharen.
Together we learned about DVR services and their willingness
1
to supply us with assistive technology. Although I could not
be certain that the reason we received such vastly different
appropriations was not based on differences in our residual
vision, I reasoned that my endowment was greater than my
peer's because I had graduated from high school with a higher
grade point average than she, because I was receiving a
college scholarship, or that, perhaps, someone had put a good
word in for me somewhere along the line. Whatever the case,
what should have been appreciation and happiness over my DVB
appropriation was marred by the relative poor fortune of my
colleague and friend. I never asked her how that made her
f eel.
What, indeed, are the reasons that people receive the
technology they do? Why does one client receive a laptop
personal computer with speech output while another is refused?
Why does a closed circuit television (CCTV) take ten weeks for
one client to receive, a year for another? How do people know
what the right technology is? Who is to say who knows?
These questions have become especially relevant in recent
years. After documenting the benefits of assistive technology
in the lives of persons with disabilities and thereby the
overall benefits to society, the Federal government passed a
law in 1988 to assist with the provision of technology-related
assistive devices to persons with disabilities. These
benefits include increasing independence for persons with a
disability and enabling their employment (U.S. Congress,
2
1988) . The law is known as the Technology-Related Assistance
for Individuals with Disabilities Act (PL 100-407: Tech Act) .
The main objective of the Tech Act is to provide states with
grant monies in order to establish comprehensive consumer-
responsive programs to secure technology-related assistance
for individuals with disabilities including the provision of
training and increasing public awareness.
Upon passage of the Tech Act, the Deputy Director of DVR
in the state of Alaska went directly to the state's Governor
who agreed and sanctioned that DVR be the agency to design a
program for this grant. The Alaska Division of Vocational
Rehabilitation is a professional system that provides
counseling and funding for persons with disabilities to assist
in the attainment of employment. In Alaska, the Tech Act
grant monies were used to create a consumer-responsive,
statewide program called Assistive Technologies of Alaska
(ATA) . This program is available for persons with any
disability and of any age. The term "consumer-responsive" was
coined during the development of the Independent Living
Movement. It refers to the philosophy that the person with
the disability receiving the service is the most qualified to
know his or her own needs (Lachat, 1988).
Recently, investigators have proposed that the impact of
social policies on persons who are disabled including those
who are blind or visually impaired must be more closely
examined (Berkowitz & Scotch, 1990; Percy, 1989). In
3
particular, individuals with visual impairments may have
difficulties with tasks that require "acquisition of visually
displayed information" (Scadden, 1991, p. 10). New
technologies may offer independence to people who previously
would have required assistance for tasks such as reading and
writing. Voice output devices and keyboard braille displays,
among other technologies, are permitting persons with visual
impairments to gather information themselves (Scadden, 1991) .
Social policies that include provisions aimed at getting such
useful technologies made available to persons with visual
impairments has pertinent value.
Technology has certainly had "pertinent value" in my
case. In my Anatomy and Physiology classes in college, an
adapted large television screen enabled me to view microscope
slides that would otherwise have been off-limits to me. Four-
track tape recorders allowed me to listen to text books on
tape. A closed circuit television set made it possible--and
still makes it poss ible--f or me to read materials of all
kinds, ranging from recipes to professional articles, from
letters to phone bills, not to mention performing other tasks,
such as locating a splinter in my hand. Personal computers
with screen enlargement access and speech output have allowed
me to accomplish the written tasks of undergraduate and
graduate schools on my own accord, and also contribute to my
current occupation in that they allow me to type reports,
memos, and other work-related materials. In short, the access
4
to assistive technology primarily in my own home, opened up a
world of independence and efficiency and increased, most
importantly, personal conviction of my capabilities.
But by no means has it been easy to get to this point.
From the beginning, I've had to defend my educational and
career interests to DVR. I was told to get a 2-year
associate degree in medical transcription because my counselor
said other people who were blind had successfully held such
positions. But I didn't want to go into medical
transcription. Instead, I earned a bachelor's degree in
social work and psychology, with the hope of going on to earn
a graduate degree in occupational therapy. I was accepted by
several schools and offered a handsome scholarship, but DVR
said I couldn’t expect to continue to receive services,
because they thought I couldn't handle the schooling nor a
career in occupational therapy. I was able to maintain
services only after a lengthy review of my case by an upper-
level DVR administrator, and by researching and providing
information myself that occupational therapy was a feasible
and marketable career choice for me.
At the same time that I was defending my career
interests, I was also trying to deal with a clumsy and slow
bureaucracy that was supposed to be supplying me with
technology that would make my life easier and more productive.
As my original equipment became outdated, I began researching
assistive technology products myself. I expressed an interest
5
in equipment that would enlarge print, both on a computer
screen and on paper. I also needed repair work done on my
four-track tape recorder. My requests were eventually
approved, but I didn’t receive the equipment for 2 years. I
also had to undergo three evaluations of my assistive
technology needs before I was authorized to receive any
equipment. The whole process also was frustrated by turnover
in DVR counselors and in the arrival of equipment in separate
boxes that I had to assemble and operate without guidance.
I did complete my training and am now a registered
occupational therapist (OTR). in retrospect, the lack of
enthusiasm shown by my DVR counselor for my selection of
occupational therapy as a career choice strikes me as ironic.
I believe occupational therapy (OT) can play an important role
in helping people with visual impairments incorporate the
appropriate assistive technologies into their lives.
Occupational therapy expertise is useful in fitting,
modifying, training, and follow-up services for consumers of
assistive technology. The OTR is trained to look at the whole
picture: from the individual's sensorimotor to psychosocial
functioning, and from the environmental constraints to that
person's lifestyle (American Occupational Therapy Association
E AOTA}, 1991) .
I certainly could have benefitted from someone who was
willing to look at my whole picture, as a DVR client. The
absence of such a person was perhaps the most aggravating part
6
of my experience with the system. I resented being told how
I should react to my blindness by people who had no idea what
it was like to be visually impaired. 1 felt that my own
thoughts on my abilities and my requests for equipment were
dismissed and presumed to be excessive. I was disappointed
that a service which I thought existed to help me achieve my
career goals instead seemed intent on changing and ignoring
them. Overall, I felt that DVR, which I had once thought
existed to help me realize my potential, was more capable of
knocking down my dreams, and more interested in closing the
case of Linda Bennett as quickly and painlessly as possible-an
impetus for this study.
Make no mistake: my own experience suggested to me that
the vocational rehabilitation system is helpful and can make
a positive difference in the client's life by providing means
to accomplish goals of education and employment. However, for
it to work, had to work hard at educating myself and DVR
counselors and supervisors as to my needs and the solutions to
them, and I had to get used to being frustrated. I felt I was
the one doing the educating— teaching my counselors what
assistive technologies were available, and where to get them,
not to mention which technologies I thought would be useful
for me, specifically. My dealings with DVR required patience,
creativity, persistence, and research on my part.
Was my friend Sharen denied greater assistance from DVR
because she did not know how to handle, educate, or manipulate
7
the DVR system--a system which she should have had every
reason to believe existed to serve her? How do clients view
the DVR system, and how do they know they're getting the right
technology? in an effort to find out, I conducted this study-
-a qualitative look at the lives of clients of the Alaska
Division of vocational Rehabilitation. The purpose of this
study was to gather Alaskans having some form of visual
impairment to hear what they thought about the effectiveness
of the DVR system and its role in helping them with their
assistive technology needs. My hope would be that what they
tell me would be useful, not only to them, but to the Alaska
Division of Vocational Rehabilitation and other clients
throughout the state.
8
CHAPTER II
LITERATURE REVIEW
Historical Background
Legislation
Assistive technology is allowing persons with visual
impairments to live and work with more efficiency and
independence and recent federal legislation now makes it
easier for technology to get into the hands of people with
disabilities (Galvin & Phillips, 1991). Section 508 of the
Rehabilitation Act of 1973, for example, dictates that access
to electronic office equipment in federal agencies be provided
for persons with disabilities. The Technology-Related
Assistance for Individuals with Disabilities Act of 1988 (Tech
Act) provides that states receive financial assistance to
create comprehensive statewide consumer-responsive delivery
systems for assistive technology services. Most recently, the
Americans with Disabilities Act of 1990 (ADA) prohibits
discrimination against persons with disabilities in private
sector employment, public services and accommodations,
transportation, and telecommunications. De Witt (1991) claims
that success of the ADA legislation will depend on the
creative use of technology.
Assistive Technology and Its Costs
The Tech Act defines the term "assistive technology
device" as "any item, piece of equipment, or product system,
9
whether acquired commercially off the shelf, modified, or
customized, that is used to increase, maintain, or improve
functional capabilities of individuals with disabilities"
(U.S. Congress, 1988, p. 1046). The Alaska Division of
Vocational Rehabilitation considers such adaptive equipment
"high technology," that is, "technology and equipment that
often involve electronics and sophisticated materials." "Low
technology" is described as "technology that generally relies
on simple solutions, using mechanical principles requiring
only simple hand tools and easy to find materials to develop
and put in place" (Anderson, 1988, p. 2). Oftentimes, it is
the lower tech solution that is more advantageous. When a
higher technology solution is necessary, it can be very
challenging to come by for a variety of reasons, the most
common being steep costs. High technology is the primary
focus of assistive technology in this study.
Scadden (1991) reports that visually impaired persons
using microcomputers to access information must learn four
categories of hardware and software technology. The first is
the computer. The second category includes the peripheral
hardware that creates a preferred display, permitting the
ability to change the character size using cursor keys, mouse,
or joystick. The third and fourth categories involve the use
of a voice synthesizer and braille display. In addition to
these, the individual may need to be skilled in manipulating
the printer, modem, and the software. Further examples of
10
high technological devices created for persons with visual
impairments include a variety of optical character recognition
(OCR) devices that enable printed texts to be heard. Such a
device may be a dream come true for many persons with visual
impairments; however, this dream often is stifled by costs
that can exceed $12,000 upon assembly of all the necessary
equipment and software.
The liberation that technology can provide in the lives
of individuals with disabilities is often blocked by the
