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The use of occupational therapists or interdisciplinary teams in the evaluation of assistive technology needs of children with severe physical disabilities in Orange County schools

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The use of occupational therapists or interdisciplinary teams in the evaluation of assistive technology needs of children with severe physical disabilities in Orange County schools

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Content THE USE OF OCCUPATIONAL THERAPISTS OR INTERDISCIPLINARY
TEAMS IN THE EVALUATION OF ASSISTIVE TECHNOLOGY NEEDS OF
CHILDREN WITH SEVERE PHYSICAL DISABILITIES IN ORANGE COUNTY
SCHOOLS
by
Jeffrey Charles Baker
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)
DECEMBER 1995
Copyright 1995 Jeffrey Charles Baker
UNIVERSITY O F S O U T H E R N CALIFORNIA
T H E GRADUATE SCHOOL
UNIVERSITY PARK
LOS A NGELES. CALIFORNIA 9 0 0 0 7
This thesis, 'written by
...
under the direction of h .iS . Thesis Com m ittee,
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
C ..
/
Dean
D a te S£.p£.Gunlxar...2j3.,...l 995
THESIS COMMITTEE
Chairman
Dedication
This work is dedicated to Diane and all the other
children who have so much to say and do and who need
to find a way to do it.
Acknowledgement
This research was supported in part by U. S. Department of
Education Rehabilitation Services Administration Grant
#H129D81011-89, entitled SKILLS and TOOLS: Occupational
Therapy Student Training for Community-Based Independent
Living Skills Using Technological Tools for Persons with
Disabilities.
iv
TABLE OF CONTENTS
Page
ACKNOWLEDGEMENT iii
LIST OF TABLES vi
ABSTRACT viii
CHAPTERS
1. DEFINITION OF THE PROBLEM 1
Significance of the Study 4
Statement of Purpose and Rationale 7
Limitations of the Study 9
2. Review of the Literature 9
Occupational Therapy and Assistive Technology 10
Importance of Interdisciplinary Approaches 12
Importance of Assistive Technology 17
Appropriateness of Assistive Technology 18
3. METHODS 24
Subjects 25
Instrument Development 29
Reliability 31
Validity 31
Procedures 32
Data Analysis 33
4. RESULTS 3 3
Research Questions 46
5. DISCUSSION 59
Comparison of Findings 60
Implications of Findings 61
Recommendations for Further Research 71
REFERENCES 74
V
TABLE OF CONTENTS continued
APPENDICES Page
A: AGENCIES CONTACTED FOR SURVEY 78
B: ASSESSMENT SURVEY 81
C: LETTERS OF INTRODUCTION 89
D: PROPOSAL FOR SPECIALIST POSITION 91
vi
LIST OF TABLES
Table Page
1. Professions of Survey Respondents 36
2. Worksites of Respondents 37
3. Years Experience Working with Children
with Severe Disabilities 38
4. Years Experience (>10) by Profession 38
5. Ages of Children Worked with 39
6. Importance of Assistive Technology 40
7. Methods of Training in Using Assistive
Technology 41
8. Training Methods by Profession 42
9. Freguency of Assistive Technology Use
by Professionals 43
10. Types of Technology Used by Professionals 45
11. Factors Which May Encourage Technology Use 46
12. Presence of Childrens' Assistive Technology
Needs Assessments 48
13. Types of Childrens' Assistive Technology
Needs Assessed 49
14. Occurrence of Interdisciplinary Assessment
for Assistive Technology 50
15. Childrens' Technology Needs Assessment
Team Members 51
16. Designated Childrens' Technology Needs
Assessment Team Members 52
17. Perceived Potential Value of Technology
Specialists 53
18. Factors Related to Childrens' Assistive
Technology Needs Potential Assessed by
Occupational Therapists 54
vii
LIST OF TABLES continued
Table
19. Reasons for Non-OT Use in Assessing Childrens'
Needs for Technology
20. Professionals' Satisfaction with Present
System of Childrens' Technology Needs
Assessment
21. Satisfaction of Professionals with Present
System of Assessment
Page
56
57
58
viii
Abstract
Assistive technology enables children with severe
physical disabilities to engage in meaningful activities.
Ensuring appropriate technology should involve an
interdisciplinary assessment which focuses on all aspects
and environments of the child. Occupational therapists have
had longstanding experience with assistive technology and
are appropriate members of the assessment process. Two
hundred and twenty six professionals serving children with
severe physical disabilities in Orange County were surveyed
to learn the extent a team approach and occupational
therapists were involved in technology assessments. The
study also attempted to determine who was doing the
assessments, as well as the attitudes of professionals
toward the present systems of assessment now in place.
Results indicate that a team approach was used only
sometimes or not at all. Occupational therapy services were
used less than thirty percent of the time compared to sixty
seven percent for speech pathologists. Many respondents felt
that existing technology might be used more if there had
been a team assessment to determine appropriateness prior to
acquisition. Respondents also expressed their belief in the
potential value of having a technology specialist or team
available for assessment or consultation, while at the same
time they expressed dissatisfaction with the present system
of evaluation and acquisition of assistive technology.
CHAPTER 1
THE PROBLEM
Assistive technology is defined as "any item, piece of
equipment, or product system, whether acquired commercially
off the shelf, modified, or customized, that is used to
increase, maintain, or improve functional capabilities of
individuals" (NICHCY, 1991). Technology that is comprised of
computer-based technology, adapted switches, or augmentative
communication devices can play a critical role in the lives
of children with severe physical or multiple disabilities.
This technology can include both simple low end items such
as mouthsticks or pointers used to access a computer
keyboard, and high end items such as electronic
communication systems. Benefits include improved information
access, environmental control, communication, social
interactions, leisure, and vocational training. Increased
independence in activities of daily living may enable
children to participate in less restrictive environments.
Anecdotal reports by teachers seem to confirm the
benefits of assistive technology. In Orange County schools,
children with severe orthopedic and expressive language
handicaps are able to take part in regular academic programs
through the aid of communication devices which enable them
to give verbal input to classroom discussions. They can also
submit printed materials which they have been able to
produce by interfacing with computers and printers. Not long
2
ago, these students would have been in separate programs
because they would have had no means by which to
academically perform.
Children with severe and profound cognitive and
physical handicaps are participating in functional classroom
activities through the use of technology where before they
would have been passive recipients of stimuli provided by
their teacher or aide. These children are accessing toys and
music by activating adapted switches which can be positioned
to take advantage of any consistent movement of any body
part. They can operate appliances such as a blender to help
prepare a snack, and then enjoy the product of their
efforts, rather than having to passively accept food which
has been prepared without any input by them.
Legislation now defines assistive technology in Public
Law 100-407, the Technology Related Assistance for
Individuals with Disabilities Act of 1988; Public Law 101-
336, the Americans with Disabilities Act of 1991; and Public
Law 101-476, the Individuals with Disabilities Education Act
of 1990 (IDEA), formerly known as Public Law 94-142, the
Education for All Handicapped Children Act of 1975 (Luebben,
1992). P.L. 100-407 has the primary purpose of assisting
states in developing comprehensive, consumer-responsive
programs of technology-related assistance and to broaden
technology availability to individuals with disabilities and
their families.
3
P.L. 101-336, (ADA), guarantees equal opportunity for
individuals with disabilities in employment, transportation,
public accommodation, government services, and
telecommunications. P.L. 101-476 (IDEA), which provides for
a free and appropriate education for all children regardless
of their disability, states that there must be evidence that
the educational team has considered assistive technology
devices and services to help the student in the transition
to vocational rehabilitation, employment, postsecondary
education, or adult services. Further, if it is found that
assistive technology services or devices are required to
provide the student with a appropriate public education,
then the services must be provided at no cost to the student
(Buck, 1992; Chandler, 1991; Struck, 1993).
Other laws, the Individuals with Disabilities Education
Amendments of 1990 (P.L. 101-236) and the Elementary and
Secondary School Improvement Act of 1987 (P.L. 100-297),
enable the provision of assistive technology and services.
They also define assistive technology devices, for the first
time, as any equipment used to increase, maintain, or
improve the capabilities of individuals with disabilities.
Assistive technology services are defined, in brief, as
evaluation of individuals with disabilities, acquisition of
assistive technology services, selection, maintenance, and
replacement of devices, use of therapy with technology, and
training. Technology can now be specifically provided as a
4
defined service in the educational program instead of simply
another related service (Parette & VanBiervliet, 1991;
Shuster, 1993).
The potential benefits of technology, as well as its
increasing cost and complexity, calls for an assessment
process that leads to the most appropriate match between
child and device. This implies an interdisciplinary team
approach involving all concerned professionals working
together within a common delivery system, such as the public
school, and toward a common goal (Edwards & Hanley, 1992). A
trans-disciplinary approach may be utilized, if role
relinquishment and sharing of knowledge with other
professionals is involved (Fields, 1991). In the
transdisciplinary model, the multiple needs of the child are
considered interrelated and individual team members must not
work and think in isolation (Benson, 1993). The importance
of either of these approaches remains in the joining of
relevant members' efforts.
Significance of the Study
In the Special Education setting, the Individualized
Education Plan (IEP) is utilized to develop appropriate
educational goals. Ideally a collaboration of all parties
concerned with the student's educational outcome, the IEP
reflects the awareness that the child has specific needs and
that all parties will be working toward those needs. In
reality, time constraints and large caseloads may lead to a
5
multidisciplinary approach in which various professionals
may do separate evaluations and work toward necessary but
not always related goals. Evaluations may be on different
time tracks, and written summaries of goals may substitute
for the actual presence of professionals at the IEP meeting,
further negating the ideal "team" meeting. If this is the
case, then perhaps the IEP meeting is not serving its
intended role. Different assistive devices may be
recommended by various professionals but without
consultation with each other. After device acquisition,
there may be no real joint approach, either for reevaluation
or for follow-up training.
Low Incidence Funds (LIF) are moneys designated by the
Federal government to acquire adaptive or alternative
curricular materials or equipment for students with
specified categories of disabilities who are unable to
access standard materials. LIF money is often utilized to
acquire assistive technology such as computers and
interfaces, communication devices, and adaptive switches and
keyboards. California Children Services (CCS) is a state
wide organization which provides therapy services and
medical intervention to children with designated
disabilities. CCS may also fund some technology, such as
augmentative communication devices, under the guise of
durable medical equipment. However, due to budget
constraints within government organizations, greater
scrutiny of funding requests for high-priced technology is
occuring. More' detailed justification is being required and
the cost versus benefit ratio has become very important.
However, costs of technology items might ultimately be less
if these funding sources are used more appropriately.
Personal observation at several school sites, and a
literature review, has shown that assistive technology may
be acquired and then set aside due to lack of training or
poor suitability. The intent may have been to provide a
"taste of technology," or to find a quick fix. The result is
"closet technology", devices that are shelved due to their
inappropriateness or to a poor understanding of the best use
for the device (Leubben, 1993; Page, 1980). The different
environments in which the child and an assistive technology
device must function are often overlooked when acquiring the
device. At the same time, according to Kanny, Anson, & Smith
(1991), therapists working with children tend to recommend
technology more frequently than therapists in adult
settings. There is an important need for all disciplines to
focus together on the student. Only then will his or her
