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A Person-Centered Assistive Technology Service Delivery Model: A Framework for Device Selection and Assignment

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Background. The introduction of assistive technology (AT) into people’s lives is a deliberative and long-term process, which presupposes teamwork as much as professionalism, time, and experience. The aim of the assistive technology assessment (ATA) process is to suggest guidelines to follow in order to reach valid results during the AT selection and assignment process. Purpose. Critically discuss the application of the model of the ATA process developed by Federici and Scherer in the 2012. Method. Cross-cultural comparison of AT service delivery systems and discussion of the ATA process model adopted by Leonarda Vaccari Institute of Rome. Conclusion. Nowadays, the wide variety of AT devices on the market opens new frontiers to the individual’s enhanced functioning, inclusion, and participation. Since the choice of the most appropriate match is often a complex process, a systematic selection process such as the ATA process described in this article can help practitioners to efficiently achieve successful outcomes.
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Life Span and Disability XVII, 2 (2014), 175-198
175
A Person-Centered Assistive Technology Service
Delivery Model: a framework for device selection and
assignment
Stefano Federici1, Fabrizio Corradi2, Fabio Meloni3, Simone Borsci4,
Maria Laura Mele5, Saveria Dandini de Sylva6
& Marcia J. Scherer7
Abstract
Background: The introduction of assistive technology (AT) into people’s
lives is a deliberative and long-term process, which presupposes
teamwork as much as professionalism, time, and experience. The aim of
the assistive technology assessment (ATA) process is to suggest
guidelines to follow in order to reach valid results during the AT
selection and assignment process. Purpose: This paper aims to critically
discuss the application of the model of the ATA process developed by
Federici and Scherer (2012c). Method: A cross-cultural comparison of
1 Department of Philosophy, Social & Human Sciences and Education, University of Perugia, Perugia, IT.
E-mail: stefano.federici@unipg.it;
2 Leonarda Vaccari Institute for Rehabilitation Integration and Inclusion of Persons with Disabilities,
Rome, IT. E-mail:fabrizio.corradi@gmail.com;
3 Department of Philosophy, Social & Human Sciences and Education, University of Perugia, Perugia, IT.
E-mail:fa.meloni@gmail.com;
4 Human Factors Research Group, Live Augmented Reality Training Experience project (LARTE),
Nottingham University, Nottingham, UK. E-mail:simone.borsci@gmail.com;
5 Department of Philosophy, Social & Human Sciences and Education, University of Perugia, Perugia, IT.
E-mail:marialaura.mele@gmail.com;
6 Leonarda Vaccari Institute for Rehabilitation Integration and Inclusion of Persons with Disabilities,
Rome, IT. E-mail:presidenza@leonardavaccari.it;
7 The Institute for Matching Person and Technology, Webster, NY, USA.E-mail:IMPT97@aol.com;
Correspondence to: Prof. Stefano Federici, Department of Philosophy, Social & Human Sciences and
Education, University of Perugia, Piazza G. Ermini 1, 06123 - Perugia, IT; E-mail:
stefano.federici@unipg.it; Tel.: +39 347 3769497.
The authors report no conflicts of interest.
Received: September 20, 2013; Revised: April 24, 2014; Accepted: May 5, 2014
© 2014 Associazione Oasi Maria SS. - IRCCS
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AT service delivery systems and discussion of the ATA process model
adopted by the Leonarda Vaccari Institute of Rome was conducted.
Conclusion: Currently, the wide variety of AT devices on the market
opens up new frontiers for the individual’s enhanced functioning,
inclusion, and participation. Because the choice for the most appropriate
match is often a complex process, a systematic selection process such as
the ATA process described in this article can help practitioners to
efficiently achieve successful outcomes.
Keywords: Assistive technology assessment process; Assistive
technology service delivery; Matching person and
technology; ICF; Rehabilitation technology; User-centered
delivery process; Assistive technology abandonment.
Assistive Technology Assessment Model
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1. Introduction
The process of matching assistive technology (AT) with a person requires
a well-designed and researched sequential set of assessments that are
administered by professionals with different areas of expertise in specialized
service delivery within rehabilitation technology (Scherer, 2002, 2005;
Corradi, Scherer, & Lo Presti, 2012; Federici & Scherer, 2012a). In the field
of rehabilitation technology, service delivery refers to “the set of facilities,
procedures and processes that act as intermediaries between the AT product
manufacturers and AT endusers” (Stack, Zarate, Pastor, Mathiassen,
Barberà, Knops et al., 2009, p. 28).
A more broad and complete meaning of service delivery is offered in the
United States Assistive Technology Act (United States Congress, 2004)
which, in order to disambiguate and clarify the general term “service
delivery” which could refer to any platform, even one providing architecture
in telecommunications, refers to it by the more suitable nomenclature
“assistive technology service”. The Assistive Technology Act, indeed, better
specifies the variety and nature of the services provided by an AT service,
listing seven different services:
- “(A) the evaluation of the assistive technology needs of an individual
with a disability, including a functional evaluation of the impact of the
provision of appropriate assistive technology and appropriate services
to the individual in the customary environment of the individual;
- (B) a service consisting of purchasing, leasing, or otherwise providing
for the acquisition of assistive technology devices by individuals with
disabilities;
- (C) a service consisting of selecting, designing, fitting, customizing,
adapting, applying, maintaining, repairing, replacing, or donating
assistive technology devices;
- (D) coordination and use of necessary therapies, interventions, or
services with assistive technology devices, such as therapies,
interventions, or services associated with education and rehabilitation
plans and programs;
- (E) training or technical assistance for an individual with a disability
or, where appropriate, the family members, guardians, advocates, or
authorized representatives of such an individual;
- (F) training or technical assistance for professionals (including
individuals providing education and rehabilitation services and entities
that manufacture or sell assistive technology devices), employers,
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providers of employment and training services, or other individuals
who provide services to, employ, or are otherwise substantially
involved in the major life functions of individuals with disabilities;
and
- (G) a service consisting of expanding the availability of access to
technology, including electronic and information technology, to
individuals with disabilities” (United States Congress, 2004, p. n. a.).