burden of heavy costs. Presently, much research and
discussion under way is examining the issue of funding
technology for persons with disabilities. The National
Council on Disability has held hearings at conferences around
the country allowing consumers and their guardians to voice
their experiences with funding of assistive technology.
Funding workshops held at the 1902 California State
University’s Technology and People with Disabilities
conference allowed participants to share, in an open forum,
their ideas on ways to feasibly fulfill assistive technology
needs.
Vocational rehabilitation (VR) has long provided services
aimed at helping persons with disabilities gain employment.
These services have included the loan or provision of
assistive technology devices. Unfortunately, the
dissemination of new and changing assistive technology to
appropriate clients is creating unfamiliar tensions in the
11
system to both the VR counselors and their clients. The
Alaska Division of Vocational Rehabilitation (ADVR) policy and
procedure manual for Rehabilitation Assistive Technology
(1988), states that: "It is the policy of the ADVR to not use
high technology nor low technology exclusively, but to use the
least complex technology which will do the job. in other
words, the VR counselor is encouraged to use the r ight
technology" (p.2). But do clients agree that they are
receiving the right technology, or is the right technology
denied them many times on the basis of cost?
Alaska and the History of Vocational Rehabilitation Services
Employment was the first issue to which public policy was
applied concerning persons with disabilities. The Federal
Government first became involved in employment issues as a
response to accidents in the workplace and in dealing with
soldiers returning disabled from World War I (Percy, 1989).
In 1920, Congress passed a law for the "vocational
rehabilitation of persons disabled in industry or in any
legitimate occupation" (Berkowitz, 1979, p. 43), in order to
return injured persons to employment. Shortly after, VR
services were disseminated to the States.
The general rule was that a person had to want to engage
in rehabilitation, giving the program success because it was
not viewed as a welfare program. Berkowitz (1979) expressed
this by stating, "Where welfare promotes dependence,
rehabilitation promotes independence (p. 64)." He also found
12
that welfare is viewed as a cost to society while vocational
rehabilitation is seen as an investment in society's future.
Cost-benefit analysis showed that the VR system returned more
to society than it cost. Since the program paid for itself,
officials argued that it was deserving of public support.
Congress responded to these officials' arguments in 1973
by mandating that people with severe, or more involved,
disabilities be served by DVR. The influx of clients with
severe disabilities caused a decline in the program's success
rate, since the Vocational Rehabilitation system has
traditionally favored clients with mild impairments over more
severe ones. A person with mild impairments was traditionally
viewed by DVR as having a greater likelihood of attaining the
goal of successfully being placed in employment as closed
cases, coding these as a "26." If employment is not achieved,
the case is given "28" status, which carries with it the
*
stigma of wasted tax dollars. Perhaps because they are a
well-organized lobby, people with visual impairments may call
greater attention to themselves. Blindness is considered a
severe disability. Are the clients with visual impairments of
the Alaska Division of Vocational Rehabilitation qualifying as
individuals who are severely disabled and therefore viewed as
potential liabilities to the system? Do projected employment
outcomes of a client influence the quality of services
rendered by the VR counselors?
Millie Ryan, Supported Employment Coordinator for ADVR
13
and primary author of the Tech Act grant for the State of
Alaska explained briefly the history of vocational
rehabilitation services in Alaska (Personal communication,
March 10, 1992). The Alaska Division of Vocational
Rehabilitation was organized in 1946 within the territorial
Department of Education. This was a federal program until
1959, when Alaska became a state. Alaska DVR is a combined
agency with both a general program for persons with
disabilities and a program specifically for persons who are
blind and visually impaired. Like Alaska, many states have
these as separate programs. The strong organization of the
National Federation of the Blind may be credited as a powerful
influence for this. From 1975-1985, there was a strong
emphasis on the implementation of standard-based management
system. In 1987, control was decentralized to become a
participatory field. How are communicative relations between
counselor and client affected by this participatory approach?
What implications might this have with Assistive Technologies
of Alaska and the goals of the Tech Act? Is it enabling the
communication for a consumer-responsive approach?
Prof esslonal-Client Relations in Vocational Rehabilitation
Unfortunately, the relationship between the prof essiona1s
of the VR systems and the consumers of assistive technology
has been marked by incongruence. Berkowitz and Scotch (1990)
depict three views of the role vocational rehabilitation
professionals traditionally have had with their clients.
14
First is a neo-Marxist view based on Piven and Cloward (1971)
in which "vocational rehabilitation becomes an exercise in
social control that shapes people with disabilities according
to the needs of corporate capital into compliant workers who
function on the periphery of the economy as a 'reserve army'
that helps maintain discipline over the workforce as a whole"
(p. 7) .
The second view described is that of Neo-conservatives
such as in the book by Charles Murray (1984) , Losing Ground:
American Social policy, 1950 to 1980, which emphasizes the
professional dominance of VR service providers as a "self-
serving professional class, which needs a dependent and
cooperative clientele to justify its existence" (Berkowitz &
Scotch, 1990, p. 7). The final view, in the style of
Blassingame's 1979 publication, Slave Community, in which the
minority "delight in outfoxing their masters," (p. 7)
describes VR clients as people with disabilities who outwit
their counselors, by "agreeing to the vocational objective,
taking the training, and then going out and leading their own
lives" (p. 7).
Do clients of the Alaska DVR feel that their interactions
with their VR counselors are in accordance with one of these
models? Do clients alter their behavior to accommodate the VR
system in order to get their needs met? How do the
professionals view themselves?
The U.S. Department of Education, Rehabilitation Services
1 5
Administration awarded a grant in 1992 to the Assistive
Technology/Rehabilitation Engineering Program at the National
Rehabilitation Hospital in Washington, DC to research
satisfaction with assistive technology services in the
state/federal vocational rehabilitation system (Phillips,
1992). The agency has conducted Town Hall meetings and focus
group interviews around the country to gather input from
vocation rehabilitation clients as consumers, as well as to
obtain data from vocational rehabilitation counselors,
supervisors, independent living center clients, and technology
providers in hopes of improving the state of the VR service
delivery. The study found both clients and counselors in the
vocational rehabilitation system to be dissatisfied with the
service delivery.
Independent Living Movement
The Independent Living Movement (ILM) is forcing the
vocational rehabilitation system to listen more closely to
consumers' voices. Persons with disabilities became more
visible in the 1960s at the same time that the independent
Living Movement pushed government agencies to include people
who were severely handicapped in vocational rehabilitation
services. The Independent Living Movement came into full
force in the early 1970s (Berkowitz, 1979). Through
legislative, social, and philosophical forces, the foundation
of the Independent Living Movement became more sensitive to
the civil rights needs of minority groups, as people with
16
disabilities realized that they shared in a minority status.
They also began recognizing themselves as consumers— not
merely as recipients of health and rehabilitation services
(DeJong , 1979) .
Starting in academic settings where students with
disabilities began helping themselves and each other,
independent living centers (ILC) began to be established. The
Independent Living Movement changed the emphasis of disability
management from adapting the individual to the environment to
adapting the environment to the individual. This new paradigm,
or shift in thinking, reflects that "since individuals with
disabilities are the best judges of their own interests, they
should have the larger voice in determining what services are
provided in the disabilities services market” (DeJong, 1979,
p. 13) .
Purpose of Technology
Does technology necessarily and/or automatically become
the solution for accessing printed material for an individual
with a visual impairment? Sherer (1991) points out that a
piece of technology does not always remove a disability.
Technology, especially high technology, also can have a
negative value for a disabled person as, for example, when a
wheelchair lift breaks repeatedly and makes the driver afraid
to go anywhere (Hahn, personal communication). Berkowitz
asks, "How could it be determined whether the gains in a
person's outcome after rehabilitation stemmed from the
rehabilitation?" (1979, p. 165).
17
An AOTA Position Paper on the Independent Living Model
(11991) is in agreement with the Independent Living Model in
that individuals with disabilities are to be regarded as the
best judge of their needs. An advantage of the profession of
occupational therapy is in its ability to see individuals as
wholes greater than the sum of their parts. When an
assessment is done, an occupational therapist looks at the
interactions between the sensorimotor, cognitive, and
psychosocial aspects of the person and the environment in
which the person will be functioning. As Irving Zola, a
founder of the Independent Living Movement, writes, "the needs
of people with disabilities go beyond technical services (i.e.
rehabilitation) to something deeper" (Dell Otto & Marinelli,
1984, p.X). Zola was referring to the social and
psychological needs of an individual along with cultural,
personal, and interpersonal components. The qualifications of
occupational therapists help to ensure the efficacy of
assistive technology. A comprehensive, qualitative analysis
will most appropriately take these factors into consideration
and provide consumers with a means of describing the value
technology has in their lives. This is the function of this
study.
Vocational Rehabilitation and independent Living models
both focus on the person with a disability as the recipient of
their philosophy and service, but score their successes in
much different ways. Achieving employment is the priority of
18
VR services presently. The independent Living Model
recognizes that having a voice in one's destiny is a need of
people with disabling conditions. Independence is the cry to
be heard, and a more thorough look at the contexts the pleas
are coming from will enrich understanding.
Assistive Technologies of Alaska contracted an assessment
of needs of persons with disabilities in Alaska with the
Institute of Social and Economic Research (ISER) at the
University of Alaska at Anchorage. According to the
researchers, Hannah and Kruse (1991), four percent of the
State's populat ion— over 20,000 Alaskans— have disabilities.
More than 4,300 households containing at least one individual
with a disability were randomly surveyed; the findings
revealed that many Alaskans with disabilities lack more
recently developed assistive technology and services. Reasons
presented in the study included a lack of technology-related
newsletters, lack of support groups for people with similar
disabilities, and inability to buy or borrow needed equipment.
It was noted that relatively few surveyed had adapted
computers (Hannah & Kruse, 1991). These findings provide a
basis for further studies to explore.
The Tech Act and Persons with Visual impairments in Alaska
Among the varied target groups of disability policies in
the United States, the "blind" make an exemplary case study.
The blind were among the first groups of people with
disabilities to have remedial services organized on their
19
behalf. They have since compelled a separate track ensuring
more generous benefits in the legislation of various states
(Berkowitz & Scotch, 1990). For example, Berkowitz and
Scotch point out that blindness was the only disability
explicitly included in the original Social Security Act of