participation in education be enhanced by the technology
(Attermeir, 1987; Campbell, 1987).
The American Occupational Therapy Association (AOTA)
states that occupational therapists are important to the
process of applying technology to both habilitation and
rehabilitation (Deterding, Youngstrom, & Dunn, 1991). The
7
ability to analyze, evaluate, recommend, and train in the
use of assistive devices makes the occupational therapist an
essential part of a team approach, whether interdisciplinary
or transdisciplinary.
Statement of Purpose and Rationale
Children with severe physical disabilities have
significant posture and movement handicaps. Additional
associated handicaps, such as vision, hearing, or cognition
problems would classify the child as multiply disabled
(Esposito and Campbell, 1987). A literature review revealed
that team approaches in evaluating these children for
assistive technology are scarce despite the growing
acknowledgement of the importance of these approaches
(Darling & Ogg, 1984; Edwards & Hanley, 1989). This study
surveyed, through a mailed questionnaire, the various
professionals who provide more frequent service to children
with severe physical or multiple disabilities in public
schools in Orange County. It investigated the following
research questions:
(1) Are assistive technology needs for each child
being addressed in the IEP process?
(2) Are childrens' assistive technology needs being
assessed in Orange County and if so, for what
types of technology?
(3) Is there interdisciplinary or team assessment for
technology and is there a perceived value in having
a team of experts?
(4) What factors are being assessed by occupational
therapists?
(5) Why are occupational therapists not used more in
the assessment process?
(6) How satisfied are professionals with the current
system of assessment for childrens' assistive
technology needs?
(7) Would there be greater use of existing assistive
technology if prior interdisciplinary needs
assessments had been made?
The lack of either a team approach, or the use of
occupational therapists, may indicate that there is not
always an awareness of the potential contribution that
various professionals might make to an interdisciplinary
team. It also may indicate that there is not enough of an
occupational therapy presence in the schools to create an
awareness of the occupational therapist's area of expertise.
In part, it may be that there are simply too few
occupational therapists available. However, if therapists
have the prerequisite knowledge or training, they may feel
able to be play a more assertive role. It is hoped that by
acquiring answers to these questions, and others that might
9
arise through this and similar studies, better utilization
of resources might develop.
Limitations of the Study
Limitations of this study were that: (1) there are
other parties involved in the acquisition of technology
beyond those already mentioned, including rehabilitation
engineers, vendors, psychologists and careproviders.
However, to have included all concerned individuals would
have entailed a survey of unmanageable proportions for this
researcher. The potential respondents selected were those
who were likely to have the most frequent contact with the
child and the technology in the school. (2) Only Orange
County was chosen for this study because: (a) California
Children Services (CCS), as the major source of therapists
working with these children, is organized on a county by
county basis; and (b) the personnel surveyed were employees
of Orange County school districts or Orange County agencies.
CHAPTER 2
REVIEW OF THE LITERATURE
The effectiveness of assistive technology in enabling
individuals with disabilities to become more independent has
been well established, although the appropriateness of
specific devices is not always clear. In this literature
review, an attempt will be made to show that appropriate
assistive technology for children with severe disabilities
is best determined when there is a comprehensive,
collaborative approach to the assessment of the individual,
a team approach.
The components of a technology assessment are described
in many resources, several of which were gathered from
various professionals at the 1993 Technology and Persons
with Disabilities Conference sponsored by California State
University, Northridge (Church & Glennon, 1992; Jacobs,
1993; Williams & Stemach, 1993). There seems to be a general
agreement among most technology experts that these factors
should include physical and cognitive resources. Physical
resources would include such areas as vision, hearing,
muscle tone, range of motion, coordination, and appropriate
seating or stability to enhance functional movement.
Cognitive resources include comprehension of the use of
switches, a reference system for choice-making, and adequate
attention span. The delivery of technology is also not
limited to any particular discipline (Vanderheiden, 1987).
Many disciplines should be involved, in light of the many
factors to be considered in a comprehensive evaluation.
Occupational Therapy and Assistive Technology
Occupational therapists have had an historic
relationship with technology. An important issue in this
relationship has been not just the technological
intervention but the context in which it is used (Smith,
Hammel, Rein, & Anson, 1992). Smith et al. (1992) note a
four-fold responsibility that occupational therapy
11
practitioners have: (1) to use technology when beneficial;
(2) to not use technology when not beneficial; (3) to be
competent with the technology; (4) to use technology in
meaningful activity.
Adaptation has been a key word in occupational therapy
history. As adaptation may be the only means by which an
individual may function in a particular environment,
therapists must actively seek out appropriate methods by
which that individual can cope with the demands put upon him
or her. A least restrictive school environment for a child
with a severe disability may be contingent upon finding a
means for that child to expressively communicate or to
independently feed himself or herself. However, there is a
tendency to overuse high-end technology; more is not always
better. A simpler form of assistive technology such as a
letter/alphabet board may be easier and faster for the child
to use in a spelling exercise than an elaborate
communication device.
Competency in the use of the technologies prescribed
for the child with a disability is essential if the "closet
syndrome" is to be avoided. If the assistive device is to
become an integral part of the child's functional
capabilities, then it must be available at all times. Down
time for repairs or to seek out additional assistance only
detracts from the student's independence.
Finally, technology must first and last be utilized in
meaningful activity. Adaptive switches used to activate a
toy for a three year old with cerebral palsy may be
meaningful and appropriate. However, the appropriateness
diminishes when the individual with disability is a
teenager. This last responsibility is what differentiates an
occupational therapy technologist from a technologist from
another professional base, according to Smith et al. (1992).
The attractiveness of technology, they feel, is such that it
may be used regardless of whether the activity is
meaningful. However, occupational therapy has traditionally
stressed meaningful, functional activity and, in the
educational setting, occupational therapists focus on the
student's abilities and remediations needed to enhance his
or her educational function (Shuster, 1993). Occupational
therapists are more likely to provide a holistic approach to
a client's needs, an approach that is often neglected if the
primary focus is on technology (Smith, 1989; Trefler, 1987).
Smith also states that occupational therapists cannot apply
technology in isolation, that they must know what their own
particular contributions can be as team members.
Importance of Interdisciplinary Approaches
The process of providing effective services, whether
educational or therapeutic, to children with disabilities
has also been a process of self-evaluation to try to
determine what is the most effective practice. Meyer,
13
Eichinger, and Park-Lee (1987) reviewed the educational
literature for quality indicators that could be specified
and utilized in developing educational programming for
students with severe disabilities. Not all of these
indicators were supported by empirical research; most were
derived from expert opinion, position papers, court cases,
and legislation.
Meyer et al. (1987) noted several highly rated quality
indicators. These were that: the program philosophy
emphasized integrated therapy rather than a pull-out direct
service model in which the child is pulled from the
classroom to be treated in an isolated setting; that
alternative communication modes and adaptive equipment
devices were used as needed for instruction across all
program areas; and that each child had adaptive equipment as
needed. Integrated therapy implied that therapy services
were collaborative and provided in actual situations and
environments where skills would be used.
Campbell (1987) described various team approaches to
service provision in schools, which have historically been
utilized since the inception of P.L. 94-142, now known as
the IDEA. "Multidisciplinary" approaches imply separate
assessments and isolated programming by each discipline to
remediate deficits. Thus, IEP goals may be developed in
tangential areas. In an "interdisciplinary" team approach,
the team members still individually assess the student's
14
abilities but share results in planning comprehensive
intervention. Services may or may not be provided in
isolation. The "transdisciplinary" approach, while
designating a "primary therapist" to provide parent
instruction and child programming in all areas, still
entails a coordinated team with other members sharing
programming information needed by the primary therapist.
Campbell (1987) further described an "integrated"
programming approach which even more thoroughly coordinated
all involved professionals and careproviders to guide
implementation of specific activities appropriate for the
unique characteristics of a district or educational agency.
She stressed that the most effective interventions were
those which draw on and combine methods from all concerned
disciplines in ways unique to the student's needs.
The support for an interdisciplinary approach seems to
exist among professionals. Guidelines of the American
Speech-Language Association recognize the need for
interdisciplinary efforts in service provision (National
Joint Committee for the Communication Needs of Persons With
Severe Disabilities, 1992). Their Communication Bill of
Rights proposes the right of individuals with severe
disabilities to have access to augmentative and alternative
communication devices, and other assistive devices. They
stress that enabling communication interactions for these
individuals will require the knowledge and skills of a
15
variety of disciplines, including occupational therapy. They
further state that each member of the interdisciplinary team
must be recognized as having a specific and crucial
contribution to make.
These potential contributions are noted by many
authors. A survey in which occupational therapists and
speech/language pathologists employed by school systems
across the country were asked how often occupational
therapists and speech pathologists interacted with each
other and what factors, if any, hampered their interaction.
The findings of the survey were that, although there was
overwhelming support for interdisciplinary interaction, this
communication was only sporadic. This was attributed to
staff shortages, financial constraints, physical barriers,
and administrative management. Respondents also listed many
benefits to be gained, the most important being improved
quality of treatment (Stahl, 1993).
Allen (1993) noted that, with the espousing of
inclusive education for children with disabilities, the role
of occupational therapists needs to change in the manner in
which services are provided. She felt that working as a
member of a transdisciplinary team would make occupational
therapist better therapists because, in addition to teaching
others, they would also be able to learn from them. She
further noted that using an integrated approach to IEP
development would lead to coordinated goals and support
16
services, and that therapists would no longer be working in
a vacuum in which isolated skills were being addressed.
Other therapists advocated a transdisciplinary team
model as the most effective approach in planning and
providing services in that IEP goals become collaborative
rather than discipline-specific (Cooper et al., 1992).
Integration of assistive devices into the student's program
would likely be enhanced if the assistive technology
assessment occurred as a focus of the educational team
(Shuster, 1993). This is echoed by Struck (1994) and Volpe
(1993), who noted that collaborating with other disciplines
not only provided guality intervention, but fostered
cohesiveness among team members.
The effectiveness of direct/isolated versus
indirect/integrated therapy services in a school-based
program for a student with severe disabilities has also been
examined. A study by Giangreco (1986) involved a functional