Having made the term service delivery clear, we also wish to clarify the
use of the term AT in this paper. According to A Glossary of Terms for
Community Health Care and Services for Older Persons, we use AT as “an
umbrella term for any device or system that allows individuals to perform
tasks they would otherwise be unable to do or increases the ease and safety
with which tasks can be performed” (United States Congress, 2004, p. 10).
This broad meaning of AT is more commonly attributed to the term
“Assistive technology device”, as stated in the Assistive Technology Act
(United States Congress, 2004) and acknowledged by the WHO and World
Bank in the World Report on Disability, defined as follows: “Any item,
piece of equipment, or product system, whether acquired commercially,
modified, or customized, that is used to increase, maintain, or improve
functional capabilities of individuals with disabilities” (WHO & World
Bank, 2011, p. 101).
The purpose of this study is to critically discuss the application of a
model of the assistive technology assessment (ATA) process, developed by
Federici and Scherer (2012c), in a service delivery system. In the first
section, we will present the service delivery features including the
assessment of and matching with persons when AT was provided; a
subsequent section will describe the model of the ATA process adopted by
the AT service delivery team.
2. Method: Cross-cultural comparison of AT Service Delivery
Systems and discussion of the ATA Process Model
2.1. The Centre for AT Evaluation of Rome, Leonarda Vaccari Institute
The model of the ATA process developed by Federici and Scherer
(2012c) with contributions by 55 researchers from five continents, is not the
result of mere academic exercise, but emerges from evidence-based data
provided by applied research on the model (Müller, 2012). Beyond the
practical experiences of each contributor in developing the ATA process
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(Federici & Scherer, 2012c), the ATA ideal model has been tested in the
Center for AT evaluation of Rome, thanks to the scientific and clinical
collaboration and economic and operational support of the Leonarda Vaccari
Institute - which, in turn, is part of the Italian Network of Centers Advice on
Computer and Electronic Aids and cooperates with the Institute for
Matching Person & Technology. The Leonarda Vaccari center (hereafter
Center) for AT evaluation offers non-commercial advisory services and
support for AT and computers for communication, learning, and autonomy.
The service is free of charge for users who access it through the Italian
National Health Service.
According to the definitions of the Assistive Technology Act (United
States Congress, 2004), the Center for AT service covers five (A, C, D, F,
and G) of the seven services characterizing an AT service, as quoted above
in the previous section. According to a trans-cultural taxonomy as stated by
the United States Congress, we acknowledge how much the Italian AT
service delivery system permeates the Center model with features that might
remain hidden in a cross-cultural viewpoint of other health and service
delivery systems. We agree with Smith who compared service delivery in
the field of rehabilitation technology to an iceberg (Smith, 1987).
Before exploring the ATA process, we will now dive a little deeper into
the model of the Center (next sub-section) by turning to the more systematic
modeling of service delivery according to Smith (1987). Smith gives six
considerations or variables affecting service delivery - (1) purpose and
mission; (2) functional areas; (3) geographical catchment area; (4)
population served; (5) internal operation; (6) method (Smith, 1987, p. 13)
and seven models in service delivery in rehabilitation technology (1)
durable medical equipment supplier; (2) department within a comprehensive
rehabilitation program; (3) technology service delivery center in a
university; (4) state agency-based program; (5) private rehabilitation
engineering/technology firm; (6) local affiliate of a national nonprofit
disability organization; (7) miscellaneous types of programs (Smith, 1987,
pp. 15-19).
The first variable regards the “purpose and mission” of a service delivery
program.
“For example, some service delivery programs are based primarily as
evaluation centers, where clients come from all areas within a fairly
substantial geographical region for the purpose of receiving a
comprehensive evaluation and recommendations. Ongoing treatment and
therapy is not a part of the mission of this type of program. On the other
hand, some rehabilitation technology programs are based on a consulting
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model. The nature of these programs is based on a short-term relationship
between the provider and the user” (Smith, 1987, p. 13).
In order to understand the purpose and mission of the Center, we have to
take into consideration that AT devices in Italy are mainly provided through
the National Health Service that underpins specialist healthcare. AT devices
are prescribed by certified physicians (physiatrist, or doctor in rehabilitation
medicine). The prescription must be approved by the local health agency
(Azienda Sanitaria Locale: ASL), who can also refuse the prescription or
require further documentation if the ASL is unsure as to the suitability of the
AT prescribed or because the AT requires a specialized assessment process
(Estreen, 2010). In the latter case, the ASL makes use of an accredited AT
service delivery operating within the National Health Service via contract
with a single ASL. However, users can also access an accredited AT service
delivery center before accessing the ASL’s physician. For the user/patient,
the assessment by an ASL and/or by an AT service delivery center is free of
charge. Only AT services that are not included in the National Health
Service list (document drafted and regularly updated by the Ministry of
Health) or in the National Insurance for Labor Accidents (INAIL) system
must typically be paid for by users themselves. Because the Italian health
care system consists of three levels national, regional, and local regional
and local laws provide several ways to obtain partial or complete
reimbursement (Estreen, 2010).