1935. They point out that special care was given to the blind
community, as expressed in the public statements by officials
of the time, such as this appeal from an Ohio representative:
"Who is it that elicits your sympathies more than the poor
blind beggar? I am sure that you will agree with me that
there is no affliction worse than blindness ..." (pp. 9-11).
The authors also note that in Congressional testimonies
regarding rehabilitation of and benefits for persons who were
blind, testimonies by blind persons, who may have arrived with
a cane or guide dog, carried more emotional impact than did
similar petitions by human service professionals (p.13).
The effect of these testimonies on Congress was and
continues to be felt in Alaska. Under the Tech Act in Alaska,
the purposes of Assistive Technologies of Alaska include
increasing the public's awareness of the needs of persons with
disabilities and disseminating information about the efficacy
of assistive technology to persons with disabilities, their
families, to employers, professionals, and other appropriate
persons. Considering the terrain, large land mass, and the
cultural diversity of its people, the difficulties inherent in
completing these tasks in Alaska are obvious. Half the
20
state's roads are unpaved. There are 300 bush (small, remote)
towns throughout the Alaska. The primary forms of
transportation in these areas are bush planes and snowmobiles-
-which are extremely expensive. However, Alaska has excellent
telecommunication and computer hook up networks which play an
essential role in eliminating problems of distance and
isolation. Given these facts, how is the Tech Act, through
the conduit of ATA, touching the lives of people with visual
i mpa i rments?
Qualitative Methods
Research is needed with the clients who have visual
impairments of the State of Alaska's Division of Vocational
Rehabilitation about their personal experiences and viewpoints
regarding attainment and use of assistive technology.
Supporting such a need, Percy (1989) thought it "interesting
that the rationales for the VR program have been evaluated
largely from the vantage of society, not the person with the
disability" (p. 193). Qualitative methods provide the means
to gather such information effectively as, "the fundamental
principle of qualitative interviewing is to provide a
framework within which respondents can express their own
understandings in their own terms" (Patton, 1987, p. 142).
Ethnography, a form of qualitative methodology,
"incorporates learning from the individual in addition to
learning about them” (Krefting, 1989, p. 62). Similarly, the
qualitative method of a focus group interview provides a
21
setting foe a group of individuals to learn from each other
while the interviewer can also observe and gather "behavioral
data, opinions, feelings, knowledge, sensory data and
background information” (Patton, 1987, p. 142). Later
interviews with individuals allow the researcher to probe with
follow-up questions soliciting depth and detail. Personal
rapport helps provide a sense of mutual interest, allowing the
researcher to tell the participants why the information is of
value and to let them know how the interview is going. This
qualitative approach has provided an opportunity to uncover
new and perhaps valuable information from the consumers'
perspectives--information that may enhance service delivery
systems and the quality of the lives of individuals with
visual impairments.
22
CHAPTER III
METHODOLOGY
Focus Group Interview
The focused group interview approach was used for this
study as it provides participants with the opportunity to hear
what others have to say and also to add comments, expanding
on their own original responses. It is not imperative that
the participants agree, nor is it necessary for everyone to
differ in their responses. Participants tend to render checks
and balances on one another, discouraging false or extreme
views. The goal is to obtain high-quality data within a
social framework that allows people to analyze their personal
views and hear how these compare or contrast with those of
their peers (Patton, 1987).
Aware that consumers often make decisions based on the
comments and recommendations of others, market researchers in
the 1950s began bringing together consumers to simulate a
group process of decision-making. This form of interview,
usually consisting of six to eight people and lasting for one-
half to two hours, is referred to as a focus group. The
exemplar text on focus group interviews, is The Focused
I nter v iew (Merton, Fiske, Kendall, 1956).
Patton (1987) defines a focused group interview by
describing what it is not: "It is not a discussion. It is
not a problem-solving session. It is not a decision-making
group." It J_s, simply, an interview in which a writer or
23
reporter obtains information from a group of relatively
homogeneous people (p. 135).
The number of persons responding to a question compounds
the time the interview takes. This influences the number of
questions that can be addressed in a given time limit. The
facilitator must also insure that one or two people do not
dominate the interview, encouraging people who are quiet to
share their thoughts (Patton, 1987). The four focused group
interviews devised for this study were scheduled for a ninety-
minute block of time with groups of six to eight participants.
Subjects
Nine percent of Alaskans with disabilities have visual
impairments. Fifty-five current clients of the Alaska
Division of Vocational Rehabilitation services with visual
impairments and an additional 18 with visual impairments as a
secondary disabling condition, were contacted throughout the
state and asked to be the subjects of this study. As clients
names and files are confidential by state and federal law, I
was not able to access them directly. Assistance was
provided by the Chief of Rehabilitation Services at the
Division of Vocational Rehabilitation in Juneau, Alaska. In
October 1992, DVR sent out the following to each qualified
client in the state: A cover letter, the letter that I wrote
introducing myself and the purpose of the study, informed
consent forms, and return stamped envelopes addressed to me
(see Appendix A for cover letter and informed consent form).
24
The Division of Vocational Rehabilitation paid the costs of
postage. They played an associated and cooperative role in
this study with such assistance. The Division is attempting
to make changes through team management and consumer input to
improve services to persons with disabilities (D. C.
Quisenberry, personal communication, September 24, 1992) and
is welcoming of such constructive research.
My letter opened with this statement: "Too often the
most important source is not included in policy making:
That's you I" I went on to tell clients that they, with their
experiences with both DVR and assistive technology, would be
the focus of my study, and I told them the focused group
interview approach could provide them an opportunity to learn
a lot for themselves.
Seventy-seven letters were sent out to active applicants
and eligible clients of the division with a primary reported
disability of blindness and serious visual impairment
(Disability codes 100-129). Twenty-one responses were
returned to me presenting an interest in the study. Three of
these respondents also called to inquire further. When their
informed consents were signed and returned to me in November
1992, I contacted each responding client by phone. We
discussed the study and the most convenient times, among the
options I offered, that they could participate. I followed up
the phone calls with a letter to each subject reminding them
of the date, time, and location for the focus group interview
25
that we had agreed upon. Along with this letter was a three-
page background information request (see Appendix B) .
(Volunteers to assist with these forms also were available at
the interview sites.)
Of the twenty-one interested respondents, fourteen
actually attended one of the three focus group interviews.
Air fare and accommodations for four persons was provided by
Assistive Technologies of Alaska; however, one of these three
was unable to attend due to a medical emergency.
Procedures
A conference room at the Alaska State Library for the
Blind and Physically Handicapped, in downtown Anchorage, was
the site of morning and afternoon focused group interviews on
Friday, November 13, 1992. A third interview was held on
Saturday, December 19, 1992 at the Center for Blind Adults,
also in Anchorage. Each group interview lasted ninety
minutes. As the researcher--the primary tool--I facilitated
conversation, recorded observations, and noted subjects'
commentary. The interviews were tape-recorded for
professional transcription to provide a more detailed and
accurate analysis. Multiple microphones were set up on the
table. (Participants were informed of the tape-recording in
the cover letter and agreed to it by signing and returning the
consent form.)
Two specific questions were used to elicit information in
the focused group interviews. The first question was: How do
26
you know you are getting the "right” technology? This
question was asked to reveal where information on assistive
technology is sought and found by these Alaskans with visual
impairments, to explore the overall value consumers place on
technology in their lives, and to examine the influence of
Assistive Technologies of Alaska and, ultimately, the social
policies behind it.
The second topic addressed client-professional relations
and the performance of DVR from the perspective of the client:
How effective Is the Alaska Division of Vocational
Rehabilitation in meeting your assistive technology needs?
Evaluation of technological needs, the training to use them,
and maintenance of the equipment also were discussed here (see
Appendix C for an outline of the interview questions).
in preparation for developing coded categories for
analysis, the interviews were transcribed from the taped
recordings by Kron Associates in Anchorage. As a referral
from Assistive Technologies of Alaska, a discount was
provided. Costs were endured by this researcher.
Additionally, behavioral observations were recorded for more
thorough analysis.
The results of this study are to be shared with Assistive
Technologies of Alaska and the Alaska Division of Vocational
Rehabilitation, with all parties associated hoping to gain
insight into the provision of services.
27
CHAPTER IV
RESULTS
Three focus group interviews were held. Each group had
a combination of men and women participants. Three subjects
participated in the first focus group, six in the second, and
five in the third. These DVR clients were also given a brief
background information form to fill out prior to the meeting,
and were provided assistance if necessary. Their responses
were factored into the results along with 180 transcribed
pages of data derived from the three focus group interviews.
The participants were five men and nine women. They
varied widely in age, educational level, income, severity and
onset of blindness, frequency of membership in disability
organizations, and employment status (Table 1). in addition
to blindness, eight participants in this study also reported
having other disabling conditions: diabetes and kidney
failure, leg and foot problems, back problems, missing digits,
aphasia from a residual stroke, severe allergies, hearing
impairment (Table 2).
Examples of the various living situations, disability
organizations, and assistive technology devices used by these
participants included the following. Five subjects lived with
a spouse or other family or friends; three lived alone; and
one indicated she lived in a group home. Five participants
were members of the National Federation of the Blind; these
and others were also members of a variety of other
28
1 #
S
E
X
A
G
E
EDUCATION VOCATION INCOME LIVING |
SITUATION |
1
H 45 10th grade Student $11,000-
20,000
alone in an I
apartaent |
I 2
F 37
»
2 years of
college
Part-time
secretary
gO-
10,000
alone n a 1
condo/town 1
house B
1 3
F 19 college
■ophoaort
-aualc Major
Student 10-
10,000
house with |
faaily/
friends
4 F 53 soae college
courses
Snackbar
owner/
aanager
$41,000
or aore
signi f icant
other in a
duplex
5 F 42 in college
■coaputer
science
Student/
housewi fe
$41,000
or aore
faaily in a
house H
6 M 27 2 BA’s
-Poli Sci A
history
Seeking
employment
$0-10,00 with |
significant I I
other f l
7 F 31 Living skills
trsining
Dry cleaner
employee
$0-
10,000
group hoae |
8 F 45 1 seaester of
college
C o m rcial
snowplower
$21,000-
30,000
alone I
I 9
F 52 11th grade Aaway and
Caaeo Sales
-Housewi fe
gO-
10,000
with faaily
in an
apartaent
10 M 46 — Volunteer go-
io ,000
with faaily
in a duplex H
11 M 56 High school
graduate
Snackbar
operator
$41,000
or aore
faaily in a
house
12 F 39 BA in
developmental
education;
working on
■aster1s
Graduate
student
(was in law
enforcement)
$11,000-
20,000
with faaily