activity using assistive technology. Indirect therapy in
this context referred to the therapist acting as a
consultant in a team format rather than as a direct service
provider. Direct/isolated therapy referred to the
traditional "pull out" approach. Therapeutic procedures were
incorporated in the context of functional activities
integrated with other disciplines and referenced to the
educational plan. The study demonstrated significant
positive behavioral changes in the student's ability to
17
activate the technology and seemed to support the value of
indirect/integrated team approaches to therapy services.
Importance of Assistive Technology
Izen and Brown (1991) surveyed special educators
working with students with profound or multiple handicaps,
or medically fragile conditions. They found that, although
all curriculum domains were considered important, nonverbal
communication, self-help, and social skills were among the
most highly rated by the majority of teachers. The majority
of respondents felt that teaching students functional, age-
appropriate skills, as well as preference and choice-making
skills, were highly important instructional approaches.
However, less than 60% of these educators seemed to feel
that the use of technology would be an effective method of
enabling these students to achieve these skills. Among the
reasons cited were insufficient resources and the lack of
belief in its effectiveness. Further, its use was not
included in more than 20% of the classrooms surveyed.
Adaptations and technological devices do enhance both
educational functioning and independent living of
individuals with severe and multiple disabilities, according
to Garner and Campbell (1987). They found that technology
serves two purposes: (1) as a remediator of specific
impairments, and (2) as an aid for the individual to learn
specific tasks or material. Adaptive positioning equipment
enables an individual, who otherwise could not independently
18
sit, to assume a functional position. An augmentative
communication device enables a child with no speech to
communicate with his or her peers through speech synthesis
or printed output. Special devices for writing, mobility or
feeding enable the child to learn independence in many
environments. Most importantly, technological applications
have enabled these individuals to perform many functional
activities in environments shared with their peers without
disabilities (Esposito and Campbell, 1987).
Appropriateness of Assistive Technology
Garner and Campbell (1987) also felt that the expanding
use of technology requires the rethinking of the scope of
instructional opportunities. Activities once thought
inappropriate, given the student's particular limitations,
may well be achievable given technological assistance. They
suggest factors which may guide this rethinking including:
(a) obstacles to the use of technology; (b) alternatives for
the integration of technology into instruction; and (c)
values which would guide the use of technology.
Obstacles to the use of technology in instruction are
varied. They include (a) lack of training in device setup
and operation; (b) inability to maintain or service devices;
and (c) use of devices as an end rather than a means of
enhancing the curriculum, or as a replacement for teacher
interaction. When malfunctions occur, or on-going training
is required, then the technology is put aside. Garner and
19
Campbell (1987) outlined an oft-occuring sequence of events
regarding school personnel, technological devices, and
students with significant motor and cognitive impairments:
(a) A judgement is made that the student is not
acquiring necessary skills; (b) a determination is made
that "some type" of augmentative or technological
device will assist the student to acquire these skills;
(c) a search of available catalogues is made to
identify potentially "useful" technological devices;
(d) concerns are expressed about sources of funding for
these devices; (e) a purchase is made; (f) the
purchased device is implemented with the student; and
(g) after a reasonable period of time, the purchased
device is found to be ineffective and placed in storage
(p.126).
Vanderheiden (1987) also noted that devices are
inappropriately applied simply because nothing else has
worked or because having some technology is better than
none. There seems to be a tendency to select technology as a
quick cure and an assumption that "bigger is better". When
it doesn't prove to be, then "closet technology" occurs.
Assistive technology can have new and alternative roles
in education. Garner and Campbell (1987) suggest that
educators and related services personnel have often been
trained in strategies which emphasize the acquisition of
developmental milestones. Current strategies in the
20
education of students with severe disabilities focus more
and more on ecological assessment strategies, functional
goals, integration of learning and social experiences, and
the attainment of social and vocational independence as an
adult (Campbell, 1987). This focus provides much greater
opportunity for the application of technology.
Finally, Garner and Campbell suggest that we need to
select and apply technology in ways that promote the
individual's dignity and offer opportunity for personal
choice. The student with a severe handicap can be given the
opportunity to exercise autonomy in everyday situations, as
well as greater community participation. Technology should
not be viewed as an end but rather a means.
Letzinger and Hydle (1986) discuss their approach to
assessment and decision-making leading to technology
recommendations. They point out three important questions to
be asked: (1) what are the actual present and projected
needs of the individual; (2) what are the present and
projected capabilities of the individual; and (3) is funding
available and is technology the most beneficial area to
apply it? In the evaluation of cost, they point out that
non-obvious costs such as training and maintenance need to
be considered. These services are at least as important as
the technology itself and may possibly be more important.
Today there is a growing consensus that the application
of technology is best accomplished through an integrated
team approach (Campbell, 1987). Because of the near
impossibility of any one individual keeping abreast of the
many developments in the assistive technology field, a
technology assessment team is best comprised of all the
disciplines involved with the individual with special needs.
Certainly, at a minimum, all of the school system's related
services should be represented, including physical,
occupational, and speech therapists, and teachers. Assuring
the appropriateness of assistive technology by means of team
assessment should help assure that scarce funds are best
used and reduce the degree of closet technology.
Technology for a school-age child with a disability can
make a difference between participation and isolation. A
child with severe orthopedic and cognitive disabilities at
this researcher's school/work site has been provided with a
switch-activated, voice output device. This has enabled him
to greet and socially interact, although in a limited way,
with his peers without disabilities. This interaction has
encouraged other children to initiate more frequent contact
with him. However, the provision of technology, such as
communication devices, in the Individualized Education Plan
(IEP) has often been difficult for families to achieve.
There is a reluctance not only on the part of schools, but
of insurance agencies and other funding agencies to pay for
devices they perceive to be personal in nature or do not
understand (Golinker, 1992). New legislative language
22
clarifys the U. S. Department of Education's position on
assistive technology. According to Golinker, it states that,
if a child with a disability requires such technology to
receive the most appropriate education, then the public
agency must assure that devices or services are made
available. Determination of the need for assistive
technology must be made on an individual basis through the
IEP.
State Departments of Education reported an increase of
7,000 students with multiple handicaps between 1980 and
1985, with approximately 10% increases in each of the last
three years (Campbell, 1987). These increases are accounted
for by the greater survival rate of low birth weight
infants, the medical practices of neonatal care, and
increasing sophistication in the identification and
diagnosis of sensory impairment with infants and difficult
to test children. The ability of educators and related
services personnel to develop programming for these children
has not kept pace. Each professional discipline, according
to Campbell, brings a distinct knowledge base to the issue
of appropriate programming strategies. Effective
programming, and evaluation to implement this programming,
should be designed as an amalgam of these various
strategies.
Even though there is great potential for improving the
quality of life for individuals with severe disabilities
23
through the application of technology, it is often
inappropriately applied or is not used in solving functional
problems (Somerville, Wilson, Shanfield, & Mack, 1990). Lack
of trained professionals, difficulty in keeping up with new
developments, and effective strategies for using technology
are major factors in this problem. A survey of occupational
therapists indicated a need for training in all identified
technology service delivery areas (Somerville et al., 1990).
Most frequently named were information resources, funding,
and task analysis to indicate where technology can enhance
performance. In regards to training related to specific
technologies, software, equipment/device interface, and
computer hardware were most frequently named. The survey
also showed that recommending and using technology appeared
to be universal among occupational therapists. Given this
widespread appeal, it seems even more important that
assistive technology be acquired and applied in the most
efficient and effective manner. A team approach to
assessment, whether interdisciplinary or transdisciplinary,
seems to be the most critical factor in this process. Within
this team, it is also important for occupational therapists
to begin asserting and defining the potential of their
unique role.
Assistive technology can play a critical role in the
lives and occupations of children with severe disabilities.
It can have a profound impact in many areas including
communication, social skills, vocation, and recreation.
Technology changes and expands on a continual basis with new
and more effective applications constantly being developed.
The difficulty of keeping abreast of these developments
grows while at the same time available funding sources tend
to shrink. If occupational therapists, as part of a
professional support system for these children, are to make
the most appropriate use of this technology, and of the
funding base, then it is critical that an effective means of
evaluating for this technology be used. Using all relevant
personnel in a team approach seems to be the logical means
of doing this. Further, as occupational therapists have the
expertise to use and adapt assistive technology to maximize
the functional skills of children with disabilities, they
should be essential team members.
This study has attempted to determine, in Orange County
public schools, how needs assessments for assistive
technology are being made to acquire appropriate technology
for children with severe or multiple disabilities. It has
also tried to examine the role that occupational therapists
are playing in this process.
CHAPTER 3
METHODS
A descriptive survey, utilizing a mailed questionnaire,
was used to obtain data about assistive technology
assessments from special education teachers, speech language
25
pathologists, physical therapists, and occupational
therapists serving students with severe physical or multiple
disabilities in Orange County public schools. Polit &
Hungler (1987) state that data obtained from surveys may be
more superficial than from alternative methods such as
interviews. This study, however, was intended to take an
extensive rather than an intensive look at current
conditions.
The survey was used to obtain data with which to
determine the manner in which assessments of childrens'
needs for assistive technology are being done. Specifically,
it addressed whether an interdisciplinary team approach was
being used, whether occupational therapists were part of the
assessment process, and, if occupational therapists were not
used in the assessment, why not? The survey also attempted
to learn whether there was a perceived need or desire for a
formal technology assessment process, and whether it was
believed that existing technology would have been used more
if there had been a comprehensive evaluation to determine
its appropriateness before acquiring it.
Subjects
The sample for this research study was derived from
several sources. Criteria for the subjects were that they
served children with severe physical or multiple
disabilities and that their professional status met those
listed in the survey. These were special education teachers
26
with Severely or Orthopedically Handicapped credentials,
speech/language pathologists, occupational therapists,
physical therapists, or augmentative communication
specialists.