In view of the situation, an Italian center for AT service delivery never
sells the product chosen by the user or assigns it directly to the user, thus
freeing centers from bias towards any particular product or vendor. The
device provision must be made later by the ASL. Therefore, in an accredited
Italian AT service delivery center, the individual who utilizes it will always
be a user, never a client; sometimes a patient, never a purchaser (Federici &
Scherer, 2012b). This health care system gives major autonomy to the
service delivery center in evaluating and choosing an AT as there is no
conflict of interest between AT evaluation of a user’s needs and AT
manufacturing and distribution market (Stack et al., 2009). This
characterizes well the purpose and mission of the Center as an evaluation
center, where users/patients come from all sectors within a fairly substantial
geographical region for the purpose of receiving a comprehensive evaluation
and recommendations for a device. The Center also offers on-going
treatment and therapy (e.g., logo-therapy, cognitive therapy, pediatric neuro-
psychomotricity therapy) and subsequent follow-ups to check the AT use
and the assistive solution appropriateness over time.
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The functional areas addressed and the populations served by the Center
are children and adults with communication disorders and learning
disabilities. The internal operations of the assessment process are always
conducted by a multidisciplinary team, employees or consultants in the
Vaccari Institute which in turn is accredited by the regional ASL who
finances both the Institute’s programs and each user.
After clarifying the nature and services of the Center by taking advantage
of Smith’s (1987) six considerations of variables affecting service delivery,
the difficulty remains of identifying one among seven models within which
to classify the Center. All seven models in service delivery in rehabilitation
technology - even the seventh, “miscellaneous types of programs”, as stated
by Smith (1987) do not align well with the characteristics of the Italian AT
service delivery. As already mentioned above, adopting USA taxonomies of
service delivery models in a system where 70 percent of the devices are paid
for privately, either out-of-pocket or as gifts (Freiman, Mann, Johnson, Lin,
& Locklear, 2006; Stack et al., 2009) is difficult as, in Italy, almost the total
AT costs are covered by the National Health Service or by the INAIL.
Therefore, the incompatibility of Smith’s taxonomy and the Center model is
due to the inability to reconcile two radically different systems of healthcare:
the American and Italian ones (for an overview of the European service
delivery systems see: Estreen, 2010; Federici & Scherer, 2012a).
2.2. The Assistive Technology Assessment Process in the Center
In a recent report, Stack and colleagues (2009) find basic procedural
steps common to every service delivery system among 21 European
countries:
- Initiative: initiation of the overall service delivery process, the first
contact between the client and the service delivery system.
- Assessment: recognition of the need for an assistive product,
evaluation of needs.
- Typology: recommendation for a type of assistive product,
identification of solution typology, i.e. the appropriate kinds of AT for
meeting needs.
- Selection: selection of the specific set of assistive devices and
services, final choice of the assistive product among the different
types available.
- Procurement/financing: authorization by the financing body, since
private and public funds pay most of the products that are purchased.
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- Usage: actual delivery of AT to the user, also including installation,
personalization and training for the end-user and his/her supporting
environment (family, employer, teacher, caregiver, etc.).
- Follow-up: subsequent follow-ups. Maintenance and, for the longer
term, continuous monitoring that the technical aid is still the
appropriate one for the individual requirements of the disabled
person” (Stack et al., 2009, p. 29).
Figure 1 - Flow chart of the ideal ATA process model (Federici & Scherer,
2012c). On the left is the User Action flow chart and on the right
are the procedures of the AT Service Delivery; the numbers refer
to phases and the small-cap letters designate the steps in each
phase.
These basic procedural steps are also common to the ATA process
(Federici & Scherer, 2012c). It outlines an ideal process that provides
reference guidelines for both public and private centers for provision of
technical aids allowing them to compare, evaluate, and improve their own
matching model. The ATA process borrows a user-driven working
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methodology from the Matching Person and Technology Model (Scherer,
1998; Corradi et al., 2012, p. 52). Furthermore, the ATA model embraces
the International Classification of Functioning, Disability and Health’s
(ICF) bio-psycho-social model (2001) aiming for the best combination of
AT to promote a consumer’s personal well-being.
The ATA process can be read either from the perspective of the user or
from the perspective of the Center (Fig. 1).
Because the ATA process is a user-driven process, any activity in an AT
service delivery center must find correspondence to a user action and vice-
versa. The user’s actions in the ATA process can be grouped into three
phases.
- Phase 1: The user seeks a solution for one or more personal activity
limitations or participation restrictions and seeks assistance from a
center.
- Phase 2: The user checks the solution by trying and checking one or
more technological aids provided by the professionals in a suitable
evaluation setting (Center, house, hospital, school, rehabilitation
center, etc.).
- Phase 3: The user adopts the solution after obtaining the technological
aid(s) from the public health system (or public/private insurance), and
receives training for the daily use of the AT and follow-up.
The actions of the Center can be grouped into four phases.
- Phase 1: (a) The AT service delivery center welcomes a user’s request
by activating an initial meeting at a time and location suitable for the
user/client population. (b) The initial interviewer is focused on
gathering the user’s background information and psycho-socio-
environmental data. (c) After the user provides data to the center, data
are collected and the case is opened and transmitted to the
multidisciplinary team.