in a house
1 13
F 40 Master's of
social work
Peer
counselor/
Coordinator
of ILC
$21,000-
30,000
with child I
I 14
M 36 working on BA Student go-
io ,000
with son a
Table 1 : BackgroundInformation on Participants
29
H #
VISION/
OTHER
DISABLING
CONDITIONS
ORGANIZATIONS TYPES OF
TECHNOLOGY
USED
DVR R 1
A M
T I
E 1
'
visually
i■paired
since birth
National
Braille
Assoc.
National
Federation of
the Blind
IBM A Apple
coaputers with
speech output,
Braille ’ n Speak.
CCTV, 4-track
tape- recorder
1990 5 I
2 total vision
loss since
age
1 9/diabetes
and kidney
failure
Chal1enge
Alaska;
Nat ional
Federation of
the Blind
IBM PC with speech
output,
telebraille TTY,
Kurzweil Personal
Reader, talking
calculator, scale
A glucoaeter
1982 3
3 visually
impaired
since birth
None aonocular, glasses
with telescopic
attachaents
1989 1
4 visually
impaired
since birth
National
Federation of
the Blind
CCTV, coaputer
equipaent with
adaptive software
1988 4
S visually
iapaired
since age 24
None CCTV, Zooatext,
InFocua, Aortic
Business Vision
1988 2
6
1
visually
iapaired
since birth
None reading glasses,
coaputer with no
adaptive equipaent
1983 4
7 total
bl indneas
since
birth/leg and
foot probleas
was a aeaber
of National
Federation of
the Blind
speller,
interested in
coaputers
1979
2 H
8 visually
iapai red
since age
29/back
probleas
None None 1991
'
30
1 *
VISION/
OTHER
DISABLING
CONDITIONS
ORGANIZATIONS TYPES OF
TECHNOLOGY
USED
DVR R |
A 1 1
T 1
E D
I 9
totally
blind since
birth/leg
and foot
probleas
National Federation
of the Blind; Alaska
Independent Blind
Brailler,
typewriter
1986
'
U io total
blindnesa
since age
46/aiss ing
fingers
None taperecorder
4 a
talking
clock
1988 2
i i progressive
visual
iapairaent
since age 54
None None 1991
'
12 visual
iapairaent
onset at age
37/aphasia,
speech
iapairaent,
residual
stroke on
right side
Ability Designs,
Alaska Center for
Blind Adults
coaputer
equipaent,
taperecorder
1990
5 1
13 total vision
loss since 6
weeks of
age/severe
allergies;
no taste or
saell
SE Alaska
Independent Living
Center;
Coaaisaion of Jews
and Disabilities;
California Council
of the Blind; Alaska
Independent Blind;
Blind Power Moveaent
coaputer
with speech
and video
screen,
laptop
coaputer
with speech
synthesis,
Braille 'n
Speak
1967
2.5
1 14
progressive
visual
iapairaent
onset at age
27/hearing
iapairaent
Aaerican Foundation
for the Blind; SE
Alaaka Independent
Living Center;
Assistive
technologies of
Alaska
desk and
laptop
coaputers
with
adaptations,
Kursweil
Personal
Reader.
CCTV, phonic
screen
1990 5
Table 2 ( continued)
31
organizations such as National Braille Association, Alaska
Independent Blind, the Blind Power Movement, and Challenge
Alaska. Only two study participants reported that they used
no technologies to help them manage. The rest used a variety
of devices. Four clients used closed-circuit televisions;
five used computers with adaptive devices such a s speech
output and screen enlargement software. Other technologies
included Braille typewriters, tape recorders, and talking
calculators and clocks.
Questions on the evaluation form also addressed the
length of clients' contact with DVR and their satisfaction
with the agency. A question on the background information
form asked, "How effective is DVR in meeting your assistive
technology needs?" Clients were asked to respond through a
rating system, a scale of one to five with five being the
most positive response and one the least favorable, to the
question: "How would you rate your satisfaction with DVR
services in meeting your assistive technology needs?"
Thirteen of the fourteen participants answered this question;
their ratings averaged 3.115, correlating with the middle
response, "Mediocre services, only fairly happy." (Table 2)
The interviews provided an opportunity to expound on the
views and information clients provided in their background
form. The first major question posed in the interviews was
"How do you know you're getting the right technology?" The
question was purposely a broad one, designed to reveal how
32
much clients know about the high technology that is available
to them, how they find out about it, and how they get it. The
second major question, "How effective is DVR in meeting your
assistive technology needs?" was designed to uncover the
strengths and weaknesses of the DVR system in getting this
"right technology" to clients. Throughout the interviews,
questions also were raised about how information was gained
about technologies, funding, timeliness in receiving
equipment, training and maintenance, relationships with
counselors, thoughts on being a counselor, and "wish lists" of
what clients would change about the DVR system if they could.
Findings below are categorized according to the importance
clients' seemed to place on discussing these issues, the
amount and quality of discussion provoked, and this
researcher's analysis of the transcripts derived from the
three focus group interviews.
Attitudes Toward Technology
Feelings toward the assistive technological devices
(ATDs) owned and used by the study participants, when
considered independently of the way they were obtained, were,
overall, positive. Some participants expressed the belief
that ATDs were directly responsible for allowing them to be
gainfully employed and competitively employable, or that
without ATDs it would have been impossible to be full-time
students. Others expressed gratification at simply being able
33
to write letters or complete tasks--both personal or work-
related. Client #2 had wanted a Kurzweil Personal Reader for
years, saying, "For one, I usually have to find someone to
read my mail. I don't like everybody reading my mail." This
was a sentiment that ran throughout the discussions: that
assistive technology increased independence and self-esteem.
(Client #4 was pleased to mention that her husband, who was
sighted, would take small print and read it under her own
closed circuit television.) However, some clients were
compelled to remark that they really saw nothing "special"
about assistive technology at all, with one (Client #9)
remarking that a computer is a wise investment for almost
anyone, disabled or not, and that familiarity with computers
is now a requirement of anyone who wants to use a public
1ibrary.
The value of assistive technology in the life of someone
living with blindness was often mentioned. "I knew I needed
Zoomtext from working with the computers at the Center [for
Blind Adults]. And so it came. It was a miracle." (Client
t
#4) . Client #1 added that before he became aware of the ways
(career options and access to printed text) technology could
assist him, he thought "blindness was the end of the road, but
now I realize that it's just another door you got to go
through."
Many clients did not know what the "right technology" was
for them. When asked if they did, many were stifled by the
34
question and either said that frankly they didn't know or they
only had vague ideas. (Client #13, Client #0, Client #7).
Other responses included: "I find out what the best product
is for me, what will work best” (Client #14); "When it gets
the job done" (Client #1). Client #10 said that "the question
in my mind was, will this fulfill my needs. And if it does
not, how can I get it changed.” This client was seeking
technological devices to assist with typing and printing
business letters. Client #3 and Client #2, each having
significantly different visually acuities, expressed identical
comments, "You just have to kind of try things out."
Similarly, Client #6 said, "It was more guess work that
anything else.” She was referring to what technologies would
best meet her needs with operating and managing a vending
stand .
Many depended on what others told them. Client #13
expressed distress over this matter when she said: "I've been
asking for years and years the right— [assistive
technologies]. And unfortunately. I would hear [about)
different screen access and different speech synthesizers with
each person I talked to. It was very confusing."
Methods of Obtaining information on Assistive Technologies
While all clients said they relied on the Division of
vocational Rehabilitation (DVR), at least to some degree, as
an informational resource, the level of dependency varied
35
remarkably. Clearly, those clients who felt confident that
they were getting the most appropriate technology for their
needs said that research on their own part was key. When DVR
was unable or, in their view, unwilling to help them, they
readily looked to other resources, such as Elk's Help, an
organization based in Fairbanks, Alaska that lends assistive
technology devices, or the Center for Blind Adults, in
Anchorage; one even said he called the American Printing
House, seeking informationfor services for persons with visual
impairments. Client #14 said, "I know what's out there. I
make it a point to be on top of things, reading and studying,
going to the {technology] conferences and stuff." Clients #5
expressed similar sentiments ("What I found out, I found out
on my own."), as did Client #6.
Most other clients were not as active in the search for
information. For some, an absence of action on their own part
was made up for by family and friends. One client said she
still relied on the occasional assistance of an old school
counselor. Another relied on a childhood friend who had gone
into the computer business. Another had a sister who shared
technology information with her. Two others had an
optometrist and neurologist providing some direction. Client
#10 shared; "I only know what I've been told here by the
computer whiz at the Center [for Blind Adults)."
Remaining clients said they had been counting on DVR to
come to them with whatever information they needed, and had
36
little idea as to where else they would turn. They had little
idea what the "right technology” was for them. Client #8,
even though she'd connected with DVR a year earlier, said "I
didn't even know about this until listening to you people
talking
In summary, clients who felt that they were getting the
information and technology they needed also felt that DVR had
only a minor role among their resources. Those who didn't
have information said they were waiting for DVR to supply it--
and that if DVR didn't have the information on technology that
was best for them, they expected the agency to direct them to
the proper resources because they assumed or were led to
believe that this was among the services DVR would offer them.
Funding of Assistive Technological Devices
DVR was the Number One source of funding overall, the
first place clients looked to whether they'd learned about
technology through the agency or from an outside source.
Clients believed, however, that whether they got the funding
they wanted from DVR depended on certain factors: (1) their
own motivation and ability to justify their requests, and (2)
the motivation and willingness of their counselors to
represent their interests. Several said having an outside
advocate--a professional such as a physician or computer
expert— increased their chances of getting funding. For most,
getting their needs funded was an exercise in aggravation:
37
"It's pretty frustrating. And tiresome, too, to try to keep
going and having to hit the wall every time," said Client #2.
"You can't get it unless you can prove that you needed it
yesterday," according to Client #10. "It depends on the ears
that hear your request," said Client #4. The question of
funding seemed to divide clients into those with politically
conservative or liberal viewpoints--that is, those who felt
government was not responsible to address their needs and
those that felt it was. While all agreed that the funding
process depended on the client’s luck and motivation, they
disagreed over whether this pointed to a strength or weakness
of the system. One client complained that she didn't like the
idea of competing with others; her counselor had made it clear
that if she gets an appropriation, someone else will go
without (Client #13). Another felt DVR was totally justified
in operating this way: "I make good money now. Is it really
their (DVR's) obligation to supply it (equipment) to me?"
Conjecture also arose over the question of whether DVR had the
means to provide everyone with their technology needs; some
wondered whether the agency's bureaucracy resulted in
inefficiency and wasted dollars that might otherwise be used
to the clients' benefit.
When DVR failed to meet a client's perceived or agreed-
upon equipment need, clients said they rarely gave up.
Rather, they would work harder to justify the request; one
client even called her elected representatives. However, some
38
clients simply turned to other sources. These included
Supplementary Security Income (SSI), family, scholarships, the
public school system, and loan programs; one client mentioned
that he was also looking into assistance from the Lion's Club,
Moose Lodge, and Veterans of Foreign Wars organizations.