Orange County consists of 12 Special Education Local
Plan Areas (SELPAs). These SELPAs are administrative
structures by which school districts are able to combine
resources to coordinate special education programs. They are
organized geographically although if a school district is
large enough, it may become a SELPA in itself. The Orange
County Department of Education also maintains a special
education system, including the Special Centers for the
Severely Handicapped. The County system provides programming
for students who are not able to be served by their home
school districts, either because of the severity of their
disabilities or the low numbers of these children within a
district or SELPA. All SELPAs, plus the Orange County
Department of Education, were contacted for this research
project. Appendix A lists these organizations.
For the most part, administrators were very cooperative
and interested in the research project. However, it was not
possible to have the survey distributed to the Santa Ana
School District, which has one of the larger special
education programs in Orange County. The contact person did
offer to fill out a copy for the district as a whole but
this did not seem a very productive alternative. One SELPA
27
did not respond after several contacts and one reported not
having any applicable personnel.
California Children Services (CCS) is a mandated
service for California children who have designated
orthopedic or neurologic handicaps. It provides medical
direction, physical and occupational therapy services, and,
in some cases, funding for medical services and durable
medical equipment (DME). It is organized on a county by
county basis with each county a separate entity for
logistical and funding purposes. In Orange County, a great
many of the children who have severe physical or multiple
disabilities meet the eligibility criteria of CCS and are
served by CCS therapists. Names of 57 occupational and
physical therapists were obtained primarily from the
personnel list of Orange County CCS. Several of the
occupational therapists included in the sample were employed
as contract therapists by various school districts to serve
children who do not meet CCS eligibility criteria. Surveys
were distributed to these contract therapists through the
same channels that school district teachers and
speech/language pathologists obtained theirs. In this case,
as confidentiality was an issue, it was not possible to
obtain individual names. Instead, school districts' special
education coordinators were contacted and asked to
distribute the surveys to relevant educators and therapists.
28
Packets of surveys were then sent to these administrators to
be distributed.
Three hundred and seventy six surveys were mailed to
school districts and CCS Medical Therapy Units based on
numbers given by administrators. Two hundred and twenty six
surveys were completed and returned. Of these, 10
questionnaires were dropped from data analysis secondary to
the respondents' professional status not meeting the survey
criteria. These 10 respondents were school nurses, special
education administrators, teachers of students with
primarily vision, hearing, or learning impairments, resource
or program specialists, and psychologists. Their
questionnaires were kept for interest and future reference,
but the data were not included in the final analyses. An
additional 21 respondents noted that while they worked with
children with severe developmental or emotional
disabilities, they did not work with children with severe
physical or multiple disabilities. However, these
respondents did use assistive technology with their students
and, as technology appropriateness is an issue in this
study, it was felt that their response could justifiably be
included.
Characteristics of the study participants whose data
were used are listed in Tables 1-4 in Chapter 4. Respondents
were teachers possessing credentials to teach children with
severe or orthopedic handicaps, speech pathologists,
29
occupational and physical therapists, and augmentative
communication specialists. Work sites included Special Day
Classes, Medical Therapy Units, Special Centers for the
Severely Handicapped, and integrated classrooms. More than
half of the respondents had over 10 years experience working
with children with severe disabilities.
Instrument Development
The questionnaire used in this study was the Assistive
Technology Assessment Survey developed by this researcher
(see Appendix B). It contains two sections and was utilized
to obtain the following types of information.
Section I asks for data pertaining to the respondents,
the frequency of use of technology, and attitudes toward
technology. Section II requests data pertaining to the type
of assessments done, assessment factors, professionals
involved in the assessment, satisfaction with the current
system of assessment, and consideration of technology in the
IEP process.
For the most part, the survey questions were closed-
ended and offered a number of alternative answers. Question
II-4 addressed the use or non-use of occupational therapists
in the assessment process and was partially open-ended to
allow for additional comments. Two questions, II-6 and II-7,
also allowed professionals not working with children with
severe physical disabilities, and those who did but who did
not use technology, to respond in an open-ended fashion. The
30
research questions of this study were rephrased in the
questions of Section II of the survey.
The questionnaire briefly defined assistive technology
so that respondents would be clear that the survey was not
concerned with all types of adaptive equipment. To ensure
consistency of content interpretation, a pilot study was
conducted to reveal variations in responses or lack of
clarity in the survey questions. The site used for the pilot
study was the researcher's place of employment, Lord Baden
Powell School in Anaheim, California, a site which serves
children with severe physical and multiple disabilities, and
which also accommodates a Medical Therapy Unit (MTU) of
Orange County CCS.
Each CCS Medical Therapy Unit is located on a public
school site and consists of both occupational therapists and
physical therapists who have contact with a wide variety of
children with severe disabilities. Consequently, using an
MTU site for the pilot study made available a sample of not
only occupational and physical therapists but of speech
language pathologists and teachers. The sample for the pilot
study consisted of two occupational therapists, four
physical therapists, one speech pathologist, and eight
teachers with either Severely or Orthopedically Handicapped
credentials. Following the pilot study, participants were
questioned as to clarity of the questions, as well as
whether there were other items which might have been
31
included. Suggestions were to include additional diagnoses
in question 5, Section I and additional assessment factors
in question 5, Section II. These additional assessment
factors were consistent with findings from the literature
review. Otherwise, the survey was left intact.
Reliability
Reliability refers to an testing instrument's ability
to measure consistently over time (Isaac & Michael, 1990).
As this survey dealt more with physical or demographic data,
as opposed to psychological data, standard reliability tests
were not deemed appropriate. There was an intent to follow-
up with phone calls to at least 10 percent of respondents to
discuss the questionnaire and clarify any vague or
incomplete responses. However, due to confidentiality
issues, names of respondents were not obtained and so they
could not be contacted.
Validity
The validity of an instrument shows how well the
instrument measures what it seeks to measure. In
questionnaires, the establishment of validity usually relies
on content (Isaac & Michael, 1990). The literature review
indicated a consensus of the importance of a team approach
to assessment (Edwards & Hanley, 1992; Fields, 1991;
Deterding, Youngstrom, & Dunn, 1991; Campbell, 1987). It
also provided an overview of the appropriate components of a
technology assessment (Church & Glennon, 1992; Jacobs, 1993;
32
Williams & Stemach, 1993). Thus, the survey question
addressing evaluation factors (question II-5) was based on
the literature review. As already stated, the other survey
questions were checked for clarity and understanding in the
pilot study.
Procedures
Once the survey pilot study and questionnaire revision
was completed, all SELPAs in Orange County were contacted to
ascertain whether they had programs serving students with
severe physical or multiple handicaps. Appropriate special
education and CCS administrators were contacted and given a
verbal explanation of the research study via telephone
conversations. The numbers of appropriate professionals to
be surveyed were then obtained. However, individual names
and addresses were not obtainable, as originally intended,
due to confidentiality issues. The questionnaires were
mailed to these administrators, in packet form, along with a
follow-up letter of introduction and explanation. Each
questionnaire had attached a letter of explanation (Appendix
C) and was accompanied by a stamped, self-addressed envelope
to encourage a greater rate of return.
As this research project only involved a questionnaire
survey, and there were no attendant discomforts or risks to
respondents, an informed consent letter was not necessary.
Instead, respondents' verbal consent was implied by their
returning the survey. Follow-up postcard reminders were
33
originally intended to be sent but again confidentiality
made this impossible. The cutoff date for survey return was
to be six weeks after the initial mailing but going through
various administrative channels slowed the process down and
the actual data collection period grew to a three month
period.
Initially, a sample size of approximately 200 was
expected, however, a total of 376 surveys were sent out with
a return of 226. This gave a 60% return rate. As the return
rate is traditionally low for mailed surveys, this was a
very encouraging response. The surveys were received by this
researcher and examined to eliminate those which did not
meet the minimal criteria. Eligible responses were tallied
and analyzed in terms of frequencies and percentages.
Data Analysis
The sample was described with the demographic data
collected. Simple descriptive statistics, frequencies and
percentages for categorical variables, were used in
analyzing the data from the survey. A subject was deleted
from the analysis of a questionnaire item when no response
was indicated.
CHAPTER IV
RESULTS
The data consists of responses to the research
questions by school personnel who work with children with
severe physical or multiple disabilities in Orange County
public schools. These included occupational therapists,
physical therapists, speech/language pathologists, and
teachers with credentials to teach children with severe
physical or multiple disabilities. Of the 376 questionnaires
sent out, 226 were returned, yielding a response rate of
60%. As the surveys were distributed through administrative
channels, it is uncertain as to total numbers of
professionals by category who received the survey. This may
have caused some duplication of responses as some
professionals do work at multiple sites. However, some
factors were quickly apparent.
One hundred twenty five of the respondents were
teachers, with many of these having over 10 years experience
in working with this disability group. Teachers having
credentials to teach children with severe handicaps were the
largest number to respond. However, although physical and
occupational therapists employed by CCS numbered only 11%
and 13% respectively of the survey respondents, nearly all
of them returned their surveys. These therapists noted their
experience with all ages of children and all work settings.
The many responses seem to indicate the interest in this
subject.
Dissatisfaction was expressed by many respondents as to
the present system of evaluation of the assistive technology
needs of their students/patients. However, value was also
placed by most respondents on the use of assistive
35
technology and on having technology experts available to
help evaluate and train professionals in its' use.
Survey results are presented in the next section in the
form of frequency distributions and percentages. Demographic
data is presented first followed by responses to the
research questions. A summary of the major findings ends the
chapter.
Table 1 lists the professions of the survey
respondents. Therapists employed by California Children
Services gave almost a 100% response although only 11% and
12% respectively of all respondents.
Table 2 shows that over 40% percent of respondents
worked in Special Day Classes. Nineteen percent work in
Special Centers for the Severely Handicapped, almost the
same number as at Medical Therapy Units (MTUs). However, CCS
therapists, although based at MTUs, deal with all education
settings. Other respondents who reported working at all
sites were primarily speech/language pathologists.
Table 3 shows that over half of the respondents have
had over ten years experience, and over 70% at least five
years experience. Table 4 shows a similar statistic across
all professions except for physical therapists. The mean for
each profession was also surprisingly similar.
Table 1