- Phase 2: (e) The multidisciplinary team evaluates the data and user’s
request and arranges a suitable setting for the matching assessment.
- Phase 3: (f) The multidisciplinary team, along with the user, assesses
the assistive solution proposed, tries to find the solution and gathers
outcome data. (g) The multidisciplinary team evaluates the outcome of
the matching assessment, then (h) proposes the assistive solution to
the user. When the assistive solution proposed requires an
environmental evaluation, the team initiates the Environmental
Assessment Process (Fig. 2).
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- Phase 4: (j) When the technological aid is delivered to the user, a
follow-up and on-going user support is activated and the assistive
solution is verified in the daily life context of the user.
There are three general considerations about the phases in the ATA
process. First, it is easy to identify within the phases of the ATA process the
basic procedural steps identified by Stack and colleagues (2009). Regarding
the common step procurement/financing, corresponding to phase 4, step
(i) “assistive technology provision” of the AT service delivery, the
authorization for financing must be given by the ASL. Second, in the ATA
process model, AT service delivery does not provide just a device (i.e., AT),
but much more an assistive solution that “does not coincide with assistive
technology, since [… it] is a complex system in which psycho-socio-
environmental factors and assistive technology interact in a non-linear way
by reducing activity limitations and participation restrictions by means of
one or more technologies” (Federici & Scherer, 2012a, pp. 8-9). Third,
keeping the above in mind, it is also clear why in phase 4, step (i) of the AT
Service Delivery, the Center identifies an “AT” that will be provided to the
user by the National Health Service and not an assistive solution. In fact, in
phase 4, we are referring to the provision of an AT device evaluated as
instrumental to reach an assistive solution. The assistive solution is the goal
of the entire process of matching. Hypothetically, an assistive solution may
not require any technological aid, but, for example, changes to fit the
environment.
The ATA process model acknowledges that the environment is
antecedent to the AT and crucial for determining an assistive solution
(Mirza, Gossett Zakrajsek, & Borsci, 2012). According to the ICF bio-
psycho-social model of disability (2001), Environmental Factors (i.e.,
products and technology, the natural and constructed environment, support
and relationships, attitudes and services, systems and policies) and Personal
Factors (i.e., age, sex, race, motivation and self-esteem) belong to
Contextual Factors. Therefore, we define the environment in the ATA
process as any context in which the AT is used by a person, according to the
WHO’s description of the environment as the “world in which people with
different levels of functioning must live and act” (2011, p. 5).
Even though an environmental evaluation can occur at any phase of the
ATA process and is considered at its inception (during the user data
collection phase, Figure 1: AT Service Delivery, phase 1, step [c]),
nevertheless the ATA process includes a specific environmental assessment
to be activated when, in the matching process (Fig. 1: AT Service Delivery,
phase 3, step [f]), the assistive solution proposed requires a more accurate
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evaluation of the user’s context of use. The evaluation of cost-benefit
balance for the impact of the AT on the environment can lead the
multidisciplinary team and the user to proceed either by modifying the
environment, changing the AT, or both (Fig. 2).
Figure 2 - Flow chart of the Environmental Assessment Process in the ATA
process model (Mirza et al., 2012). The Environmental
Assessment Process expands and describes the rectangle in
Figure 1, phase 3 of the AT Service Delivery entitled
“Environmental assessment process. On the left is the
Environmental Assessment Process flow chart and on the right
are the procedures of the AT Service Delivery. The numbers refer
to phases and the small-cap letters to steps in each phase.
As displayed in Figure 2, we identify three main phases in the
environmental assessment procedure:
- Phase 1: Practitioners assess the impact of the environment for
supporting or obstructing full participation for the user.
If a match between the environment, the user and the AT is obtained,
the assistive solution is found, the environmental evaluation ends
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and the process proceeds with step (g), phase 3 of AT Service
Delivery.
However, if a match does not occur, a cost-benefit balance is
initiated to determine whether either modifying the environment,
changing the AT or both is best.
- Phase 2: Practitioners have to check the economic and socio-cultural
impact of modifications. The modifications can include the
environment, the AT, or both.
- Phase 3: On the basis of the impact analysis, practitioners can take one
of the following decisions: (I) modify the environment; (II) change the
AT; (III) do both of the preceding.
As a consideration for the environmental assessment process, the job of
practitioners involved in an environmental assessment (e.g., architecture,
engineer, psycho-technologist, ergonomist, etc.) should never replace the job
of control, supervision, and assessment carried out by the multidisciplinary
team of an AT service delivery. The environmental assessment, when
needed, supports and integrates the ATA process driven by two main actors:
the user and the multidisciplinary team. In light of this, it should be clear
why it is necessary to restart the environmental assessment process at step
(d), phase 2, in AT Service Delivery when the outcome of the environmental
assessment process suggests a need to modify or change an AT.