Finally, when clients really felt they needed a piece of
equipment, they often were self-reliant and bought it
themselves. To at least one client, this was fine; it allowed
him to choose the exact equipment he wanted. This sentiment
seemed to mirror a thought expressed by two clients, who felt
that even when DVR funding came through, it was often for the
most inexpensive--and therefore lowest quality equipment the
agency could find.
Training and Maintenance of Equipment
When clients said that DVR provided training, it was
often directly through the vendors of the equipment or through
training with technology experts at the Center for Blind
Adults in Anchorage. The focus group interview did not
address how these participants felt about this training, but
one client expressed the wish that he would be allowed
training before his visual impairment worsened; as it was, DVR
didn't see the need to train him given his current condition.
Client #14 had to undo and reload everything set up by a
service provider paid by DVR. He explained, "he [the service
provider] didn't know as much as I did."
39
Most often, clients said they taught themselves how to
use their assistive technology. They saw it was a necessity
because DVR wouldn't provide training, or, more often, didn't
fit in with their particular constraints: they couldn't go to
Anchorage to receive the training, or they didn't have the
time to undergo the training their counselors recommended.
They wanted me to go off to school . . . it would
be necessary that I would have to live in this
center for six [weeks] and not go out. And I told
them, I'm sorry. I'm married. I have a dog. I
have businesses. I have things in my life I have
to attend to. (Client #10)
For their own independent training, clients often relied on
other assistive technologies, such as CCTVs, special software
programs, and voice-output devices. They also relied on
assistance from family and friends, or relied on their other
technology information sources, such as computer consultants
at their universities, or at the National Federation of the
B 1 in d .
When assistive technologies broke down and required
repair, clients were overwhelmingly likely to rely on
themselves to get it done, either by fixing it themselves,
asking a family member or friend for help, going directly to
the Center for Blind Adults for help, or taking it upon
themselves to send it back to the manufacturer. Clients
rarely turned to DVR for help when they needed repairs done;
however. Client #15 said he was pleased that he could just
"box up the computer or whatever, and drop it off at [the DVR]
office,” and expect them to handle shipping charges. The same
40
client was pleased with support he received from DVR when a
merchant balked at making adjustments to his equipment.
Maintaining an old, second-hand piece of equipment
appropriated by DVR, posed a great challenge for both Client
#2 and DVR, because it needed parts that were no longer in
production.
Getting repairs done often took a long time. Clients
complained that manufacturers seemed more eager to replace
equipment than make even the simplest repairs — and often
charged exorbitant prices for these repairs. But perhaps most
troublesome was the inconvenience and loss of independence
that occurred when equipment broke down. Client #5 reported
that she had to drop all but one course during a semester of
college when the university's CCTV broke down and she couldn't
read her textbooks. One client advised other participants in
her focus group interview to get service contracts with all
their high technology assistive equipment, as a way to ease
the burden of breakdown.
Views on DVR with Meeting ftssistive Technology Needs
This particular group of clients, in responding to the
question, "How would you rate your satisfaction with DVR
services in meeting your assistive technology needs?" gave the
Alaska Division of Vocational Rehabilitation a C (3.115)
rating. Why?
A review of Table 2 demonstrates that the C rating was
41
more the result of an average of high and low scores than a
general consensus of mediocrity. Some clients clearly thought
that DVR was adequately meeting their needs and providing an
important, valued service. These tended to be motivated self
starters or those who had someone acting as an advocate on
their behalf. Comments by these clients indicated that they
had a focus or direction when dealing with DVR--but by no
means relied on DVR as their only resource. Client #12 summed
up this attitude succinctly when she recalled telling her DVR
counselor: "If you want to support me, I appreciate it. If
not, I'm still going to go on.”
Clients who felt that DVR tended to be ineffective in
meeting their assistive technology needs had a variety of
reasons, but the basis of all their grievances was the desire
to be understood as a distinct individual in the face of a
large bureaucracy. Client #5, for example, expressed
dissatisfaction with the screening and evaluation process for
assistive technology because the evaluator of her needs was
not the same person who would seek approval for her
appropriation. (She urged prospective students to study
computer science, for that would all but force DVR to admit
that their technology needs were justified.)
Clients also said that they felt DVR had discriminated
against them when their vocational desires did not match DVR's
perception of their abilities. They expressed anger that
their voices were not being heard regarding career goals and
42
assistive technological means that could make these goals a
reality. Counselors were described as trying to "read
people's minds" (Client 17) or "judge a book by its cover"
(Client #9), allowing stereotypes and preconceived notions to
determine the direction of counseling, from the moment an
unfamiliar or new client walked in the door. Still another
client complained about a general lack of any career guidance,
much less any advice on a specific vocation (Client #8).
Whether clients rated their satisfaction with DVR
services as high or low, they described their relationship as
one in which they had to "fight" (client #9, Client #10,
Client #13), "beg," (Client #2), and "scrap" (Client #6) for
what they believed were justified needs. As Client #2 said:
I feel that DVR is working for me. I'm not
supposed to be grovelling at their feet for me to
get back in to society and be productive. Why
should i have to beg [for assistive technologies]?
I feel like they're supposed to be working for me
and I'm--and they're not. They're giving me all
sorts of problems.
Time delays in getting assistive technology needs met
were another source of frustration with the DVR system.
Clients reported that the time it took to receive approval for
equipment or the receipt of the equipment itself never seemed
to occur within a reasonable time frame. At least one had
received a piece of equipment within a few weeks, but more
often, delays were lengthy. One client (#5) said it took her
over two years, from the time of approval, to get a computer,
and almost four years to get a CCTV. One said that, because
43
of counselor turnover, a request for technology which was
previously okayed was canceled. It took a third counselor to
follow through--and then another year passed before the client
saw the equipment. Client 114 who had received a variety of
equipment from DVR was not dismayed by waiting for equipment
to arrive. He believed that an adequate expanse of time was
necessary in case there were changes in technologies or
personal needs.
Clients often did not know the reasons for the delays in
approval and acquisition, but they had their suspicions. They
thought those who were pursuing prescribed occupations (that
counselors were familiar with, or had recommended, such as the
vendor program), had a better chance of receiving their
equipment because the request was not "complicated” by an
unusual vocation. (A client with a high degree of
satisfaction with DVR, #4, agreed with this view, saying, "I
think perhaps the thing that enabled me to have success with
DVR was that 1 did make a very definite decision to go into
one of their pet projects [vending program], I made a very
calculated decision to do that.") Others suspected that the
high turnover rate of counselors disrupted the approval
process. Still others blamed equipment delays on unnecessary
bureaucracy and the heavy case-load placed upon counselors.
Clients' Views on Counselors
Often it is the individual counselor who makes the
44
difference. What is the difference between a good and bad
counselor? Clients reported that a good counselor was
motivated, interested, shared and invested his or her time,
and was willing to listen to what the client felt was
important and to make sure that they understood each other
were major factors in the clients positive responses.
Client #4 spoke for many when she said, referring to her
view of DVR, "It depends on your counselor." Clients
indicated that the client-counselor relationship was key in
their appreciation or dissatisfaction with DVR's assistive
technology service. Several spoke fondly of counselors they
had in the past or presently. These relationships were marked
by a lot of communication between client and counselor
(initiated by either party), a willingness on the part of the
counselor to listen to what a client had to say, and
counselors being supportive of dreams and desires even if they
did not think DVR would offer direct support. Client #1 said
his best client-counselor relationships were marked by open-
mindedness. He added that even if a counselor "didn't know
anything about blind people out there, but at the same time
[was] willing to listen" he considered their relationship a
good one. Client #3 agreed, saying that she most appreciated
a willingness to listen, adding that a good counselor was one
who, even if "he didn't know exactly what was out there, he'd
hook you up with someone that did." Client #5 was delighted
when a counselor took the initiative to call her and offer her
45
a CCTV that the client had long felt was needed, but that a
previous counselor had never appropriated. Client #6, was
pleased with that same counselor taking the initiative to be
in contact with him--"there are people out there who do have
the . . . they've got the drive to do it."
Other clients described much more troubling relationships
with their counselors: "She's looking at me as a blind person
[incapable] of reading and distributing the mail, not looking
at me as [someone who could be] using an assistive device to
do the same work as any sighted person," said Client #2. "He
. . . chewed me out. And told me he didn't know why I was in
the university--'What are you doing, going to college? you
don't look like your typical college student'--were his exact
words," Client #7 said. Regarding an electric typewriter
approved by a former counselor yet not appropriated by a
present counselor, Client #9, spoke with indignation: "He
(the present counselor) had enough nerve to ask me, 'What do
blind people do with typewriters?1 I said, '1 don’t know.
Maybe they play with them.'"
Perhaps these patronizing attitudes simply reflect those
of the general society. But a surefire way for a client-
counselor relationship to start out on a negative footing was
when clients felt insensitivity from their counselor— when
they were being told what technologies to use, career choices
to make, and what other things could or could not be done for
them, rather than the counselor hearing what they had to say
46
regarding their capabilities and desires. Client 49 spoke
for many when she said, "They don't want to give you a chance
to say what you can do."
Some clients said they could sense an eagerness on the
part of their counselors to close their cases, and that this
eagerness overrode their best interests. They felt that
returning to the counselor for help would be unwelcome, a kind
of failure. Two clients reported that counselors had used
guilt to sway a client's point of view, with one client
remarking that her counselor "always told me DVR costs a lot
of money." Other clients said problems with their counselors
arose when counselors spoke in terms clients could not
understand.
Clients expressed that a negative relationship with their
counselors struck a deeply personal chord with them. "I was
very down. Very upset,” following the meeting. Client 45 said.
Client 48 said she wished she could leave a meeting without
feeling "despondent, looking for the closest bridge."
In closing the discussion, clients were asked if they
would ever want to be a DVR counselor. In one group the
question met with a general round of laughter. Only one
person answered affirmatively; he thought the job would be a
"gas." Another answered that she would do it only if she had
more freedom and funding than she saw in the current system to
justify the appropriations she felt her clients would need.
47
But in general, given all of the hassles and inadequacies that