Professions of Survey Respondents
Profession Number Percent
Teacher-SH Credential 110 51%
Speech Language 38 18%
Occupational Therapist 24 11%
Physical Therapist 27 12%
Teacher-OH Credential 10 5%
Dual SH/OH Credentials 5 2%
Augmentative 2 1%
Total 216 100%
Note. SH = Credentialed to teach children with severe
handicaps. OH = Credentialed to teach children with
orthopedic handicaps.
37
Table 2
Worksites of Respondents
Worksite Number Percent
Special Day Class 92 43%
Medical Therapy Unit 48 22%
Special Center for the 40 19%
Severely Handicapped
Integrated Classroom 20 o%
All of the Above 16. 7%
Total 216 100%
38
Years
< 1
1 > 3
3 > 5
5 > 10
over 10
Table 3
Years Experience Working with
Children with Severe Disabilities
Number
30
24
36
118
Percent
3%
14%
11%
17%
55%
Total 214 100%
Table 4
Years Experience (>10) by Profession
Profession Number Percent Mean
Teacher 72 58% 4.6
Speech Language Pathologist 22 58% 4.2
Occupational Therapist 11 54% 3.9
Physical Therapist 11 41% 3.5
NOTE; Percentiles are of the total # of respondents in
each professional category.
39
Occupational and physical therapists, as indicated in
Table 5, tend to work with all ages in more or less equal
proportions. However, a much higher proportion of speech
language pathologists work within the 4-10 year age groups
than with children over 10 years of age.
Table 5
Ages of Children Worked With
Age in Years
Profession 0-3 4-5 6-7 8-10 11-14 15-21
Teachers 2 38 15 31 22 29
SLP 6 26 29 28 12 13
OT 18 24 24 24 18 17
PT 26 27 27 27 26 26
Note: SLP = Speech/Language Pathologist; OT = Occupational
Therapist; PT = Physical Therapist.
One hundred ninety five respondents reported that their
students/patients had severe physical or multiple
disabilities (question 1-4) with all disability categories
included in the questionnaire reported. The questionnaire
did not make provision for listing numbers of children with
particular disabilities so this question could not really be
broken down. However, cerebral palsy and developmental
40
delays were among the most frequently reported categories of
disability.
Table 6 shows that 92% of the respondents felt that
assistive technology of the type denoted in the survey, that
is, computer-based technology, adapted switches, or
augmentative communication devices, was of some or great
importance to their students/children (question 1-8). Over
half of the respondents felt it to be of great importance.
ImDortance
Table 6
of Assistive Technoloay
Importance Number Percent
Great Importance 113 54%
Some Importance 79 38%
Little Importance 12 6%
No Importance 4 2%
Total 208 100%
Table 7 summarizes the methods of training of 216
respondents in using assistive technology (question 1-7).
The high number of responses, over double the number of
respondents, indicates that multiple training methods are
most commonly experienced. The most frequent method of
training was by inservice, with almost one third of
respondents having used this method. Workshops and self-
teaching were the next most common.
Table 7
Methods of Trainina of Respondents
in Usina Assistive Technolocrv
Method Number Percent
Inservice 153 30%
Workshop 105 21%
Self-taught 83 16%
Conference 71 14%
College Class 67 13%
None 30 6%
Total 509 100%
A breakdown of methods by profession is provided in
Table 8. Across professions, inservices and workshops seem
to be the most common methods of training although no method
really stands out. Interestingly, occupational therapists
not only had the highest percentage of professionals
reporting no technology training but also, while a
significant number of teachers reported self-teaching, no
occupational therapists reported this method.
42
Table 8
Training Methods bv Profession
Method Teacher SLP OT PT Total
Inservice 84 33 19 17 153
(28%) (30%) (37%) (34%) (30%)
Workshop 65 20 11 9 105
(22%) (18%) (21%) (18%) (21%)
Self-taught 56 20 0 7 83
(19%) (18%)
(14%) (16%)
Conference 40 19 5 7 71
(13%) (17%) (10%) (14%)
(14%)
College Class 45 13 6 3 67
(15%) (12%) (12%) (6%) (13%)
None 8 4 11 7 30
(3%) (4%) (21%) (14%) (6%)
Total 298 109 52 50 509
Note: %s = percent of responses by professional category.
Teacher categories were grouped together as were
speech language pathologists and augmentative
communication specialists. SLP = speech/language
pathologist; OT = occupational therapist; PT =
physical therapist.
43
Question 1-9 asked whether respondents used technology
with their students/children and, if they did, how often was
it used? Over 75% of the respondents to this question
reported that they did use assistive technologies of
different types with their students/children. As Table 9
indicates, of this 75%, almost half used technology daily
and over three fourths used it at least several times a
week.
Table 9
Frequency of Assistive Technology Use
by Professionals
Frequency Number Percent
Daily 74 45%
2-3 times per week 52 32%
2-3 times per month 25 15%
1 time or less per month 14 81
Total 165 100%
Respondents reported the use of many types of assistive
technology (question 1-10), with computers being used by at
least 90% of all teachers, and adaptive switches used by 88%
of occupational therapists (Table 10). All devices were
reportedly used by all professions although physical
therapists tended to use these devices less often. However,
as alternate keyboards, touch windows, joysticks are usually
interfaced with computers, these are not necessarily
exclusive categories. Joysticks are also a means of guidance
for power wheelchairs and may also be used with a computer
and specialized software in pretraining for these
wheelchairs. Adaptive switches may or may not be used with a
computer as, in some circumstances, they are utilized to
activate toys, appliances, or other electrically powered
devices. Communication devices may be interfaced with a
computer although they are often freestanding. Pointers or
mouthsticks may of course be used with all of the other
technologies.
Respondents were also asked to prioritize the factors
that would most encourage them to use assistive technology
(question II-9). However, more than a few respondents simply
indicated factors without prioritizing. Consequently,
factors are listed by number of respondents and percentages
rather than with an indication of priority (Table 11).
45
Table 10
Profession
Technology Teacher SLP OT PT Total
Computer 112 27 16 5 160
(90%) (71%) (67%) (19%) (75%)
Alternate 62 14 11 1 88
Keyboard (50%) (37%) (46%) (4%) (41%)
Adaptive 78 23 21 19 141
Switches (62%) (61%) (88%) (70%) (66%)
Touch Window 60 18 11 1 90
(48%) (47%) (46%) (4%) (42%)
Communication 71 23 13 7 114
Devices (57%) (61%) (54%) (26%) (53%)
Head Pointer/ 21 10 6 5 42
Mouth Stick (17%) (26%) (25%) (19%) (20%)
Language 61 25 10 11 107
Board (49%) (66%) (42%) (41%) (50%)
Note. Teacher categories were combined. SLP = speech
language pathologist, OT = occupational therapist,
PT = physical therapist.
46
Table 11
Factors Which May Encourage Assistive Technology Use
Factors Number Percent
Training in Applying 125 20%
Technology
Support 113 19%
Knowledge of Available 103 17%
Products
More Funding 90 15%
More Time 70 11%
More Comprehensive 62 10%
Evaluation
Increased Staffing 51 8%
Total 614 100%
Research Questions
Section II of the survey dealt with the assistive
technology assessment process and respondents' attitudes
toward this process. These responses answer the research
questions posed in this study.
Research Question 1: Are assistive technology needs for each
child being addressed in the IEP process?
Two hundred and nine professionals responded to
Question II-8. Only 46% were able to state that the
consideration of assistive technology definitely was a part
47
of the IEP process. More than a third stated that it was not
an IEP issue.
Research Question 2: Are assistive technology assessments
going on in the public schools in Orange County, California,
and, if so, for what technology?
Of 213 valid responses to this item, almost the same
number of respondents reported that assessments were done as
reported that they were not. That is, less than half of the
settings do not specifically assess the technology needs of
their students with severe disabilities (Table 12). Even
though CCS therapists are occasionally called to other
settings to take part in evaluations, the bulk of their work
is at a particular MTU. It was assumed that CCS therapists
would answer this question for the setting at which they are
based.
Respondents reported that the assessments that were
done were for the technologies listed in Table 13. They were
able to denote more than one type of technology but no one
type of technology really stands out as receiving
assessments more frequently. Assessments for
computers/computer adaptations do show a slightly larger
percentage but this is also a more inclusive category.
48
Table 12
Presence of Childrens' Assistive Technology
Needs Assessments
Profession Yes NO Not Sure Total
Teacher -
SH Credential
37 52 19 108
Teacher -
OH Credential
10
Speech Language 14
Pathologist
17 38
Occupational
Therapist
24
Physical
Therapist
15 27
Teacher - Dual
Credential
Augmentative
Communication
Specialist
Total 84 85 44 213
49
Table 13
Types of Childrens' Assistive Technology Needs Assessed
Technology Number Percent
Computer or computer adaptation 70 27%
Switches 59 23%
Communication Devices 69 27%
Language Boards 60 23%
Total 258 100%
Note. %s are of the total number of responses.
Research Question 3: Is there interdisciplinary or team
assessment for technology and is there a perceived value in
having a team of experts?
Responses to guestion II-3 are summarized in Table 14
and answer the above question. Thirty eight percent of the
172 who responded to this question were able to state that,
yes, there were team technology assessments at their
setting. This figure compares to the 84 respondents, or 39%
in Table 12, who related that assistive technology
assessments of some kind did occur at their work settings.
However, question II-l asked only about assessments, not
whether they were team assessments. Another 39% noted that
team assessments occurred sometimes, although frequency was
not noted.
50
Occurrence of
Table 14
Interdisciplinary Assessments
for Assistive TechnolooY
Team Number Percent
Sometimes 67 39%
Yes 66 38%
No 39 23%
Total 172 100%
Those respondents who indicated that YES or SOMETIMES
team assessments occur also further indicated that teachers
and speech language pathologists were the most frequent
assessment team members. Table 15 summarizes the responses
to this item. Teachers and speech pathologists were named
over twice as often as occupational therapists.
51
Table 15
Childrens' Technology Needs Assessment Team Members
Professional Number Percent
Teacher 120 90%
Speech Language Pathologist 116 87%
Occupational Therapist 54 41%
Augmentative Communication 49 37%
Specialist
Physical Therapist 30 23%
Other 26 20%
Note. %s are the percentages of those who answered
question II-3 (N = 133).
Table 16 illustrates combinations listed by respondents
as assessment teams. Twenty three percent indicated an
interdisciplinary team of four or more disciplines, with
about half indicating a team of three or more. If
interdisciplinary implies three or more professions, with a
representative from at least the teaching, speech, and
therapy professions, it appears that only slightly more than
50% of work settings can report a team process. Thirty six
percent reported that occupational therapists were part of
the team when the team had three or more members.
Table 16
Designated Childrens' Technology Needs
Assessment Team Memhers
Team Members Number Percent
Teacher, SLP 51 38%
Teacher, SLP, ACS 21 16%
Teacher, SLP, OT 17 13%
Teacher, SLP, OT, PT 17 13%
Teacher, SLP, OT, PT, ACS 13 10%
Teacher, ACS 6 5%
Note. %s are the percentage of total respondents who
answered question II-3 (N = 133). Only teams
designated by at least six respondents are listed.
SLP = speech language pathologist, ACS =
augmentative communication specialist, OT =
occupational therapist, PT = physical therapist.
Respondents were also asked how valuable it would be to
have a technology specialist or team of specialists for
assessment and consultation. Table 17 shows that over half
the respondents indicated that it would be of great value to
them to have specialists available for assessments, or
perhaps to increase the workshop or inservice opportunities
that were their primary source of training.
Perceived Potential
Table 17
Value of Technolocry SDecialists
Value Number Percentage
Great Value 113 57%
Some Value 73 37%
Little Value 9 5%
No Value 2
li
Total 197 100%
Research Question 4: What factors are assessed by
occupational therapists?
Multiple factors which could be assessed, and
professions which might assess them, were listed for
question II-5. Respondents could choose what they saw as
potential interactions, although their answers did not
necessarily reflect the actual assessment process going on
at their worksite. In other words, there may be a feeling by
a respondent that a particular professional is qualified to
assess certain factors although this may not be the case.
Although more than one professional may assess a particular
factor, this researcher wanted to know primarily with which
factors respondents felt occupational therapists should
deal. All of the factors are listed in Table 18. A
percentage of respondents felt that occupational therapists
54
should be involved in the assessment of each of the listed