2.3. The relevance of the presence of the psychologist in the
multidisciplinary team
Effective team work plays a crucial role in rehabilitation, producing
better patient outcomes. However, there is limited published evidence
concerning what constitutes the key components of successful teams in
rehabilitation programs (Neumann, Gutenbrunner, Fialka-Moser,
Christodoulou, Varela, Giustini et al., 2010). Although the structure, level of
intensity, and services available for rehabilitation vary widely from one area
to another, whether comparing facilities, cities, states, or countries;
nevertheless, there is considerable cross-cultural consistency in the view of
the composition of the rehabilitation team (Scherer & Federici, 2012) from
Singapore (Chua, Ng, Yap, & Bok, 2007) to the USA [Joint Committee on
Interprofessional Relations Between the American Speech-Language-
Hearing Association and Division 40 (Clinical Neuropsychology) of the
American Psychological Association, 2007] and Europe (Gutenbrunner,
Ward, & Chamberlain, 2006, 2007). In this framework, the role of the
psychologist and psychiatrist is well and universally recognized.
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However, we want to call attention to the importance of the
psychologist’s role in AT service delivery because we observe that in the
field of AT the technical features of a device are often focused upon to the
detriment of the psychosocial aspects. A large amount of data on AT
abandonment showed the importance and effects of personal and
psychosocial factors on the non-use and discontinuance of AT use (e.g.:
Phillips & Zhao, 1993; Riemer-Reiss & Wacker, 1999; Riemer-Reiss &
Wacker, 2000; Scherer, Sax, Vanbiervliet, Cushman, & Scherer, 2005;
Verza, Carvalho, Battaglia, & Uccelli, 2006; Söderström & Ytterhus, 2010;
Federici & Borsci, 2011). A recent study carried out by Federici and Borsci
(Federici & Borsci, 2011; Federici & Borsci, under review) in Italy shows
that users receiving an AT device from the Italian National Health System
without both personal support in the initial AT use and a follow-up after the
AT assignation are more likely to not use the AT (24 out of 100) compared
to those users that are included in a structured and personalized AT
assessment process and a well-planned, post-assistance follow-up service. In
this latter case, indeed, the AT non-use falls to 13%.
A basic understanding of human behavior is considered sufficient by
many in the AT field to assess the personal factors of a potential AT user.
Implicitly or explicitly, this seems to be the attitude of several AT service
delivery models (Meloni, Federici, & Stella, 2011; Meloni, Federici, Stella,
Mazzeschi, Cordella, Greco et al., 2012). However, this behavior carries the
risk of under-evaluating the effect of personal factors on effective AT
selection, use, and realization of benefit from use because knowledge of
personal factors is not equivalent to knowledge of subjective dimensions and
individual functioning. Even when assuming team members possess
theoretical knowledge of personal factors, this does not provide them with
the appropriate skills to acknowledge and manage the psychological and
psychosocial facets of an individual’s functioning. The psychologist in an
AT service delivery process provides an appropriate psychological
evaluation or a precise clinical intervention with the users and/or their
significant human context over the course of the whole AT assignment
process. Assigning greater importance to personal factors would help
dramatically reduce the abandonment rate of technologies by users (Phillips
& Zhao, 1993; Riemer-Reiss & Wacker, 1999; Riemer-Reiss & Wacker,
2000; Scherer & Craddock, 2002; Scherer, 2005; Scherer et al., 2005; Verza
et al., 2006; Söderström & Ytterhus, 2010; Meloni et al., 2011; Meloni et
al., 2012).
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Meloni and colleagues (2012) have defined five points in the
psychologist’s role and the professional skills of psychologists in the ATA
process:
1. Identify the user’s personal factors, priorities, preferences, etc. During
user data collection, the psychologist analyzes the clinical and
psychosocial data in order to identify the greatest number of personal
factors that are relevant when matching the user with technology. In
addition, the psychologist will identify the user’s preferences and
priorities in relation to the objective to be achieved through an
assistive solution.
2. Advocating the user’s request in the user-driven process by which the
selection of one or more technological aids for an assistive solution is
reached. Active listening, empathy, and the ability to reformulate in a
shared language the user’s requirements are the main tools employed
by the psychologist at this step. Advocating the user’s requests is also
the psychologist’s task at follow-up.
3. Acting as a mediator between users seeking solutions and the
multidisciplinary team of an AT Service Delivery center. The
presence of a multidisciplinary team, in which each professional
carries out his or her values and preferences, might exponentially tend
to dis-empower the consumer’s point of view (Brown & Gordon,
2004, p. S13). Consequently, the psychologist should mediate between
the user seeking solutions and the multidisciplinary team during the
team meeting and the assistive solution team evaluation.
4. Team facilitating among members of the multidisciplinary team. As
an expert in human relationships, the psychologist plays a key role in
making connections easier between the different perspectives of the
team professionals.
5. Reframing the relationship between the client and his or her family
within the framework of the new challenges and limitations and
restrictions they face. Families and caregivers also have expectations
about AT assignment possibly overestimating or underestimating
outcomes, which will affect their relationship with the user and the
professionals. During the user agreement step and the support and
follow-up steps, the psychologist might help the family and/or
caregivers to reframe their relationship with the user.
The role of the psychologist within the ATA process is displayed in
Figure 3.
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Figure 3 - The psychologist’s role in the ATA process model. According to
Meloni and colleagues (2012), the five actions (identify,
advocate, mediate, facilitate and reframe) of the psychologist in
the ATA process are shown in relation to the User’s Actions and
the AT Service Delivery procedures.