the subjects had discussed in these interviews, few of them
thought the rewards of being a counselor would outweigh the
difficulties.
48
CHAPTER V
DISCUSSION
The goal of a focus group interview is not to create a
problem-solving or decision-making session (Patton, 1987) but
rather an information-gathering arena in which the
participants can analyze their personal views in the framework
of others in an alike group. Bearing this in mind, what can
be said about the particular focus group interviews held for
this study? First, these three groups were clearly successful
in generating discussion and contributing information.
Clients represented a homogeneous group (Patton p. 135} in
that they all had some degree of visual impairment, all were
Alaska residents, members of the Alaska Division of vocational
Rehabilitation (DVR), and all had at least some level of
interest in assistive technologies. As an interviewer, I
directed questions and responses when necessary to allow input
from as many participants as possible. I guided discussion
only as much as was necessary to keep it tied to the focus:
assistive technology and the role it, and DVR, plays in
clients' lives. Clients were glad to participate and provided
"the behavioral data, opinions, feelings, knowledge, sensory
data, and background information" that mark a successful focus
group interview (Patton, p. 142).
As a person with a visual impairment and as a client of
the Alaska Division of Vocational Rehabilitation (as opposed
to a facilitator with non-impaired vision or worker in the DVR
49
system), my presence as facilitator of these focus group
interviews may have increased the ease with which clients
shared in the discussion. While I was able to restrain myself
from answering my own questions based on my own experiences,
I still learned that the story of my good and bad experiences
was not unlike those of my peers. This is both comforting and
discouraging. It is comforting to not feel alone with my
struggles, concerns, and successes in my association with the
Alaska Division of Vocational Rehabilitation, but on the other
hand, it is discouraging to learn that so many of us find that
association to be so unsatisfying. The results and discussion
generated from these focus group interviews can aid consumers
and service providers alike.
The question, "How do you know you're getting the right
technology?" was a good question in that it generated a free
flow of discussion, but the "open nature of the question often
was challenging. Clients often needed to be probed ("What
kind of technology do you have? Where did you get information
about it? What steps did you go through to learn about it?)
to get discussion going. If I were performing this research
again, I might introduce the topic by illustrating with
anecdotes or stories of my own and others’ experiences.
The second question, "How effective is DVR in meeting
your assistive technology needs?" was easier for clients to
answer because they could provide ready examples to back up
their opinions. Not only did clients provide plenty of
50
insight for the researcher, but they also provided information
that their peers--not to mention their counselors--found
beneficial, such as places to turn for assistance, types of
assistive technological devices, and ways to acquire them.
The results show six areas that were the focus of discussion.
Clients* Attitudes Toward Technology
It became clear from the beginning of each focus group
interview that clients’ attitudes toward assistive
technologies were very positive, as these technologies
provided, in their view, independence and self-esteem, not
only in their professional lives but in their personal lives
as well. People with visual impairments should be encouraged
to display this appreciation with as many people as possible--
counselors, employers, others experiencing impairments,
family, friends, teachers--so that others, whether disabled or
not--can appreciate the importance of assistive technology.
They can communicate this appreciation by writing letters to
editors of local and national newspapers and other
publications, writing articles and essays themselves, and
writing to their elected representatives. Counselors,
especially, must not underestimate the premium that persons
who are visually impaired place upon assistive technology.
The clients in this study almost without exception felt that
their DVR counselors needed more supportive attitudes toward
assistive technology. Indeed, the lack of positive attitudes
51
among the counselors appeared to be a major source of
frustration and dissatisfaction between clients and
counselors. Perhaps training efforts for counselors could be
directed toward learning more about the latest assistive
technologies and increasing awareness of the importance of
technology, not only on career and vocational choices but also
on personal independence and self-esteem. Manufacturers of
this equipment would certainly be happy to have a chance to
show off their technology; a few phone calls to company
representatives would likely result in more equipment
demonstrations than the counselor can schedule. Conferences
and workshops devoted to technology are held often around the
nation; these are another resource DVR could tap.
Methods of obtaining information on Assistive Technologies
The general lack of technology-related information for
persons with disabilities in Alaska reported by Hannah and
Kruse (1991) in their study for the Alaska Institute for
Social Research was corroborated by some, if not all, of this
study's participants, "it's hard to know what else--what else
is out there," said Client #2. information on technology
discovered by these clients came from a variety of sources:
from television news to conferences to family and friends to
computer experts to DVR to "not knowing where to begin."
Clients need to become aware of the multitude and variety of
potential information sources; by networking with each other.
they could greatly expand their information sources. Better
communication about experiences with assistive technologies
with clients' counselors, and others working with people who
have visual impairments would almost certainly help.
Even though DVR was usually only a minor resource in the
information-gathering process, clients clearly thought it
should have a bigger role. They agreed that their counselors
should have a better knowledge of assistive technology for
persons with visual impairments. That so many clients looked
elsewhere for help can be instructive; DVR counselors also
might do well to have a sense of these other resources.
Unless DVR plans on seriously addressing information problems,
the agency can simply suggest to clients other places to look,
such as Assistive Technologies of Alaska. Counselors also
might be able to greatly aid their clients simply by having
information resources (product brochures, catalogs, resource
referral numbers) handy in accessible forms (i.e. large print,
Braille versions, cassette tapes--in different languages).
Again, attending conferences and contacting industry
representatives can provide a wealth of information at minimal
expense of time and money, although Alaska's isolation may
limit access and participation in such activities.
Funding of Assistive Technological Devices
Clients tended to see funding of assistive technologies
as perhaps DVR's primary purpose, although a few thought that
S3
those with adequate personal resources could assume more
responsibility for costs. Consequently, they didn't
understand why they had to work so hard to justify their
requests, or why their requests were denied so often when they
thought the agency was there to help them. Although actual
costs of equipment were not discussed, participants made it
cleat that they thought the chances of their being approved
equipment were heavily dependent on these costs. Client #2
said that "anybody with any kind of useful vision can get a
closed circuit television without even being employed. But
I'm totallly blindj--and [DVR] still won't get me a Kurzweil
Reader." (The difference in price between a closed-circuit
television and a Kurzweil Personal Reader is approximately
$10,000.) Obviously, the ideal solution would be to increase
funding or to decrease equipment costs. Including
technologies in insurance coverage, -whether private or
publicly funded, is one way to accomplish both these goals.
But as long as private and public payors seem unlikely to
agree to such a solution, clients should be prepared to work
harder to justify their requests. They could also learn from
each other's success stories. Regular contact or group
meetings with others with their disability— and even others
with other disabi1ities--would provide a forum where ideas
about money-saving suggestions could be shared. Clients also
should not rule out other funding sources; knowledge of these
sources also would be improved by more networking with their
54
peers. Counselors might teach skills on justifying needs in
understandable ways. In the clients' view, counselors need to
keep in mind that clients dislike having to grovel for
equipment, they need to recognize the importance and value
their clients place on technology, and realize that the costs
of doing without equipment are more than just financial to
these people.
Clients in this study expressed the desire to be able to
test out equipment in their own homes or communities, instead
of having always to travel to Anchorage and the Center for
Blind Adults. Doing so, they said, would enable them to
discover what works and what doesn't, while at the same time
saving travel and boarding expenses. Also, it would eliminate
the problem of having to buy technology out of catalogs unseen
and untried, only to find that the technology doesn't suit
their needs. DVR may want to have clients share informally or
in writing their thoughts on the effectiveness of the
equipment they've received. This could aid counselors as they
seek to provide future clients with assistive technology.
Clients should be encouraged to be frank about what they liked
or did not like about the equipment, and explain how useful it
was.
Many could argue that not every client needs to own every
piece of equipment. There are some technologies, such as a
personal reader (a device that translates printed material
into a synthesized voice output) that are simply too expensive
55
(with a price tag up to $12,0000 to supply to everyone.
However, having one personal reader available in a community
setting (such as the Alaska State Library fcr the Blind and
Physically Handicapped), would open the benefits of this
technology to many people at once. The more widespread use of
a computer software system which allows clients to send text
by modem to a central locale, where a librarian could then
translate the text, via a personal reader device, onto
cassette tape to be mailed back to the client, also could make
a difference without funding each individual.
Training and Maintenance of Equipment
Many clients said they usually taught themselves how to
use assistive technology devices, noting that other forms of
assistive technology often were necessary to provide
assistance (i.e., using a CCTV to read a manual, or using
computer software with a voice-output device), and
occasionally turned to outside help on their own. DVR was not
always seen as a routine training source. Again,(holding
group meetings of clients or encouraging clients to get in
touch with each other would enable clients to share the
knowledge they gain through their own training. DVR often
attaches stipulations to training that clients find difficult
or bothersome to manage (for instance, having to live at the
Center for Blind Adults for up to six weeks at a time, or
DVR's rule that clients must be enrolled as full-time students
56
to be eligible for tuition funding). By designing training
programs around each individual's needs, as opposed to
providing a single training option, the agency might increase
client satisfaction.
Clients raised concerns that they were given used,
outdated, and low-quality equipment that often was likely to
break down. They primarily relied on themselves to get it
fixed; but they turned to DVR, and a variety of other sources,
when this proved impractical or impossible. Again, networking
between clients through group meetings, phone lists,
newsletters, and computer technologies could help ease the
when equipment breaks down, through sharing of information on
self-repair, troubleshooting, getting loaners or back-up
equipment. Perhaps, as stated by one participant. Client #13,
in the interviews, clients should be allowed to insist on
service contracts with all equipment. DVR could improve
client satisfaction in this regard by recognizing the quality
of equipment they provide clients, accepting full
responsibility for repairs and replacements (which,
themselves, should be provided in a timely manner) , and having