factors. Only cognition and language were not considered
appropriate factors by at least 50% of the respondents.
However, adaptive switches and motor control received the
greatest number of responses.
Table 18
Factors Relating to Childrens' Assistive Technology Needs
Potentially Assessed Bv Occupational Therapists
Factors
Number Percent
Switch Type
157 83%
Motor Control 154 82%
Range of Motion 149 79%
Muscle Weakness 146 77%
Type of Access 142 75%
Visual/Perceptual 131 69%
Positioning 130 69%
Attention Span 102 54%
Cognition 58 31%
Language 30 16%
Note. %s are the percentages of the total # of respondents
who answered this question (N = 189).
55
Research Question 5: Why are occupational therapists not
always used in the assessment process?
One hundred fifty eight respondents answered question
II-4, and Table 19 shows their answers. Note that a greater
percentage of teachers and speech language pathologists than
occupational therapists stated that occupational therapists
were not available. However, a greater percentage of
occupational therapists felt that OT services are used for
other tasks than did both teachers and speech language
pathologists. A general theme seemed to be that a more
appropriate role for occupational therapists was in
addressing daily living skills. However, many respondents
noted that an occupational therapy presence was simply not
there. Few respondents felt that occupational therapy was
not necessary, but a lack of clarity of the occupational
therapist's role was noted by almost 40% of all teachers who
responded.
56
Table 19
Reasons for OT Non-Use in Assessing
Childrens7 Needs for Technology
Profession
Reasons Teacher SLP OT PT Total
OTs not available 54
(39%)
23
(61%)
5
(22%)
1
(7%)
83
(39%)
OTs used for other 3 7 8 3 50
tasks (2%) (18%) (35%) (22%) (24%)
Role of OTs not 31 1 1 1 34
clear (23%) (3%) (4%) (7%) (16%)
OTs are not 3 1 1 1 6
necessary (2%) (3%) (4%) (7%) (3%)
Total 108 38 23 14 212
Note. Teacher categories (Severely Handicapped,
Orthopedically Handicapped, and dual credentials)
are combined. SLP = Speech Language Pathologist, OT
= Occupational Therapist, PT = Physical Therapist.
%s are percentages of the total # in each
professional category.
57
Research Question 6: How satisfied are professionals with
the current system of assessment for childrens' assistive
technology needs?
Responses to Question 11-10 summarized in Table 20
indicate that there is a substantial amount of
dissatisfaction present among professionals. Almost 60% of
the respondents expressed this dissatisfaction. When this is
broken down by profession, the results in Table 21 are seen.
Almost 60% of teachers, about 64% of speech language
pathologists, and 70% of occupational therapists were
dissatisfied, while less than 10% of physical therapists
were.
Table 20
Professionals' Satisfaction with Present System of
Childrens' Technology Needs Assessment
Degree of Number Percent
Satisfaction
Very Satisfied 11 6%
Satisfied 70 36%
Dissatisfied 88 45%
Very 25 131
Dissatisfied
Total 194 100%
Table 21
Satisfaction of Professionals with
Present system of Assessment
Degree of
Satisfaction
Teachers SLP OT PT
Very Satisfied 7 (6%) 2 (5%) 2 (9%) 0
Satisfied 39 (35%) 11 (31%) 5 (22%) 15 (63%)
Unsatisfied 48 (43%) 18 (50%) 14 (61%) 8 (33%)
Very
Unsatisfied 17 (15%) 5 (14%) 2 (9%) 1 (4%)
Note. Teacher categories have been combined.
Research Question 7: Would there be greater use of available
assistive technology if prior comprehensive or
interdisciplinary assessments had been made?
One hundred and seventeen, or 80% of the respondents
who answered this question (N = 148), indicated that they
believed they would indeed be able to use their existing
technology more if a prior comprehensive or
interdisciplinary assessment had been done to match the
needs of the child with the technology before acquiring it.
In summary, despite a prevalent feeling that assistive
technology could be important in the lives of children with
severe physical disabilities, there does not seem to be any
systematic interdisciplinary assessment. Further, more than
half of those surveyed were unhappy with current assessments
59
going on at this time. Occupational therapists were ranked
behind speech pathologists and teachers as assessors of the
technology needs of these children even though most
respondents felt that occupational therapists were capable
of assessing most of the factors noted as important in an
assessment process. An unavailability of occupational
therapists was noted frequently but many respondents also
noted that they either were not clear as to the role of an
occupational therapist in this area, or they felt that
occupational therapists simply were not necessary in the
assessment process. Less than half of the respondents could
state that assistive technology was considered as part of
the Individualized Education Plan (IEP) but more than 50%
felt that it would be valuable to have a technology expert
available. It seems that even though there is an apparent
lag in the delivery of technology services in any systematic
way, there is also an interest in having more services
available.
CHAPTER V
DISCUSSION
This study was an attempt to ascertain the extent to
which an interdisciplinary assessment process is used in
Orange County public schools to evaluate children with
significant physical or multiple disabilities for their
assistive technology needs. It also attempted to determine
how much occupational therapy involvement there is in this
assessment process. Also examined were the attitudes of the
professionals working with these children toward assistive
technology, and the frequency of technology use. As this
study originated through a personal interest of this
researcher, the various responses were interesting and
enlightening. This discussion section is divided into three
parts: (1) comparison of this study's findings with those
noted in the literature review, (2) implications of the
findings, and (3) recommendations for further research.
Comparison of Findings
Legislation now requires the consideration of assistive
technology in the IEP process as a part of the transition to
postsecondary education, vocational programs, and adult
living (Leubben, 1992). Technology is reportedly used often
in Orange County schools. That only a third of the survey
respondents could report that assistive technology
consideration was a part of the IEP process seems to
indicate that there is either an unawareness of the
legislative mandate in P.L. 101-476 (IDEA), or an inability
to carry this consideration out. Informal discussions with
school personnel seem to indicate that there is some
reluctance on the part of administrators to really push for
technology acquisition. This may be due to the expense of
technology rather than a reluctance to try new formats of
education. However, there may also be a lack of
understanding on the part of administrators of capabilities
61
that assistive technology may enable a child to acquire.
That over 20% of respondents reported that they were not
sure whether technology was included in IEP planning
reinforces the idea that communication between professionals
may not be what it could be. If a substantial number of
respondents report that they use assistive technology at
least several times a week but also report a lack of
assessment of technology needs, then are many children being
given technological devices which may or may not be
appropriate for them?
Many professionals also reported using computers,
alternate keyboards, adaptive switches, and communication
devices with their students with severe physical or multiple
disabilities. Successful use of assistive technologies such
as these, in the case of individuals with severe physical
disabilities, is dependent on factors such as motor control,
range of motion, positioning, and visual/perceptual skills.
These are factors which should be evaluated by the
appropriate professionals.
Implications
Personal observation in a variety of special education
settings, and a review of the literature, seemed to indicate
that appropriate interdisciplinary assessment is not always
done. This seemed, in some instances, to lead to what has
been titled "closet technology", devices which go unused
because of a poor match between the child's needs and
62
assistive technology (Leubben, 1993; Page, 1980). Further,
although current legislation mandates that assistive
technology at least be considered for these children in the
Individualized Education Planning (IEP) process, the reality
of the school setting seems to be that an appropriate
interdisciplinary team of personnel are not always
available. Consequently, it is not always possible to
coordinate efforts to adequately consider technology needs.
The results of this survey appear to correspond with these
observations.
Occupational therapists have traditionally been
involved in the acquisition of assistive devices and
technologies. Their ability to look at individuals in a
holistic manner makes them a valuable part of an
interdisciplinary assessment team. However, this survey
revealed that, not only were occupational therapists used as
assessors less frequently than some other professionals, but
they were a part of an assessment team in only about a third
of the time that such teams were used. Further, when either
intermittent or consistent team assessment was reported by
respondents, only a small percentage reported that the team
consisted of all relevant school professionals, that is,
teacher, speech pathologist, occupational therapist, and
physical therapist. When team assessment was used,
occupational therapists were frequently not team members.
63
These figures seem to negate a holistic approach to the
assessment process.
Guidelines of the American Speech-Language Association
state that each member of the interdisciplinary team has a
specific and crucial contribution to make. Occupational
therapists and speech pathologists likewise have noted the
many benefits of interaction between the disciplines
(National Joint Committee for the Communication Needs of
Persons with Severe Disabilities, 1992; Stahl, 1992).
Edwards and Hanley (1992) and Fields (1991) noted that team
format assessments for technology are strongly desirable to
obtain an appropriate match between client and technology.
Despite these references to the importance of drawing from
all disciplines in order to provide the most effective
interventions, occupational therapists were named as
assessors by only 28% of respondents, with physical
therapists receiving a meager 9%. Speech pathologists were
the most frequently named assessors followed by teachers.
The sparse inclusion of physical therapists in the
assessment process is interesting, given that many of these
children with severe disabilities are non-ambulatory and in
wheelchairs as their primary mode of mobility. Physical
therapists have expertise in positioning issues, and proper
positioning, whether in or out of a wheelchair, has a great
impact on the functional skills of individuals with motor
impairments.
The literature dealing with assessment for assistive
technology lists a fairly standard set of factors which
ideally should be included in an evaluation (Church &
Glennon, 1992; Jacobs, 1993; Williams & Stemach, 1993).
While not fully inclusive, these are motor control, range of
motion, muscle weakness, visual/perceptual factors,
attention span, positioning, cognition, and language. Of
particular interest to this researcher were the factors that
respondents felt that occupational therapists should assess.
The largest number of responses were to those factors that
are generally considered within the realm of occupational or
physical therapy, such as motor control and range of motion.
However, a significant number of respondents felt that
occupational therapists could assess any and all of the
listed factors. Given this response, one wonders why there
is not more of an occupational therapy presence in this
assessment process.
When questioned as to why occupational therapists were
not used in the assessment process, a variety of reasons
were given. Very few respondents felt that occupational
therapists were not necessary. However, a significant
portion of teachers indicated that they were really not
clear about the role of occupational therapists in the
assistive technology acquisition process. Only one percent
of speech/language pathologists reported this. More
disturbing is that over a third of all professionals
65
reported that occupational therapists were not available,
with almost two thirds of speech pathologists reporting this
occupational therapist unavailability. This finding seems to
reinforce Stahl's survey results, that only sporadic
occupational therapist/speech pathologist communication
takes place secondary to staff shortages, financial
constraints, and physical barriers (Stahl, 1992).
Many respondents reported that occupational therapists
were used for other tasks. Interestingly, 35% of
occupational therapists gave this answer, making it the most
frequently given reason by occupational therapists.
Significantly, occupational therapists also had the highest
number reporting no training in using assistive technology.
This may, in part, account for the fact that many therapists
are not taking a part in the technology acquisition process.
However, there may also be a feeling of uncertainty on the
part of occupational therapists as to their competence in