2.4. The psycho-technologist: a new profession in the ATA process
Whereas in the previous section we have stressed the role of the
psychologist within the ATA process, here we will introduce a new
interdisciplinary profession: the psycho-technologist (Federici, Corradi,
Mele, & Miesenberger, 2011; Federici & Scherer, 2012b; Miesenberger,
Corradi, & Mele, 2012; Borsci, Kurosu, Federici, & Mele, 2013).The
psycho-technologist is an expert on Information and Communication
Technologies, in particular Human-Computer Interaction and human factors,
and analyzes the relations emerging from the person-technology interaction
by aiming to reach a high level of autonomy for people in need and their
social participation. The assessment process is critical for the success of
assistive solution-seeking and use.
The psycho-technologist differs from a cognitive ergonomist because the
main role of the latter is to analyze person-artifact interactions in the
working environment by taking into account both the cognitive and
Life Span and Disability Federici S. et al.
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190
behavioral effects arising from the interaction system, the activities and
skills needed to improve productivity and effectiveness and, at the same
time, avoid any cognitive or physical overload (Bridger, 2003). Conversely,
the psycho-technologist evaluates the interaction between person and
technology by following a user - AT - environment model of mutual
influence (Federici & Meloni, 2013).
Furthermore, the psycho-technologist distinguishes him/herself from the
professional role of the psychologist in AT service provision, as the latter
focuses on personal factors, human relationships and communication,
connecting the “bio”, “psycho” and “social” components affecting the ATA
process, whereas the former may not be a clinical/dynamic psychologist,
even though he or she has a background in psychology, specifically in
rehabilitation (Miesenberger et al., 2012).
How does the psycho-technologist work in the Center? By following the
bio-psycho-social perspective, the psycho-technologist aims to analyze
barriers and facilitators to obtain the best combination possible. Specifically,
the psycho-technologist analyzes the interaction between three different
systems (Figure 4): the person, the technology, and environmental factors, as
in Scherer’s Matching Person and Technology model (1998, 2005).
Figure 4 - The socio-environmental system according to the bio-psycho-
social perspective (Federici & Meloni, 2013; 2001). The
psycho-technologist meets the user’s needs by seeking a proper
assistive solution (in cooperation with the multidisciplinary
team). With the use of different tools (MPT measures (including
the ATD-PA), QUEST, SUMI, IPDA, etc.), the psycho-
technologist leads the team by observing critical issues and
problems.
Assistive Technology Assessment Model
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This process aims to reach a level of autonomy for the person in need
(related to contextual factors and technological features and functions). The
psycho-technologist verifies if the environmental expectations (such as:
family, health, and educational operators) can meet the user’s possibilities of
benefitting from the technology. In other words, by the use of different
psychometric tools e.g., the Survey of Technology Use (SOTU) and the
Assistive Technology Device Predisposition Assessment (ATD-PA; Scherer,
1998), the Quebec User Evaluation of Satisfaction with Assistive
Technology (QUEST; Demers, Monette, Lapierre, Arnold, & Wolfson,
2002), the Software Usability Measurement Inventory (SUMI; Kirakowski,
1998), etc. the psycho-technologist explores the user’s needs by seeking a
proper assistive solution by leading the multidisciplinary team to observe
critical issues and problems (Scherer, Jutai, Fuhrer, Demers, & Deruyter,
2007).
Figure 5 - The psycho-technologist’s actions in the AT Service Delivery flow
chart. Button numbered signs depict the steps of participation for
the psycho-technologist’s intervention.
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As displayed in Figure 5, the psycho-technologist acts in the ATA
process in five main steps.
1. The psycho-technologist analyzes the collected user’s data and
emphasizes any environmental, personal or technological issues (button
chart 1, phases 1-2, steps [c], [d]). In agreement with the
multidisciplinary team, he or she studies the medical case by considering:
the individual’s predisposition for AT use; previous experiences with AT;
the current motivation to use AT; and environmental factors that might
affect the matching process (e.g., administering the SOTU and the ATD-
PA).
2. The psycho-technologist sets up the assessment setting and checks
if the technologies are ready for the matching process (button chart 2,
phase 3, step [e]).
3. The multidisciplinary team, along with the user, assesses the
assistive solution proposed, tests the solution and gathers outcome data
(button chart 3, phase 3, step [f]). The role of the psycho-technologist in
this phase is to guide the matching test by introducing and explaining the
functions and features of the AT proposed. Then, he or she supervises the
interaction between the user and the AT, recording any critical
situation(s).
4. The psycho-technologist reports the outcome of the matching
process and discusses the solution proposed to the user with the
multidisciplinary team on the basis of observations made during the
interaction between user and the AT (button chart 4, phase 3, step [g]).
5. When the AT proposed by the AT Service Delivery is delivered to
the user, follow-up and ongoing user support is activated. The psycho-
technologist, in coordination with the multidisciplinary team, evaluates
the outcome of the assistive solution in the context of use (button chart 5,
phase 4, step [j]).
In conclusion, the current concept of psycho-technology is related to a
neologism for explaining a new professional figure who investigates the
psychological and cognitive components involved in the interaction
environment, whether it be a physical environment or an information and
communications technology one. Here, one can think of other compounds
that we use: psycho-therapy, psycho-metrics, and so on.
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3. Conclusions
Assistive technology devices (ATDs) can be very important to an
individual’s enhanced functioning, task accomplishment and
inclusion/participation. With almost 40,000 different ATDs on the market,
the wide variety of choices available in products and features can make the
selection of the most appropriate match for a person seem daunting and
complex. However, when a systematic selection process is followed, such as
the ATA process outlined in this article and in Federici and Scherer (2012c),
complexity can be made manageable and better outcomes can be achieved.