a ready supply of back-up loan equipment. At the very least,
DVR could strongly advise or even require that clients fill
out warranties and are given service contracts to facilitate
their own maintenance needs.
Views of DVR with Meeting Assistive Technology Needs
57
Clients perceived DVR in different, almost contradictory
perspectives: either as one of many resources, or as the sole
provider and caretaker of all their vocational, assistive
technology, and career preparation needs (and, perhaps, in a
third way: as a general nuisance with regard to meeting these
needs). In which light does DVR think of itself? Making its
own role clear will give clients a better sense of what the
agency is there for.
It was obvious that clients' perceptions correlated with
their satisfaction with services. Some felt very grateful for
DVR's support in making their vocational goals become reality.
These tended to be clients who were more skilled in justifying
their needs, or had an advocate working on their behalf.
Others felt that DVR was too large a bureaucracy to hear their
individual voices, and felt that the relationship was an
antagonistic one, in which they had to "grovel," "beg,"
"fight," and "scrap" throughout their dealings with the
system, whether they were trying to justify a career goal, an
equipment appropriation, training or repair, or simply if they
were seeking guidance. Certainly, the clients with the less
successful experience of DVR could learn from those with
better experience; those pleased with DVR said that learning
on their own, persistence and firmness in their desires, and
using DVR as only one of many resources, increased their
satisfaction when dealing with the agency.
Most clients felt that DVR too quickly tried to "box" or
58
"tag" them into preconceived notions and categories. They
believed they were being told what they could or could not do
based on prior experience with someone else, or prejudice, or
ignorance about what people with visual impairments are
capable of. Clients may be able to avoid this by forcefully
speaking about previous successes in their lives, and by
demonstrating a willingness to confront challenges.
Participants from each of the three focus group interviews
shared the same opinion that workers in the system should bear
in mind that two people who are visually impaired may be no
more alike than two people with brown hair, and their needs
will vary depending on a host of personal and vocational
factors.
Many clients assume, rightly or wrongly, that their
encounters with the system will be antagonistic.
Encouragement and expressions of a desire to help therefore
can't be stated often or clearly enough by evaluators,
trainers, counselors, and administrators. Most clients feel
that they are the ones doing the work. Although many clients
do not mind this, they do mind when their efforts do not have
a productive outcome, as when they have researched their
precise equipment needs only to have a new, disapproving
counselor take the place of one who would have approved the
request, or having their needs change in the time it takes to
receive a piece of equipment they'd requested. Client #13
spoke for many when she said, "I don't mind [doing the work]
59
if everything would just work out."
Clients' Views on Counselors
Clients described a range of attitudes toward their
counselors, meeting all three of the roles described by
Berkowitz and Scotch (1990). Some clients might have said
that they'd had counselors who were "Seo-Harxist" when the
clients described how counselors told them what equipment they
needed (or didn't) or what careers they should consider to be
of benefit to the general society--even if the recommendation
didn't match their desires. Some clients might have said
they’d had counselors who were "Neo-Conservative" because
they'd felt rushed into case closure or pushed into a tried-
and-true career path to limit government intervention— and,
not incidentally, "make the counselor look good"— again, even
if the plan didn't match their desires. Still others saw
their counselors as bureaucrats who were best dealt with by
being "outwitted" and subverted as quickly as possible; this
certainly described several clients who felt they'd gotten
what they needed by, as Client #6 shared, "circumventing the
system" to meet his needs.
But the relationship clients most often sought, and
occasionally found, with their counselors might represent a
fourth category: that of the counselor as catalyst, a partner
in helping them meet their goals. Many did speak of specific
counselors who did exactly this; they recalled their
60
communication skills, their accessibility, open-mindedness,
motivation, and, if not their guidance, their willingness to
support them. Clients who experienced such relationships with
their DVR counselors, rated their satisfaction with DVR
meeting their assistive technology needs higher than those who
did not share such a relationship, regardless of the equipment
they were appropriated.
More often, clients said counselors didn't understand
them and their disability, weren't accessible or motivated,
and lectured clients on their perceived needs rather than
listened to their beliefs. Many expressed the wish that their
counselors were more familiar with blindness, if not visually
impaired themselves. Clients can make an effort to share what
their experiences with visual impairments are like. They
shouldn't be discouraged from taking a lead in communication.
They could explain more why it is they feel they would benefit
from specific assistive technologies and be complimentary and
supportive of the help they do receive from their counselors.
Perhaps there is no one that clients can learn from as
easily as an experienced peer. As suggestions above express,
increased contact with clients' peers with visual impairments
could reveal solutions for each other to many of the problems
and frustrations that clients have with understanding of
technology, access to information, funding, training and
maintenance of equipment, and dealing with DVR. This suggests
that a type of "mentor system," in which experienced and long-
61
term clients of DVR make themselves available to recent and
Inexperienced clients to provide insight and advice on how to
maneuver in the system. The mentors themselves could be
provided with some sort of stipend or even a technology bonus
for their assistance in this minor but important duty.
For their part, counselors can consider what skills they
need to improve, and be aware of how a rejected request for
equipment or a discouragement from a career path effects
clients on a deeply personal level. Clients said a counselor
can never be open-minded and patient enough. Many indicated
that they would be impressed to learn of a counselor’s
independent efforts to learn about blindness; it does not seem
to much to ask for sighted counselors to spend a day in a
center for blind adults, perhaps even blindfolded, to gain a
greater appreciation for their clients' disability. If
counselors are unable to improve their relationship with their
clients even after making specific changes such as these,
perhaps the antagonism between counselors and clients may only
be reduced by changes in personnel procedures, or even policy
and systemic changes.
Conclus ion
This study set out to find out how effective the Division
of Vocational Rehabilitation was in meeting assistive
technology needs of clients with visual impairments from the
clients' point of view. The clients' views were revealed
62
through focused group interviews. In this paper I have broken
down the wide-ranging discussion that resulted into six main
areas: attitudes toward technology, access to information,
funding, training and maintenance of equipment, views of DVR
as a system, and views of DVR's counselors. The discussion
not only revealed aspects of these areas that both pleased and
frustrated the clients, but also uncovered and suggested ways
in which the problems might be solved.
The findings of this study were very similar to the
findings of a National Rehabilitation Hospital study,
"Perspectives on Assistive Technology services in Vocational
Rehabilitation: Clients and Counselors," (Phillips, 1992).
in that study, 39 clients of vocational rehabilitation centers
in the mid-Atlantic region expressed many of the same concerns
as those in this study. Clients reported that technology
enhances independence, that equipment breakdown causes
hardship, counselors often lack information regarding
technology, they feel uninvolved in decision-making, there are
lengthy delays in receiving equipment, training and repair of
equipment is an awkward process. They also felt that
counselors are often insensitive to individual needs, are
motivated by closure, and vary in their quality (Phillips,
1992). In that study, however, clients put more emphasis on
the stigmatizing effects of technology and the hassles of
paperwork, bid processes, and the vendor contract system than
did clients in this study. The differences between these
63
studies may be attributed to the fact that the National
Rehabilitation Hospital's focus groups consisted of clients
with a range of disabi1ities, not just visual impairment.
More focus groups, with more clients, also were conducted for
that study. Technologies discussed were not limited to high-
tech equipment, which was the focus of this study. Geographic
differences between the mid-Atlantic states and Alaska may
also have caused differences in results. Certainly, Alaska's
small client population and limited transportation resources
played a role in determining how much information could be
gathered for this study.
The National Rehabilitation Hospital study also
considered the views of the counselors, with thirty taking
part in the focus group interviews, contributing their
insights on assistive technology and how clients get it. In
that study, counselors were similar to clients in that they
thought there were bureaucratic delays, time and money
constraints, inadequate counselor training, and that product
quality was not consistent, but they also tended to think that
clients had inappropriate expectations of technology
(Phillips, 1992). A study of the views of counselors working
in the Alaska Division of Vocational Rehabilitation would
also, no doubt, reveal areas where clients and counselors
share concerns and point to areas where improvement can be
made.
As both counselors and clients of the vocational
64
rehabilitation system seek to improve their knowledge and
awareness of assistive technology, they should turn to a
variety of resources for information and assistance. As an
occupational therapist, I would like to recommend that my
field be given increased consideration as a resource.
Occupational therapists who take a holistic approach to the
consumer (Kielhofner, 1985), might offer insights that
counselors may benefit from and clients might also appreciate-
-for, as shown here, clients often resent not being seen as
individuals. The practice of Occupational Therapy is aligned
with the philosophy of the independent Living Movement which
expresses the need to have the person with a disability be the
manager of their own services (AOTA, 1991). Occupational
therapists also are well-versed in tailoring specific kinds of
equipment to individuals, with the goal of increasing
independence. Both clients and counselors should be
encouraged to turn to occupational therapists, working in both
private and public sectors, for their expertise. Conversely,
occupational therapists should remember that the vocational
rehabilitation system may be a valuable source of information
on the desires, needs, and know-how of people with
disabilities. As shown here, focus group interviews represent
at least one way to generate productive discussion.
65
References
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system? Historical perspective on disability policy.
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Patton, M. Q. (1987). How to Use Qualitative Methods in
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67
APPENDIX
Dear DVR Client:
(date)
Too often the most important source is not included in
policy making: That's you 1 As a person with a visual
impairment and a client of the Alaska Division of Vocational
Rehabilitation (DVR), you are invited to participate in a
study designed to explore the consumer's perspective on
obtaining and using assistive technology. Specifically, I
hope to learn more about the role assistive technology plays
in your life and how effective the Alaska Division of
Vocational Rehabilitation (DVR) is in conjunction with meeting
these needs. I, myself, am a client of DVR with a visual
impairment, and this research study is a part of the
requirements for a master’s degree in occupational therapy at
the University of Southern California. I am looking for 32
DVR clients who are blind or visually impaired to contribute
to this study. The procedure is in the form of four focused