using technology. Somerville et al. (1990) had noted that a
lack of trained professionals was a major factor in
inappropriately applied technology. They also found that
many occupational therapists indicated a need for training
in technology service delivery areas. Occupational therapy
curriculums of educational institutions may be a factor in
this by not keeping current with developments in this field.
However, continuing education availability is probably as
important, as is the availability of experts or mentors who
66
can guide professionals through this sometimes bewildering
area. Given this lack of resources, occupational therapists
may well feel that this is an area better handled by other
professionals, or perhaps by an occupational therapist whose
role is more specifically devoted to assessment of
technology needs.
The great majority of respondents found the use of
assistive technology for their students of some importance,
with over half rating it of great importance. However, the
opposite seems to be true in regard to professionals7
satisfaction with the present system of assessment for
technology. Over half expressed varying degrees of
dissatisfaction with the present situation. When these views
are compared with the perceived value of having an assistive
technology specialist, or team of specialists, then the lack
of occupational therapist use in the assessment process
become even more important.
Occupational therapists in the public schools work in
all settings and with all ages of children. Speech
pathologists, while having some representation at all
programs, seem to be more clustered at programs serving
children ages 3-10 years of age. Consequently, the greater
exposure of occupational therapists to all ages might mean
that they also would have the ability to take part in
assessing the technology needs of a greater number of
67
children, assuming time and personnel constraints allow
this.
Many factors were suggested that might encourage
greater technology use. While no one factor clearly stood
out as a majority response, training and support services
were the top responses. Lack of training is one of the
factors mentioned as being responsible for the "closet
technology" syndrome (Page, 1980). As previously stated,
nearly one quarter of occupational therapists responding to
the survey reported no training in the use of the type of
assistive technology addressed in this survey. If
occupational therapists, who traditionally have been
technology users, are untrained, then it seems less likely
that they would be as enthusiastic in promoting its' use as
other professionals.
Knowledge of available products was also a significant
factor quoted. The rapidly expanding scope of assistive
technology has long since grown beyond the point where a
single individual can keep track of new developments. Thus
it becomes even more important that there be a coordinated
team effort in which ideas and resources can be shared.
The survey responses were interesting in that many of
the respondents seemed to use it as an instrument with which
to vent their frustration with the current system. Over half
of the respondents, including almost 70% of occupational
therapists, expressed dissatisfaction with the system of
68
technology acquisition. By profession, 60% of teachers
claimed to be dissatisfied while 64% of speech therapists
did likewise. The similar statistics seem to indicate that
there is, across professions, a desire to find another
method of acquiring assistive technology, such as an
interdisciplinary consultation process.
Other respondents complained that occupational therapy
has become a pull-out program rather than a team approach;
that occupational therapists "choose" not to be involved, as
they claim no expertise in technology; that professionals do
not coordinate services; that many children do not seem
eligible for therapy services; and that CCS therapists do
not usually recommend technology but rather are usually only
involved in daily living skills such as dressing or feeding
training. These complaints and comments lead to the final
question of the survey. Would professionals use existing
technology more if there had been a comprehensive or
interdisciplinary assessment of the student's needs to
determine the technology's appropriateness prior to it's
acquisition? Interestingly, across all professions, the
answers vary by only a small degree. Fifty to sixty percent
in each professional group indicated that they likely would
be using the technology more. This, in itself, seems a clear
indication of the value of having an interdisciplinary team
approach to assessment.
69
Research indicates that unused or "closet technology"
is already an issue of concern for professionals. When
compounded by increasingly scarce financial resources, the
inability to acquire appropriate devices may cause
technology to be seen as an expensive and unnecessary item
in school budgets. The fact that product requisitions are
being more closely scrutinized indicates that this is not
really an unlikely occurrence. However, assuring
appropriateness through comprehensive evaluation may instead
cause technology to be seen as an item which has equal
standing with other, more traditional educational materials.
The fact that occupational therapists are not more
actively involved in, or have not sought out, training in
the area of needs assessment for assistive technology in the
school system seems to imply that uncertainty or
disagreement exists within the profession regarding the role
of occupational therapy in this field. The further fact that
so many other professionals indicated an unawareness of the
role of occupational therapists in the evaluation process
may imply a number of things. There is either a real lack of
communication between disciplines or the lack of an
occupational therapist presence is making itself felt. This
lack of communication certainly must have a negative effect
on the conception of a team effort, not only for
occupational therapists, but for all disciplines. The scarce
70
recognition of physical therapists as important members of
the assessment process seems to reinforce this.
Many respondents felt that occupational therapists
could be involved in the assessment of appropriate factors,
indicating there is some recognition of the potential value
of occupational therapists. This, plus the fact that the
majority of respondents placed value in having an assistive
technology specialist or team of specialists, implies that
there is a real role for occupational therapists in
assessing needs and working with technology in the schools.
The fact that 63% of the respondents noted that occupational
therapists were not available, or were used only for other
tasks, again implies a lack of communication among
professions or a general unawareness of the role of
occupational therapy.
This survey indicated that there is a multifaceted
problem with the issue of providing assistive technology. It
is a problem related not only to the school system but to
other agencies such as California Children Services. There
seems to be a lack of knowledge of the appropriateness of
assistive technology, a lack of training opportunities, and
a lack of personnel to do the assessment and training.
Although legislation states that assistive technology
should be considered as part of each child's IEP, this is
not occuring in all cases. Further, there does not appear to
be any consistent method of assessing the assistive
technology needs of children with severe physical
disabilities in Orange County public schools. Technology
assessment took place in only half of the programs
responding to the survey and, in the cases where it did,
there did not seem to be any real interdisciplinary team
effort. It also seems that the resources of occupational
therapists are not drawn upon in a great many of these
cases. If these findings are typical of school programs in
other locales, what does this mean for this important field.
Recommendations for Further Study
Issues emerged from this research which would bear
further exploration. Recommendations for further study are
listed below:
1. Determine whether "closet technology" is a problem
in Orange County schools. If so, an additional survey
addressing the feasibility of technology banks or lending
programs might be done.
2. The issue of scarce occupational therapist resources
is a difficult, one, given that so many therapists are public
employees and are thus subject to hiring and budget
constraints. However, California Children Services in Los
Angeles County has been able to develop job categories which
designate occupational therapy specialists who deal with
only technology issues. This should also be pursued within
Orange County CCS.
72
3. The issue of the uncertain role of occupational
therapists could well lead in several directions. One of the
more easily addressed would that of interdisciplinary
communication and education. Efforts are currently being
made by the Orange County Department of Education to develop
committees to deal with these issues. One committee would
deal with developing a consistent or standardized technology
evaluation. A second committee would work to develop
awareness of legislation pertaining to assistive technology
in the educational system, funding sources, and
appropriateness of assistive technology for children with
severe disabilities.
A strong statement of preference for either a
technology specialist, or for an interdisciplinary team of
experts, did not emerge from this study. However, it is
clear that there is a real need for expert input of some
kind regarding the evaluation of assistive technology needs,
as well as training in technology use. As a representative
of California Children Services in Orange County, this
researcher has been invited to become a member of these
committees. In such a position, I would be able to give
input regarding the importance of occupational therapists as
team members in the evaluation of the assistive technology
needs of children with severe disabilities. I would also be
able to take part in the process of interdisciplinary
communication so that an awareness of the varied and
important roles of occupational therapists can be developed
among all professions. It is also my intention to develop a
proposal for a job position to address these needs. This
proposal is listed in Appendix D.
74
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78
Appendix A: Agencies Contacted for Survey
Orange County Health Care Agency
California Children Services
Medical Therapy Units (MTUs)
Lord Baden Powell MTU
2911 Stonybrook Drive
Anaheim, CA 92804
(714) 761-093
Carl Harvey MTU
1635 S. Center Street
Santa Ana, CA 92704
(714) 241-6436
Richard Henry Dana MTU
24242 La Cresta
Dana Point, CA 92629
(714) 831-0172
Urbain Plavan MTU
9675 Warner Avenue
Fountain Valley, CA 92708
(714) 963-4593
Philip J. Reilly MTU
24171 Pavion
Mission Viejo, CA 92692
(714) 587-8590
John Tynes MTU
735 Stanford Drive
Placentia, CA 92670
(714) 993-2093
Woodcrest MTU
1300 South Richman Avenue
Fullerton, CA 92632
(714) 992-4292
Orange County Department of Education
200 Kalmus Drive
Costa Mesa, CA 92628-9050
Anaheim City SELPA
Anaheim City School District
890 South Olive
Anaheim, CA 92805
(714) 535-6001
79
Garden Grove SELPA
Garden Grove Unified School District
10331 Stanford Avenue
Garden Grove, CA 92640
(714) 663-6233
Greater Anaheim SELPA
501 Crescent Way
Anaheim CA 92803
(714) 778-2791
Irvine SELPA
Irvine Unified School District
5050 Barranca Pkwy
Irvine, CA 92714
(714) 651-0444
Newport-Mesa SELPA
Newport-Mesa Unified School District
1601 Sixteenth St.
Newport Beach, CA 92663
(714) 760-3503
North Orange County SELPA
Hermosa Drive School
400 E. Hermosa Dr.
Fullerton, CA 92663
(714) 870-4850
Northeast Orange County SELPA
Placentia-Yorba Linda Unified School District
1301 E. Orangethorpe Ave.
Placentia, CA 92670
(714) 996-2550
Orange SELPA
Orange Unified School District
370 Glassell St.
Orange, CA 92666
(714) 997-6229
Santa Ana SELPA
Santa Ana Unified School District
1405 French St.
Santa Ana, CA 92701
(714) 556-0331
South Orange County SELPA
O'Neill School
24701 San Doval Ln.
Mission Viejo, CA 92691
(714) 859-0331
Tustin SELPA
Tustin Unified School District
300 South C St.
Tustin, CA 92680
West Orange County SELPA
Huntington Beach Union High School District
10251 Yorktown Ave.
Huntington Beach, CA 92646
(714) 964-3339
81
Appendix B: Technology Assessment: Survey
Assistive Technology Assessment Survey
For the purposes of this survey, assistive technology is
defined as "any item, piece of equipment, or product system
that is used to increase, maintain, or improve the
functional capabilities of individuals with disabilities"
(NICHCY, 1991), and that is comprised of computer-based
technology, adapted switches, or augmentative communication
devices, either singly or in combination.
Jeffrey C. Baker, OTR
University of Southern California
Department of Occupational Therapy
(714) 761-0936
Section I
82
1. Your profession (please check any that apply).
Special Education Teacher (SH credential)
Special Education Teacher (OH or PH Credential)
Speech/Language Pathologist
Occupational Therapist
Physical Therapist
Augmentative Communication Specialist
2. Type of program at which you work.
Special Day Class
Special Center for the Severely Handicapped
Integrated classroom or school
Medical Therapy Unit (MTU)
Other (describe)____________________________
3. Ages of the children you work with?
0-3
3-5
5-7
7-10
10-14
14-21
4. Do any of the children you serve have severe physical or
multiple disabilities?
YES ___ No
What types of disabilities do the children you serve
have?
Cerebral Palsy
Developmentally Delayed
Juvenile Rheumatoid Arthritis
Muscular Dystrophy
Spina Bifida
Traumatic Brain Injury
Multiply Handicapped (ex.deaf/blind, cerebral
palsy/retardation)
Communicatively Handicapped
Severely Emotionally Disturbed
Mental Retardation
Other (describe)_________________________________
How many years have you worked with this population?
0-1
1-3
3-5
5-10
over 10
What type of training have you had in using assistive
technology with disabled individuals?
College class
Workshop
Inservice from other professional
Conference
Self-taught
None
84
8. How important do you feel that assistive technology is to
your students/patients?
Great importance
Some importance
Little importance
No importance
9. Do you use assistive technology with your
students/patients?
YES ___ NO
If YES, how often?
Every day
2-3 times a week
2-3 times a month
1 time a month or less
10. What types of technology have you used?
a. Computer
b. Alternate computer keyboard (ie., Unicorn Board,
Power Pad)
c. Adaptive switches
d. Touch Window
e. Communication devices
f. Head pointer/mouth stick
g. Language boards
h. Joystick/mouse
h. Other (describe)____________________________ _____
Section II
Are there specific assistive technology assessments done
at your school or program?
YES ___ NO ___ Not Sure
If YES, for what technology?
Computer or computer adaptations
Switches
Communication devices
Language boards
Who normally does the assessment?
a. Teacher
b. Speech/Language Pathologist
c. Occupational Therapist
d. Physical Therapist
e. Augmentative Communication Specialist
f. other_________________________________
Are assessments done in a team format (more than one
professional working together)?
YES ___ NO Sometimes
If YES or Sometimes, who are the team members?
a. Teacher
b. Speech/Language Pathologist
c. Occupational Therapist
d. Physical Therapist
e. Augmentative Communication Specialist
f. other
86
If an occupational therapist does not normally do the
technology assessment, or is not on the assessment team,
is it because:
Occupational therapy services are used for other
tasks.
Occupational therapy services are not necessary for
technology assessment.
The role of occupational therapy services with
assistive technology is unknown or unclear.
Occupational therapists are not available.
In evaluating for assistive
these factors?
technology, who should assess
a. Cognition Teacher OT PT Speech
b. Type of access Teacher OT PT Speech
c. Sitting balance or
positioning
Teacher OT PT Speech
d. Switch type Teacher OT PT Speech
e. Range of motion Teacher OT PT Speech
f . Visual/perceptual
skills
Teacher OT PT Speech
g-
Motor control Teacher OT PT Speech
h. Muscle weakness Teacher OT PT Speech
i . Language Teacher OT PT Speech
j-
Attention span Teacher OT PT Speech
87
6. If your students have developmental or emotional
disabilities such as retardation or autism rather than
severe physical or multiple disabilities, and you do use
assistive technology, is there an assessment process you
use before acquiring this technology?
7. If you work with students with severe physical or
multiple disabilities but do not use assistive
technology, briefly explain why.
8. Is assistive technology considered for each of your
students/patients in the Individualized Education Plan
(IEP) process at your work site?
YES ___ NO Not sure
9. What factors would most encourage you to use assistive
technology? (Please prioritize from 1-7)
training in applying technology
more time
support service (technology expert)
knowledge of what is available
more funding
increased staffing (classroom aid or therapy
assistant)
an evaluation that would help ensure that technology
is appropriate to the student/patient.
88
10. How satisfied are you with the present system of
evaluation and acquisition of assistive technology at
your program?
Very Satisfied
Satisfied
Unsatisfied
Very Unsatisfied
11. How important would it be for you to have an assistive
technology specialist or team of technology specialists
available for assessment and consultation?
Great Importance
Some Importance
Little Importance
No Importance
I would like to know the results of this survey:
YES NO
"Thank you for your participation and for returning
the questionnaire promptly."
Appendix C: Letters of Introduction
89
Jeffrey C. Baker, OTR
8423 Leeward Dr
Huntington Beach, CA 92646
(714) 761-0936 (Wk)
(714) 969-1739 (Hm)
Date
Dear Colleague:
I am a CCS therapist in Orange County, and a graduate
student in Occupational Therapy at the University of
Southern California. As partial fulfillment of a Master of
Arts degree, I am examining the assessment procedures used
to determine the need for assistive technology for children
who have severe physical or multiple disabilities.
Because this study involves only public school systems in
Orange County, the sample size is already limited. As a
result, every response is needed to establish any valid
conclusions. Your participation should require only about
twenty to thirty minutes. A stamped, self-addressed envelope
is included for your convenience. All responses will remain
confidential.
Responses are requested by ________ . Results of the study
will be forwarded to all interested respondents upon
request. Thank you for your time and consideration.
Sincerely,
Jeffrey C. Baker, OTR
90
Jeffrey C. Baker, OTR
8423 Leeward Dr
Huntington Beach, CA 92646
(714) 761-0936 (Wk)
(714) 969-1739 (Hm)
January 24, 1994
Dear Administrator:
I am a CCS therapist and a graduate student at the
University of Southern California. As partial fulfillment of
a Master of Arts degree, I am examining the assessment
procedures used to acquire assistive technology for children
with severe disabilities. Such technology would include
computer adaptations, switch-based technology, and
augmentative communication devices. My concern is that
expensive technology is not always appropriately applied to
our students with severe disabilities. This may, in part, be
a result of the lack of comprehensive evaluations involving
an interdisciplinary team of professionals. My own bias is
in knowing the extent to which occupational therapists, who
traditionally work with adaptive technology, are involved in
this evaluation process.
I intend to survey teachers, speech/language
pathologists, and occupational and physical therapists to
acquire basic demographic information and to learn their
attitudes toward technology and the process of acquiring it.
Responses will be confidential and survey results will be
made available on request. The survey will be accompanied by
a stamped, self-addressed envelope and the only expense to
participants will be the twenty minutes needed to fill out
the survey. Names and work sites of potential respondents
would be appreciated, so that information can be clarified,
if needed; or to resurvey respondents should further
research in this area be desirable. If it is not possible to
obtain these names, then I would still like to distribute
the survey through the appropriate channels. Because this
study involves only public school systems in Orange County,
the sample size is already limited. As a result, every
possible response is needed to establish any valid
conclusions.
Thank you for your consideration,
Jeffrey C. Baker, OTR
91
Appendix D
Proposal for a CCS Occupational Therapist
Technology Resource Specialist Position
Assistive technology has great potential to enhance the
functional abilities of children with severe physical or
multiple disabilities. There are many assistive technology
products already available and many technology solutions.
Funding for technology is available through various sources
but is being scrutinized more closely for appropriate use.
Among the difficulties in acquiring appropriate technology
is learning:
a. what products are available
b. what is possible with technology
c. how can a technological solution be implemented
d. where can assistive technology be acquired
Most importantly, it is critical that a comprehensive
evaluation of the assistive technology needs of the child be
done by a professional or interdisciplinary team of
professionals who are knowledgeable about technology. This
problem could be addressed in part by an Occupational
Therapy Technology Specialist, a position which would be
modeled on the specialist positions now used in Los Angeles
County.
Briefly, the Technology Specialist would assess the
technology needs of children but would also rely on the
treating therapist's evaluation and input. The specialist
92
would also collaborate with the speech therapist, if
applicable, and with the child's teacher. Assessment would
be done at the individual's MTU but could also include
visits to the specialist's site. A model technology site
might be feasible at some point but as the trend now is to
disperse and integrate special education classes, this might
be difficult. The proposed Specialist position is as
follows:
Job Title: Occupational Therapy
Technology Resource Specialist
Proposed Definition of Assignment: Develop and provide
access to assistive technology for children with physical
and/or multiple handicaps. Implement consultation and
training with staff, caregivers, and related agencies to
increase the child's functional communication skills,
computer access, or environmental control.
Examples of Duties:
Assessment:
1. Assesses child to determine his/her need for assistive
technology.
Consultation:
1. Consults with occupational therapists, physical
therapists, teachers, speech pathologists, and other
professionals to determine the needs for assistive
technology.
93
2. Consults with outside agencies to coordinate services
for the child.
3. Consults with vendors and manufacturers regarding
technological devices.
4. Identifies product availability.
5. Participates in, and consults with, school assessment
or IEP teams.
Administration:
1. Approves assistive technology requests after analyzing
cost vs function, appropriateness of devices, and
compatibility with existing equipment.
Education:
1. Creates and maintains product database and remains
knowledgeable of new advances in technology,
2. Develops and presents training programs to staff and
outside agencies depending on needs.
3. Provides inservice training to new employees and
affiliating students.
Research:
1. Participates in the development of new equipment.
2. Explores funding sources to obtain equipment for
assessment purposes.
This specialist position would have among its goals
that of developing technology competencies. Among these
would be:
1. Describe methods for applying and integrating
technology within the service delivery system.
2. Explain applications of technology across major
categories of disability.
3. Describe potential roles and qualifications of members
of technology evaluation teams.
4. Define terminology related to assistive technology.
5. Evaluate, select, modify, and adapt assistive
technologies.
6. Describe potential benefits and limitations of
technologies as applied to individuals and settings.
7. Describe strategies for basic troubleshooting.
Methods for achieving these competencies would include:
1. lectures and slide shows
2. product demonstrations
3. practice labs
4. case studies
5. treatment plans
6. invited speakers
7. vendor demonstrations
8. database and bibliography searches
Projection of Implementation:
While it is difficult at this point to develop
timelines, should the proposal be accepted, there are
several things which should be implemented within the first
three to six months. Among these are:
1. Survey CCS occupational and physical therapists to
determine specific training needs.
2. Determine extent and availability of existing
technological products within the CCS system with the
intent to develop a lending library of products for
trial and assessment purposes.
3. Examine and evaluate existing technology needs
assessment forms, with input from other therapists, to
begin development of a consistent tool to be used
county-wide.
This would be a position which hopefully would develop
into an interdisciplinary collaboration with school agencies
and professionals.
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Asset Metadata

Creator Baker, Jeffrey Charles (author)

Core Title The use of occupational therapists or interdisciplinary teams in the evaluation of assistive technology needs of children with severe physical disabilities in Orange County schools

School Graduate School

Degree Master of Arts

Degree Program Occupational Therapy

Degree Conferral Date 1995-12

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

Tag education, special,education, technology of,health sciences, occupational health and safety,OAI-PMH Harvest

Language English

Contributor Digitized by ProQuest (provenance)

Advisor Zemke, Ruth (committee chair), Frank, Gelya (committee member), Neville-Jan, Ann (committee member)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c18-9605

Unique identifier UC11357921

Identifier 1378398.pdf (filename),usctheses-c18-9605 (legacy record id)

Legacy Identifier 1378398-0.pdf

Dmrecord 9605

Document Type Thesis

Rights Baker, Jeffrey Charles

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