By following both a user-driven and bio-psycho-social perspective, the
ATA model provides practitioners in the AT service delivery field with an
ideal and comprehensive set of guidelines to help them to reach effective AT
selection and assignment processes and, moreover, to carefully take into
account the effects of personal and psychosocial factors on the non-use and
discontinuance of AT use. Unused ATDs and ineffective service delivery
systems represent waste that our economies cannot afford. Resources today
must often be pooled, but this can be accomplished in a beneficial way
rather than becoming a hindrance when it results in cross - and multi-
disciplinary collaboration and the adoption of processes designed to
simultaneously address multiple facets of the individual and ATD match.
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Assistive devices (ADs) can help individuals with disabilities achieve greater independence, and it can enhance the quality of their lives. This study investigated the use of and self-perceived need for ADs in individuals with disabilities, and determined the influence of gender, age as well as type and degree of disability on the use of and self-perceived need for ADs. This descriptive study utilized a cross-sectional survey design with a convenience sample of participants. A total of 1018 subjects with disabilities who visited an exhibition of assistive technology and two ADs research and development centers completed a questionnaires either by themselves or via a caregiver who completed the questionnaire on behalf of the subject or via interviewers trained specifically for this study. The Mann-Whitney U test and Kruskal-Wallis test were used to determine the influence of participant characteristics on the use of ADs. The results showed that 77.2% and 83.3% of the participants reported that they used and needed AD(s) to engage in activities of daily living. The mean quantity of the use of and self-perceived need for total types of ADs were 3.0 and 5.3, respectively. Participants with different disabilities reported different percentages of the use of various types of ADs. No difference was found between genders and among the age groups in the use of quantity of ADs. Individuals with different types and degrees of disability used different quantities of ADs. Participants with physical, visual and multiple disabilities used significantly more ADs compared to participants with intellectual disability. The total quantity of ADs used increased significantly with increased severity of disability. The mean use of assistive devices was lower compared to the mean need of individuals with disabilities. Further study is required to determine why patients feel the need for but not currently use a specific assistive device.
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Purpose Digital technologies have a great potential to improve the quality of life of people with dementia. However, this group is usually not involved in their development and dissemination. A consumer-directed role in the delivery of digital technologies could allow this group to regain autonomy and certain independence. This article aims to conceptualise the components of the Consumer Direction theory in the context of digital technologies and people with dementia. Method A literature review was conducted. We searched for studies within the aforementioned context in five relevant databases, covering the years 2012–2020. Identified studies were screened and assessed for inclusion. The data were categorised using two-stage qualitative content analysis. Results Forty articles were included. The results provide definitions of the four components of the Consumer Direction theory in the context of this study. Namely, what it means for people with dementia to be (1) in control of technology use, (2) offered a variety of technological options, (3) informed and supported regarding the use and training of digital technologies, and (4) actively participating in systems design. These can lead to the empowerment of people with dementia. Conclusion The four theoretical components of the Consumer Direction theory are conceptualised differently in the context of this study. By providing new definitions, this paper contributes to research and practice. We expect the definitions to be deployed by researchers, practitioners, and policymakers for the creation of a more consumer-directed delivery of digital technologies to people with dementia. • Implications for rehabilitation • Digital technologies have a great potential to improve the quality of life of people with dementia. • A consumer-directed role in the delivery of digital technologies could empower people with dementia and give them the opportunity to take control over the offered services as well as maintain a degree of independence. • The Consumer Direction theory and its components should be conceptualised differently in the context of digital technologies and people with dementia than in previous contexts that used the theory. • The new definitions can be utilised by researchers, practitioners and policymakers for the creation of a more consumer-directed delivery of digital technologies to people with dementia.
Chapter
This chapter discusses the influence of cognitive impairment in the prescription and effective use of electronic assistive technology (EAT). The authors consider the impact of cognitive, emotional and executive impairments on the use of EAT, and the effect of the course and prognosis of different types of neurodevelopmental versus acquired or progressive disorders. Self-awareness and motivation are also considered as key influences on the use and outcome of EAT. The effects of executive, attention and memory impairments on the ability to engage with technology and its implications for the uptake of EAT are explored, alongside strategies and technology developed to address these problems. The authors conclude the chapter by emphasising the importance of the development and improvement of affordable technologies with health applications. They highlight the usefulness of the neuro-socio-technical and technology acceptance models as a framework to adopt when prescribing EAT to people with cognitive impairments to fully consider the interplay between clinical presentation, social environmental factors and technological capabilities.
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Background: This study was an extension of research which began in the Umbria region in 2009. Aim: To investigate the extent to which assistive technology (AT) has been abandoned by users of the Italian National Health Service (ULHS) and the reasons for this. Design: Observational study. Setting: Users who received a hearing device (HD) or mobility device (MD) by ULHS between 2010 and 2013. Population: 749 out of 3,791 ULHS users contacted via telephone completed the interview: 330 (44.06%) had a HD and 419 (55.94%) a MD. Methods: Data were collected using a specially developed telephone interview questionnaire including the Italian version of the Quebec User Evaluation of Satisfaction with AT (QUEST 2.0) and Assistive Technology Use Follow-up Survey (ATUFS). Results: 134 users (17.9%) were no longer using their assigned AT device within seven months of issue and 40% of this group reported that they had never used the device. Duration of use (for how long the AT device was used before abandonment) and satisfaction with service delivery did not predict AT abandonment. People who received a HD where more likely to abandon their device (22.4%) than those who received a MD (14.4%). Conclusions: Abandonment may be due to assignment of inappropriate devices or failure to meet user needs and expectations. These findings are consistent with previous data collected by Federici and Borsci in 2009. Utility of AT in use, reasons of abandonment, and importance of device and service satisfaction for the use or non-use of an AT are presented and discussed. Clinical rehabilitation impact: AT abandonment surveys provide useful information for modelling AT assessment and delivery process. The study confirms the relevance of person centredness approach for a successful AT assessment and delivery process.
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In this chapter, the assistive technology assessment (ATA) model has been presented. The ATA model outlines an ideal process that provides reference guidelines for both public and private centers for technical aid provision, allowing them to compare, evaluate, and improve their own matching model. The actions required by the ATA model to centers for technical aid can be divided into four fundamental steps: access to the structure and activation of the process, evaluation and activation of the aid/AT selection, delivery, and follow-up. The ATA is a user-driven process through which the selection of one or more aids/ AT is facilitated by the utilization of comprehensive clinical measures, functional analysis, and psycho-socio-environmental evaluations that address, in a specific context of use, the personal well-being of the user through the best matching of user/client and assistive solution (Scherer et al. Early Online). Because the ATA process and the MPT model and accompanying measures share a user-driven working methodology and embrace the ICF biopsychosocial model, they can be integrated within a path aiming for the best combination of AT to promote user/customer’s personal well-being.
Technical Report
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There are currently approximately 45 million people in Europe who report a long standing health problem or disability. Further, the aging population means that more people will have to live with some sort of disability. Recent figures from the 2008-based national population projections EUROPOP2008 show that the share of people aged 65 years or over in the total population is projected to increase from 17.1% to 30.0% and the number is projected to rise from 84.6 million in 2008 to 151.5 million in 2060. Many assistive technology devices are allocated to the elderly and the needs will not be smaller with an aging population. For example, in Sweden, around 70% of assistive devices prescribed go to people aged over 65. These demographic shifts are going to be an important driver behind increases in demand, as well as increases, or changes in the types of demands for more accessible products, including some forms of assistive technology. This report represents the final report of the study, “Analysis of the Assistive Technologies Information and Communication Technologies (AT ICT) industry in Europe” for the European Commission. The global objective of the study has been to gain information as to the state of the EU AT ICT industry and develop conclusions and recommendations to what steps can be taken to improve the competitiveness of the companies which form this industry. To carry out this study, the study team employed a variety of techniques and sources of information in order to gain as complete and accurate a view as possible on the AT ICT industry in the 27 Member States of the EU
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The Matching Person & Technology (MPT) assessment process is a set of person-centered measures, all of which examine the self-reported perspectives of adult consumers regarding strengths/capabilities, needs/goals, preferences and psychosocial characteristics, and expected technology benefit. There are separate measures for general, assistive, educational, workplace, and healthcare technology use; in Ireland, the measures were used to assess outcomes of assistive technology (AT) provision for (a) people throughout the country participating in a new localized AT service delivery process and (b) students transitioning from secondary education. There are companion provider forms so that consumer-provider shared perspectives can be assessed and to ensure that the matching process is a collaborative one; the Irish version assumes collaboration from the start. Each measure can be used when evaluating a person for technology use and as person-centered, ideographic, outcomes measure. The measures have been determined to have good reliability and validity.
Article
The use of assistive technology by college students with disabilities is a necessary tool to enhance their academic success. Many individuals with disabilities, however, discontinue use of their technology. Discontinuance represents a waste of functional abilities and a disadvantage to college students with disabilities. The purpose of this study was to report the rate of use and abandonment of assistive technology among college students with disabilities. Fifty-three college students with various disabilities participated in a survey on assistive technology device use and abandonment across the domains of home, school, recreation, leisure, hearing, vision, and mobility. Results showed that a total of 51 devices were abandoned across all domains. School was the domain with the highest rate of use and the second highest rate of abandonment. The mobility domain represented the second largest number of devices used and the largest number of devices abandoned. These findings demonstrate that college students are using assistive technology devices for school and mobility. However, they are also abandoning them at a high rate.
Article
Purpose: The study brings together three aspects rarely observed at once in assistive technology (AT) surveys: (i) the assessment of user interaction/satisfaction with AT and service delivery, (ii) the motivational analysis of AT abandonment, and (iii) the management/design evaluation of AT delivery services. Methods: 15 health professionals and 4 AT experts were involved in modelling and assessing four AT Local Health Delivery Service (Centres) in Italy through a SWOT analysis and a Cognitive Walkthrough. In addition 558 users of the same Centres were interviewed in a telephone survey to rate their satisfaction and AT use. Results: The overall AT abandonment was equal to 19.09%. Different Centres' management strategies resulted in different percentages of AT disuse, with a range from 12.61% to 24.26%. A significant difference between the declared abandonment and the Centres' management strategies (p = 0.012) was identified. A strong effect on abandonment was also found due to professionals' procedures (p = 0.005) and follow-up systems (p = 0.002). Conclusions: The user experience of an AT is affected not only by the quality of the interaction with the AT, but also by the perceived quality of the Centres in support and follow-up. Implications for Rehabilitation AT abandonment surveys provide useful information for modelling AT assessment and delivery process. SWOT and Cognitive Walkthrough analyses have shown suitable methods for exploring limits and advantages in AT service delivery systems. The study confirms the relevance of person centredness for a successful AT assessment and delivery process.