group interviews. Each person will meet for approximately an
hour and a half in one of these groups to examine assistive
technology concerns and the effectiveness of DVR in meeting
personal needs in acquiring, learning about, and maintaining
appropriate equipment. I will be facilitating these group
interviews and no persons from DVR will be present,
participation in one of these groups may provide you with
beneficial resources on assistive technology and produce
69
valuable information that could influence improvement in DVR's
service delivery.
This study is strictly voluntary and participants'
identities will remain anonymous in the write up of the study.
If you decide to consent please fill out the attached
agreement form and Demographic Information Sheet. Return
these directly to me in the enclosed self-addressed stamped
envelope. I will contact participants by phone to confirm
time and location of the focused group interview each person
will take part in. Please feel free to contact me if you have
any questions.
Thank you for your time and consideration, it is deeply
appreciated.
Si ncerely,
Linda L. Bennett, OTR
P. O. Box 771807
Eagle River, AK 99577
(907) 694-9706
70
CONSENT FORM
I HAVE READ THE ATTACHED LETTER AND UNDERSTAND THAT M Y
PARTICIPATION IN THIS STUDY IS VOLUNTARY AND THAT MY IDENTITY
WILL BE KEPT ANONYMOUS. I UNDERSTAND THAT I WILL BE A MEMBER
OF A GROUP INTERVIEW THAT WILL TAKE ABOUT AN HOUR AND A HALF.
I AGREE TO PARTICIPATE IN THIS STUDY AS DESCRIBED.
Signature Date
Address Phone
71
APPENDIX
BACKGROUND INFORMATION
Are you . . ?
[ 1 Male [ ] Female
How old are you? ___________________
Age at onset of Visual Impairment?
Do you have any other disabling conditions? [ ] Yes
t J No
If yes, please describe:
Do you have a . . ?
[ ] High School Diploma
[ ] Bachelor's Degree (major field:^________________________)
[ ] Master's Degree (major field:_____________________________)
[ ] Doctorate (major field:_____________________________________ )
I ] Other (highest grade completed:__________________________ )
Are you employed . . ?
[ ] full-time [ ] retired [ 1 part-time
I ] student [ ] volunteer [ ] not employed
[ ] other ____________________
What is your occupation?_______________________________________
What is your annual income?
I ] $0-310,000 t ] $11,000-$20,000
[ J $21,000-330,000 [ ] $31,000-340,000
[ ] $41,000 or more
9. I live (check as many as apply):
alone ( ] with family [ ) with roommates
in a group home [ ] with my children
with significant other [ ] in a detached house
in a condominium or townhouse [ ] in an apartment
in a subsidized/supervised apartment
in a nursing home facility
] other (describe:_______________________________________________ )
10. When did you first start seeking DVR services?
11. Are you involved in any Disability Organizations?
t 1 Yes ( ] No If yes, which organizations?
12. Do you currently use any assistive technology devices?
{ 1 Yes [ ] No If yes, list (i.e., computer
equipment: special keyboard, voice output, adaptive
software, CCTV, etc.)
7 4
13. Have you used (or plan to use) sources other than DVR to
obtain these (or future) assistive technological
services/devices?
[ ] Yes [ 1 No If yes, what type of sources?
14. How would you rate your satisfaction with DVR services in
meeting your assistive technology needs?
[ ] 5 - Excellent services, very pleased
[ ] 4 - Happy
[ ] 3 - Mediocre services, only fairly happy
[ ] 2 - Poor services, not happy
[ ] 1 - Terrible services, very disappointed
75
APPENDIX
OUTLINE OF INTERVIEW QUESTION/TOPICS
I .
I I .
INTRODUCTION
A. Purpose of interview
B. Guidelines
1. Definition of assistive technology for purposes
of this interview: will refer to high-tech
equipment such as computers, adaptive software,
CCTV*s, and talking calculators rather than
canes and Braille watches
2. My role to ask questions; subjects to respond;
informal nature of discussion
C. Introductions of participants
HOW DO YOU KNOW YOU ARE GETTING THE "RIGHT" TECHNOLOGY?
A. Have subjects share what types of assistive
technology they use daily and the role it plays
1. How did you find out about these pieces of
equ i pment?
a. Resources for technology information
(b. DVR? Assistive Technologies of Alaska?)
B. The process: The steps you went through to get the
piece of assistive technology
1. What parts of the process were more difficult or
frustrating than the others?
2. Easiest parts?
77
3. Who initiated the process?
a . You?
b. Your DVR counselor?
4. How involved in the process were you?
a. How did that make you feel?
b. Describe a typical meeting with your
counselor
C . Fund i ng
1. Who paid for your equipment?
2. What do you do if you really want a device you
can't seem to get?
D. T imeli ness
1. How long does it actually take to hav the
device in your hands?
2. What are your thoughts on this?
E. Training and maintenance
1. How do you learn to use an ATD?
a. Does DVR provide training? The dealer?
b. Who puts it together/sets it up?
2. What do you do when it breaks down?
a. Can you get a loaner in the meantime?
b. Does DVR cover the costs? Warranty?
78
III. HOW EFFECTIVE IS DVR IN MEETING YOUR ASSISTIVE
TECHNOLOGY NEEDS?
A. What would you say is the best part of the
technology service delivery system that DVR
provides?
B. The worst or most frustrating part?
C. Would any of you want to be a DVR counselor for the
blind?
D. Wish list? if each of you could change one thing
about the system, what would it be?
IV. WRAP-UP
A. Give appreciation for their participation
B. Ask if it was a beneficial experience for subjects
C. Share resource of Assistive Technologies of Alaska
79
APPENDIX D
80
SUMMARY
Focus Group A
Focus Group A was held at 9:30 AM on Friday, November 13,
1992 at the Alaska State Library for the Blind and physically
Handicapped. Six clients of the Alaska Division of Vocational
Rehabilitation (DVR) were invited to attend. Each client was
either blind or visually impaired. One client/subject called
the day before saying that she was not feeling well enough to
come to the interview. Three subjects arrived with valuable
information and ideas to share.
The purpose of the gathering was to explore the
experiences of this man and two women in their acquiring or
attempts to acquire assistive technological devices (ATDs),
The role of DVR was also examined. These clients had a lot to
offer for improving the DVR services they were receiving.
Two of these subjects were using computers with speech
output amongst their other high-tech pieces of equipment.
They found the assistive technology to be an important tool
for increasing their independence which carried a sense of
psychological well-being with it as well. One woman was
pursuing the acquisition of a Kurzweil personal reader not
only to help with employment reasons but to have some privacy
with reading such things as letters and bills.
Other than DVR, the Special Education service Agency was
the only other resource sought or used to obtain ATDs by this
81
group.
For the most part, the group felt that their vocational
rehabilitation counselors had a lack of knowledge and
understanding of what it was like to be blind or realize that
there are many varying degrees of sight and visual loss. The
feeling from the group was mostly of frustration. Although
there was an occasional story of success when a DVR counselor
had initiated the process of obtaining equipment, these
clients mostly felt that persistence on their part was
necessary to get what they wanted. ("It's the squeaky wheel
that gets the grease," said one.) There was an appreciation
for the skills they were learning subsequent to their
struggles with dealing with DVR services. Part of their
frustrations seemed to emerge out of the perceived dichotomy
of DVR services. They felt DVR was established to work for
them, yet they felt they were having to work to please DVR.
The group was often networking supportively with one
another throughout the interview. Everyone seemed
appreciative to have the opportunity to share their stories
with me and with a group of individuals who could benefit.
8 2
SUMMARY
Focus Group B
Focus Group B was held at the Alaska State Library for
the Blind and Physically Handicapped in Anchorage. The
meeting was held in the afternoon on Friday, November 13,
1992. Six clients of the Alaska Division of vocational
Rehabilitation (DVR) participated, five women and one man.
This group was considerably varied in their possession
and use of assistive technological devices (ATDs) . One of the
subjects was studying computers with the support of DVR while
another subject was learning about assistive technology for
the first time--even though he'd been a client of DVR for a
year and a half. Only two of these six subjects had support
from DVR in obtaining high tech equipment while others had
looked or were looking to Supplementary Security Income, the
Lion's Club, VFW, or themselves to acquire ATDs. The majority
of subjects were aware of pieces of equipment that they did
not have that they believed would make their lives easier and
more productive.
Expressions of the group included many hurt feelings
regarding their experiences with counselors of DVR. Such
comments shared were: "They should not act like they can read
people's minds when they can't . . . I have my own mouth to
speak with," and, "You have to be strong and persistent to
accomplish anything."
83
The clearest recommendation to improve the DVR system lie
in improving communication--sharing information with clients
in a way they can understand, and having them repeat this
information so that its clarity and accuracy are assured. An
improved screening process of clients along with a greater
knowledge of assistive technology--so that the two could be
better matched--was suggested.
This group was full of ideas and supportive comments to
assist one another.
84
SUMMARY
Focus Group C
A talkative group of five clients of the Alaska Division
of vocational Rehabilitation (DVR) met on Saturday, December
19, 1992 at the Center for Blind Adults in Anchorage. The
purpose of the gathering was to provide an arena for these
individuals, who all had either a visual impairment or total
blindness, so that they could share their experiences with
acquiring assistive technology. High-tech equipment such as
computers and closed circuit televisions, rather than canes
and braille watches, were the types of technologies that were
hi gh1i ghted.
Seven subjects were invited and the five who participated
represented different geographical regions of the state.
Transportation and lodging for some were provided by Assistive
Technologies of Alaska (ATA). The group met for approximately
an hour and a half and discussed the primary question of: How
do you know that you are getting the right technology? The
effectiveness of DVR in meeting their assistive technology
needs was also examined.
Generally, these participants expressed appreciation and
higher satisfaction when they had a DVR counselor who
understood their needs as a person with a visual impairment.
Curiously, no one wanted to be in the role of a DVR counselor
for the blind.
85
For the most part, assistive technology needs were best
met when the client personally researched his or her own needs
and was persistent with the justification of them to DVR.
Others expressed discouragement because they did not know how
to research equipment or even what they were looking for. The
time spent waitng for a piece of equipment through DVR, which
might be marked by vision changes rendering the equipment
inadequate, were strong concerns.
Sources for information and funding of assistive
technologies, other than DVR, were discussed. Notably, ATA
was not mentioned. (This resource was shared with the clients
at the close of the interview.)
The gathering provided a setting for networking and
support. This was displayed after the interview ended as the
participants exchanged book titles and other information with
one another.
86
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Asset Metadata

Creator Newman, Linda Lee (author)

Core Title Assistive technology for clients with visual impairments of the Alaska Division of Vocation Rehabilitation: a qualitative evaluation

School Graduate School

Degree Master of Arts

Degree Program Occupational Therapy

Degree Conferral Date 1995-05

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag education, technology of,education, vocational,health sciences, occupational health and safety,OAI-PMH Harvest,sociology, public and social welfare

Language English

Contributor Digitized by ProQuest (provenance)

Advisor Frank, Gelya (committee chair), Hahn, Harlan (committee member), Zemke, Ruth (committee member)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c18-7123

Unique identifier UC11357614

Identifier 1376495.pdf (filename),usctheses-c18-7123 (legacy record id)

Legacy Identifier 1376495-0.pdf

Dmrecord 7123

Document Type Thesis

Rights Newman, Linda Lee

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA